J Wound Ostomy Continence Nurs. 2013;40(2):1-8.
Published by Lippincott Williams & Wilkins
CONTINENCE CARE
The Impact of a 1-Week Residential
Program on Anxiety in Adolescents
With Incontinence
A Quasi-experimental Study
Hollie Gabler Filce 䡲 Leslie C. LaVergne
■ ABSTRACT
PURPOSE: To determine the effect of a 1-week residential
program on anxiety in adolescents with bowel and/or bladder
dysfunction.
SUBJECTS AND SETTING: Participants were 89 adolescents (mean
age ⫽ 14.56 years, range 11-18 years) attending a 1-week
residential program for individuals with bowel and/or bladder
dysfunction. The program is both educational and social in
nature and is held at 1 of 3 rotating university campuses.
METHODS: A quasi-experimental study design that included
3 administrations of the Multi-dimensional Anxiety Scale for
Children (MASC) was employed for data collection. The MASC
was administered immediately before the program,
immediately after the program, and 2 to 4 months after
conclusion of the program.
INTERVENTION: The 1-week program includes structured and
unstructured sessions facilitated by young adults with these
conditions and/or WOC nurses. Topics are physiological and
psychological in nature, focusing on strategies for home,
school, and medical settings. There are also social activities
designed to facilitate development of social relationships
among peers.
RESULTS: A positive, statistically significant impact on total
MASC scores was found (F1.679, 80.587 ⫽ 3.587; P ⫽ .404) as well as
on the Social Anxiety scale (F2,96 ⫽ 5.299; P ⫽ .007) and its 2
subscales, Humiliation/Rejection Fears (F2,96 ⫽ 3.876; P ⫽ .024)
and Performance Fears (F2,96 ⫽ 6.453; P ⫽ .002).
CONCLUSIONS: This 1-week residential summer program was
found to exert a positive impact on anxiety symptoms, particu-
larly social anxiety, and benefits persisted for 2 to 4 months.
This suggests the psychological benefits of even relatively brief
experiences for individuals with bowel and/or bladder
dysfunction.
KEY WORDS: fecal incontinence, support group, urinary
incontinence
Copyright © 2013 by the Wound, Ostomy and Continence Nurses Society™
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
■ Introduction
Children with special healthcare needs represent approxi-
mately 13.9% of the population in the United States.1
Within this larger group are children whose conditions
negatively affect urinary and fecal continence. It is diffi-
cult to report the prevalence of children with continence
issues owing to inconsistency in defining pediatric void-
ing disorders,2 and variability in definitions for conti-
nence, study, populations, and research settings.3 Reported
prevalence rates of children with daytime urinary inconti-
nence vary from 1.8% to 20%,3 and reported fecal incon-
tinence prevalence rates vary from 1.9% to 4.4%.4 Research
also reveals an association between daytime urinary
incontinence and fecal incontinence,5 which can have
implications for children with conditions such as spina
bifida, Crohn disease, Hirschsprung's disease, imperforate
anus, and Down syndrome.
Chavira and colleagues6 report that 20% of pediatric
patients in the general population scored greater than the
identified clinical cutoff for 1 or more anxiety disorders
during cross-sectional screenings. When a child has a
chronic illness, this percentage may be even higher.7,8 In
1992, Lavigne and Faier-Routman9 published a meta-
analysis of 87 studies examining psychosocial adjustment
in children aged 3 to 19 years. They concluded that
䡲 Hollie Gabler Filce, PhD, Associate Professor, Department of
Curriculum, Instruction and Special Education, The University of
Southern Mississippi, Hattiesburg.
䡲 Leslie C. LaVergne, PhD, Research Assistant, Department of
Curriculum, Instruction and Special Education, The University of
Southern Mississippi, Hattiesburg.
The authors declare no conflicts of interest.
Correspondence: Hollie Gabler Filce, PhD, Department of
Curriculum, Instruction and Special Education, College of Education
and Psychology, The University of Southern Mississippi, Hattiesburg,
MS 39406 (Hollie.Filce@usm.edu).
DOI: 10.1097/WON.0b013e31827e8465
J WOCN ■ March/April 2013 1
2 Filce and LaVergne
children with physical disorders are at increased risk for
psychological adjustment problems, anxiety, depression,
social withdrawal, and externalizing symptoms. Youth
with chronic illness may also develop avoidance behaviors
such as refusing to attend schools in response to fears
associated with attending school or interacting with peers
after periods of illness. Level and Leiker10 observed that
avoidance is associated with increased anxiety, a feeling
of being overwhelmed, and increased chances of
depression.
Identification of psychological issues in children with
underlying conditions that lead to urinary of fecal incon-
tinence may be further complicated because of similarities
in the medical manifestations of their conditions and
somatic symptoms of their anxiety. Rockhill and
associates11 cite frequent urination and urinary urgency, as
well as gastrointestinal symptoms including diarrhea,
