OBJECTIVE. We present the case report of a 3-yr-old boy with retentive fecal incontinence and sensory overresponsivity. Sensory integration theory was used to address the overresponsivity affecting the child's ability to acquire age-appropriate toileting habits. We describe the 7 mo of treatment and 3 mo of follow-up in occupational therapy. METHOD. We analyzed a retrospective chart review of daily defecation log outcome data and parent interview. RESULTS. Notable improvements in acquiring age-appropriate toileting habits were documented and measured using daily defecation logs. Improvements in sensory processing were documented using the Sensory Profile and corroborated improvements in the child's ability to participate in toileting routines and parent report of improved quality of life. CONCLUSION. Occupational therapy using Ayres Sensory Integration(®) was a useful framework for addressing this child's toileting habits. This case explicates occupational therapy using data-driven intervention principles to address the relationship among sensory processing, behavior, and occupational performance.

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Introduction: Preliminary reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Clinical practice in this area is limited by the lack of validated measures. The toileting habit profile questionnaire was designed to address this gap. Methods: This study included two phases of validity testing. In phase 1, we used Rasch analysis of existing data to assess item structural validity, directed content analysis of recent literature to determine the extent to which items capture clinical concerns, and expert review to validate the toileting habit profile questionnaire. Based on phase 1 outcomes, we made adjustments to toileting habit profile questionnaire items. In phase 2, we examined the item structural validity of the revised toileting habit profile questionnaire. Results: Phase 1 resulted in a 17-item questionnaire: 15 items designed to identify habits linked to sensory over-reactivity and two designed to identify sensory under-reactivity and/or poor perception items. The analysis carried out in phase 2 supported the use of the sensory over-reactivity items. Remaining items can be used as clinical observations. Conclusion: Caregiver report of behaviour using the revised toileting habit profile questionnaire appears to adequately capture challenging defecation behaviours related to sensory over-reactivity. Identifying challenging behaviours related to sensory underreactivity and/or perception issues using exclusively the revised toileting habit profile questionnaire is not recommended.

Date Presented 04/06/19 Reports indicate that sensory issues may be related to atypical defecation habits in some children. Practice in this area is limited by the lack of validated measures. The THPQ-R appears to capture defecation behaviors related to sensory over-reactivity. While preliminary studies regarding the THPQ-R are promising, further examination of its validity is warranted. In this study, we examined discriminative and concurrent validity. Primary Author and Speaker: Isabelle Beaudry-Bellefeuille Contributing Authors: Shelly Lane, Simon Chiu, Alison Lane, Eduardo Ramos-Polo