Re: Nine-year-old - stays on toilet ...

[Guest guest]

Hello and welcome:

> I have a nine-year-old daughter who sits on the toilet ( " doing "

> nothing) for about 30 minutes before school, about an hour after

> school, and about an hour and a half before bed. She also gets up in

> the night around 1am (about 4 nights out of 7) and spends an hour or

> so on the toilet in the middle of the night.

A lot of OCDers have obsessions and compulsions around body functions. My

daughter (almost 7 now) had an abrupt onset of OCD at four, and one of her

original symptoms was the obsession that there was always more urine that

needed to come out, so she sat for hours on the toilet and was very

distressed (hysterical) when I insisted she get off. This compulsion got

so bad that she then avoided urinating altogether, to keep from kicking the

whole cycle off again, which came near to landing her in the hospital for

catheterization. She's had a whole array of " bathroom " compulsions by now.

> It all began about 2 years ago - she became constipated and by

> necessity had to spend 10 minutes or so sitting on the toilet

> trying " to go " . The constipation cleared within a week or so - but

> she still spent longer than normal on the toilet. This has developed

> into the situation described above.

In a person with OCD tendencies, a certain incident can seem to kick off the

disorder. My daughter had a bladder infection just prior to OCD onset and

the obsessional thought that more urine needed to come out.

> We have taken her for all the gastro-type tests - bowel x-rays -

> varied her diet - the lot - and have satisfied ourselves that

> there are no reasons by way of digestive system problems that she

> sits on the toilet for excessive periods.

It's good to rule these things out, since obsessions and compulsions can be

almost indistinguishable from a physical problem, especially in a child who

may not have great insight into the disorder. We tested my daughter several

times for bladder infection when her compulsion was in full swing.

> recently, we took our daughter to visit a psychiatrist who

> specializes in anxiety, OCD etc.

> Within what seemed to me an alarming short period of time, he

> diagnosed her as OCD and wrote out a prescription for Zoloft.

> ly, my wife and I are still not convinced that our daughter has

> OCD - but I suppose that's a natural reaction of parents.

Does your daughter have other obsessions and compulsions? Sometimes these

are very well hidden by the child. Is she worried about germs, does she

have rigid routines that she doesn't vary? Does she tap or touch things or

enter a room in an unusual way? Are her toys and belongings always

arranged " just so " ? Are unexpected changes upsetting to her? The key is,

how much distress does it cause your daughter *not* to do the thing that you

suspect may have an element of OCD about it? Not doing compulsions causes

the OCDer great anxiety and upset.

> Our daughter is so " normal " in every other way - does very well at

> school, has lots of friends, involves herself in team sports at

> school, completes her homework diligently and quickly (albeit, on the

> toilet sometimes) and is an all-round " normal kid " .

Mine too. The diligent attention to homework may also be OCD. There are

many on this list who have described encouraging their children to get Bs,

leave some work undone, do less well at school to boss back perfectionistic

OCD compulsions.

> She definitely WANTS to get off the toilet quickly - but it's as

> though there are two parts of her mind in some kind of conflict - and

> the part that says " sit there " wins all the time.

This describes OCD to me. Untreated, the child has no " tools " to win out

over that part of her mind that tells her, you better stay put.

> We are about to embark (a little more seriously than to date) on some

> in-house behavioral therapy - turn the sitting on the toilet into

> something of a game - and get her to get off as part of a game. (No

> amount of loving or logical coaxing works. And also, we have tried

> the " angry " method - that doesn't work either.)

There are some great Exposure and Response Prevention designers on this list

who will be glad to help out here. Perhaps the most straightforward

approach would be to time how long and when your daughter is " stuck " on the

toilet, then with her cooperation begin cutting back the time, maybe by only

a minute or two to begin with. It's important that this be done gradually

to ensure your daughter is successful. You can expect her to feel some

anxiety when she does this, but its level will fall with repeated efforts.

My four-year-old described OCD as a " bad boss " . You are right that there is

no logic where OCD is concerned, and usually the sufferer--even a young

child--knows this. But they must do the compulsion anyway, despite the fact

that they are upsetting family members, going against common sense, and that

they themselves do not in any way want to be doing the compulsions. No

punishment we as parents can dole out is as awful as what OCD " threatens " if

the compulsion is not done.

> I am still working on the basis that within our family, we can help

> our daughter beat this thing of sitting on the toilet.

You have every reason to expect she will be successful! OCD is very

treatable :-)

Let us know how things go.

Kathy R. in Indiana

[Guest guest]

Welcome ! Which are you referring to?

>She definitely WANTS to get off the toilet quickly - but it's

as though there are two parts of her mind in some kind of

conflict - and the part that says " sit there " wins all the

time. <

I cannot comment on whether your daughter has ocd or not, but based on

this description, it does sound like an O-C conflict.

