PRESCHOOL BEHAVIOR MGMT Chap 7 MISC

Therapeutic Parenting 

PRESCHOOL BEHAVIOR MGMT

CHAPTER 7

MISC

Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  

a.    Mental Illness/ co-morbid

b.    Allergies/ other physical causes for behaviors

c.    Food Issues

d.    Lying/ stealing – developmental

e.     Media

f.    Potty Issues
g.  RAD stink/ dysregulation

a.  Mental Illness/ Co-morbidity
I firmly believe that people with "issues" (including alcoholism, substance abuse, trauma and mental illness) are often attracted to each other (Bear is a good example of this), leading to children with increased odds of a genetic predisposition toward addiction and mental illness.  Add in things like fetal alcohol syndrome and children born addicted to drugs (due to mother's  drinking/ substance abuse during pregnancy), abuse and/or neglect...  Plus, children with "issues" are harder to parent, especially if the parent(s) have their own "issues," frequently leading to abuse and neglect of the child.

A lot of times a child's genetic predisposition to mental illness can be triggered by trauma to have an earlier onset.  Co-morbidity (more than one diagnosis) is also very common for our kids.  If you look at the Chart of Overlapping Behavior Characteristics of the symptoms and characteristics of many different childhood disorders, you can see why children are often misdiagnosed and receive the wrong treatments.

b.  Allergies/ other physical causes for behaviors - 
In addition to effecting the body (rashes, mouth sores, swelling, hives, trouble breathing, tremors...), allergies can also cause behavior issues.  Common foods, chemicals, medication, or common allergic substances could be the culprits that cause some children or adults to feel unwell or act inappropriately. If your child is always sick, hyperactive, a slow learner, or cranky, we can't automatically assume that it is trauma or psychologically based!  Allergies, foods and meds have caused constipation, unusual reactions to medications, and behavior issues.  I have a friend whose child literally bounces off the walls when she eats apples.  Due to what turned out to be a gluten sensitivity, Ponito had chronic severe ear infections without any apparent symptoms other than a little crankiness (which for my generally easy-going child was a big deal).

Some people find that changing diet can help alleviate some of these issues.  A gluten free/ casein free diet is often recommended for children on the autism spectrum.  Other common options include no red dyes, no processed foods, all raw foods, vegetarian, vegan, adding in supplements (I have friends that swear by Niacin to help their child manage and even prevent impulsivity and rages)... 

c.  Food Issues – Food issues usually have nothing to do with food, hunger or even control, and tend to be more about attachment and trauma.  My daughter eats to make herself feel better (emotional eating).  My son eats lots of sweets because he has an addictive brain (he also had problems with tobacco, alcohol and drugs).  He also hoarded, probably because there was not enough food when he was a child.  This is definitely not an issue now, but their brains don't always "get" that they are safe now.

d.  Lying and Stealing - There are a lot of typical developmental issues that cause lying and stealing.  I wrote a pretty thorough post on the subject here.

e.  Media -  I subscribe to the “Garbage In, Garbage Out” philosophy.  I have removed anything I don’t think is GOOD for them (not just "not bad").  We purchased a Clearplay DVD player and any videos rated higher than PG must be played on that (and most PG movies benefit from it too).  We don’t allow any TV shows rated higher than PG (no PG – 14), and we completed banned certain channels.  No Cartoon Network at all (no Spongebob – too violent and rude), no shows like iCarly which is pretty much rude all the time.  Nothing on Nick at Nite.  Most of the more violent cartoons and pretty much everything on the Military or History Channels.  We even dumped ABC Family channel which played some good movies because they were advertising really inappropriate shows (Degrassi, stuff about teenage moms…).  I’ve also had the children switch to all Christian music (there are all kinds – rap, heavy metal, pop…). 

