| Behavioral and medical treatments for the behavioral complex often referred to as Toileting Refusal were investigated using two multi-component, additive treatments in a multiple-baseline design across seven preschool-aged children. Following Pretreatment A (baseline), Treatment B increased the child's high-fiber food consumption and intake of liquids, initiated mineral-oil therapy by mouth, and provided positive reinforcement for appropriate bowel movements. Treatment C used enema-induced bowel clean-out, glycerine suppository-controlled bowel movements, simple correction, positive practice, and time-out for inappropriate bowel movements. The child behaviors measured were appropriate and inappropriate bowel movements. Toileting Refusal (an unacceptable ratio of appropriate and inappropriate bowel movements) was eliminated in two boys in 27 and 30 days (including 11 and 7 days of baseline, respectively) using Treatment B alone. Treatment B + C, following an unsuccessful intervention with Treatment B, eliminated Toileting Refusal in four girls in 37, 42, 49, and 65 days (including 4, 7, 8, and 9 days of baseline, respectively). This same treatment sequence reduced to satisfactory levels, but did not eliminate, one boy's Toileting Refusal in 92 days (including 5 days of baseline). All seven children were accident-free during 5 days of follow-up conducted 3 to 4 months after treatment. These findings suggest Toileting Refusal can be effectively eliminated or reduced to satisfactory in some children using a treatment package of additive behavioral and medical protocols. |
