QUESTION:

I am currently at a loss with a recent referral of a 2-year-old child without any cognitive delays but with some definite sensory issues. The child was adopted within the past year and is likely a drug-exposed baby. I do not have much more family history than that. Based on the report form other providers, this child has some intense meltdowns at least a couple of times a week. They have started to try potty training her, and she refuses to have anything to do with the toilet but is now playing in her feces. I don’t think she has eaten any of the feces but likes to play in it. Looking for some suggestions for the parents to use. Any insights or suggestions are appreciated.

GWEN’S ANSWER:

This is always a tough behavior to address! It definitely can be a sensory issue, but it can also be a behavioral issue. Here is what I would do:

  • Gather antecedent-behavior-consequences (ABC) data. You may be able to do this through parent interview without getting any actual data. Does she tend to do this most when she’s bored (during naptime), when she is seeking attention, when she is overstimulated, for example? Try to determine the antecedents and develop an appropriate plan. Example: If it’s typically during naptime, we can probably assume that boredom may be a trigger. If that’s the case, I would try giving her a couple of books she can look at in her crib. I would also either keep a video monitor on her or dress her in hard-to-remove clothing to remove the temptation. If a parent sees she is starting to remove clothing and she has pooped, the parent should change her with very little conversation and minimal facial expression. Keep it boring and put her back to bed.
  • Be sure she has access to intense sensory experiences throughout the day: scented Play-Doh and slime, sandbox, and so on.
  • Make sure nothing positive results from the behavior from the child’s perspective. When this happens during nap or nighttime, parents will clean up the child and let him sleep in their bed for the rest of the night to avoid a lengthy clean-up. This only reinforces the child’s behavior.
  • Provide rewards for the desired behavior. You may want to call the desired behavior “clean hands” or “keeping poo where poo belongs” (diaper or toilet). If the behavior only happens in bed, hang a picture of her in her bed showing her clean and happy and the bed clean. When she gets up, have parents ask her if she and her bed look like the picture. If they do, yay, reward! If not, so sad, no reward.
  • Pick something as a goal for consistently keeping poo where poo belongs. For example, if she is in a crib and would like a toddler bed, help her understand only kids who keep poo where poo belongs can sleep in toddler beds. Or if she likes to go swimming, make sure swimming is reserved for kids who keep poo where poo belongs. Help her understand she can definitely go swimming when she keeps her hands/bed clean for two weeks (or any amount of time you and parents determine).
  • I would probably require her to stay in time out while parents clean up the mess. If she were any older, I would probably require her to participate in the clean-up process, but that has to be determined on a case-by-case basis.

About meltdowns: Without knowing much about this case, typically the best place to start is with a visual schedule. Meltdowns are usually based on feeling out of control and not knowing what to expect. Beyond that, have parents fill out a sensory symptoms checklist and gather ABC data for more insight into the meltdowns.

Best Wishes,
Gwen