Anger around toileting

[toiletanger]

DS is 4 almost 5

He's always had an issue with going for a wee

He knows he needs to go but holds on (as I think most kids do)

My problem is he's becoming very aggressive and violent towards me and rude when he does and the bigger he gets the harder this is to handle. He hit me all the way home from school today yelling at me and then went to his room screaming and throwing toys around. It was a full on temper tantrum

He's like Jekyll and Hyde - before going and after going. After - he's lovely again

I'm sure some of today is tiredness but this is what always happens... he's hitting and screaming me so often until he has gone

I tell him to go very firmly but I'm also unable to physically wrestle him to go - he's very strong and I'm actually getting punched in the face and bruises if I try and he will rush at me and punch me when I'm telling him

This isn't normal is it? What can I do?

No other needs so not like it's ASD which would make a little more sense to me if it was. I don't see anyone else's kids behave like mine without other needs and it's only when he needs a wee. Number 2s aren't an issue

It's gone on ever since he was potty trained which he did really early (2nd birthday he'd done it by) and he happily trained... he decided to and was very proud of himself etc

But I can't cope with it. I'm bruised...

It's not just with me... he does it to anyone (rudeness) but I think it's only me he's actually hitting

Blood pressure increases with a fuller bladder, maybe he is having problems regulating blood pressure causing the anger?

I would go back and see your GP. It's not normal behaviour and my first though is that this is a medical issue not behavioural.

Sounds odd but think what your advise would be if this this were a dog, if you had a dog that was aggressive when he needed to wee, yet he refused to wee, you'd see a vet, not a behaviourist.

GP. Maybe go without him initially. This isn't a usual problem, and the suggestion that peeing hurts him is a good one.

My DS is very similar to this. He's almost 9, and I hate to say it but as time has gone on, we've found more and more indicators of Asperger's.
He still holds on until the last possible moment, and gets v angry if we suggest he goes to the loo, insisting he doesn't need it. He never wets himself though, but he cannot be comfortable.
We think it may be a sensory thing, like stimming, because he can feel it IYSWIM.

@QuirstThenching that sounds plausible

Is it dangerous for him? Would the gp be able to do something about it?

I did get a family support worker involved over his behaviour once but the problem was he was given glowing reports from nursery and also at home when she came he was lovely every time... but it just never combined to when he needed the loo unfortunately that I looked like an over anxious mum imagining it but I'm honestly not... family/friends/babysitters have all witnessed it multiple times

@haba because of the aggression I have wondered quite often but he just doesn't seem to tick enough boxes on the checklist (forget what it's called but I've done it re ASD)

However he does have some sensory things I personally think but I'm looked at mad if I call it sensory by professionals (obviously I involved a FSW once, and also he had music therapy... both didn't see anything to be concerned over so I just look stupid and get scared they'll think I have munchausens) can't spell that I don't think

One being his hair... I'm very gentle but he actually screams when I comb it at the slightest touch. I know it can't hurt more than the mildest tug... but he insists and screams I'm hurting him

The other being sounds - he will get hysterical over a motorbike zooming past, used to be dryers and hoovers but he'll not freak out the way he did anymore

And mud... it's allowed in a mud kitchen but if he comes across it IRL he gets really upset about having to walk on it

As a baby he hated soil/sand/goo of any kind - anything not solid basically disturbed him

Oh and showers... the one at the pool is quite fast/powerful and that's okay but the one at home you'd think he was being murdered if I use it or one at relatives... only difference is them being slower flowing

I know it's normal for small kids to have dislikes... it's just his reaction seems OTT iyswim

Apologies for massive post!

There would need to be an ultrasound booked to start detecting the condition OP.

OP - can you google Pathological Demand Avoidance? It may not fit... but if it does, start to use some of the strategies recommended and see if things improve. Good luck

Definitely see the GP though to eliminate any physical cause...

Lots of children have sensory issues when small though, especially when things such as motorbikes, hand dryers etc are so loud. Go down the "does it hurt" route first, and check there's nothing physical. My DS has got better as he's grown older, so I'm sure you'll see some improvement.

Before you posted about the other issues I thought possible SPD (you're right it's the level of the reaction/distress it causes that sets it apart from just disliking something).

You can have SPD without ASD and a lot of professionals can be very dismissive about it unfortunately.

If he does have sensory issues then something like his hair being brushed will be hurting him as his brain may process things like this as pain.

It would also make sense him registering going to the toilet as being thirsty.

This is quite a good checklist.
www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

I may be completely wrong though, obviously best to get any physical problems ruled out.

He doesn't fit PDA I don't think but does I think get anxious and covers it up by 'deciding he knows' even when he doesn't. I'm not sure... some of the behaviour does fit but then the development of it doesn't... he always met milestones, wasn't a watcher, etc

He does tick quite a few boxes on the SPD checklist but how many do you need to tick to wonder? Also done in one section then some on the opposite so doesn't it balance out?

I'm going to push the GP for some more investigation physically I think and hopefully school will notice since it's a much longer day and give weight to my concerns.

He is incredibly literal though... to the point it's hilarious frequently

(But he's 4 turning 5)

So I don't know if that makes any odds eg - threw a tantrum someone said he was too big for his boots and yelled "my boots fit" and protested by wearing them to prove it

If someone says they'll have a little snack - he'll comment on the size as to if it is actually little or big eg "but that's not a little apple"

It's cute... but it does happen constantly and I have to remind relatives he's very literal quite often to explain his responses or why he hasn't done what they've asked him to do

The literal thinking can be indicative of ASD but like you've said, also common in children at this age. His reaction to things being explained would probably indicate whether it is a problem or not, so if he's quite accepting/understanding when you explain the person didn't mean the apple is small it's just a phrase used. If it causes him to get anxious/upset/stressed out or he insists that the person corrects it before he can 'move on' then that can indicate it's more than just his age.
Also, if you find you are having to accommodate him/change how you would normally say things, that can also be a good indicator.
He sounds very funny and clever with the boots

The SPD is hard to get your head around. You can struggle in some areas and not others, so could struggle with tactile issues but have few problems with noise for example.
You can also be under responsive with some things and over responsive with other things in the same area. So, clothes/socks could really bother you but falling over hard/bumping into things could not really hurt the way you would expect.

It sounds like whatever the reason for him holding his wee / going for a wee is really distressing for him and his way of communicating is behaving the way he is.

Does he hate the sensation of going for a wee? Have you asked him?

He doesn't mind the sensation no. He's sometimes surprised there's a wee there... if he's been fighting that he doesn't need it and I've said just find out then, give it a try and if one doesn't happen no problem... he'll do a massive one and then go "oh there was actually one"

The literal thing - he does get very upset, obviously we find it funny but then he gets even more upset that we're laughing at him

It's common for children with SPD not to recognise they need a wee or to mistake the feeling of needing the toilet for something different.
So is it the sensation of having a full bladder that distresses him? Along with you telling him he needs a wee when he genuinely thinks he doesn't? So in his head you are saying something that is 'wrong'/untrue and this makes him stressed out and angry?

I don't kno, am just guessing?? If you can find out the cause of his behaviour it will be easier to find ways to help him manage it.

it's really important to check if his testicle has descended.it may or may not be related to the wee issue but it is a separate health issue on its own.

Has he been checked for it by the GP?

http://www.nhs.uk/conditions/undescendedtesticles/Pages/Introduction.aspx

I would take him to the gp to get a physical cause ruled out

Yes @littledinaco he seems to think he doesn't need one but he's doing all the tell tale signs sometimes - hopping, running in circles, can't concentrate, and begging for a drink and glugging it down like he's dying of thirst

It's like unless his bladder is about to burst he won't believe he needs a wee but he gets so angry and irritated in the run up but he's holding it himself rather than relieving the frustration of it

@mypoornips I think I need to take him asap for that alone then... I'd hate him to suffer fertility problems. I've had them!

You could do a social story with him. Make a little book, very simple, with pages showing 'how I know when I need a wee'. Some times when I am playing I get a funny feeling. I have a bit of tummy ache. I start shuffling my feet. I think I need a drink. I get quite cross. When all that happens, I need a wee. When I go to the toile and do a wee, I feel much better. And I get a jelly bean!

If you do several, like How I know when I'm thirsty. How I know when I'm hungry. Then he won't feel like you are targeting the wee.

Social stories explain in a simple, matter of fact way, things which most people pick up through experience. Some children need to be taught more directly to help them understand social cues like when it is ok to hug people, or how to know when they need a wee.

That's a great idea @picklemepopcorn I do wonder if it's physical too so will go to the doctor but what you say about knowing when to hug too has struck a little chord. I will do a social story and see if it helps

I don't think he's just angry at being told he needs it... I think he's generally massively out of control of his feelings when he needs it. He used to rage as a baby and I never got to the bottom of it... in hindsight I wonder if he wasn't peeing till completely bursting but because of the nappy I never knew

I don't know... he was so easy to potty train that it's very strange!

With one descended testicle he is unlikely to be infertile which is good but the risk of the undescended one developing cancer is high. That why they usually do surgery after the first birthday. Someone should have been monitoring him so I would find out about that asap.

Undescended testicles are usually checked for at the newborn check and 6 week check, unless it was missed for some reason.
You will be able to see if you can feel them both there.
Obviously, best to go to the GP though and get any physical causes ruled out.

I was going to suggest social stories too.

Also, naming his feelings can sometimes help, so 'I can see you are really cross/angry/frustrated'.

Giving him alternatives, so telling him it's ok to be angry but it's not ok to hit mummy/shout at mummy. Tell him what he can do instead, maybe throw soft toys in his room/punch the pillows on his bed (or whatever you feel is acceptable). It enables him to take control of managing his feelings.

It could be that he has difficulty with sensory registration and lacks interoception (the brain getting the message from the bladder that it needs to empty).
This explains it quite well
www.thesensoryspectrum.com/what-is-interoception/

Does he struggle to know if he's hungry?
Get full up really quickly or seem hard to fill up?
Does he struggle to know what is hurting him when he's unwell, so can't easily tell you if it's a headache/sore throat/earache?

There are activities you can do to help 'regulate' his system, an OT with Sensory Intergration would be able to advise but it can be things like dragging heavy objects, carrying a heavy backpack, deep pressure touch so rolling him up in a mat or tight blanket. There are loads but it's most beneficial to target the areas he is struggling in.

From when you've toilet trained him has he ever told you he needs a wee/took himself to the toilet when he needs to go or is it just some of the time he's like this?
I know you've said he was easy to toilet train but usually you would say they were properly trained when you no longer had to remind/tell them to go. What you describe is often the late stages of potty training so when they are not having accidents but still need sometimes reminding/taking to the toilet.