nausea, and abdominal pain as clinical manifestations of
anxiety. Other researchers postulate that feelings of fear
related to chronic illness often result in physiological re-
sponses, including headaches, nausea, diarrhea, sweating,
and a rapid heartbeat.9 Healthcare professionals, parents,
and the children themselves may fail to see the medical
conditions and anxiety as potentially comorbid condi-
tions and continue to focus on physiological diagnosis
and treatment alone.
Some researchers contend that it is unnecessary to
examine anxiety in children by disaggregating the popula-
tion by specific chronic illnesses.6 Instead, they suggest
that it is sufficient to study children with chronic condi-
tions collectively in order to identify strategies to relieve
the distress associated with anxiety. However, the poten-
tially stigmatizing nature of conditions that affect
continence may warrant a more condition-specific analy-
sis. A review of the literature identified several studies of
the psychological and/or psychosocial impact of various
conditions impacting bowel and bladder function such as
anorectal malformations,12-17 Hirschprung's disease,18-20
exstrophy,21-26 and irritable bowel disease.27,28 These studies
described anxiety, but they did not evaluate the impact of
psychological or psychosocial treatments.
In examining the literature for efficacious treatments
for children in general, there is well-documented evidence
showing the positive effect of counseling and other men-
tal health interventions on anxiety.10 Research also shows
that positive social and emotional development of youth
with chronic illness can be fostered through opportunities
for social interaction with peers, increased social interac-
tion with adults with special healthcare needs, and per-
sonal care education.29-33 Access to experiences specifically
for children with bowel and/or bladder dysfunction may
be even more critical, as the conditions experienced both
are rare and carry potential social stigma.
In 2001, Plante and colleagues31 published a review of
125 studies exploring the impact of group treatments
(including summer camps) for pediatric populations. Of
Copyright © 2013 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
J WOCN ■ March/April 2013
the studies examined, 23 described summer camp experi-
ences as the primary intervention for children with diag-
noses of asthma, cancer, diabetes, HIV, obesity, renal
disease, and spina bifida. They summarized that campers
in the studies reviewed showed improvements in the areas
of self-esteem, anxiety, attitudes toward the illness, and
management of some of the conditions studied (asthma,
diabetes, and obesity).31 An exhaustive search of the litera-
ture revealed only 1 study exploring the impact of a camp
experience on adolescents with conditions affecting bowel
and/or bladder function. Shepanski and colleagues32
reported positive impact on several health-related quality-
of-life factors, but no impact on anxiety.
This study was designed to investigate if anxiety was
significantly impacted by participation in a 1-week resi-
dential program for youth and young adults with various
special healthcare needs that involve bowel and/or blad-
der function. The following null hypotheses were tested:
1. Participation in a 1-week residential program will not
affect overall anxiety levels.
2. Participation in a 1-week residential program will not
affect reported physical symptoms of anxiety.
3. Participation in a 1-week residential program will not
affect harm-avoidance associated with anxiety.
4. Participation in a 1-week residential program will not
affect social anxiety.
5. Participation in a 1-week residential program will not
affect separation/panic associated with anxiety.
■ Methods
This study was reviewed and approved by the Human
Subjects Protection Review Committee at the University of
Southern Mississippi. Informed assent from participants
and consent from their legal guardians were obtained
using a signed consent form describing the purpose of the
study and explaining that participation was voluntary.
The Multi-dimensional Anxiety Scale for Children (MASC)
was administered during registration on the first day of
the program (pretest) and on the last day (posttest).
Additional data were collected between 2 and 4 months
following the program. At follow-up, instruments were
mailed to participants by the program staff, ensuring
anonymity of responses. Reminders were sent to partici-
pants by program staff via e-mail and an additional packet
was sent to nonresponders 2 months following the initial
mailing in an effort to maximize returns.
Participants in the study were campers and counselors-
in-training; both groups experienced urinary and/or fecal
incontinence. They were under the age of 21 years and
attended a 1-week residential program during the summer
of 2010.
The intervention comprised attendance at a 1-week
program (5 days) held on a college campus located near a
major hospital, airport, and recreational activities.
J WOCN ■ Volume 40/Number 2 Filce and LaVergne 3