>We are about to embark (a little more seriously than

to date) on some in-house behavioral therapy - turn the

sitting on the toilet into something of a game - and get

her to get off as part of a game. <

Before you try some therapeutic stuff on your own - have you read any of

the current manuals on how to treat children with ocd? The most popular is

by March and Mulle OCD IN CHILDREN AND ADOLESCENTS: A COGNITIVE BEHAVIORAL

TREATMENT MANUAL. I recommend that you look into purchasing or borrowing

two other new books (I'm sorry I dont have the names in front of me, but you

can find them by author) DR. TAMAR CHANSKY (whose an advisor to this list)

and the other by DR. FRED PENZEL (from the Western Suffolk Psychological

Services). Both of these books are excellent. Finding a trained therapist

would definalty help!

Have you tried reducing the time allowed to sit? Rather than telling her

not to sit, allow her to sit for a period of time. Choose a time of day that

she is not pressured to be somewhere or distracted. She should never be

allowed to do her homework on the toilet!! When you allow her to do things

like homework, eat, whatever...., it is called enabling - you are actually

supporting the ocd! When she asks for something that is unreasonable your

can respond with " NO, that sounds like OCD telling me what to do. I dont

listen to OCD " . You are her coach, so be direct and cheer all successes!

With younger kids, giving ocd a name can help. OCD needs to be

externalized so she understands that this is something that is harrassing

her! One of my favourite childrens books is BLINK, BLINK, CLOP, CLOP, WHY

DFO WE DO THINGS WE CAN'T STOP? AN OCD STORYBOOK. by Katia Moritz and

Jablonsky. Another book that I like which helps kids and families

understand that they are not alone and treatment is available is UP AND DOWN

THE WORRY HILL by Dr. Aureen Pinto Wagner (the other list advisor).

>I would welcome any suggestions or comments.

>I am still working on the basis that within our family, we can help

>our daughter beat this thing of sitting on the toilet.

I hope this helps - and doesnt confuse you! Ask as many questions as you

want - you'll get many opinions!! You might want to look at our archives

and the FILES on our website for more information. We have a chat each

sunday evening at 10pmEST that everyone is welcome to join.

Take care, wendy, in canada

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[Guest guest]

Kathy:

Thank you so much for your time in responding in such detail.

My wife and I have a lot to learn about this - I look forward to

learn more for the participants here - and will always appreciate

helpful and caring advice such as you have provided.

.

[Guest guest]

:

Thank you for the detailed response - very much appreciated.

I will take you advice re the books - and look forward to " talking "

with you again.

.

[Guest guest]

Hi :

Welcome to the group. Bowel and/or urinary obsessions are much more common

that you might suspect. As you have learned, getting tough with OCD and

coaxing it into being rational do not work. It is very frustrating at

first because all we do to help seems to lose its effectiveness almost

immediately.

The first part of dealing with OCD is psychoeducation about OCD for the

sufferer and their family. Once you know what you are up against and how

it is effectively treated you have taken an enormous leap towards improving

things for your daughter. Generally OCD is a big enough problem that it

cannot be solved without competent professional help. Perhaps your

psychiatrist can recommend a skilled CBT therapist with experience in

childhood OCD. If you share where you live perhaps another lister can let

you know of good OCD resources in your area. If not many of us can share

how we have found resources or made them.

The state-of-the-art CBT therapy manual for children and adolescents is Dr.

March and Mulle's book, " Obsessive Compulsive Disorder in

Children and Adolescents " . We are also very blessed in this group to have

two wonderful OCD docs who have written their own OCD books. Dr. Tamar

Chansky has written " Freeing Your Child from Obsessive Compulsive Disorder "

and Dr. Aureen Pinto Wagner has written " Up and Down the Worry Hill " . My

son Steve was diagnosed just over three years ago and there has been an

explosion of great OCD books since that time. A former list member, Mitzi

Waltz, has also written an excellent book on OCD entitled, " Obsessive

Compulsive Disorder, Help for Children and Adolescents. "

Managing their lives and suffering from OCD at the same time is called

" competence " by doctors. It is amazing how well many kids (and adults)

with OCD manage to cope with the considerable challenge of OCD. Sometimes

this can make it difficult for others such as teachers and even some

relatives to understand how much they are suffering. Also very typically

we only see the tip of the iceberg of our beloved OCDers' symptoms at

first. As we delve deeper we are shocked at how much of their lives OCD

influences.

