School and poo withholding - wondering about SEN(36 Posts)
I've posted a few times before about difficulties with my dd's behaviour and poo withholding but only recently have I begun to wonder if there's a connection and I'd be grateful for any thoughts or experiences.
My dd1 (4, Aug birthday) started school in September.she also has a new sibling born in June. She likes school and is making friends and learning a lot but she's been anxious and withdrawn when I collect her. She's not wanted to do her normal activities and has been very clingy towards me.
It could just be a normal reaction to school starting and a new sibling but I have had feedback from school that she's "a nightmare " over carpet time and following instructions and certainly I find discipline a real challenge. She's not aggressive or disruptive so we don't have issues around big things like hitting or damaging things but she doesn't follow instructions about things like "put your shoes on, don't open that cupboard, get down from there". It's constant and exhausting. and she will interrupt constantly even when told not to. She doesn't really respond to being told off or threats. I generally have to rely on her good nature to do the right thing rather than be able to make her. It's worse when she's tired but it's been almost constantly like this since she started school. Over the holiday her behaviour has been much improved except for three days when she had slightly later bedtimes.
The poo issue is that she withholds her poo till she's constipated and loses the ability to recognise when she needs to go. She's on laxatives at the moment and I'm hopeful we can get her back on track as we had this issue when she started pre school too and eventually, after a lot of hard work and rewards, cracked it.
I've recently noticed that she has the same vacant expression and distraction techniques when I'm trying to get her to poo as when I'm trying to tell her off or get her concentrate on writing or reading.
The Dr agrees the withholding is anxiety related. What I'm not sure about is if her anxiety is a normal response to a Summer born child starting school and adjusting to a new sibling or if there's something underlying making school particularly stressful for her. She's always been fine (almost exceptionally happy and confident) in a range of childcare settings but both pre school and school have been night adjustments because of their expectations about listening and conformity.
I posted on the special needs board about adhd as I'd read there was a link with constipation and apparently it can present differently in girls as inattention rather than hyperactivity (though she can be hyperactive when tired and talks incessantly) but the two replies I got suggested asd instead.
There's family history of both adhd and asd but I don't recognise her as having asd traits. She adores imaginative play and isn't fazed by stimulus. It's more concentration and authority that seem to unsettle her.
I don't know what to do. I'm fully aware she might just be behaving badly and the responsibility rests with me for getting her to listen at school, but I don't want to let her down if there is something I should be exploring.
I need to talk to school about the constipation and accidents anyway, and they're always trying to talk to me about her listening but in a frustratingly round about way and always in front of dd so I'm wondering about asking their opinion about adhd or similar but they've previously been quite patronising about my parenting responsibility and quite dismissive about my concerns over her mental wellbeing and anxiety so I don't really know how best to approach it. The talk about the toileting is urgent so I may need to separate the two.
Sorry if this is confusing. Happy to answer any questions
Oh one extra thing that may be relevant. She's very attached to her teddy bear and although was happy with the idea he couldn't go to school is anxious about leaving him and it's the first thing she asks for when I collect her. I'm starting to wonder if making her leave him behind is counterproductive.
I'm sorry no one else had posted, maybe someone more helpful will come along but I wanted to confess, I hated to poo!
No special needs here, but I had 2 younger brothers and I remember clearly NOT wanting to miss out on anything. I also didn't like the "feeling" of pooing, and it took too much time out of my busy childhood day. I could control it, suck it back in nearly and get on with playing.
It all came to a head when I was so blocked up I had explosive diarrhoea in the middle of the night and it wouldn't stop and my tummy was really sore.
My mum sat on the bathroom floor with me and told me it was my own fault and I wasn't allowed to do it anymore. She put a sanitary towel on my pants to catch an accident just incase, and said I was a big girl and she didn't want me to have to wear nappies like my baby brothers!
I was just telling DH this the other day, because my daughter struggles to poo and I hope she's not like me!. My mum has no recollection of it at all - still swears I was a golden child!