Participants took part in educational sessions, facilitated
discussions, and both structured and unstructured recre-
ational activities all facilitated by young adults with these
conditions or WOC nurses. Over the course of the
program, approximately 7 hours of structured educational
sessions were conducted focusing on teaching participants
about their conditions, building self-esteem, and learning
to handle the physical and psychological impact of their
medical diagnoses and personal differences across multi-
ple settings (ie, home, school, social). Each educational
session was followed by a facilitated discussion in groups
organized by diagnosis, age, and gender. These discussions
were facilitated by program staff and were intended to
allow participants to explore the implications of the con-
tent learned on their specific condition, as well as to allow
for questions, hear suggestions from peers, and engage in
collaborative sharing and problem solving. Approximately
5 hours were devoted to facilitated discussions. Structured
and unstructured recreational activities made up the
remainder of the time spent at the program (approxi-
mately 25 hours). These activities allowed time for
relationship building, sharing, and mentorship. Examples
of activities include games, dances, fitness training, day
trips to local attractions, a dance, crafts, swimming, and a
graduation ceremony.
■ Instruments
The MASC, a self-report psychometric assessment devel-
oped to identify the presence and severity of anxiety
symptoms in youth aged 8 to 19 years, was used to mea-
sure outcomes of the study. The instrument also includes
the Anxiety Disorders Index (ADI) used to identify children
and adolescents with clinically significant levels of anxiety.
Population-based scores for the MASC were established
using a school-based sample of 2689 children and adoles-
cents (nonclinical) and 390 children and adolescents
diagnosed with an anxiety disorder (clinical). Using a
4-point Likert scale, respondents rated 39 items. Based on
these responses, raw scores are generated for the total
MASC, including subscores for 4 scales, 6 subscales, and
the ADI score. The MASC technical manual also provides
a means to convert the raw scores of individuals to t scores,
which will allow for comparison among genders and
ages.34 These scales and subscales of the MASC are
summarized in Table 1.
The MASC was administered prior to program partici-
pation, at the end of the program, and at follow-up (2 to
4 months postprogram). Winnicott35 suggests that partici-
pants may appear to have no improvement or even regress
after experiencing a therapeutic process. Such regression
and subsequent progression may be necessary for psycho-
logical growth and maturation.36,37 By conducting both a
posttest immediately after the program and follow-up
administration 2 to 4 months later, true effects are more
likely to be seen as participants had time to integrate what
was experienced and learned. A delayed posttreatment
assessment was also helpful to determine if any postinter-
vention benefits are maintained over a 2- to 4-month pe-
riod following the end of treatment.
■ Statistical Methods
Valid data were available from 81 participants at pretest,
86 participants at posttest, and 58 participants at follow-
up. Descriptive statistics were used to summarize