Maybe some kids can handle the innuendo, adrenaline-inducing, emotionally-triggering, violence…  mine can’t.  My kids are developmentally much younger and have very black and white thinking that makes it hard for them to understand when it is (and is not) appropriate to emulate what they see on TV.  We decided that to treat them as though they were their chronological age, or as if they are able to handle things we have recognized as triggers, is just cruel and unfair.  It is definitely hard to follow through on this!!  Most people don’t understand it, and my kids certainly don’t love it, but we’ve had fewer meltdowns and the language and attitudes have improved, for both my kids of trauma and my “neurotypical kids.”

f.  Potty Issues –
There are many different causes for "potty issues" (enuresis - wetting and encopresis - pooping).  Sometimes there is more than one cause.  "Potty issues" can be bed wetting, refusal to poop, daytime wetting or pooping, pooping or wetting in inappropriate places or at inappropriate times, "painting" with poop...).  Dysregulation, trauma triggers, a need for control... can cause issues and regression.

Developmental - lack of readiness for potty training.  
My Potty Training Philosophy is that it is better for children to switch straight from diapers to underwear when they have all of the signs of readiness (Showing an interest in the potty.  Able to take own clothes on and off.  Staying dry for an hour or so - Children who are not physically ready will “dribble” all the time, rather than hold the urine).

Physical causes - Potty issues can be caused by:

chronic constipation (can also cause urinary tract infections), urinary/ bladder/ kidney infections, problems with the "plumbing" (Kitty and my sister had to have surgery to correct issues with their "plumbing" - the "tubes" leading from the bladder being too small and the valves from the kidneys not working correctly), allergies can cause severe gastrointestinal issues, med changes can cause problems with sleep, hormones (trauma can trigger early onset of puberty meaning hormones can come into play at a much younger age!), even hernias (my nephew had a hernia at age 8 that caused him to wet his bed at night)...

Emotional causes - This subject will always make me think of Christine Moer's  "Pee Song."

• Some children develop an irrational fear of the potty or "losing" part of their body (poop).  I have seen a child "hold it" all day to avoid having to use the restroom at daycare, waiting instead until she was put in a diaper at night causing serious intestinal issues.
• Distracted, forgets, or doesn't like transitions (stopping what they're doing and going potty) or may be too focused on what they are doing to stop and use the restroom.
•  Doesn't want to draw attention to themselves.  The child may be afraid or uncomfortable asking or interrupting to ask to go.  
• Dissociation from physical self or lowered awareness of body - not knowing they need to go until it is too late - this can include not realizing or not caring that they have wet or messed their clothing.   
• Sexual abuse can cause a fear of bathrooms (might reminds them of the place they were abused), unwillingness to be naked (for toileting, baths, or showers), and unwillingness to touch themselves in places they were abused (causing issues with wiping and hygeine as well).  
• Outdated defense mechanism - a sexually abused child, may have made him/herself "unattractive" by being "dirty" or smelly. Sometimes old defense mechanisms outlive their usefulness, but the child can't stop.
•  Regression or delayed development.  Frequently children with trauma issues will remain stuck in earlier developmental stages or will regress - especially when dysregulated or triggered. The child may not be ready for potty training yet (or any more). It might be a way for your child to tell you they need the support and attention you would give a younger child - like kids who start baby talking, "forget" how to do things they used to be able to do, and wanting to be fed by you.
• Way of expressing without words that they are unhappy or in emotional distress. Sometimes it really is a way of saying, "I'm pissed," or "Poo on you!" It also could mean "This is a poopy situation!" or "I don't give a poo!"
  
