Date Approved


Date Posted


Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School


Committee Member

Flora Hoodin, Ph.D., Chair

Committee Member

Susana Patton, Ph.D.

Committee Member

Barbara Felt, M.D.

Committee Member

Jennifer Rice, Ph.D.

Committee Member

Michelle Byrd, Ph.D.


A six-session group intervention for treatment of retentive encopresis designed by Stark and colleagues yields high adherence for fiber (Stark et al., 1990a; Stark et al., 1997), but not fluid (Kuhl et al., 2009), recommendations. Children may also rely heavily on drinking juice to meet their clear fluid targets (Kuhl et al., 2009). This study examined the effectiveness of an enhanced intervention (EI) in improving children’s fluid goal adherence and modifying their daily fluid intake to include more water and less juice.

Data for 19 children who completed treatment previously served as the Non-Enhanced Intervention (NEI), and 18 children completed the EI. Participation in the EI significantly predicted higher daily water intake, lower daily juice intake, and better adherence to clear fluid goals. These findings demonstrate the importance of nutrition-based education and behavioral strategies in helping children make lifestyle changes necessary to meet fluid-based recommendations.


Additional committee member: James Todd, Ph.D.