TABLE 1.
Descriptions of Scales and Subscales: Multidimensional Anxiety Scale for Children
Scales and Subscales Description
Total MASC Score
Physical Symptoms
Tense/Restless Symptoms such as feeling uptight, muscle tension, unable to sit still, fidgety
Somatic/Autonomic Reported feelings of dizziness, nausea, upset stomach, shakiness, sweating, and racing heartbeat
Harm Avoidance
Perfectionism Trying extra hard to do things exactly right and obey parents and/or teachers; looking for constant reassurance
Anxious Coping Checking to make sure nothing was done wrong
Social Anxiety
Humiliation/Rejection Worry about being made fun of or laughed at by peers or being called on in class
Performance Fears Worry about doing something embarrassing, or performing in public
Separation/Panic Scared when alone or in unfamiliar situations, prefers to stay close to family members or home. Fears harm will
come to important people in their lives
Anxiety Disorders Index Used to differentiate children with a diagnosis of an anxiety disorder from children without a diagnosis of an
anxiety disorder. The ADI can also be used to identify children and adolescents who may be experiencing
clinically significant levels of anxiety symptoms

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4 Filce and LaVergne J WOCN ■ March/April 2013
demographic characteristics and levels of anxiety symp- TABLE 2.
toms based on ADI scores. Analysis of covariance was used
Medical Diagnoses Represented in the Samplea
to determine if the program had an impact on total, scale,
or subscale MASC scores while controlling for the number Medical Diagnosis % n
of times participants had previously attended the pro- Imperforate anus 13.5 12
gram.38 For this analysis, only participants with complete Bladder exstrophy 12.4 11
data sets were included (n ⫽ 58). The independent vari-
Crohn disease 12.4 11
able was attending the program, and the dependent vari-
able was levels of anxiety. Years of attendance was the Hirschsprung's disease 12.4 11
covariate. Mauchly's test was used to determine if the as- Colitis 10.1 9
sumption of sphericity was violated and the Greenhouse- Neurogenic bladder 9.0 8
Geisser correction was used when the assumption was
Cloaca 5.6 5
violated.39 When statistical significance was found for a
scale or subscale, further planned contrasts examined Renal defects 5.6 5
whether the effect was seen between the pre- and postpro- VATER/VACTERL 4.5 4
gram administrations and/or the pretest and follow-up Spina bifida 4.5 4
administrations. Ileostomy 2.3 2
Anal stenosis 1.1 1
■ Results Scoliosis 1.1 1
Of the 142 potential participants, 89 agreed to participate Stretched spinal cord 1.1 1
in the study, yielding a 63% participation rate. Eighty-one Tracheo-esophageal fistula 1.1 1
of 89 participants submitted valid pretest protocols, 86
I don’t know 10.1 9
valid posttest protocols, and 58 valid follow-up protocols.
Of the 8 pretest protocols excluded, 2 were incomplete, 1 No response 3.4 3
a
was missing, and 5 were not submitted at the beginning of Diagnoses reported are not mutually exclusive and do not add up to 100%.
the program and it could not be verified whether they
were completed prior to engaging in program activities. Of
the 3 posttest protocols excluded, 1 was incomplete and 1 (categories of “much above average” or “very much
was missing. Thirty-three participants did not return above average) represent clinically significant levels of
mailed follow-up protocols. anxiety symptoms.34 Of the participants in this study,
The mean age of participants was 14.56 years (range, 30.8% had slightly above average levels of anxiety, 16%
11-18 years); the most frequent age reported was 17 years had scores elevated levels of anxiety, and 14.8% had
(18.0%, n ⫽ 16). Average years of attendance at this “much above average” or “very much above average”
program was 2.02; 1 year of attendance reported most levels of anxiety that were considered clinically signifi-
frequently (44.9%, n ⫽ 40). Nearly half of respondents cant. At posttest, levels dropped slightly with 27.9%
were white (n ⫽ 64, 49.6%); 5.4% (n ⫽ 7) were African with anxiety levels of concern. However, there was an
American; 4.7% (n ⫽ 6) were American Indian or Alaskan increase in elevated levels (from 16% to 18.6%), and a
Native; 2.3% (n ⫽ 3) were Hispanic; and 10.1% stated that more marked decrease in clinically significant levels
they “do not wish to report” their racial heritage. (from 14.8% to 9.3%). At follow-up, only 13.7% had
The most common self-reported medical diagnosis was anxiety levels of concern (8.6% elevated levels and 5.1%
imperforate anus (13.5%, n ⫽ 12). Bladder exstrophy, clinically significant levels). However, caution must be
Crohn disease, and Hirschprung’s disease were each iden- used when interpreting follow-up fi gures, since the
tified by 12.4% of participants (n ⫽ 11, for each diagnosis). number of participants for whom data were collected
Ten percent of the participants (n ⫽ 9) were unable to was lower. Table 3 provides descriptive data based on
identify their medical diagnosis and no response was the interpretive guidelines of the MASC.
given by 3.4% (n ⫽ 3). Frequency data for these and other
diagnoses are summarized in Table 2. Impact of the Program on Anxiety
The MASC technical manual provides guidance for In order to evaluate the impact of the program on anxi-
interpreting t scores generated by the instrument. ety, analysis was limited to the 58 participants with com-
Categories range from “very much below average” to plete data sets. Analysis of covariance was used to
“very much above average.” Scores greater than 56 on determine if the program had an impact on total, scale,
the MASC represent elevated levels of anxiety. Scores of or subscale MASC scores while controlling for the num-
56 to 65 (categories of “slightly above average” or ber of times participants had previously attended the
“above average”) represent participants with elevated program.37 The mean MASC scale and subscales scores
levels of anxiety symptoms, and scores greater than 65 and their standard deviation for participants for whom

