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
PURPOSE: Preliminary reports indicate that sensory issues may be related to atypical defecation habits in some children. Clinical practice in this area is limited by the lack of validated measures. The Toileting Habit Profile Questionnaire-Revised (THPQ-R) is a parent-report screening questionnaire designed to: 1) differentiate children with typical toileting habits from those with atypical toileting habits and 2) to identify toileting habits potentially related to sensory concerns in children with functional defecation disorders (FDD; i.e. constipation, fecal incontinence, and stool toileting refusal). While preliminary studies regarding the THPQ-R are promising, further examination of its validity is warranted.
DESIGN: In this descriptive study we utilized quantitative methods to examine the discriminative and concurrent validity of the THPQ-R. Caregivers of children with and without functional defecation concerns were recruited for the study. Participants were eligible for the diagnostic group if they belonged to one of the following categories: 1) Parents of children aged 3 to 6 years old with functional constipation (FC) and no additional diagnosis; or 2) Parents of children with autism spectrum disorder (ASD) aged 3 to 6 years old, identified by parent report of diagnosis, with FC. Parents of children with organic causes of defecation issues were excluded. The comparison group consisted of parents of children without FC. We recruited participants from several Spanish and English speaking countries using social media. Responses were collected and managed using a web-based survey platform.
METHODS: Between-group comparisons on the THPQ-R were conducted using an independent-samples t-test. Using data from both the THPQ-R and the defecation specific items of the Virginia Encopresis-Constipation Apperception Test (VECAT-S), a correlation coefficient was calculated to examine the concurrent validity of the THPQ-R. To further explore the relationship between the THPQ-R and VECAT-S scores, linear regression analysis was performed.
RESULTS: 110 caregivers participated in the study; 60 of which had children with FC. As expected, mean THPQ-R score for children without FC (3.89 logits) was 1.65 (95% CI, 1.17 to 2.12) higher than mean THPQ-R score for children with FC (2.24 logits). The difference in mean THPQ-R score between children with FC and those without FC was statistically significant t(108) = -6.809, p < .0005. A Spearman's rank-order correlation was run to assess the relationship between THPQ-R total scores and VECAT-S scores. There was a strong positive correlation between THPQ-R scores and VECAT-S scores in children aged 3 to 6 years, rs = .644, p < .0005. The linear regression model showed good fit for the data with average VECAT-S score accounting for 40.6% of the variation in THPQ-R score with adjusted R2 = 40.0%. The analysis confirmed a linear relationship between VECAT-S scores and THPQ-R scores with a coefficient for VECAT-S score of .152 (95% CI, .117 to .187; p < .0005). Average VECAT-S score statistically significantly predicted THPQ-R score, F(1, 108) = 73.77, p < .0005.
CONCLUSION: Results support the use of the THPQ-R in identification of behaviors which may be reflective of underlying sensory over-reactivity in children with FC. In practice, occupational therapy practitioners might consider the following implications: 1)The behaviors included in the THPQ-R clearly differentiate between children with and without FC. The THPQ-R can be used to document these behaviors, 2) In clinical assessments of children with FC, the use of the THPQ-R may be useful to identify sensory-based behaviors which may be impacting participation in healthy age appropriate defecation routines.
References
Beaudry-Bellefeuille, I., Booth, D., Lane, S. J. (2017). Defecation-specific behavior in children with functional defecation issues: A systematic review. The Permanente Journal, https://doi.org/10.7812/TPP/17-047.
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. https://doi.org/10.5014/ajot.2017.022707
Beaudry-Bellefeuille, I., Lane, S. J., & Ramos-Polo, E. (2016). The Toileting Habit Profile Questionnaire: Screening for sensory-based toileting difficulties in young children with constipation and retentive fecal incontinence. Journal of Occupational Therapy, Schools, & Early Intervention, 9(2), 163-175
Cox, D. J., Ritterband, L. M., Quillian, W., Kovatchev, B., Morris, J., Sutphen, J., & Borowitz, S. (2003). Assessment of behavioral mechanisms maintaining encopresis: Virginia encopresis-constipation apperception test. Journal of Pediatric Psychology, 28(6), 375-382.
