Eight Year old with ADHD diagnosis, possible encopresis and ODD

Discussion in 'General Parenting' started by maryntom, Dec 31, 2011.

  1. maryntom

    maryntom New Member


    My son was diagnosed with ADHD in the beginning of Dec, and we're exploring our options. I truly believe that he has ODD as well, but it hasn't been diagnosed. He's had previous bouts of soiling, and it's now re-occurring. He just turned 8, and over time, his performance in school has deteriorated, and his behavior at home has followed suit.

    He has a lot of trouble paying attention in class, which causes his teacher to have to spend extra time with him. In the past when my husband and I have tried to discuss it with him, he would break down in tears. His teacher reported to us, and he admitted as well, that he often speaks out during class and causes disruptions, trying to be funny. Unfortunately, he doesn't have a lot of friends right now.

    At home, we've noticed a severe change in his behavior. We decided not to sign him up for baseball this spring because of this. He simply acts like he doesn't care, and said that he hates everyone who was on his team last year anyway. Tonight, we had a bad episode with him and I nearly broke down in tears. luckily, my husband calmed the situation down somewhat, but I still feel like the situation is out of control.

    When he was five, he started to have bowel movements in his pants. After a few weeks, we were able to get him back to using the toilet. He had a relapse at seven, but it was short and he had no more problems. When school let out for Christmas break, he started to do again. At first he said that they were accidents, but two days before Christmas, he was playing in the family room with his legos and simply stopped what he was doing, squatted and had a full bowel movement in his pants right in front of his father and I.

    Since then, he's made no effort to stop. I tried to set aside time for him to use the toilet after breakfast, lunch and dinner, but with no success. The first time I made him sit, he willfully shook his head and told me he didn't have to go. As soon as I let him up, he pulled his underwear back on and soiled while he was standing next to the toilet! After cleanup I put him in time out for what was supposed to be 15 minutes, but he threw a tantrum and screamed at the top of his lungs, so it turned into a 10 minute cry and 10 minutes of him begging me to let him come out.

    I don't know what to do anymore. His appointment with the pediatrician isn't until January 17th. We're dreading the wait, and I'm terrified that he'll act out at school, or even worse, that he'll soil. I pray that he understands that the other kids will ridicule him, but I'm worried that he doesn't even care. I've spoken with my husband about keeping him home, but he feels like that's a bad idea and will only reinforce the behavioral issues.

    I'm not really sure what I'm asking for. Mainly support, I guess, or some advice if anyone has it to give. He starts school again on Tuesday, and I have a feeling of dread that I can't even describe.
  2. buddy

    buddy New Member

    I am pretty much dreading Tuesday too. I just really hate the worry of what is going to happen.

    Sounds like you are still sorting things out. Many kids who do not get social skills well act out, blurt out and turn into the funny man to get their attention needs met. If they dont have skills to do better in that area, well then kids laughing (they think with them) is pretty good. My girlfriends son who is very autistic, no question about it...does that. My son who is brain injured and Autism Spectrum Disorders (ASD) has times when he does that... He says but mom they are laughing so it is ok, they like it. No matter the diagnosis, kids with social issues do things like that a lot.

    My cousin had a son who had bm problems and just so you know there is hope...he is in highschool now and amazing...but really until a couple of years ago he still had issues! NO other developmental problems either, it was very strange.

    One thing that made me crazy was when my son would do that (have a bm in the wrong place) and sometimes he did it on the floor or outside! It was not often but clearly a choice, not an accident. He was imitating our dog when he did it outside (also went in the crate, wanted to eat from a bowl on the ground and to wear a collar, sigh ) I feel for you.

    Are you in a public school? Does he have an IEP? Sounds like if not, it is time for that. Problem is that these kids get reputations and mislabeled if they do not get the appropriate ed. label and support. Let us know if you are interested, you will find many of us here are pretty passionate about the subject. If they tell you he is not far enough behind academically, just let us know...we can help with that too.

    I can imagine it is a scary time for you and a sad time too. You will find that here, many of us do not think the ODD label is very helpful and if you can, dont mention it at school ever. (they may then assume he has full control over behaviors and use punishment such as suspensions etc. only to help him... it also can become a self-fulfilling prophecy for some kids). Only after a complete evaluation such as a neuropsychologist evaluation, plus Occupational Therapist (OT) evaluation--which I would for sure do because this kind of bm issue can be sensory--and communication evaluation (for the social skill issues) will you start to get some idea of the bottom line issues and then you can really get some interventions going.

