Gifted kids, OT issues and encopresis (x-post)

[Tigerle]

I’m asking about this on behalf of a friend of a friend, whom I know only vaguely (and her kid not at all) but who’s signaled that she doesn’t mind my asking as she is fairly desperate for answers.

I was actually supposed to ask much sooner but I felt I didn’t have enough information to get good answers and the mom never followed up so it kind of fell by the wayside....now, however, I’ve heard a new angle to the story and feel it is kind of incumbent upon me to find out more about this in order to maybe help this little boy...

The boy in question is in 2nd grade, I assume 8 years old, and has had frequent toilet-training regressions, soiling himself regularly, with better phases and worse phases. The mom was already very worried when he was in K, but hoped that things might work out until school entry.

At the time, according to my friend, physical reasons had been completely ruled out, with the boy apparently saying that he “didn’t notice having to go” or “couldn’t be bothered going”, and being unfazed by having to clean up himself. I remember that upon hearing her describe the boy as a “dreamer”, I suggested asking whether sensory under-responsivity and petit mal seizures had been ruled out, but I do not know whether this was the case or not.

Now that the child is in grade school, instead of getting better things have gotten so bad that he is soiling himself three times a day, and the mom regularly has to pick him up from school because of this. Specialists have posited that the problem is due to the boy struggling with his schoolwork due to very bad fine-motor (or maybe rather graphomotor) skills; apparently he has a very clumsy pencil grip and struggles with writing. And school must have something to do with it, because during a week when he had to stay home for unrelated reasons, he never soiled himself at all. But there may be more going on: according to my friend the mom then said “well his intelligence can’t be the problem because they’ve tested that as well and apparently he’s very bright, he scored more than 130 points on the IQ test.” My friend, who is one of the few people IRL I talk to about giftedness, immediately said “what makes you so sure it’s not very much part of the problem?” but the mom dismissed it. She has also discontinued OT because she felt it didn’t help at all.

The mom is rather stressed out due to sharing in the care for an elderly relative on her husband’s side of the family, which involves doing the housework two afternoons a week and then hanging out at granny’s for the rest of the day, I assume with her kids in tow – which is already better than when the boy was still in his K program at preschool and her share was two full days, which entailed having to take the boy out of school against his will on those days. So there appears to be a pattern of some persons in the family having their needs ignored, but I feel it isn’t my call as a stranger to point this out or even to make a difference if I did.

But I think I might be able to nudge the mom towards taking the discrepancy between her child’s writing skills and his cognitive ability more seriously, and accept that his being gifted might have something to do with the encopresis. I have found anecdotal evidence about a connection, but wonder whether anyone can point me towards more persuasive resources (information only, not places, we’re in Europe). And maybe give an informed opinion about whether OT not helping might mean that there just wasn’t enough of it or rather that the therapist was useless?

Thanks in advance!

[Roar]

Does he have a encopresis diagnosis? Has he had treatment from a pediatrician or psychologist.

[moominmamma]

Originally Posted by Tigerle 

At the time, according to my friend, physical reasons had been completely ruled out, with the boy apparently saying that he “didn’t notice having to go” 

It seems to me that the specialists have a fairly antiquated understanding of encopresis. Regardless of what control/fear/constipation/OT/manipulation issues might have been present early on, by the time it presents as soiling encopresis *is* a physical condition, because the stretch receptors in the sigmoid colon and rectum have become desensitized. It becomes just as the boy says: these kids "don't notice having to go" because their nerves no longer send them the signals they need to appreciate the need to go. I would be willing to bet that the difference between school days and home days has everything to do with diet, activity levels,the rhythm of the day and the easy, unhurried access to a private washroom than with psychological issues. If there are psychological issues they are generally felt to be secondary to the humiliation of dealing with persistent soiling.

I would suggest finding specialists who better understand the primary physical basis of encopresis, and treating the physical component aggressively with stool softeners and laxatives so that gradually over time the bowel can regain some of its sensitivity. 

Miranda

[RiverTam]

Now that the child is in grade school, instead of getting better things have gotten so bad that he is soiling himself three times a day, and the mom regularly has to pick him up from school because of this. Specialists have posited that the problem is due to the boy struggling with his schoolwork due to very bad fine-motor (or maybe rather graphomotor) skills; apparently he has a very clumsy pencil grip and struggles with writing. And school must have something to do with it, because during a week when he had to stay home for unrelated reasons, he never soiled himself at all.

