poo/hygeine issues, at wits end

Post Reply New Topic

So I thought I had gotten this buttoned under, but lately this has made a huge resurgance and I don't know what to do.

My daughter is 5 and has either HFA or Aspergers depending on which doctor you talk to or how you look at it. She is very very smart (she is 5 and reads chapter books and can do advanced math for her age). But then... there is the bathroom. There are a couple of issues:

1) wiping is unimportant and often forgotten. I put a picture chart up in each bathroom to help remind her of the steps involved with using the bathroom. She used it for a couple of days (and would get a reward each time). Then she stopped using it and kept demanding a reward, which when I didn't give her the reward (becuase she didn't follow the chart) she determined I was somehow cheating her.

2) When she does do it.. she does a pretty bad job and gets stuff every where. I have tried showing her proper technique many times, she doesn't get it. She gets hung up on small details like "how many squares of tissue?" I even have a poo social story and it's not helping.

3) Sometimes, if she gets it on her hands, or I think this may even be sort of on purpose, she thinks nothing of smearing it in various places like on the floor, on her clothes, or on her skin. One time she put a thin layer all over her legs and then pulled her pants up over which caused a ghastly rash.

She gets angry when I remind her to use proper hygeine and will frequently lie about what went on in the bathroom. Help me out here.

It sounds like she's not ready for you to turn over this responsiblity to her yet. When my son was 5, I was still doing what I would call "supervised wiping". (He never poops anywhere but home, and wiping pee isn't much of an issue for boys.) I keep wet toddler wipes in each bathroom (to this day he doesn't realize you can use regular toilet paper for poop.) I would verbally coach him through each step, including directions like "reach around behind", "Check the paper -- is there any brown?", "get way up in there", and then do the final wipe myself. We also sometimes used a hand mirror to check. It was a very long time, maybe a year, before I backed off on this support. For instance, at one point he would do all the wiping and then call me for the final check.

Does she understand the direct relationship between poop residue and rashes? I would emphasize this relationship, so she knows what the natural incentive for wiping actually is. So when she balks about wiping I would constantly reinforce that it prevents rashes and ask her if she wants a rash. It may take awhile for this to sink in. Even when they understand it intellectually they have a short term time preference for not wiping vs worrying about the slightly longer term issue of rashes. I would reinforce it, anyway.

As far as her worrying about inconsequential things like number of squares of tissue, sometimes it is easier to humor it because to them it is important. I wouldn't worry about making a complex rule based on the size of the mess, but give her a number of squares that is apt to cover all likely contingencies (3 or 4 squares or whatever) based on how she holds the tissue. If you waste some tissue, it is not a big deal relative to getting her to wipe. You can always save that for a later iteration.

If you have to, simplify the chart so that you reward the wiping and not making a mess part and then help her with the other steps like washing her hands etc. This way she can focus on that part. Once she gets it down you can move to other aspects.

What I like to do is have limited time incentive programs for specific things and then depending on progress I can either continue to work on the same thing and renew it, or move to something else with a "new" incentive program. Then you can move the goal posts without it appearing so to the child where they might think it is unfair. I do this during the summer months so there will be a June program, a July program and an August program. They really are limited in duration so it is not a lie, and it doesn't look like I am constantly requiring more, even though I often am.

We have issues with wiping, too. Sometimes we get some backsliding, but in general we are making progress. It is really hard.

This is basically how we handled it, although I am all for charts and self-care if one can get it to work. We supervised until we basically knew it was no longer needed. Don't look at other aspects of your child (age, intelligence, etc) and assume that they should be able to do skill C. Just look at skill C and determine what your unique child seems to need to get it done.

You think, because she's intelligent, that she's ready for this. She's not.

I was able to read Reader's Digest by the time I went into first grade. I was considered a "genius". But I could not tie my own shoes. Although I knew what every one of the words meant in the instructions I was given, I could not figure out how to translate those instructions into actions. (And I was still pretty sloppy at wiping. I needed another year or two to get enough practice to be very good at it.)