    So, welcome and glad you found us here. I pray 2012 will be a time of answers and new ideas for you and your difficult child!
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hi there and welcome to the board, but sorry you have to be here. If you give us more info, we can help you better. I'm going to ask a few questions that will help us help you. Hope you don't mind.

    1/Who diagnosed him? Has he ever seen a neuropsychologist?

    2/Can you tell us about his early development in infancy and toddlerhood? Did he make good eye contact with you and others? Did he babble and coo and like to be held and talk and mimic you on schedule? How was his health? Did he do well with his motor skills? Did he engage in imaginative play with toys or did he sort of dismantle them, ignore them, or line them up? How about TV...did he ever copy what he heard verbatim? Any speech problems? Now, jumping into the future, does he understand how to relate to his same age peers? Does he poop in school and does he realize it is unacceptable? Is he socially clueless? Does he have any strange quirks? (You don't have to answer every question...lol).

    3/Are there any psychiatric problems, substance abuse, or autism/Aspergers on either side of his genetic family tree? What are the family dynamics like? Does he live with both biological parents? Any siblings? Any early chaos?

    Phew! Sorry if I overwhelmed you!!!! Others will also come along to try to help. YOu may want to do a signature like the one I did below so that we can quickly refresh our memories about your boy whenever you post!
  4. maryntom

    maryntom New Member

    Thank you for the kind words. I hope that 2012 brings good things for you and yours.

    We're hoping to get a referral from the pediatrician for a neuropsychologist evaluation, but honestly all of this is still new to me. We've always managed to reason in the past that he was just being a boy, or that he would get over his tantrums with age.

    he does go to public school. We're looking into an IEP right now. Because of this, the school wants to send someone from the Virginia Department of Social Services to interview my husband and I in our home. We were given the option of doing this at the school, as well, but were told that they prefer to do it at my house.

    I'm a little worried about giving him medication for ADHD because I've heard so many different stories about it. One friend I have had her son on Adderall and he lost a tremendous amount of weight. My son is in the 73rd percentile right now for his age, which is great, but he barely eats as it is right now so I don't know how he'll do with something like that.
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    in my opinion don't give any medication for ADHD until he sees a neuropsychologist. I think there may be more going on than ADHD and to put him on ADHD medications without being sure (a second opinion is always a good thing) is not that great an idea. I agree with buddy that ODD is not a useful diagnosis. We KNOW our kids are defiant, but we don't know why. That's what the neuropsychologist evaluation is for. in my opinion, and I've had a lot of experience, neuropsychs are the best diagnosticians because they actually test the child in every way possible for every possible disorder and often catch things that other diagnosticians miss because they are too hasty or too fast to pull out the prescription pad. I would not trust a pediatrician, no matter how good, to diagnose a childhood disorder. They do not test; this is NOT their field of expertise. And the school can help A LOT, but I also would not trust them to do the diagnosing. It is always a wait to see a neuropsychologist. They are popular. in my opinion the wait is worth it.

    Um, WHY does the school want to send social services to your home? Are they accusing you of abuse??? Do you WANT to talk to them? I'm not sure I'd go there with social services. You two have not done anything wrong.

    On another subject, again in my opinion, his soiling is not defiance at all. I think there is something wrong with him that makes him not really understand how critical it is for him to use the toilet. Or maybe he has sensory issues that prevent him from understanding when he has the urge to go. A lot of k ids with childhood disorders also have bowel and toileting issues. in my opinion punishing him will not help because in my opinion again I don't believe he is being disobedient or doing it to tick you off. I think you should wait for guidance about what to do. Does he also have a problem maybe peeing at the wrong time?

    I would try to get him an IEP under Other Health Impaired for now since the total reasons for his problems is not known, but the fact that he HAS issues is obvious. The school will have to test him...they always do. If they won't cooperate, call the Department of Public Education in your state and ask for the head of Special Education to find out what to do. His behavior is g oing to affect his ability to learn (again in my opinion) and he deserves a free and appropriate public education. The key is getting your school district to go along with you, and I personally wouldn't allow them to just say he is a behavior problem. I don't think it's that...why let them label him "emotionally disturbed" when you haven't found out yet if he has a neurological issue or LDs?