• Entertainment and attention. Enjoys watching others jump around and get upset. Draws attention to them (negative attention is still attention!).
• Feeling in control of their environment - a lot of kids feel that they can't control what's going on in their lives, but they can control what goes in to and out of their bodies. 
• Pushing you away before you can reject them - Many kids of trauma "know" they are unworthy or unlovable and believe that when you find out you will leave like everyone else - so to get control of that they find ways to push you away - If you find out I'm not perfect you'll leave.
• For reasons we don't always understand!  I worked with a fully potty-trained child in a daycare situation who liked to change her clothes... frequently.  When told she couldn't just change her clothes for no reason (teacher didn't have time to stop everything and let her change multiple times a day) - the little girl "made" a reason!  It took us awhile to figure it out, and the first thing I tried (stopped allowing her to change into her pretty princess panties and cute outfits and providing her with gender neutral clothes from the class stash) caused her to step up her game, until eventually she even started finger-painting with poop. We had to back up and stop making it a control issue. 
• Some combination of the above - Dysregulation, illness, hormones, med changes, trauma triggers... all can suddenly trigger or worsen issues. 

So what do you do about it? This is why part of our job as a therapeutic parent is to be a detective. Figuring out why it's happening can help figure out how to stop it.

• Avoid shaming or making it a control issue.
• Remain as calm and matter-of-fact as possible. 
• Expect the child to help clean up, but try to keep within their developmental abilities. Remember an emotionally delayed child should only be expected to do what is developmentally appropriate for their emotional age. For example, you wouldn't expect a 2-year-old to mop up all the potty water from an overflowing toilet, disinfect the room, cleaning supplies and themselves.
• A child in fight/ flight/ freeze is acting purely instinctually - the thinking part of the brain is not online so it is best to address things when they child is more regulated. 
• Keep a change of clothes (or 3) with the child (back pack, locker, cubby...) or in the nurse's office or somewhere the child can access it. Waterless, antibacterial handsoap can often help with odors and cleaning.
• Give the child some socially acceptable words/ euphemisms they can use to explain to others what happened. My 16yo daughter called me from school once asking me to bring her a change of clothes, because she'd, "lost an argument with the water fountain."
• Make a schedule. Does the child need reminders to go potty? Assistance getting up in the middle of the night to go to the bathroom?
• Make an appointment - have a doctor make sure the cause isn't a medical issue.
• Wear gloves. This was less from worry about germs or the ick factor and more about the fact that the smell of poo really adheres to your skin. When cleaning up yet another overflowing potty I always wear gloves!
• Keep hygiene lessons brief - but do give them. Not changing underwear/clothes/ sheets with pee or poo in it can burn the skin and lead to infections. Kids may not understand that. I also gave lessons (with clothes on!) in how to wipe and clean. (Also in how to change out a toilet paper roll!).
• Check often. My daughter slept in a loft bed. I frequently had to give it a smell test. I also had to watch for wet pull-ups, which for some reason she liked to hide.
• A trick for bed wetters - We had a plastic covered mattress (of course) and made the bed as usual (fitted and flat sheet). Then we covered that with a plastic layer of some sort (I liked shower curtain liners - preferably ones that didn't make crinkly/ crunchy noises). Made the bed again (fitted and flat sheet). Repeat for several layers. Keep some clean pjs (and pull-ups if used) by the bed - we used a little wooden chest. When the child woke up in the middle of the night to wet sheets, all they needed to do was strip the top set of sheets and their pjs, the plastic sheeting generally kept the urine from getting everywhere. Put on new pjs - kept in the box/ drawer/ whatever right next to the bed. Grab a new blanket if needed (we kept folded up comforters/ blankets on a shelf at the bottom of the bed. Voila! Back in bed ready to sleep in minutes. Could be done multiple times in one night if needed. In the morning, the child could put the whole mess in the washer (with some hydrogen peroxide and/ or vinegar or whatever you like to use).

g.  RAD Stink - You've heard of the "smell of fear"?  This is the smell of dysregulation.  It usually smells like a combination of poo and the worst body odor you can imagine.  Yes, sometimes our kids' hygiene is not the best, but this doesn't go away, even with thorough washing and a change of clothes (although we have found that using a combination of antibiotic waterless hand soap under the armpits and a change of clothing can frequently keep the school from sending her home yet again!).