Behavioural treatment of urinary incontinence and encopresis in children with learning disabilities: transfer of stimulus control

Urinary and faecal incontinence present a considerable problem in people wi th learning disabilities, despite the general effectiveness of behavioural techniques in continence training. Children with learning disabilities and obsessional behaviour may be particularly resistant to toilet training, eve n where relatively cognitively able, and often despite a substantial degree of control over their eliminatory functions. Their resistance may be more appropriately regarded as a challenging behaviour and their incontinence be tter explained by factors other than a simple failure to learn. A 'stimulus -control' hypothesis proposes that the child's nappy (diaper) /potty/underw ear has developed strong stimulus control over the elimination response. Th is report describes three case studies in which treatment-resistant childre n, aged between 8 and 12 years, with mild or moderate learning disabilities , were successfully treated for nappy-dependent nocturnal encopresis or diu rnal urinary incontinence, The children were routine case referrals for who m previous attempts to train bowel or bladder control had failed. Behaviour al techniques, such as 'shaping' (gradually increasing the proximity to the toilet), 'fading' (reducing the presence of the nappy), and rewards for el iminating, effected successful transfer of stimulus control over eliminatio n from nappy to toilet. Treatment times varied, depending on the degree of the child's obsession and resistance to change.