    I hope this helped and I wish you a lot of luck. Hang in there. You WILL gain ground.
  6. maryntom

    maryntom New Member


    1. He was diagnosed by the school psychologist, which is why we're taking him to see his pediatrician before we make a decision about medication. I've read so many articles about wrong diagnoses' at school, but I can't be in denial about his prevalent issues. He has not seen a neuropysch and we are trying to get a referral from his doctor.

    2. He had colic as an infant, but into his 9th month, it started to wane. He would scream at the top of his lungs at the slightest inconvenience, but when he was content, he would look up and smile at both his father and I. His health was otherwise okay, I breastfed him until he was 11 months, then we made the transition to baby food and then regular food.

    No speech issues to speak of. His favorite shows as a toddler were Bob the Builder, Dora the Explorer, Blues Clues and Bear in the Big Blue House. We started reading to him at an early age and got him involved in tee ball when he was five. He seemed to be doing well in his peer group, and even had a birthday party this year at Chuck E Cheese with a lot of classmates that attended. But he hates to lose, and will go out of his way to avoid it (shutting off the PS3 in the middle of a game). Because of this, he doesn't get a lot of invitations to play over anymore.

    He hasn't pooped at school (luckily), but this is the worst episode of soiling that he's had. He will soil, then he'll smash it in his underwear by sitting down on it or squeezing it with his hands from the outside of his clothes. I should also mention that on Wednesday he soiled himself three times. After he went to bed, I went upstairs to check on him and heard him talking to himself in his room. He was basically telling himself a story about how he had pooped his pants. I haven't heard him do that since, but needless to say, it adds to my angst.

    3. We have no history of encopresis on either side of the family. His dad and I both did well in school with no issues from any of our siblings that we're aware of. Neither of us has done drugs, and we barely drink from time to time. We're his biological parents and there's no real tension in the house, aside from the normal arguments that couples have from time to time. He's an only child.
  7. buddy

    buddy New Member

    do you know if it is routine for them to have social services interview you? Do they use a co-op. I am asking because I am a speical educator and the only time we would refer out like that ...and they would not really be a part of the evaluation...was if we thought there was an issue at home that needed to be checked on. I am just giving you a heads up. and it may not be that they think you are doing anything... It may be that with the pooping..they are wondering about abuse... specifically sexual abuse. Kids will pee or soil themselves to keep people away if they are sexually abused.

    I just want you to not be blind-sided. It could be that this is just routine but just in case....
  8. maryntom

    maryntom New Member

    We were told that this is routine for the school district we live in. They gave us the option of doing it at the school, but they prefer to do it in the home. My guess is that they want to look around, and that's okay with me. They've actually made it convenient for my husband to be there by coming in the afternoon when he's off work, so he doesn't have to use any of his PTO.
  9. InsaneCdn

    InsaneCdn Well-Known Member

    Wanted to add my welcome...

    There is a logical order to things, but so often, schools want the "fast fix" (especially if its cheap for them).
    FIRST, you need to know what you are dealing with. In as much detail as possible.
    THEN, you can look at interventions, accommodations and perhaps medications.

    A couple thoughts on medications...
    (I try to be balanced - have seen really good things with medications, but they can be awful also)
    - Each human body is different, and what works for one, doesn't work (or worse) for the next.
    - medications are not dictated by a set of symptoms... but by the combination of dxes and symptoms. What works for ADHD, may send a high-functioning Autism Spectrum Disorders (ASD) child off the deep end. What works for Autism Spectrum Disorders (ASD) may be the wrong thing for Bi-polar... and so on.
    - medications are always trial-and-error... which medication, dosage, timing...
    - When they work - its like a miracle.
    Bottom line (in my opinion) = don't close the door to medications, but walk careful, and get a really solid diagnosis first.

