Treatment of A Retentive Encopretic Child Using Contingency Management and Diet Modification with Stimulus Control1

This clinical case study utilized a new method of systematic diet modifica-tion in combination with stimulus control training and contingency manage-ment to treat a 7-year-old retentive encopretic male. Diet modification comprised increasing the child's intake of dietary fiber through a point system. Diet change (increases in "fiber points") was associated with increases in ap-propriate bowel movements and decreases in soiling accidents. The combina-tion of diet modification, stimulus control, and contingency management eliminated soiling accidents, and treatment gains were maintained at 1-year follow-up. The findings provide preliminary support for diet change as a possible alternative to use of purgatives in behavioral treatment for reten-tive encopresis. Limitations of the study are discussed, and recommenda-tions for further research on diet modification are made. KEY WORDS: encopresis; dietary fiber; stimulus control; contingency management