And I'm guessing you made this much worse. What are "minor details" to you are in fact, from our perspective, essential facts we need to sort out before we have any hope of understanding what to do. Our minds are not like yours, and I can't even count the times when people have tried to explain something to me, over and over, with no success - and, when I finally figured it out on my own, my reaction was "Why didn't you just tell me (X) instead of all the useless, misleading things you said?" This is not going to be resolved until either she figures it out on her own, or you figure out how to explain it in her terms.

To give you a head start, I'll explain why she forgets. (And, yes, I do understand why this is important.) To her, the world is full of pointless, meaningless things people expect you to do. This is just one more of them. It is probably, from your description, also one of the ones she finds difficult to figure out (I also had trouble spreading peanut butter on bread - anything involving motor skills, really). And if she is easily distracted (as many of us are, especially the smart ones) a dull chore that makes no sense to her is easily forgotten when the slightest thought distracts her. Until she understands why this is important, she's going to forget. Or be sloppy, or both. This will not be deliberate. Being easily distracted, and lacking the executive function skills most people take for granted, she will forget, or rush, with no way to do otherwise. The lesson has to reach her.

And you're making it harder by expecting her to do it herself before she's ready. The more she gets used to ignoring the nasty itch you get when you aren't able to do a good job, the harder it will be for that little sensory nag to work in your favour. Get her used to feeling clean, until the lack of it annoys her, and then she's much more likely to "get it" herself, as long as you make sure she understands the link. (Or humiliation might help you along - if she gets to a point where she doesn't want anyone else to know you have to do this for her, it might make her desperate enough to work to learn how. If she can. Reaching around like that is actually a pretty tricky motor skill, by my standards at least. It took a lot of practice to make perfect.)

Baby wipes are awesome. Using them finally got my oldest son to do a good enough job to not smell bad all the time. This was long after the time when he decided he was too big for any intervention. My 4 1/2 year old son (who is very smart and probably NT) is still in the stage where he'll only sometimes try to wipe himself, and he won't even consider using toilet paper.

I should have been more clear, we did throw in the towel at home, I do the job for now because I am pretty much aware that for whatever reason it is not important to her and she lacks the proper focus and coordination to get the job done to specification. Problem is that she goes like 5 times a day minimum and she is in kindergarten so that is where there are really starting to be some problems. I'm thinking of sending in some wipes for her, the issue being that even with those she doesn't even get it close to correct. she holds it with her fist so she ends up wiping with her closed fist rather than the wipe itself. You get the idea I'm sure... I'm trying to put together a little instructive chart for her with pictures, but if I want to send such a thing to school with her it has to be sans "parts" even if it is illustrated...

I see that is REALLY tough. Our son does not make BMs at school, so all our issues are at home where we can manage it better. (and it is still not going well)

Does your child have an aide? If not I think she may need one for this, even if she does not have other needs. If she does not want one because it is "embarrassing" than she will have some incentive to try to focus on this. The reason I say this, is that if your child is coming home from school with a poopy leg, aside from the health issues, she is going to have social issues and other problems at school that you will not want.

If she has an aide, and it is a matter of getting the aide to help her better, then if the school does not have one, your visual instruction list sounds good. The wipes are a good idea too, because she can do what she needs to do more efficiently. Flushable would be best, so she does not have to remember to put them in the trash. The K area bathrooms probably will not have trash cans for sanitary items in the stalls like the older girls bathrooms would. Taking poopy wipes into the main trash would be embarrassing to do.

Okay, you've said enough that I can identify one problem she's having. (And, if she's anything like I was, simply knowing she's not able to do a good job may be enough to discourage her from trying.) As simple as it may seem to you, holding the paper or wipe in such a way that you are using that surface and not your hand to wipe with is one of those motor skills I had to work hard to figure out. I've done it for so many years now it's hard to recall exactly what the breakthrough was for me, but that one 'trick' could be at the core of this entire thing.