    I'm seeing "sensory issues" as something that stands out... has he had an Occupational Therapist (OT) evaluation? if not, try and get that - and include a motor skills evaluation while you are at it. They often go together, either one is enough to send a kid around the bend... and the Occupational Therapist (OT) has therapies to help.
  10. buddy

    buddy New Member

    I hope they are being honest... and even so, I would do the same, people are in my home all the time! Happy to have you... you want him for a while???? go ahead! Glad to have the break!!! LOL
  11. TeDo

    TeDo Guest

    I agree with what everyone else has said. You need a thorough evaluation by a neuropsychologist but since they are sometimes hard to find/get in to, you might want to find a Child Psychiatrist or PhD psychologist to do assessments. I agree with Insane that an Occupational Therapist (OT) evaluation sounds like it is also warranted. If the school made the diagnosis and THEY have sent Social Services(I would also be VERY wary of this), I would absolutely request that he be "evaluated for special education services including academic, psychological, Occupational Therapist (OT) and Speech evaluations". Send it in writing to the Director of Special Education at your school by Certified Mail with Return Receipt Requested. Regardless of his diagnosis, interventions and accommodations at school will make a difference. ' I also agree that ODD is not a "valid" diagnosis. My son carried ADHD & ODD diagnosis's for 4 years and it turned out that the way they handled his behavior made things SO much worse because we just found out almost a year ago that it wasn't ODD at all. MWM is right, you need to find out WHY he seems to be difiant. Until you know WHY, you can't fix the REAL problem.

    Welcome to our little corner of the world. You have come to a wonderful place!
  12. maryntom

    maryntom New Member

    Thank you again, I'm taking notes so I can formulate questions for his pediatrician. Everyone here has been tremendous.

    We don't punish him for soiling, but I have punished him for lying to me about not having to go. The incident that I referenced earlier, when I put him in time out, was one where he complained that he didn't have to go. Then, when he got up, he looked right at me and went in his pants. Unfortunately, because of the mess he goes out of his way to make, cleanup is a long process. I've had to toss three pair of underwear since this began.

    He does pee his pants from time to time, but only when he's having a BM. Otherwise wetting isn't really an issue. I honestly don't know if this is a sensory issue or not, but I will say that he knows that what he's doing is wrong because tonight he taunted his father and I that he was going to soil his pants. We tried to get him to the bathroom and he refused to budge and of course went through with it. So for now, I'm leaning toward defiance.
  13. buddy

    buddy New Member

    I hear you... I imagine there is some behavioral component to it. But just will share that many issues can be neurologically started but behaviorally compounded! How do you handle the clean up process? It is clear he knows this upsets you. I KNOW this will be hard. But if you can just matter of factly, I mean no scrunching your nose, no tone of voice nothing...just ...ok time to clean up. and bring him to the tub and have a bunch of garbage bags there so he can put the laundry there and clean himself up. He needs to do as much as he can do himself. the whole time no prompts except if he needs help with water temp etc. All of it just the same tone as a normal wash up.

    My son has many behaviors that are triggered by a sensory or neurological issue, but for sure attention or power struggles will reinforce the behaviors and keep them happening longer.

    It does not have to be either or. He really may seek it and also may have Obsessive Compulsive Disorder (OCD) types of fears that come and go making being able to handle the toilet ok sometimes and not others. It is just never really clear. Wish I could say it is simple, sigh... once this gets fixed, there will probably be another issue but in the end I always do look back and realize we have come a LOOONNNNGGG way.

    one more thing...and as usual, ignore me if I am way off base, just sharing my experience...

    Our pediatrician is fantastic! BUT I will say that I would not take a diagnosis about his overall disability from him. Once I have it he is totally on board and supportive, but that is not their field. They do not do standardized testing and complete, thorough evaluations. great you are wanting referrals from him. As I said and I think IC joined the idea... an Occupational Therapist (OT) evaluation may be really helpful for you. If nothing else you can maybe rule out an issue that way.
  14. InsaneCdn

    InsaneCdn Well-Known Member

    He's not necessarily lying about having to go.
    And being treated like he is lying, is only going to compound the situation.

    "... when he got up..." - change in body position often triggers signals. Maybe he really didn't recognize the situation... until he got up. At which point, it was too late...?