Learning your child has OCD is a very difficult experience. Most of us

find we have to spend some time grieving the loss of the dream child we

thought/hoped we had. We are so conscious of their problems and the

challenges ahead and can feel somewhat pessimistic about their lives. We

have been amazed at the improvement possible for our son, Steve, who had

very severe OCD by the time we picked up on it. He probably had it almost

three years before we managed to notice. From being almost completely

dysfunctional (he also has major depressive disorder) he is today a

wonderful kid, successful in many arenas, and often happy. Although OCD is

still in his life, it is very much in the background.

After psychoeducation, the next step is learning to externalize OCD. To

see that your daughter's time on the toilet is not her desire nor her being

difficult and uncooperative, but rather is OCD bossing her around and

running and ruining her life. YOu will learn to team up together against

OCD and encourage her initial small steps in bossing back OCD. Then you

will be encouraging her large steps against OCD and she will have much more

time left to have fun and not spend it on the toilet. Recovery can take

quite a bit of time and there can be steps forward, followed by steps

backwards, but once she starts improving, she will keep moving in that

direction with your love, support and encouragement.

Welcome to the list, please keep us posted how your daughter is doing. Take

care, aloha, Kathy (H)

kathyh@...

At 01:35 AM 11/23/2000 -0000, you wrote:

>I am new to this group - and must thank for passing the group

>info to me - thank you .

>

>I have a nine-year-old daughter who sits on the toilet ( " doing "

>nothing) for about 30 minutes before school, about an hour after

>school, and about an hour and a half before bed. She also gets up in

>the night around 1am (about 4 nights out of 7) and spends an hour or

>so on the toilet in the middle of the night.

>

>It all began about 2 years ago - she became constipated and by

>necessity had to spend 10 minutes or so sitting on the toilet

>trying " to go " . The constipation cleared within a week or so - but

>she still spent longer than normal on the toilet. This has developed

>into the situation described above.

>

>We have taken her for all the gastro-type tests - bowel x-rays -

>varied her diet - the lot - and have satisfied ourselves that

>there are no reasons by way of digestive system problems that she

>sits on the toilet for excessive periods.

>

>Needless to say, this situation brings a degree of conflict within

>our household - so we saw a child psycologist - who achieved nothing -

>and recently, we took our daughter to visit a psychiatrist who

>specializes in anxiety, OCD etc.

>

>Within what seemed to me an alarming short period of time, he

>diagnosed her as OCD and wrote out a prescription for Zoloft.

>

>ly, my wife and I are still not convinced that our daughter has

>OCD - but I suppose that's a natural reaction of parents.

>

>Our daughter is so " normal " in every other way - does very well at

>school, has lots of friends, involves herself in team sports at

>school, completes her homework diligently and quickly (albeit, on the

>toilet sometimes) and is an all-round " normal kid " .

>

>She definitely WANTS to get off the toilet quickly - but it's as

>though there are two parts of her mind in some kind of conflict - and

>the part that says " sit there " wins all the time.

>

>We are about to embark (a little more seriously than to date) on some

>in-house behavioral therapy - turn the sitting on the toilet into

>something of a game - and get her to get off as part of a game. (No

>amount of loving or logical coaxing works. And also, we have tried

>the " angry " method - that doesn't work either.)

>

>I would welcome any suggestions or comments.

>

>I am still working on the basis that within our family, we can help

>our daughter beat this thing of sitting on the toilet.

>

>Thank you for your time in reading this.

>

>.

>

[Guest guest]

Kathy:

Thank you for you reply - and thank you everyone who has replied.

I am sitting here (in Australia) in tears.

I am so touched by the immediate and very caring advice I am

receiving from people I didn't even know existed a few hours ago.

My wife, our other daughter, and I love our nine-year-old so very

much. All we want is for her to be herself ALL THE TIME - and to

free herself of the hours every day that she spends on the toilet.

It's like she is chained to it.

I'm going to go away and read some of the books that have been

suggested. We are still determined to fix this thing without

medication. So I especially am grateful for the suggestions of book

titles relating to behavioral therapy.

Thank you everyone - and to everyone in USA, have a very happy and

peaceful Thanksgiving.

.

> >I am new to this group - and must thank for passing the group

> >info to me - thank you .

> >

> >I have a nine-year-old daughter who sits on the toilet ( " doing "

> >nothing) for about 30 minutes before school, about an hour after

> >school, and about an hour and a half before bed. She also gets up

in

> >the night around 1am (about 4 nights out of 7) and spends an hour

or

> >so on the toilet in the middle of the night.

> >

> >It all began about 2 years ago - she became constipated and by

> >necessity had to spend 10 minutes or so sitting on the toilet

> >trying " to go " . The constipation cleared within a week or so -

but

> >she still spent longer than normal on the toilet. This has

developed

> >into the situation described above.

> >

> >We have taken her for all the gastro-type tests - bowel x-rays -

> >varied her diet - the lot - and have satisfied ourselves that

> >there are no reasons by way of digestive system problems that she

> >sits on the toilet for excessive periods.

