Examining Sensory Overresponsiveness in Preschool Children With Retentive Fecal Incontinence

Abstract

The development of bowel control is an important activity of daily living in early childhood, and challenges in this area can limit participation in key occupations. Retentive fecal incontinence (RFI) is a common disorder in children. Up to 50% of children do not respond adequately to initial medical intervention, and behaviors around toileting, some related to sensory overresponsivity (SOR), may be partly responsible. Therefore, this study investigated the relationship between RFI and SOR and also examined the discriminative validity of the Toileting Habit Profile Questionnaire (THPQ). Per parent report, children with RFI (n = 16) showed significantly more behaviors related to SOR compared with typically developing children (n = 27). In addition, results indicated that the THPQ effectively discriminates between children with RFI and typically developing children. Results are discussed regarding RFI and SOR, the impact of RFI on childhood occupational engagement, and the role of occupational therapy with this population.

The toileting habit profile questionnaire: Examining construct validity using the Rasch model

“…Preliminary reports support the hypothesis that concerns about sensory reactivity (the process of modulating neuronal activity in response to sensory stimuli) and perception (the ability to recognize and interpret sensory stimuli) may be related to atypical defecation habits (Beaudry-Bellefeuille and Lane, 2017; Beaudry Bellefeuille and Ramos Polo, 2011; Beaudry et al., 2013). For instance, using the short sensory profile (McIntosh et al., 1999), Beaudry-Bellefeuille and Lane (2017) reported significantly more sensory over-reactivity in children with FC than in typically developing children. Furthermore, preliminary reports of the effectiveness of intervention programmes that consider the sensory issues of children with FDD are promising (Beaudry Bellefeuille and Ramos Polo, 2011; Beaudry et al., 2013).…”

“…Childhood functional defecation disorders (FDD) such as functional constipation (FC) have a high prevalence worldwide (5.3–17.4%; Van Den Berg et al., 2006) and are considered a public health problem (Rajindrajith et al., 2016). Although the Rome IV diagnostic criteria (The Rome Foundation, 2016) is considered the gold standard for identification of FDD, and there exists an extensive body of research describing a range of medical and behavioural interventions (Pijpers et al., 2010; Tabbers et al., 2014; Van Ginkel et al., 2003), approaches to identification and treatment are inconsistent and the precise mechanisms of childhood FDD are not well understood (Beaudry-Bellefeuille et al., 2017; Koppen et al., 2018; Rajindrajith et al., 2016). As a result, treatment effectiveness remains limited and sound comprehension of all factors involved in the emergence of the disorder, along with greater understanding of treatment elements, are needed to optimize outcomes (Freeman et al., 2014).…”

“…The THPQ has been found to be clinically useful in defining sensory concerns relative to FDD (Beaudry-Bellefeuille and Lane, 2017; Beaudry et al., 2013). A recent pilot study using the THPQ demonstrated that children with FC that had not responded to first-line medical management ( n = 16) demonstrated a significantly higher frequency of habits hypothesized to be linked to sensory over-reactivity than typically developing children ( n = 27) (Beaudry-Bellefeuille and Lane, 2017).…”

“…The THPQ has been found to be clinically useful in defining sensory concerns relative to FDD (Beaudry-Bellefeuille and Lane, 2017; Beaudry et al., 2013). A recent pilot study using the THPQ demonstrated that children with FC that had not responded to first-line medical management ( n = 16) demonstrated a significantly higher frequency of habits hypothesized to be linked to sensory over-reactivity than typically developing children ( n = 27) (Beaudry-Bellefeuille and Lane, 2017). While preliminary studies regarding the THPQ were promising, we recognized that the original item set, developed more than 10 years ago, required updating and that further examination of the psychometric characteristics of the THPQ was warranted before recommending its use in clinical practice.…”

“…In phase 1, we extend previous work with the THPQ that used expert review of test content and hypothesis testing (known group comparisons studies) to assess content and construct validity (Beaudry-Bellefeuille and Lane, 2017; Beaudry-Bellefeuille et al., 2016). Here we used Rasch analysis of existing data to assess item structural validity.…”