Examining Hyper-Reactivity to Defecation-Related Sensations in Children With Functional Defecation Disorders (FDD)

PURPOSE: Adequate sensory perception and reactivity to the sensory stimuli associated with defecation is key to successful stool toileting. Preliminary reports suggests that some of the difficulties that many children with functional defecation disorders (FDD) experience with toileting routines could be related to issues in sensory reactivity. The Toileting Habit Profile Questionnaire-Revised (THPQ-R) is a tool that measures sensory reactivity in relation to defecation related sensations. This study investigated the relationship between sensory reactivity and FDD, and further evaluated the validity of the THPQ-R.

DESIGN: This investigation adopted a descriptive survey methodology in which participants were invited to complete two different online questionnaires. Participants were caregivers of children with and without FDD and aged 3 to 6 years old. Children with a diagnosis of ASD or ADHD were also included because of the reported higher prevalence of FDD in children with these diagnoses. Parents of children with organic causes of defecation issues were excluded. Apart from parents of children with a diagnosis of ASD or ADHD, parents with children who qualified for their school’s special needs program or who had been referred to early intervention programs were excluded to insure that FDD was not confounded by other diagnoses. Participants whose children had not yet initiated toilet training were also excluded. Parents were recruited through parent support groups of all types and through social media. Pediatric gastroenterologists and occupational therapists from both public and private clinics were also contacted for recruitment. Snowball recruitment was permitted. Recruitment was aimed at several English and Spanish speaking countries.

METHOD: Parents of three to six-year-old children with and without FDD completed two questionnaires; the THPQ-R and the Short Sensory Profile (SSP). A web-based survey tool (Qualtrics®) was used for data collection. On both questionnaires, low scores indicate more concerns. Between group comparisons (comparison group and FDD/STR group) on the THPQ-R and SSP were conducted using the student-t test. Differences were considered statistically significant at p <.05. A Pearson correlation coefficient was calculated to analyze the relationships between the SSP scores and the THPQ-R scores. In order to use parametric statistical tests, THPQ-R and SSP raw scores, based on ordinal scaling, were transformed to linear measurements expressed in log odds probability units (logits) using Rasch computations.Considering that, the purpose of the study is to develop a better understanding of the relationship between defecation behaviors and sensory hyper-reactivity, our analysis was based on a subset of relevant items from the THPQ-R and the SSP.

RESULTS: Children with FDD showed higher level of sensory hyper-reactivity. The difference was statistically significant (p < .0005). There was a positive correlation between THPQ-R and sensory hyper-reactivity scores on the SSP (r₂₇₄ = .485, p < .0005). Further, higher levels of sensory hyper-reactivity were associated with a higher frequency of challenging defecation behaviors and difficulties with toileting routines (THPQ-R).

CONCLUSION: Health practitioners do not usually consider sensory hyper-reactivity as a possible factor contributing to the difficulties that children with FDD may have with participation in healthy, age appropriate toileting routines. Our results indicate that routine screening for sensory hyper-reactivity may be an important practice element when working with children with FDD. In addition, the present study adds support to the validity of the THPQ-R in identifying challenging toileting behaviors potentially linked to sensory hyper-reactivity.

References

Beaudry-Bellefeuille, I., Bundy, A., Lane, A., Ramos-Polo, E. & Lane, S. J. (2018). The Toileting Habit Profile Questionnaire; Examining Construct Validity using the Rasch Model. British Journal of Occupational Therapy. Advance online publication. doi: 10.1177/0308022618813266

Beaudry-Bellefeuille, I., Lane, A., Chiu, S., Oldmeadow, C., Ramos Polo, E., & Lane, S. J. (2019). The Toileting Habit Profile Questionnaire-Revised: Examining Discriminative and Concurrent Validity. Journal of Occupational Therapy, Schools, & Early Intervention, 1-12. doi: 10.1080/19411243.2019.1590756

Beaudry-Bellefeuille, I. & Lane, S. J. (2017). Examining sensory over-responsiveness in preschool children with retentive fecal incontinence. American Journal of Occupational Therapy. 71, 7105220020. doi: 10.5014/ajot.2017.022707

Beaudry-Bellefeuille, I., Lane, S. J., & Lane, A. E. (2019). Sensory integration concerns in children with functional defecation disorders: A scoping review. American Journal of Occupational Therapy, 73(3), 7303205050p1-7303205050p13. doi:10.5014/ajot.2019.030387