Comprehensive Toileting Program

NCT ID: NCT07226739

Last Updated: 2025-11-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE4

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-31

Study Completion Date

2031-01-31

Brief Summary

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The current study aims to monitor fecal continence after autistic youth complete enuresis treatment and for individuals who continue to experience encopresis after acquiring urine continence, evaluate a caregiver-mediated version of a Multidisciplinary Intervention for Encopresis (CM-MIE) delivered via telehealth to determine efficacy in a randomized clinical trial.

Detailed Description

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Participants will complete toilet training for enuresis (if needed) and then monitored to determine if encopresis persists. For individuals with resolved enuresis but persisting encopresis, they will be randomized to receive either a treatment for encopresis (delivered via telehealth) or a parent education program. The encopresis intervention involves behavioral components and administration of an over-the-counter suppository as needed. All participants will also meet with a pediatric gastroenterologist to ensure safety of study procedures and to resolve constipation as needed. Outcomes will include caregiver-completed questionnaires, data on bowel movements collected by the caregiver, and an interview between the participant's caregiver and a blinded investigator focused on encopresis, other presenting concerns, and any potential adverse events.

Informed consent will be collected via signature from one legal guardian. The investigators will collect assent from participants when appropriate given age and developmental level.

Conditions

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Encopresis ASD

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
A blinded independent evaluator will conduct the Clinical Global Impression scale.

Study Groups

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Caregiver-mediated version of multidisciplinary intervention for encopresis (CM-MIE) Arm

* A Board-Certified Behavior Analyst (BCBA) will meet virtually with caregivers for daily appointments for two weeks (goal of 10 appointments; maximum of 2-hours per appointment).
* First appointment, the BCBA will provide support on using telehealth and psychoeducation about encopresis, reinforcement, and suppository use.
* Subsequent appointments involve a scheduled sit on the toilet to encourage an independent bowel movement. If a bowel movement occurs, the caregiver is coached to provide the child with a highly preferred item, praise, and allow them to leave the bathroom. If a bowel movement does not occur, the therapist coaches the parent through administration of a glycerin suppository intended to quickly elicit a bowel movement, followed by another scheduled sit on the toilet.
* After consistent success with continent BMs following suppository administration, the suppository dose will be reduced to gradually fade out its use.

Group Type EXPERIMENTAL

Glycerin Suppository

Intervention Type DRUG

Liquid glycerin suppositories, pediatric (age 2-5 years: 4 ml/applicator) or adult (6-12 years: 7.5ml/applicator) dose used as indicated based on age will be used in the study. Up to two doses will be delivered a day.

The purpose of the glycerin suppository is to rapidly evoke a bowel movement, which allows for a predictable bowel movement to occur while the child is seated on the toilet (a continent bowel movement).

Behavioral strategies

Intervention Type BEHAVIORAL

The BCBA will provide recommendations on promoting bowel movement continence. The caregiver will be asked to collect data between visits that will be reviewed by the therapist.

Parent Education (PE) Arm

* PE includes an initial appointment with a BCBA who will provide recommendations on promoting bowel movement continence.
* First appointment will involve a didactic review of the basics of reinforcement, collecting data to identify when BMs are most likely, and scheduled sits around this time. Caregivers will be instructed to collect data on BMs after this appointment.
* The BCBA will then hold daily follow-up appointments (10 appointments total over 2 weeks). At these appointments, the BCBA will review this data and make additional recommendations (e.g., changing the timing of scheduled sits based on when BMs are most likely to occur, altering the reinforcer used for continent voids) to promote success.

Group Type ACTIVE_COMPARATOR

Behavioral strategies

Intervention Type BEHAVIORAL

The BCBA will provide recommendations on promoting bowel movement continence. The caregiver will be asked to collect data between visits that will be reviewed by the therapist.

Interventions

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Glycerin Suppository

Liquid glycerin suppositories, pediatric (age 2-5 years: 4 ml/applicator) or adult (6-12 years: 7.5ml/applicator) dose used as indicated based on age will be used in the study. Up to two doses will be delivered a day.

The purpose of the glycerin suppository is to rapidly evoke a bowel movement, which allows for a predictable bowel movement to occur while the child is seated on the toilet (a continent bowel movement).

Intervention Type DRUG

Behavioral strategies

The BCBA will provide recommendations on promoting bowel movement continence. The caregiver will be asked to collect data between visits that will be reviewed by the therapist.

Intervention Type BEHAVIORAL

Other Intervention Names

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MAJORĀ® Glycerin

Eligibility Criteria

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Inclusion Criteria

* Age 5 to 12
* Diagnosis of an intellectual or developmental delay (excluding individuals with ADHD alone)
* Encopresis (more than 1 incontinent BM a week)
* Required for pre-randomization phase only: Enuresis (\> 1 incontinent urination per day when on a consistent toileting sit schedule)
* At least one caregiver who speaks and understands English

Exclusion Criteria

* Unresolved medical condition that would impede toilet training (e.g., interference with sphincter control, short gut syndrome, urinary tract or gastrointestinal infection, unexplained diarrhea, recent intestinal surgery, inflammatory bowel disease)
* Failed intensive toileting treatment in the past 2 yrs with protocols akin to study
* Current serious behavioral or psychiatric disorder that requires another treatment
* Current or planned other intervention (behavioral or medical) for incontinence
Minimum Eligible Age

5 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role lead

Responsible Party

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Mindy Scheithauer

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mindy Scheithauer, PhD

Role: PRINCIPAL_INVESTIGATOR

Emory University

Locations

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Marcus Autism Center

Atlanta, Georgia, United States

Site Status

Countries

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United States

Central Contacts

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Mindy Scheithauer, PhD

Role: CONTACT

Phone: 404-785-9322

Email: [email protected]

Facility Contacts

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Mindy Scheithauer, PhD

Role: primary

Other Identifiers

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1R01HD115933-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY00010223

Identifier Type: -

Identifier Source: org_study_id