Expert: Dr. Sharon A. Mitchell - 7/31/2008

Question
QUESTION: I have a 6 yr old grandson who this summer started playing with his saliva.  He gathers spit in his mouth and then strings it out and plays with it.  What is causing this and how can we stop it?  He has been medically checked for digestive problems and is fine.

Also this summer he has started digging at his anal and causing himself to have several bowel movements.  He does it inside the house but more often in the backyard.  Also he doesn't start until the afternoon.  Again what is causing this and how can we stop it.

Your advice would be greatly appreciated.

ANSWER: You didn't mention if your grandson has a diagnosis of an autism spectrum disorder so I'll assume that he doesn't and you're concerned about these new behaviors.

If the child has not previously shown signs of autism, then the symptoms would not just suddenly develop when he's 6. So other factors are behind this behaviors.

It's good that he's been medically checked, but if he was my son I think I'd return to the doctor Perhaps initially the physician did not have a complete enough description of the behaviors your grandson is showing. Rather then telling the doctor that this happens a lot, try keeping a daily log and noting when you note these actions and for how long he engages in each one during each episode. What things happen before the behaviors? Is he alone? Bored? Recently eaten? Where is he? Who is around? You could keep track of this in a chart form. Along the top of the chart, draw eight vertical lines. The first column is for the behavioral description, then the remaining seven would be titled the days of the week. Along the left hand side of the page, you might list descriptors such as:
- saliva
- anus
- who is present
- where is he
- what was he doing before the behavior
- what did he do after the behavior
- when does he have bowel movements

Is the child on medication? Some medications can cause dry mouth, making the child feel the need to try to create extra saliva.

Has his diet changed? An increase or decrease in the amount of fibre he's used to can affect his bowel movements and feeling of discomfort.

Sometimes when kids are digging in the sand or dirt outside, it's possible to pick up worms that invade the gastrointestinal tract. While a child may not complain of discomfort, it might make him dig at his rectum.

Is there any chance that this child has been sexually abused? This would be something to discuss with his physician if you think it's a possibility.

Although these behaviors are distressing to all concerned, before trying to make the child stop these actions I'd want to ensure that all possible medical angles are covered. Only then would I think it's safe to treat his actions behaviorally.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca

---------- FOLLOW-UP ----------

QUESTION: Thank you for the advice.  It is very good.
Yes he was diagnosed with autism at 18 months.  
Would this have any bearing on your advice.

Answer
Yes, knowing that he has autism does have a bearing on this. Kids with autism frequently have obsessions and fixations. While this is a constant, the object of the fixation isn't. While a child can have an intense obsession with one repetitive motion or area of interest, that obsession may wax and wane, and another come to the forefront.

Since it sounds like saliva and bowel movements that are his current fascination, try to guess what he's getting out of it. Often such obsessions have a sensory basis. It may be the feel on his hands he likes, for instance.

You certainly don't want him continuing in this mode because it's unhygienic and socially unacceptable. It will ostracize him from his peers.

In my experience, it's very difficult to remove an obsession. Instead, you'll likely have better luck with replacing the behavior. Remember though when you hunt for a substitute that this replacement obsession may last for several years. It's important to make the replacement age appropriate and as socially acceptable as you can.

To help find a substitute, look at the function behind the behavior. In this case, my guess would be that it has a sensory basis. So try substituting something that will give a similar feel to his hands.

An regular intervals throughout the day, rub hand lotion on his hands. When he washes his hands, let him play with the liquid soap, enjoying the slippery feel.

Introduce him to bubbles - the kind where kids dip a wand in a bottle of bubbles and blow to create floating bubbles in the air.

Use playdough, Plasticine, etc. to allow him to feel, push and pull with his hands.

If the strong smell of feces is part of what engages him, then cook your own playdough. On the internet you can find recipes for making playdough with koolaid crystals or jello powder. It will smell strongly - this worked with another child I know who would wake each morning, defecate in his bed then play with the feces. A plastic container of this playdough beside his bed gave him something else to play with and he switched readily.

Give his hands other things to do. Try fidget toys, stress balls, small pieces of material or ribbon to run between his fingers, etc.

If you have access to an Occupational Therapist, such professionals are often excellent at helping determine the function of a behavior and at finding appropriate substitutions.

Best of luck,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca