8-Year-Old with ADHD/ASD: Chronic Stool Withholding - Seeking Behavioral Strategies

[ScwelshMamma]

We're desperately seeking new strategies to help our 8-year-old daughter, who has ADHD and ASD, overcome a long-standing issue with bowel movements. Despite successful potty training initially, she developed chronic stool withholding after a bout of constipation around age 4, and it's now a significant behavioral problem.

We've diligently followed our doctor's advice regarding diet and fiber intake, which provides some relief. We've also experienced periods of success, where she had regular bowel movements for weeks at a time, only to regress. This cycle has repeated over the past four years.

Recent medical tests, including an X-ray and blood work, have ruled out any underlying physical causes. We've engaged in numerous conversations with her to understand her perspective and challenges, but her ADHD makes it incredibly difficult to overcome her resistance. While we've successfully taught her the importance of facing problems in other areas of her life, we can't seem to apply those lessons to this specific issue.

The ongoing struggle is significantly impacting her self-confidence and causing her considerable embarrassment. We maintain a structured and consistent home environment with clear routines and consequences. However, we're at a loss for how to address this particular behavioral challenge.

We're a determined family, committed to finding a solution. Having ruled out medical causes, we're convinced this is a behavioral issue requiring targeted intervention. We're reaching out for any advice, direction, or shared experiences from others who have navigated similar situations.

Any ideas, direction or suggestions would be appreciated.

Is she on Movicol or any other meds? Does she dislike her bottom being splashed? Paper down first may help.

Blowing bubbles whilst on the toilet can help with relaxation ( really works)
Have you tried Pooland social story? Animated version on You tube.

Sharing amusing stories about poo like The Story of the Little Mole who knew it was none of his Business ( you can actually get noisy and “ plop” up versions!) might ease the stigma and add humour.

The ERIC website is recommended.

If it’s trauma related ( from constipation) she may need to see a child Psychologist ultimately.

Is she under a paediatric doctor, either general paeds or gastro? If it is a behaviour linked, then I would second what the above comment says about involving a clinical psychologist.

Thanks you 24Dogcuddler for replying.

She is not on any meds currently. She has been on Movicol for a period of time recently. This has helped but she is beginning to refuse as she doesn't like the taste of it. We've got ordinary and chocolate flavour. We're handling this challenge right now.

She hasn't had any issues with splashing as far as I'm aware. I sit with her most of the time as she can't be trusted to be alone or she will just run off to her rom right away.

Blowing bubbles is a task we've tried but not really been effective we have tried various breathing methods to aid relaxation. It helps but as time goes on getting her to do it and understand the benefits is a massive challenge.

We have a lot of poo/fart related stories as she thinks poos and fart topics hilarious which works in our favour.

I suspect at this point a more mental health approach is required. I will be exploring this next step.

YEs we're very familiar with the Eric website. We've used a lot of their handy resources over the last couple of years.

Thank you for taking the time to reply.

We seemed to have a bit o f a turn in the tide yesterday so we're going with it.

I will update down the line if this progresses. Fingers crossed she keeps cooperating now :)

Thank you Mumof1andacat for your reply.

Yes we have been seeing the doctor has some tests to rule out anything that may be causing this.

We've rules out physical elements. Purely her withholding and struggling to find a way through this challenge. Agree she may need some additional mental health support so we will be exploring this next step.

Many thanks.

Thanks for replying and hope you find a solution that works. Sorting it before puberty would help as you will have additional problems then with stomach ache etc ( sorry)
Bubbles and Movicol ( in milk) helped our daughter but it was an ongoing need and difficulty due to ASD/ ARFID.
Another route could be a specialist sensory integration OT in case it is linked to Interoception or other sensory need.

I thought I would follow up on some unexpected developments with my poop withholding 9 year old.

It seems her constipation has been caused by gluten.

It came about when she had been complaining of aches and pains that had been ongoing for months in her joints/legs etc.

Also itchy skin all the time even though no rashes or bumps on her skin.

Her father has coeliacs disease and although my daughters symptoms aren't a match to what her father experienced (Diagnosed as an adult) I got to looking at the symptoms in kids. Low and behold the checklist of symptoms you could tick off one by one and my daughter seemed to fit the profile.

We did go on to have blood tests and provided poo samples etc for analysis by her GP. Results came back she hasn't got it but after the tests were done we went gluten free right away. Within days she was pooping normally and has been ongoing frequently every 2-3 days since. No pain, no bloated-ness, moods much better, although still a working progress.

I didn't pick up on this as I thought if she was likely to inherit her fathers auto immune issue she would have had the opposite of constipation as her father had frequent tummy upsets/diarrhea.

Whilst she hasn't bee diagnosed with coeliacs, going gluten free has helped massively and was clearly an issue.

There's still progress to be made even now, after 4 weeks of being GF she's a different child and her confidence is growing.

Thanks to all who took the time to read my post and respond with some very helpful guidance.