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J WOCN ■ Volume 40/Number 2 Filce and LaVergne 5

TABLE 3.
Level of Anxiety Symptoms
Pretest (N ⴝ 81) Posttest (N ⴝ 86) Follow-up (N ⴝ 58)
n % n % n %
Very much above average 3 3.7 3 3.5 1 1.7
Much above average 9 11.1 5 5.8 2 3.4
Above average 4 4.9 7 8.1 5 8.6
Slightly above average 9 11.1 9 10.5 8 13.8
Average 18 22.2 22 25.6 12 20.7
Slightly below average 15 18.5 14 16.3 13 22.4
Below average 13 16.0 14 16.3 7 12.1
Much below average 10 12.3 10 11.6 6 10.3
Very much below average 0 0 2 2.3 4 6.9

data were available at each administration are summa-
rized in Table 4.
Analysis revealed a statistically significant decrease in
total MASC scores following the program (F1.679, 80.587 ⫽
3.587, P ⫽ .04) (Table 5). Scores at both the end of the
program (M ⫽ 46.88 ⫾ 1.65, P ⫽ .049) and at follow-up
(M ⫽ 46.74 ⫾ 1.80, P ⫽ .03) were significantly lower than
baseline scores (M ⫽ 48.54 ⫾ 1.69) (Table 6). There were
also statistically significant reductions in the Social
Anxiety scale scores (F2,96 ⫽ 5.299, P ⫽ .007) as well as the
scores on its 2 subscales, Humiliation/Rejection Fears
(F2,96 ⫽ 3.876. P ⫽ .024) and Performance Fears (F2,96 ⫽
6.453, P ⫽ .002) across the 3 time points. The Social
Anxiety scale scores at follow-up (M ⫽ 49.65 ⫾ 1.73,
mean ⫾ SD) were significantly lower than the baseline
scores (M ⫽ 52.70 ⫾ 1.96, P ⫽ .006). Differences at the
end-of-program scores (N ⫽ 49.98 ⫾ 1.52, P ⫽ 0.06) did
not statistically significantly differ from baseline scores.
The average Humiliation/Rejection subscale follow-up
score (M ⫽ 49.58 ⫾ 1.66) was significantly lower than the
baseline score (M ⫽ 52.67 ⫾ 1.32, P ⫽ .02). There was no
statistically significant difference between the baseline
and postprogram scores. The Performance Fears subscale
scores at both postprogram (M ⫽ 48.34 ⫾ 1.54, P ⫽ .005)
and follow-up (M ⫽ 49.60 ⫾ 1.70, P ⫽ .004) were signifi-
cantly lower than the baseline scores.