Might be a control issue? I don't want to poo so I'm not going to? I'm 36 and remember it so clearly.
Good luck :-)
she will interrupt constantly even when told not to. She doesn't really respond to being told off or threats. I generally have to rely on her good nature to do the right thing
What do you mean by not responding to being told off? You can't expect school to rely on her good nature - she needs to do as she is told. What exactly do you do when you tell her not to open the cupboard or whatever, and she does it anyway?
She is very little and this might pass in time and with treatment for the constipation. However, something someone on here said that I found helpful is to really try consistently a conventional behavior management system (eg 133 magic, or reward charts) .Kids without additional needs yend to respond to those. Your dd will be doing her best and if she doesn't respond to those techniques it might be a clue that she might need more support.
By the way I would post again on the special needs boards as the advice I have had on there has been amazing over the years. Your dd may or may not have a diagnosable sn, but if she needs a slightly different approach they are good people to ask
Thanks all. By not responding to being told off I suppose I mean she just doesn't seem fazed or frightened. So she will comply but only if I physically get her down from the cupboard or whatever. 123 works up to a point, as does sending her to her room, but for minor misdemeanours it's exhausting having to escalate everything all the time. similarly school have to send her out of the room because she won't sit still, though she's not hurt anyone or damaged anything or any of the usual more major things that would warrant that. Other kids seem to fear authority
Well thanks Iguana, it's not like I'm not worried about it, that's why I'm posting. What I mean is that she just doesn't seem fazed by being told off so I constantly have to escalate to sending her to her room or something. Similarly school have to send her put because she won't come and sit down, although she's not hurt anyone or snatched anything or any of the more usual things that would warrant it. Other kids just seem more deferent to authority and want to do what the others are doing. I was always told "oh she will nap at nursery/wear school uniform etc etc when she sees the others doing it" but she just doesn't. She'll take off the uniform and cry and cry. I don't like my every interaction being a battle and it's clearly stressing her out so I want to be sure coming down hard on her is the right thing rather than just carry on regardless.
Thanks for the helpful posts about pooing. I'm really hoping that whatever stress initially caused her to withhold is over now and it's more of a vicious circle thing. It's just the blank look/complete inability to repeat back what I've been telling her about why it's important that's worrying me.
Anyway I've emailed school to ask for a meeting about managing the accidents and her anxiety so will try and gauge what they think then.
Reward charts seem to work up to a point (the novelty wears off and it takes forever to get to the ingrained habit stage as she relapses when we stop) but we've had to use them mainly for toilet issues. We've recently told her she can earn a reward for listening but it's a bit abstract. I'd be grateful for ideas of how to frame this in a meaningful way.
I didn't say you weren't worried about it. I asked what you currently did.
I can certainly see why you're worried. Hope the meeting helps.
Thanks Iguana. I maybe misread your tone. I was quite stressed yesterday. it's really hard to give a clear picture of what I mean ascites not like she spends all day every day causing mayhem. She can be lovely and sweet and so enthusiastic. But she doesn't do as she's told and I've started to realise she gets really quite stressed by situations where she has to, and has this scary blank stare technique for zoning out when I'm trying to explain something important to her, and this manifests itself in the toilet issues too
She could just be wilful and disobedient, I'm fully aware of that.
Well, it doesn’t sound at all like wilful disobedience . I think your insight that the anxiety is making your DD zone out may be spot-on. By now the whole poo problem must be making her feel pretty anxious and the anxiety is probably making the poo problem worse too – it’s a bad circle
It's possible that rather than rewarding her for listening, you might need to communicate with her in a different way. Have you tried using visual cues like hand signals or cards? Sometimes giving extra time to process instructions and using very few words can help. It sounds more abrupt than you wouldiuse for most children but works for children with processing issues. So you say "Jane - we are going out - please put your shoes on". Then count to five. Then (still in a clear but neutral tone) "Jane - shoes". And pause, and repeat.