    Have you read The Explosive Child? For many of us, it was a book that changed our perspective a bit... for the better. The underlying theory is that "kids do well if they can"... as opposed to the more general theory out there, that "kids do well if they want to". I found that, just that switch in underlying assumptions about my own kid... significantly reduced the amount of "lying" going on - because I began to realize that much of it, wasn't lying. Mis-communication, twisted perceptions, prior "lessons" gone wrong... there's a 100 ways at least to not get the message. And yes, there were a handful lf lies tossed in there... like every normal kid.

    If you assume he is telling the truth about not recognizing he needs to go... then, find ways to get help. Yes, its frustrating. Horrid, for clean-up. (husband worked in nursing...) But, if you work WITH him, you may find that his frustration goes down, too.

    Just something to think about...
  15. soapbox

    soapbox Member

    Yes, this is a classical symptom of ADHD.
    However, it is also a classic symptom of Auditory Processing Disorders (APD).

    In other words... trouble paying attention may mean there is something else going on - either "as well as" or "instead of".

    Think about it.
    If you can't hear what's being said, or if you don't "understand" what is being said, or if its coming at you faster than you can take in, or if you really catch it one-on-one out in the quiet hall but just can't handle the classroom... are you going to really pay attention? of course not. You can't.

    So... while you're at it, really push for auditory and Speech Language Pathologist (SLP) testing.
    And SPECIFICALLY ask for testing around "auditory figure ground" and "Central Auditory Processing Disorder (CAPD)".
    Auditory figure ground is a problem focusing the "listening" on particular sounds, in an imperfect situation... e.g. trying to hear the teacher, in a typically "noisy" classroom. And yes, classrooms are extremely noisy - even in a good teacher's class. Rustling paper, a dropped eraser, a whispered question to the teacher, the heating system kicking in, the class next door going past on the way to the library... its NOISY.
  16. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    He may have been telling you the truth about not feeling as if he had to go to the bathroom. I'd tread very carefully on this issue. Some k ids really don't know.

    My own experience as a foster and adoptive mom (good and bad experiences with social services) is that they never just come out to look at the home...they have a reason. I work at a day care center now and the social workers go to the homes themselves unless they feel there is something going on...then they contact CPS. I agree with buddy that they are probably thinking some sort of abuse is going on for him to be soiling. This is where you need to be very careful. Peeing and pooping in a child's pants can be a sign of sexual abuse...or a billion other things...but CPS often fixates on sexual abuse. Please be prepared and not caught off guard if they are not as laid back as you expect.

    You precious son's behavior is unfortunately not typical boy stuff. Inattention is not just ADHD stuff either. It, as well as hyperactivity, is prevalant in many childhood disorders. Playing with poop is often a sensory issue. I know this may sound gross, but the child LIKES the feel of the poop, maybe even the smell. Some kids smear poop on the walls. Sensory issues are caused by a variety of things, the most common one I know of being the autism spectrum, which is often diagnosed as ADHD first. But, hey, there are other reasons too. Whatever is going on...again, that's where I'd bring in a neuropsychologist. They can do a good job of sorting out the child and how he behaves in various areas in ways other professionals just don't bother to do, however they are very much in demand and there are waiting lists. in my opinion I feel they do a much better job and are worth the wait.

    I'm just curious: Does your son have give and take conversations with people where he describes what he has done and how he feels? Or does he mostly just say "yes" or "no" or "I don't know" or "I don't want to talk about it" or does he blurt out things that make no sense to what somebody else was saying? Does he ever start talking about his own special interests, out of context, when somebody is trying to ask him or talk to him about something else? Is he an interactive kid on an emotional level or does he mostly play alongside other kids or run around with them?
  17. lovelyboy