TABLE 4.
Means and Standard Deviations: Multidimensional Anxiety Scale for Children (N ⫽ 58)a
Pretest Posttest Follow-up
Mean SE Mean SE Mean SE
Total MASC Score 48.54 1.69 46.88 1.65 46.74 1.80
Physical symptoms 44.40 1.35 44.66 1.55 44.32 1.40
Tense/restless 45.12 1.41 44.22 1.37 43.80 1.37
Somatic/autonomic 44.58 1.37 44.90 1.48 45.88 1.34
Harm avoidance 47.46 1.56 48.50 1.45 47.64 1.68
Perfectionism 47.42 1.39 48.80 1.49 47.56 1.48
Anxious coping 47.62 1.50 49.60 1.57 48.34 1.62
Social anxiety 52.70 1.69 49.98 1.52 49.64 1.73
Humiliation/rejection 52.64 1.62 50.84 1.48 49.58 1.66
Performance fears 52.00 1.75 48.34 1.54 49.60 1.70
Separation/panic 51.32 1.77 50.14 1.85 50.54 1.82
Anxiety Disorders Index 49.64 1.68 48.60 1.73 48.08 1.69
Abbreviation: MASC, Multidimensional Anxiety Scale for Children.
aCorrected means and standard errors are reported based on calculations using the covariate “Years Attending Program.” Data-only participants with complete
data sets were used in these calculations.

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6 Filce and LaVergne J WOCN ■ March/April 2013

TABLE 5.
Analysis-of-Covariance Results: Multidimensional Anxiety Scale for Childrena
SS df MS F P Error
Total MASC Score a
245.32 1.68 146.12 3.583 .040 81
Physical symptoms 22.30 2 11.15 0.52 .599 96
Tense/restless 83.06 2 41.53 1.44 .242 96
Somatic/autonomic 5.08 2 2.54 0.12 .890 96
Harm avoidancea 23.64 1.69 14.03 0.21 .772 81
Perfectionism 40.76 2 20.38 0.45 .637 96
Anxious coping 48.34 2 24.17 0.39 .676 96
Social anxiety 533.82 2 266.91 5.30 .007 96
Humiliation/rejection 398.35 2 199.12 3.88 .024 96
Performance fears 591.05 2 295.55 6.45 .002 96
Separation/panic 60.10 2 30.05 0.79 .458 96
Anxiety Disorders Indexb 197.39 1.75 112.70 1.77 .181 84
Abbreviations: df, degree of freedom; MASC, Multidimensional Anxiety Scale for Children; MS, mean squares; SS, sum of squares.
aStatistically significant results are given in bold.
bData reported are reflective of the values obtained via the Greenhouse-Geisser correction when the assumption of sphericity was violated.

■ Discussion
A review of the literature revealed only 1 previous study
relating to anxiety and children with bowel dysfunction (ir-
ritable bowel syndrome).32 This previous study used a different
instrument (the State-Trait Anxiety Inventory for Children) to
analyze anxiety and found no improvement in anxiety of
participants during a postcamp administration. These find-
ings are inconsistent with the improvement in anxiety as
measured by the MASC in our study, which found total MASC
scores of participants (and, thus the presence of anxiety
symptoms) were reduced over the week of the program, and
this improvement was maintained 2 to 4 months later.
Further analysis of the MASC revealed a statistically
significant influence on the Social Anxiety scale score and
both of its 2 subscales: Humiliation/Rejection Fears and
Performance Fears. Both the cumulative MASC scores and
subscale scores were significantly lower at postprogram
and 2- to 4-month follow-up. While the postprogram
scores on the Social Anxiety scale and its Humiliation/
Rejection Fears scale were not significantly lower than
they were at baseline, both follow-up scores were

TABLE 6.
Planned Comparisons for Statistically Significant Results: Multidimensional Anxiety Scale for Children
SS df MS F P Error
Total MASC score
Pretest vs posttest 210.398 1 210.398 4.082 .049 48
Pretest vs follow-up 473.065 1 473.065 4.812 .033 48
Social anxiety
Pretest vs posttesta 290.409 1 290.409 3.773 .058a 48
Pretest vs follow-up 1066.967 1 1066.967 8.193 .006 48
Humiliation/rejection
Pretest vs follow-up 787.566 1 787.566 6.063 .017 48
Performance fears
Pretest vs post-test 633.435 1 633.435 8.528 .005 48
Pretest vs follow-up 1080.406 1 1080.406 9.429 .004 48
Abbreviations: df, degree of freedom; MASC, Multidimensional Anxiety Scale for Children; MS, …; SS, ….
aThis planned comparison did not meet the criteria for statistical significance (P ⬍ .05) but is considered to be approaching significance and therefore is included

in this table for reference.

