A model for the treatment of encopresis.

Johnson et al. (1991) drew a road map for treating kids who soil their pants. They sorted encopresis into clear subtypes using simple rules any BCBA can follow. The paper lists red-flag questions to spot medical or psychiatric issues that need a doctor first.

The model pairs each subtype with its own behavior plan. No data were collected; the paper is a how-to guide built from clinical experience.

The authors showed that matching the plan to the subtype cuts trial-and-error. For example, kids with constipation-plus-avoidance need laxative clean-out plus scheduled sits. Kids with attention-based soiling need reinforcement for toilet use and extinction for accidents.

They also warn that anxiety, ADHD, or trauma can hide under soiling and must be screened before you start.

Kirkwood et al. (2021) tested multiply-controlled feeding refusal and found single-function treatments flop. Johnson et al. (1991) said the same for encopresis: treat every function you find, not just the top one.

Van Arsdale et al. (2024) scouted 15 feeding studies and saw wide, fuzzy definitions of noncontingent reinforcement. Johnson et al. (1991) prevent that mess by giving tight subtype rules up front.

Morris et al. (2024) remind us families may prefer a gentler plan even if a stronger one works faster. Johnson et al. (1991) built room for this by letting you pick within-subtype options that balance speed and comfort.

Stop running the same toilet program for every soiling case. Use the paper’s quick checklist to label the subtype on intake day, then flip to the matching protocol. You will waste fewer sessions and spare the child painful clean-outs or failed rewards. Add the brief psychiatric screen to your intake; if flags pop, refer before you reinforce.