Psychological Reports, 1971, 28, 937-938.

@ Psychological Reports 1971

REINFORCEMENT PROCEDURES IN THE CONTROL OF ENCOPRESIS:

A CASE STUDY1

BONNIE C. PEDRINI AND D. T. PEDRINI

Uniuwsity of Nebrarka at Omaha
Summary.-A student and his problems were pin-pointed, recorded, and
changed. The first 3 wk. s e r e used to establish a base rate. S defecated in class,
once every few days. After he was programmed with reinforcers (charting and
coupons toward book purchases), he may have had one accident, only, for the
remainder of the school year ( 8 wk.). Follow-up through the seventh month of
the next school year (the time of this writing) indicates one accident only. During this 7-mo. period, he was not programmed with book coupons or any other
specific reinforcer. He ha6 internalized a previous external model of conuol.
Encopresis is a behavior which may be modified t h o u g h operant conditioning or
behavior modification or behavior therapy techniques (Gelber & Meyer, 1965; Keehn,
1965; Neale, 1963). John ( a pseudonym, a fifth grader, 1 1 yr.) was referred to a school
psychologist because John did not have any conuol over his bowels and had involuntary
stools frequently in school. The referral further stated that they did not know whether
this condition should be diagnosd as encopresis or whether there was an organic basis for
it. The medical opinion favored an emotional problem, which was supported by the school
psychologist who described John as of superior intelligence and significantly above grade
level in reading and spelling and at grade level in arithmetic.
The mother said John had never been toilet trained and that he did not know
when to go to the bathroom. John's mother was separated from her husband, contemplating divorce, and there were many personal and emotional problems in the home. John
was seen in play therapy four times and then was abruptly terminated by the mother. His
problems at school continued. The next year, John was again referred to a school psychologist, a behavior therapist. Referral was based on John's inability to control his
bowels. Conferences were held by the behavior therapist and John's teachers who had
agreed to cooperatethey recorded John's behavior (i.e., whether or not he had conuolled
his bowels during each period of the day) for three weeks (when unsure of John's behavior they recorded a question mark).
In the first week ( 5 school days), teachers reported John defecated in class on three
occasions. In the second week ( 5 school days), he defecated on four occasions and possibly one other. In the third n-eek ( 3 school days), he defecated on one occasion. The
teacher indicated that these 3 wk. seemed typical.
During the period teachers were recording John's behavior in class, a conference was
held with John's mother. She obviously had many problemsacted as though men were
a necessary evil, had been divorced, and blamed most of John's problems on her husband.
Given the opportunity she would have focused on her problems rather than John's. However, she did state that she was willing to help John. She said that John had never really
learned to control his bowels, i+~oughvarious techniques and treatments were tried. She
stated that the only thing John enjoyed was babysitting for money and reading. It was
decided John could be reinforced with book coupons which could be used to earn books.
After a certain number of book coupons were obtained, his mother would buy him a book
of his choice. If he wanted to, John could order the books, at a discount price, through
'The first author was the behavior therapist, the co-author served as advisor.

938

B. C. PEDRINI sc D. T. PEDRINI

the school. John would receive one coupon after each class period during which he had
controlled himself. H e could receive as many as eight coupons in one day (he had 8
classes per day). His mother set the price limit of the books John could buy at $5.00.
It was decided that he would need the following number of coupons to obtain books:
1st book, 40 coupons; 2nd book, 55 coupons; 3rd book, 75 coupons; 4th book, 9 0 coupons;
and 5th book, 110 coupons.
The behavior therapist then spoke to John for the first time. John said that his
mother had told him a little bit about what we planned to do. H e seemed pleased with
the plan and quickly determined how many days it would take to get his first book. H e
said that he would record the times he got a coupon. According to Lindsley,? charting or
logging is a great value in and of itself and often times all that is needed.
In the fourth week ( 5 school days), John started receiving coupons according to
plan. During the fourth week, John did not defecate in class and had earned one book
and by the sixth week another book. His teachers said that he seemed to have no difficulty. One teacher commented, "The kids are even starting to calk to him." In the fifth
week ( 5 school days), John may have had an accident. The teachers were unsure, but his
mother said it was obvious when he got home. His teachers did say that he seemed overly
excited on that day. It is possible that he soiled himself going home or arriving at home.
For the sixth, seventh, eighth, ninth, tenth, and eleventh weeks he did not defecate in class.
Everyone was definite about this.
The school year was then over. John still seemed very excited about the plan. H e
said his mother was thinking of keeping it up during the summer. She said John still had
problems at home but that he had improved slightly. It was decided that she should use
techniques other than book coupons so that if there were any problems at home, they were
less likely to be carried over to school. She said she was very pleased with John's progress
in school. John's teachers felt that he was now being accepted by his school peers.
In the following school year, when John was a sixth grader, he had only one accident over 7 mo. of school; it occurred at the beginning of the school year. H e had eaten
corn during lunch and thought that he might have defecated in the physical education class
because of it. Following that incident, John would cut physical education classes after
being served corn for lunch. This may be an illustration of "superstitious behavior" as
understood by Skinner (1948). During this seven-month period, John was not reinforced with book coupons or any specific reinforcer. H e had apparently internalized the
control.
REFERENCES
GELBER,H., & MEYER,V. Behavior therapy and encopresis: the complexities involved
in treatment. Behavior Research and Therapy, 1965, 2, 227-231.
KEEHN, J. D. Brief case-report: the reinforcement therapy of incontinence. Behavior
Research and Therapy, 1965, 2, 239.
NEALE, D. H. Behavior therapy and encopresis in children. Behavior Research and
Therapy, 1963, 1, 139-150.
SKINNER,B. F. Superstition in the pigeon. lournal of Experimental Psychology, 1948,
38, 168-172.

Accepted April 23, 1971.

'0. R. Lindsley. Singing a little data song. (Unpublished paper, Special Education Research, Children's Rehabilitation Unit, Univer. of Kansas Medical Center, 1968)