> >

> >Needless to say, this situation brings a degree of conflict within

> >our household - so we saw a child psycologist - who achieved

nothing -

> >and recently, we took our daughter to visit a psychiatrist who

> >specializes in anxiety, OCD etc.

> >

> >Within what seemed to me an alarming short period of time, he

> >diagnosed her as OCD and wrote out a prescription for Zoloft.

> >

> >ly, my wife and I are still not convinced that our daughter

has

> >OCD - but I suppose that's a natural reaction of parents.

> >

> >Our daughter is so " normal " in every other way - does very well at

> >school, has lots of friends, involves herself in team sports at

> >school, completes her homework diligently and quickly (albeit, on

the

> >toilet sometimes) and is an all-round " normal kid " .

> >

> >She definitely WANTS to get off the toilet quickly - but it's as

> >though there are two parts of her mind in some kind of conflict -

and

> >the part that says " sit there " wins all the time.

> >

> >We are about to embark (a little more seriously than to date) on

some

> >in-house behavioral therapy - turn the sitting on the toilet into

> >something of a game - and get her to get off as part of a game.

(No

> >amount of loving or logical coaxing works. And also, we have

tried

> >the " angry " method - that doesn't work either.)

> >

> >I would welcome any suggestions or comments.

> >

> >I am still working on the basis that within our family, we can

help

> >our daughter beat this thing of sitting on the toilet.

> >

> >Thank you for your time in reading this.

> >

> >.

> >

[Guest guest]

HI :

Whereabouts in Australia are you? THere are some excellent OCD resources

in Australia. The docs who wrote " THe Secret Problem " are from Austalia.

The first line treatment for OCD in kids is CBT with exposure and response

prevention (E & RP). Generally mild to moderate OCD in children can be

treated very effectively without medications provided that you have good

E & RP going on and there are not other difficult comorbidities. My son,

Steve, controls his OCD with E & RP, and has almost always only been on a

dosage of SSRIs effective for depression and not high enough to do much for

his OCD. The information about CBT only as first line therapy is available

from the Expert Consensus Guidelines which I believe Louis has masterfully

made available in our files resource.

Good luck, take care, aloha, Kathy (H)

kathyh@...

At 08:53 AM 11/23/2000 -0000, you wrote:

>Kathy:

>

>Thank you for you reply - and thank you everyone who has replied.

>

>I am sitting here (in Australia) in tears.

>

>I am so touched by the immediate and very caring advice I am

>receiving from people I didn't even know existed a few hours ago.

>

>My wife, our other daughter, and I love our nine-year-old so very

>much. All we want is for her to be herself ALL THE TIME - and to

>free herself of the hours every day that she spends on the toilet.

>It's like she is chained to it.

>

>I'm going to go away and read some of the books that have been

>suggested. We are still determined to fix this thing without

>medication. So I especially am grateful for the suggestions of book

>titles relating to behavioral therapy.

>

>Thank you everyone - and to everyone in USA, have a very happy and

>peaceful Thanksgiving.

>

>.

>

[Guest guest]

Hello , you wrote:

> Thank you for you reply - and thank you everyone who has replied.

> I am sitting here (in Australia) in tears.

> I am so touched by the immediate and very caring advice I am

> receiving from people I didn't even know existed a few hours ago.

Louis started this group around the time my daughter had her OCD onset and I

found it about two months later. I will always be thankful for this happy

accident, and believe that our family's experience with OCD would have been

much more difficult without the input, advice and support shared by the

parents here. By reading posts and asking questions, I was very quickly

able to become knowlegeable about the disorder make informed decisions

regarding my daughter's treatment. My daughter was so, so lucky in this

regard and I cringe to think of all the time I likely would have wasted on

ineffective treatment without all the expert input I received here. I am

glad you are finding the group helpful as well. Have you looked for a local

parents support group? I attended one for several months until it

disbanded, and found it helpful as well.

> My wife, our other daughter, and I love our nine-year-old so very

> much. All we want is for her to be herself ALL THE TIME - and to

> free herself of the hours every day that she spends on the toilet.

> It's like she is chained to it.

Someone wrote a long while back, that if we as parents treated our kids as

OCD does, we'd be arrested for child abuse--!

> I'm going to go away and read some of the books that have been

> suggested. We are still determined to fix this thing without

> medication. So I especially am grateful for the suggestions of book

> titles relating to behavioral therapy.

Exposure and Response prevention therapy specifically is the type of

behavior therapy that is successful in reducing or eliminating OCD

compulsive behaviors. I mention this only because I was unclear about this

for quite awhile after running across these terms. Happy reading!

Kathy R. in Indiana