    lovelyboy Member

    Hi welcome to a very caring and supportive forum! I have learned so much from all this wonderfull people!
    My son was also at first diagnosed with ODD.....
    It turned out later that it is anxiety disorder....some Obsessive Compulsive Disorder (OCD) and Autism Spectrum Disorders (ASD)......He also have Auditory processing problems.....but this is very difficult to picture up as a parent....we still get angry about things and then later realize he misunderstood completely!
    My son also soil his pants, but just little bit.....at first we got VERY angry, before we knew he had issues....this sadens me so much that his pead didnt gave me a hint that he suspected anything! We could have saved us all so many heartache!
    I am not in a position to give andvice....but if I may.....dont even bother to upset you all regarding the soiling....believe me I tried 5 yrs! Now that I know he has sensory problems, he really sometimes cant feel he has to go.....he doesnt like the sensory feeling when he poo, coming out.....he hates the smell, doesnt want to touch it...I still have to whipe him most of the time!
    If possible.....try and have a discussion with him regarding pooing.....how it feels, if its a "funny" feeling....what he likes or dont like about it.....some kids like the sensation of poo in their pants.....some dont like the smell of the toilet, some dont like the noice, the darkness......the toiletpaper.....it can be plenty of things! Yes he does realize its inappropriate....my son feels so shy and guilty if he mess....he even hides his undies.
    But I agree....try and make it a matter of fact thing....I have given him some spare undies and we worked out a plan what to do if it happens at school....
    I KNOW its a very jucky misrable thing to deal with.....its VERY hard for us to try and stay calm in this situations!
    Ps.....my son usually soils when there is stressfull things thats going to happen, like school concerts, school starting, conflict with friends.....so in a way, it helps me to know whats going on inside of him!
  18. Estherfromjerusalem

    Estherfromjerusalem Well-Known Member

    Hello Maryntom, and welcome!

    I just felt I had to join on this thread. Dont' laugh at me -- my difficult child is now 25 and completely clean, and living on the other side of the world to me in Australia. But his encopresis was just the worst thing that I have ever had to cope with, and I think I am still traumatized although it is every so slowly getting better for me. After being a perfect child, at the age of about four and a half he suddenly started pooping in his pants. It was non-stop until he was about thirteen and a half. I've spoken to a lot of parents of children with encopresis. One of the generally accepted things advised is to have the child checked by a pediatric gastroenterologist, just to make completely sure that everything is OK with the intestines physically and to rule out any possible illnesses such as Hirshprungs disease which is something wrong with the peristalsis (movement of the intestines to keep stuff moving down). For most children with encopresis the cause is simply a bout of constipation which goes on for too long causing damage to the nerves at the anus so the child doesn't feel it coming, and he truly doesn't have control. It can however be a result of sexual abuse, and it can also be a control issue, but they are both much less common. I know I shouldn't diagnose, but it truly sounds to me rather like a control issue with your son, although it is so difficult to tell.

    For us, it ruined my son's life for all those years. In retrospect, I got the worst advice from my pediatrician (to do nothing because "it wilil pass"), and I can't forgive her for that.

    If it is the "constipation" type of encopresis (which is the most common), it usually just goes away at puberty, sometime in the early teens, just like that -- the way it started, it goes away.

    I wish you good luck with your doctor's appointments, and I shall be waiting to read how you are doing. I wish you a lot of strength, and also the strength to treat this problem with compassion and love. I and my husband learned the hard way that punishment and being angry just doesn't help at all, actually has the opposite effect. I learned just to have a really good supply of pants and underpants and to be completely matter-of-fact when getting him to wash. It wasn't enough to just change his clothes -- he had to shower off every time. And it was up to ten times a day. I am so grateful that it is now in the past, and I don't know how I survived. Oh yes, I do: I survived because I found this wonderful group of people on this forum! So -- I'm so sorry that you had to find us, but you have certainly come to the right place for support and understanding and not being judged.

    Love, Esther
  19. liz

    liz Guest

    To me that is strange that they would want to do this in your home. You need to have an evaluation done by the psychologist at the school and then you can start the process of an IEP.

    For ADHD alone, you do not want social services in your home at this point. I feel this is premature.

    As for the medications, there are ways to combat the weight loss. We feed my son a snack before bed and feed him a big breakfast before we give him his medications. Also, my other son had feeding issues and once I gave in and gave him chicken nuggets and french fries 2-3 times a week, he relaxed and started eating more foods as I introduced them slowly into his diet. Noiw he eats most foods. Whew! This is one battle that I told my husband we would not make a mountain out of is food.

    Children can control 2 things: what they put in their mouth and what they put out of their bodies : vomit or otherwise. If your child feels sad or out of control in some ways (he is now 8 and school can be a major stressor); then he is exercising control over this one area that he can control : his bowel movements.

    Please know that he cannot control his outbursts and such in class so he is feeling out of control. It is nothing you are doing and not your fault. Just get him in to see the doctor and maybe you can also get him in to some social skills groups in your area. Is he your only child?