To me, it sounds like he is having a hard time at school and he can get out of being there by pooping his pants. I'd see what happens if she stops picking him up after an accident... If it stops working, he might stop doing it.

Fair warning, though, when you stop responding to a bad behavior, sometimes it gets worse before it gets better. If a kid throws tantrums and you stop responding to the tantrum, they'll throw bigger tantrums to try to get a reaction. A behavior can severely escalate before it gets better.

If she doesn't want to do this, I'd change schools. It must be pretty bad if he's willing to poop himself to get out of class.

[RiverTam]

BTW, we had this problem last year with DS1. Last summer, he suddenly had a bunch of accidents. We finally found out that he had a bowel obstruction. We dosed him with Miralax for a few days and it finally cleared up. He passed a bowel movement the size of a large grapefruit, though. The accidents were diarrhea and soft stool squishing out around the obstruction.  He would be fine for a day or two and then have another accident. We've had two more incidents since then.  I don't mess with it now. If he has an accident, I just go straight to the Miralax.

Before we got the DX, we tried a bowel retraining program:

http://www.aboutconstipation.org/site/about-constipation/treatment/bowel-retraining

It might help.

[Tigerle]

Thank you all for your input! Lots of questions I cannot answer - however, I completely agree with those of you that there is a problem with treating this as a merely psychological issue, ie the boy soiling himself deliberately in order to get out of the classroom. after all, there were problems with him soiling himself when he was in pre-school, before he stated formal schooling in 1st. Miranda, that was so helpful!

I am not sure the mother even has a choice in whether she picks him up from school, or even in schools - they live in a rural area, there may be just the one elementary in town, and another won't have to take him. 

I need to ask my friend to put me in touch with the mom - this kind of third-hand relating of informaion is just not workable

[LauraLoo]

Another thing to consider or rule out would be food allergies or intollerances.  I mention this because we went through something similar with ds and once we removed the offending food from his diet (soy,) his issues disappeared.  Because he had anaphylactic allergies to other foods, we had done food allergy testing from a young age.  Apparently he developed his allergy to soy sometime between age 5 and 7.  The issues were a problem at school - not at home - most likely because he had quicker access to a bathroom at his discretion.  He started to ignore the symptoms of needing to go to the bathroom because he felt like he needed to go to the bathroom all the time - like IBS - and that caused accidents.  

[deminc]

Quote:

Originally Posted by LauraLoo 

Another thing to consider or rule out would be food allergies or intollerances.  I mention this because we went through something similar with ds and once we removed the offending food from his diet (soy,) his issues disappeared.  Because he had anaphylactic allergies to other foods, we had done food allergy testing from a young age.  Apparently he developed his allergy to soy sometime between age 5 and 7.  The issues were a problem at school - not at home - most likely because he had quicker access to a bathroom at his discretion.  He started to ignore the symptoms of needing to go to the bathroom because he felt like he needed to go to the bathroom all the time - like IBS - and that caused accidents.  

I really appreciate having this raised. ds2 has been on a restricted diet for a year for various reasons and we recently reintroduced gluten and soy. After two good weeks, he began to go to the toilet at least 3 times a day and many more times unsuccessfully. We were just going in and out of the toilet every 2 hours because he felt a frequent ache in his stomach. What surprised me was how he gradually became unsure if he needed to pee or poo, and there was a couple of time when he pooed but he did not realise it and was going to put his pants back on without cleaning. On some days poo would come out in his fart. He is definitely very embarrassed and distressed by it if it happened while we are out and he is just under four. He is still at home with me so we can continue to tweak his diet, but this thread has highlighted to me things to watch out for when he goes to kindy next year.

I truly cannot imagine a 8 year boy willing to soil himself just to get out of class. I feel it is much more likely that he cannot help it and is covering up his embarrassment. There might be other physical causes, but food intolerances is definitely worth checking out. It can be time-consuming, and I empathise with the mother being stretched, but it sounds like the poor boy really needs some help. Handwriting issues can be frustrating, but toilet issues are witheringly embarrassing at that age.  

If you are going to speak to the mum, ask her to consider if he often goes to the toilet even at home, and if his diet at home is quite different from his diet in school. Definitely look into the ways to help the child handle the embarrassment of this. A parent's reaction can help set the tone of the school. If mum is sympathetic and explains the situation to the school, teachers may also be more sympathetic and allow him to go as needed thus preventing accidents. This should be the first step while investigating the root causes. Next step will be to address any anxieties and fine motor skill issues.