I also see a similarity between what you are describing and some aspects of ASC, though ADD is a possibility too. Anxiety often goes along with ASCs, more so (as far as I know) than ADD. The interrupting, not deferring to authority, not doing what the others are doing, not responding well to verbal instructions and having to be moved physically also sound rather ASC-ish – there are big communication issues in ASCs which can take many different forms. Defo keep talking to the school. If she does get assessed then don’t worry too much about what she gets assessed for, because if she is investigated for ASC it will involve a multidisciplinary team who will also check out a whole bunch of other things too, including ADD.
I also don’t exactly know what you mean by doing things out of good nature, but it sounds unusual. I wonder if it has anything in common with my DS who did not at all understand authority either. He would never do something just because an adult told him to. I could get him to do things if it was a habit or a routine, something we’d done before, or if it was something new only if he understood exactly what he had to do and why and if he had had plenty of advanced warning and preparation. Yet he was not disobedient for the sake of it. Only getting him to do things was like steering an oil tanker – I had to plan ahead and start turning him in the right direction way in advance! It might not be quite the same as your DD but certainly I could never just decide what to do on the spot and tell him, that only led to panic and refusal.
I had those issues as a child, not pooing but having no fear/recognition of authority and just doing what I wanted.
I have anxiety that started in childhood so it could be that, Im also dyspraxia
and have always just been a bit of an anarchist
Thanks Kleinzitt, that's really helpful. She doesn't have any particular behavioural quirks or ocd tendencies and is really very confident and sociable. I've also never known her get stressed by noise or stimulus, that's why I thought not asd, but maybe my understanding isn't very nuanced. She's always been complimented on how articulate she is and her extensive vocabulary so it's hard to imagine her having difficulties processing what I say, but perhaps she does. I was thinking tonight of another example - teeth brushing. I have to ask, insist, shout, cajole her to get her to open her mouth for long enough. this has been every night since she first got teeth. It's like she's being deliberately difficult about it but why would she be? She doesn't ultimately mind me brushing them once I've finally got her to open her mouth.
She's always been complimented on how articulate she is and her extensive vocabulary
OP this was me. I was very bright and had a really good vocab that was always commented on, but I was a very strong willed child and just completely resisted authority.
My mum said I was not naughty but "hard work". Always asking questions, wanting to know everything, doing what I wanted etc.
Like I said my diagnoses are anxiety and dyspraxia. Is she disorganised? Clumsy?
Do you think there might be an issue with the toilets at school?
Cold? Smelly? Lack of privacy?
Could she be nervous about asking the teacher if she can go?
If she is very articulate, does she talk about her own feelings and other people’s feelings? Who is happy or sad or angry? Does she talk about social relationships – who plays with who? Who likes what? Because my DS was highly articulate, confident and socially outgoing but he never said anything at all about those things. (He does have an ASC diagnosis now and even now aged 17 they are not things he is easily aware of.)
Also the fact that she doesn’t seem fazed or frightened by a scolding might be due to a mismatch between inner feelings and her facial expression. Her anxiety might actually go up a lot and she might even get panicky and irrational when she is told off but she may not show itin that way.
I dunno about the tooth brushing - this isn't something my DS had problems with so anything I say would only be a wild guess.
I am really sorry in advance as i am completely ignorant to SEN issues but I stumbled on this thread and I was just so struck by what you wrote.
I am wondering (like I said please excuse me) why you are so sure there is SEN at play?
Not attacking you, am only asking because it's like you are describing my DD!! I've not been concerned at all but maybe I should be?
Eg you say
"I was thinking tonight of another example - teeth brushing. I have to ask, insist, shout, cajole her to get her to open her mouth for long enough."
Arent all kids like this? I mean - they know it's bed time and they obv want to play more. Maybe I am being naive but I can't say I know many kids who just obey all instructions on demand
You sound like a brilliant and attentive mum, btw. Hope i've not derailed your thread; I am certainly reading with interest.