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J WOCN ■ Volume 40/Number 2
significantly lower than the baseline scores, which indi-
cates an effect in this area as well. Our experiences strongly
suggest that treatments of a psychological nature often
produce no immediately measurable effect. Instead,
changes often occur only after the individual has had time
to process and integrate what was experienced and
learned.34 We believe that this finding is clinically relevant
because it demonstrates a positive effect of the program on
participants that extended beyond the week they spent
together. Nevertheless, additional research is needed to
determine whether the effect is maintained beyond 2 to
4 months.
No statistically significant impact was found on
Physical Symptoms Harm Avoidance or Separation/Panic
Fears. Youth with chronic illness are often referred to men-
tal health professionals for psychological management of
symptoms, including anxiety, related to illness. Symptoms
of anxiety may present as somatization (dizziness, nausea,
and/or upset stomach). These symptoms are difficult for
caregivers to address because the underlying cause may be
attributable to anxiety, illness, or both. When physical
symptoms are related to anxiety, mental health profes-
sionals can work with the youth's family and medical
team to help support the development of appropriate
coping skills and decrease anxious coping.
While the MASC is an appropriate tool for use in a clin-
ical setting by a licensed mental health professional, it was
not administered with clinical intent or intended to be
used as a diagnostic tool. Nevertheless, when considered
collectively, scores suggest that a program designed for
children with urinary or fecal incontinence include efforts
to increase paternal awareness regarding the potential
mental health needs of their children. Although parents’
decision to send their children to the program suggests
that they recognize the child's need for more information
and connection to others with similar conditions and ex-
periences, it is recommended that parents be provided
with additional material about accessing information and
local mental health resources for their children.
■ Limitations
The results of this study must be viewed in the context of
several limitations related to study design. We studied
children with bowel and/or bladder dysfunction who
chose to attend this program. Their desire to attend could
have stemmed from an increased need for information
and support that is of a higher level from others with sim-
ilar conditions who are coping more effectively. This may
have affected preprogram anxiety levels. The use of a con-
trol group of individuals with similar diagnoses who did
not attend the program would have strengthened the de-
sign. While the time-series design of this study was pur-
posely selected to address this limitation, future research
using control groups would strengthen the study. Another
limitation was the number of delayed postprogram
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Filce and LaVergne 7
responses that were collected. Despite higher numbers of
protocols available for review from preprogram and post-
program administrations, only 58 subjects completed the
2- to 4-month follow-up assessment. A larger complete
protocol set would make the results of this study stronger.
Furthermore, the method of collecting protocols during
busy times at the program (check-in and check-out)
contributed to some missing and incomplete data.
■ Conclusions
Participants in a 1-week residential program for youth
with bowel and/or bladder dysfunction showed sustained
improvement in anxiety, with improvement sustained
2 to 4 months later. Although the study was not designed
to show cause and effect, participants showed statistically
significantly improvement in overall anxiety levels, as
well as in the category of social anxiety (including both
Humiliation/Rejection and Performance Fears subscales).
This program's combination of educational and social ac-
tivities provides these youth opportunities to learn about
their condition and strategies to deal with challenges.
Providing opportunities for youth with these rare and
potentially socially stigmatizing conditions shows prom-
ise as a treatment option, with the potential to improve
the psychological health of these individuals.
KEY POINTS
✔ Bowel and/or bladder dysfunction can carry stigma and
feelings of isolation, which may be relieved through interaction
with those with common experiences.
✔ This 1-week residential summer program designed
specifically for youth with bowel and/or bladder dysfunction was
shown to positively affect anxiety, particularly social anxiety, and
maintained the benefits 2 to 4 months later.
✔ Parents and professionals should attend to both the
physiological and psychological impact of bowel and/or bladder
dysfunction during treatment.
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