And a chart without "parts" (even if I do understand the reason it would have to be this way) is probably only going to be confusing. In fact, even with the most accurate and informative illustrations possible, I don't think it will help her with the problem I noticed from your comments. I always had trouble translating instructions or diagrams into motor skills. Either option is static, while motor skills involve motion. Even an instructional video does not give you the "feel" of what needs to be done, and that was always the sticking point for me. Until I got the feel for it, nothing else did any good at all. Usually, all the "helpful" explanations and demonstrations only added to the pressure, and made it worse. I'm not sure if I'm being clear enough here, but there is a sense with almost anything physical in which it is necessary to actually understand what the action feels like in order to master it. At least, this has always been true for me. Even as an adult, desperate to figure something out, no amount of diagrams or videos will help.

In fact, I've spent hundreds on having several of my fountain pens repaired, and have others which need repair I can't afford to send out yet. I've been urged to learn to fix them myself - and I'd love to. But I know from experience that no amount of explanations, illustrations, and videos (all of which are readily available to me) would make me able to do even the most basic tasks. I can't even learn to tweak my own nibs, because I have no way of learning the feel of it. I seem like an idiot to some people on the pen forums because of this - I even declined to try Simichrome to clean up the barrel of an Esterbrook A101 I bought just last week. All it would need is a light cleaning, and the barrel and cap are pretty robust, but I know I'd manage to ruin it anyway. And this is something I want desperately (fountain pens have been one of my dearest obsessions for forty years now...) to know how to do, but will never be able to unless I can find someone able to help me get the feel of it.

My son also has motor skill issues. We try to guide him how to develop muscle memory, but it is hard for him. He gets frustrated and often we end up doing it. I do not know how helpful they will be at school. I don't think they will make the effort, to help that much, but I could be wrong.

This just gave me a flash of insight. What if I literally hold her hand? If she needs to feel what it's like to do it properly, what if I just literally kind of puppet her? Think that will help? It hadn't occured to me before. I thought diagrams would help because she can use lego instructions... but all of that is right in front of her. With this, she is literally going into unseen territory.

There is a type of teaching called Chaining and Backward Chaining. In Backward Chaining you do every step hand over hand while verbalizing the steps. After they have a feel for what to do, you do every step but the last hand over hand and just verbalize the last step allowing them to follow through with what they have learned. You continue this process slowly, backing up one step at a time as each step is learned until you have the whole chain of steps. Then you can do the same with the verbal prompts, dropping them one at a time from the last to the first until they are able to do all the steps without verbal prompts. This entire process for learning something like wiping can take several months to half a year depending on the child. It is important to keep it not stressful, include a lot of praise.

That might help... but, remember we like to be prepared. I wouldn't spring this on her. Talk about it until she's ready for it. And how many issues does she have with touch? It is probably the best idea to try - but only once she's prepared to accept it. If she freaks out, she won't learn. So don't get too excited, too quickly. (I never would have thought of this, because even something I know how to do is not something I can "translate" to "puppet" someone. I don't know if your daughter will struggle with "translation" issues, but that's something to keep in mind. Example: if the paper in her kindergarten is the usual public restroom type, even if she learns to wipe at home, it might not "translate" to different types of paper.* Sorry. But you may have to work with her on several different types of paper before this is sorted out.)

* I suspect this will sound ridiculous to some reading this. Believe me, I wish many things were easier than they are. But that's the way I work, and accepting it and learning to work with it is easier then trying to do anything else.

Doesn't sound ridiculous at all. To me, anyway. These are the kinds of insights I've most needed as a parent, and they have helped me immensely. I think we all really appreciate your taking the time to explain.

If it is happening at school, it seems like this is a self-care item that needs to be a goal in her IEP.

No, it makes complete sense. especially with a lot of the other things I've seen, she can use a pencil but not a spoon or fork. She can write letters and numbers, but struggles to draw a stick man. Your advice has been invaluable. Even though she and I have a lot in common (my husband says it's obvious who she takes after) I have a very hard time putting myself in her shoes.

She is ok with ME touching her with warning. So I don't think there is any harm in trying this out over the weekend. It can't hurt.

I'll have to bring this up with the school psych and try to get it on the IEP. She doesn't have an aide, but I'm starting to think she will need one. It's been suggested we send her to a special school for kids with autism, but the problem is that with an IQ and ability to learn school topics like she has, she won't be challenged academically. The plan is to reassess the situation at the end of the school year and see what we want to do for first grade.