AIBU - ASD son spoiling himself - Removed toys

[binkyblinky]

Hi all. I need some advice.

My son is 9 years old, diagnosed with ASD and going through the ADHD process.

He has long struggled with soiling himself. He still wears a pad to bed.

He isn't severely autistic and goes to a mainstream school.

In the past two weeks he has been prescribed 'movicol' to help move things along.

He says that his body doesn't tell him when he goes to poo.

My problem is not that he has accidents, I can accept that. It's that he won't tell anyone and will quite happily sit in his own poo. This happened twice last week at school and happens daily at home. Each time I explain that I'm not cross with him when he soils, it's that he doesn't tell me and I can't help him to clean him.

He gets so engrossed in whatever toy he is playing with, or iPad / PlayStation that it's almost as if he forgets he is pooing.

I've tried routines, everything.

Today I caught him sitting in his jeans and jumper on the floor in his room which stank of poo. He was playing with Lego, watching his iPad and a dvd as well.

I've taken away 4 boxes of his favourite toys, his iPad, Lego and PlayStation controllers. I feel so mean. I don't know what else to do.

[cartin]

Sorry to hear about the problems your DS is having with toileting. I have two DS that have struggled with both poo and wee and it really is difficult to stay positive about things. I'm not sure whether you have come across ERIC www.eric.org.uk/ ? The continence nurse my DS saw sent some printouts from that website, some of which were for parents of SN children. When feeling very low about the soiling problems I found this blog by James Parkin helpful on getting a perspective on what soiling might feel like to a child, although it doesn't have any specific advice for ASD or ADHD. childhoodsoiling.blogspot.com/ With the movicol, the advice we were given by the GP was that if the child has been constipated for a long time, it can take quite a long time even after the clearing of the backlog for the rectum to return to it's normal size and the signals of it being stretched and a poo needing to come to get to the brain. One of the other things I saw on the blog is that often children can't smell the poo smell as it is around them constantly and they don't get a sudden blast of it as someone just entering the room. So it is possible that DS really isn't aware it has happened. In my case, DS1 and DS2 have both improved gradually with a combination of movicol, routine (Dr advised to try for 5 minutes sitting on toilet, 10-15 minutes after each meal. We use a sand timer in the bathroom and a reward for sitting not for poo on toilet) and trying really hard to get them to drink more (sticker chart for finishing water bottle at school - not sure if that would be helpful for your DS - sorry if not). Dr and continence nurse also stressed importance of balanced diet and lots of fruit and veg, which is hard as DS2 is rather restricted on this part of diet). It helped our DS2 to get school on board with the routine aspect - we asked for a reminder before afternoon registration when toilets are quiet. Lots of children try to hold it in at school because of fear of school toilets (smells, hand driers etc). ERIC recommend trying to reduce stress over toileting, which it sounds like you are trying hard to do. Taking away the toys might increase stress if it is linked to having an accident and not saying - it might lead to DS trying even harder to conceal the accident if he is starting to become aware. My DS1 went through a phase of hiding soiled clothes when he did start to become aware. If your DS self care skills and time schedule allow, perhaps allowing him to shower himself once accident detected and put soiled items into a bucket/ washing machine might help him to feel more in control and lower stress?

[cartin]

Forgot to add, I've found that having a 5 minute toilet break from screentime after 40 minutes might help if accidents happen more often when in front of a screen. I've tried to rationalise the process of dealing with accidents be saying to DS1 and 2 that the sooner we clean it up, the less time of playing/ screen will be missed during the cleaning process as the poo will not have got as widespread, and the less likely to get a sore bottom due to it drying on. So not a sanction, just a natural consequence. I wonder if a social story about this might help?

[imip]

There is a ‘new’ sense, I think called interception. Which is the sense of feeling something - needing a wee, being hungry. Maybe he can’t sense he has gone?

My dd is HFA and pretty academically clever. She’s always been unable to wipe her bottom. No matter what we do. She also smears poo on walls occasionally. I remember that always as a thing more in common with severe autism. Looking at my dd, she is a great masker/copier and will look very trendy and fashionable. It’s someyimes hard to reconcile all these things.

[DuchessDumbarton]

Enteroception is the internal signals from your body.
So, he may not be aware of his bowels opening, or of the smell resulting.

This is a useful checklist for identifying why the child might be having difficulty mastering continence. There isn't a one-size-fits-all solution.

[imip]

Knew someone would know more than me! Thanks Duchess. I think this tally’s a lot with my dd.

[AnemoneAnenome]

We were told it's "interoception" on our autism parenting course.

Fabulous advice from cartin. Follow it all. A sitting habit after meals can really help, even if you are sure your child is not regular. Movicol needs to be dissolved with water before you add anything else.

There is not much point telling your son you are not cross if you take his toys away as punishment. He will know you are cross really if you take his toys away. YY to a bucket or washing machine (a lidded nappy bucket is good) and really praise him if he puts any dirty things in them. If he likes iPads etc, use them in some way - a sandtimer app or a daily reminder that dings, or time on it as a reward (but as Cartin says, reward positive actions like sitting, taking movicol rather than results)