Behavioral-medical treatment of pediatric toileting refusal

Behavioral and medical treatments for toileting refusal (TR) were investigated using two additive treatments in a multiple-baseline design with 11 preschool-aged children. After Pretreatment A, Treatment B increased high-fiber foods and liquids, initiated mineral-oil therapy, and added positive reinforcement for appropriate toileting. After bowel clean-out, Treatment C induced daily bowel movements with suppositories and applied negative behavioral consequences for inappropriate toileting. Behaviors measured were appropriate and inappropriate bowel movements. Treatment B alone eliminated TR in three boys in 27 to 36 days and reduced the TR of one girl in 40 days. When indicated, Treatment B + C eliminated TR in two boys and four girls in 37 to 79 days and reduced the TR of one boy in 92 days. All 11 of the children were accident free and having at least one bowel movement every 2 days during 5 consecutive days of follow-up conducted 3 to 4 months after treatment. Parents reported general satisfaction with the treatment.