Terri—You will have noticed young children in homes with diapers or pull ups stop, squat, and poop.  This is very natural; especially where children are kept in pull ups for too long or they have a temperament that makes training very difficult. Home circumstances may also have prevented effective and timelier training.  Basically, this has become so engrained via the simple classical conditioning paradigm that ordinary methods of training can no longer apply.  By default this child became “overtrained” to go in his clothing.  It is a habit like overeating, biting nails, etc. which can be surprisingly resistant to change. The wearing of clothes coupled with powerful voiding urges which he has been holding off makes this his ultimate default action followed by the powerful reinforcement of dramatic sensations of relief.  We do not call it “relieving ourselves” for nothing when we have to “go”! 

The only effective default procedure available today is the Soiling Solutions protocol which I developed during a Sabbatical year in Australia and then used it in my private practice.  I have reported on it in a medical textbook and a recent medical journal article, but it remains very controversial because it employs suppositories and enemas as “primers” to induce powerful urges and then repeated successful voiding on a toilet stool in a carefully timed and programmed way set forth in the detailed Clean Kid Manual-IV (CKM-IV).  Eventually, the child’s own resources are conditioned to take over and he is successfully going properly on his own! 

The CKM-IV is available only from the SS website at www.soilingsolutions.com or a health professional who has ordered multiple copies at a significant discount.  This helps to assure proper usage and supervision. The application of the program is really by necessity limited to the privacy of the home by caring parents.  Anything you try in your school setting will be ineffective.  The choice has to be made by the parents.  They will have to follow the SS protocol or allow possible physical consequences (e.g., a megacolon, recurrent infections, irritation, rashes), social isolation, or, pardon my bluntness, have the child soil for years and years with all the attendant guilt, anger, upset, and ego destroying features of encopresis!  The parents will have the advantage of being enrolled in a SS Parents’ forum with other parents who have all read the manual and who have used it with their own children.  Your parents will need parents with “street cred” who have been there with this problem!  My protocol is not “child abuse”, not employing it and blithe assurances that he will “grow out of it” is unacceptable.  I will enclose a copy of my medical journal article, editorials regarding it, and a picture of my toilet trained cat in a separate email to you.  Readers can also see my cat on the stool at www.soilingsolutions.com/megacolon.htm.