Primary encopresis: evaluation and treatment.

Four kids who kept soiling their pants got a two-part plan. First, a doctor gave them a laxative to clear out the bowel. Then parents spent extra play time with the child right after each successful toilet trip.

The team watched each family at home. They used a multiple-baseline design, starting the plan at different times for each child.

Two children stopped soiling within eight to eleven weeks with just the laxative and play-time reward.

The other two kept having accidents. The team then added three stricter steps: positive practice (walking to the toilet ten times after an accident), brief time-out, and hourly toilet sits. Only then did these two reach dryness, but it took longer.

Rinald et al. (2012) later packed the same ideas into a one-day parent workshop for kids with developmental disabilities. Five of six children trained within a week, showing the core steps still work when you teach parents faster.

Frame et al. (1984) had already shown that teaching attention first makes later punishment more acceptable. The 1986 study followed that path: start nice, add punishment only if needed.

Cohen-Almeida et al. (2000) warn that even perfect plans fail if parents do not follow through. The 1986 success hinged on moms and dads giving the laxative and running the sits every day.

If you face encopresis, begin with medical clearance and a simple reward like child-time. Track accidents daily. If the child is still dirty after two months, layer in positive practice, time-out, and scheduled sits rather than giving up. Map each step for parents and check they can do it before you add the tougher parts.