Gosh my head is spinning with the possibilities. Thanks so much for listening and replying. She does talk about people in the playground, yes, and who is friends with whom. Not so much how they feel but certainly what they like. I don't know how clumsy she is relative to other kids her age. She does spill and drop things and I'm always knocking things over myself.
Eminado, I'm not sure at all! I'm flip flopping around all over the place between thinking she's just like any other four year old and not. The reason I've suddenly thought about it is because I found out dh was diagnosed with adhd as a child and I read there was a link with constipation so I started to wonder. The blank looks worried me but I've also read that anxiety can present like adhd. She has been really difficult when tired lately but I've no idea if she's just tired. Tbh there seem to be such extreme variants with all these diagnoses that I'm not even sure how a diagnosis would help.
My son witholds his poo too. He's 8, but he also has cerebral palsy - v v mildly.
It has stressed me out sooo much over the years. The best method I found was to make sure that he did a poo every night before bed. My son responds to rules.
He's like your daughter in that he is not in any way fearful of authority. Unless I shout very loudly. But if I make something a rule and say this is what is going to happen from now on and we'll do this every day ... he likes that. And that is how I've managed to stop him being constipated.
My daughter is 4. She has no special needs. She poos fine - but would never go at school, and usually waits until she's at home, whenever we're out.
She also is going through a phase of not being bothered by authority and totally ignoring me when I ask her not to do stuff. In fact a lot of the behavioural stuff that I've worried about with my son and connected to his CP over the years is now coming out in my daughter.
And I'm realising that so much of it is normal development that they will pass through.
It’s good that your DD is more socially aware than my DS . You’re right that there is overlap between many of these conditions and it can take an expert to decide which (if any!) is the best fit. It’s not so much the exact diagnosis as the investigation process which could help pin down what your DD is struggling with – whether it is mainly anxiety or whether she has a problem with communication, or planning, or sensory, or focus. It was a real eye-opener to me to see which kinds of communication my DS simply couldn’t manage when the language therapist tried them on him.
My thought is, see what the school think. If they don’t really know what’s going on with your DD and if they are struggling to manage her then it might be worth going to your GP and asking for a referral.
And actually, the responsibility doesn’t rest with you to get her to listen in school. You can be supportive but there is no magic that you can do at home which is going to make her listen in school! That is very much the school’s responsibility.
How does her anxiety manifest itself?
Have you tried something like pasta in the jar rewards for doing what she's told the first time?
Mostly in the poo issues noteven and in being generally more emotionally sensitive, tearful etc. She's normally so confident and cheerful. Actually I do think she's got reasonable empathy - she gets v worried about scenes in books or on TV when people are ill etc or when cinderella's stepsisters tore her mother's dress. She won't watch that film now, and makes me skip through frozen until they're friends again. It's a bit extreme tbh but maybe all 4yos are like that.
Have just had a lightbulb moment. Dh does the exact same zoning out thing when I try and give him a list of instructions. he said I speak like he's not listening in a monotone and he zones out. It really pisses me off as he quite clearly isn't listening but perhaps he's having processing difficulties too. If I break the instructions up and keep the tone varied he takes it in better. As I said he was diagnosed with adhd as a child though is very intelligent with the same ridiculouslying good memory as dd and an exceptional iq.One to try with dd I guess.
I am appreciating her more today though. We went out with a couple of boys yesterday and I noticed she tantrums less than they do.
That’s interesting – your DH is the other way round from my DS Varying the tone actually distracts him. People do vary! We’re all big ones for written lists in my house and with DS we used visual lists – for his before-school morning routine DS had pictures with Velcro backs for the things he needed to do (get dressed, brush teeth, coat on, backpack…) I’d stick them up in a row and he’d pick each one off when it was done.
We went out with a couple of boys yesterday and I noticed she tantrums less than they do.
I used to wish my DS would zone out or just cry. Under stress his go-to response was to lash out. Maturity improved this a lot but it was grim at the time.
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