My daughters pretends to be hurt along with other concerns

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My daughter is nearly 4 & came home nearly 3 years ago and has a complex medical condition which means we have to hyper vigilant to any instances of pain or increases in her temperature. We manage her condition and to date she has had no serious medical emergencies however and this is the part that tears me up in the last three months she has started to complain of pain almost on a daily basis and will wake sobbing throughout the night. She flinches when we touch said arm or lift her up and so on the three worst occasions including this morning we have ended up in A&E. She’s had bloods, X-rays the lot and guess what there’s nothing there! They find nothing, all test come back ok. To add to ordel and make the experience worse on examination with the doctors she is lively, happy, singing & jumping swinging her arms and giving high fives. The doctors say I’m right to get her checked but have all hinted at this potentially being behavioural. I had already started to think this as In general she’s very demanding eating being another daily battle. On occasion when we don’t do as she ask (such as rub her foot in the car) she will scream & cry & reach till she vomits. although she’s only 3 she’s very articulate and can voic her wants and reasons very clearly. She is obsessed and I hate to use that word but it’s so intense with her dad that it is all she cares about some days and will only talk or acknowledge him. She frequently rejects or ignores me & has to be promoted or reminded by my hubby to be kind to mummy. She has also started wetting & pooing herself on a daily basis although she’s been potty trained for 2years. She shows no remorse and isn’t bothered by being wet ect at all. Treats, rewards and the opposite loss of toys telly ect have no effect. If she does earn a reward ect and gets it shortly after (within the hour) she’ll make a bad choice again. I also have massive concerns about her play she she very bright and has great imaginative play however she doesn’t play with others, she watches and observe and copies. That is until she finds an adult and it can be any adult she loves attention and will smile and basically preform For them. People comment she’s incredible friendly but I see it as she is too friendly. I honestly believe she would walk off with a stranger. I’m a teacher & trained nurture teacher so I know I probably over think but this list of concerns is growing.

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You are her mother and you will be picking up on concerns. Is it possible to arrange an appointment with a specialist so she goes to he hospital on your terms and not hers, so that you can say all the things bothering you?

I have found that if I write things down first I can then hand them over so I do not overlook some issues.

There are many reasons for complexities...I am thinking Attachment Disorder along with other conditions which will have to be discounted, but the sooner you have a framework to address therapy then the better you will handle it as you can look at behaviours in a context.

Take care of yourself through all this.


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Thank you x I’ve got a few numbers & am gonna contact my Apotion agency this week. I’ve noticed things for a long time but brushed them off of as 3year old behaviour and that I was over thinking due to job & work experience & that I was looking for issues which others weren’t seeing. The thing is as I said she’s very friendly with others, polite helpful a real people pleaser except at home and even then it’s only in the last 3 months my husband & her grandma have seen it too Even now after the hospital she telling me it hurts.

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No real advice but my dd loves the buzz the attention it creates .I think she needs it to fuel the release of adrenaline and cortisol and sorry to say at the age of 22 she does it and i have never been able to satisfactorily find a replacement for it - well maybe a roller coater in the garden

so get your concerns.

It is hard as you don't know if she needs medical attention . if you feels she is just pretending she may up the anti to get the attention she wants.

i hope you can find a positive way forward

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I would suggest you check out PDA (pathological demand avoidance syndrome ) especially the role playing stuff. My daughter has PDA. She got herself into hospital a few times for extensive tests and she loved it. She was basically role playing "ill child in hospital ". I thought of her when I read your story.

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Wow - sounds like you have a very bright, canny little girl there. Some of the behaviours you describe sound like controlling behaviours - meltdowns when she doesn't get her own way, and attention-seeking (the wetting etc). It must be very difficult to separate the cry wolf behaviour and the attention/controlling behaviour from any clinical/medical issue. She is also still almost in the terrible 2s/3s so you have that to add to the mix! My AD has lots of controlling and demanding behaviours and a professional suggested that if I err on thinking she needs nurture at these times then I won't go far wrong. Sometimes I feel like I'm rewarding the 'bad' behaviour or indulging and I'm sure I haven't always got it right. Your AD seems to want lots of attention so I'd suggest you pile it on. She may be old enough for you to do some stories with her around characters who cry wolf and what happens etc. Or perhaps role with teddies/dolls. It does sound like she's throwing everything at you which suggests to me a child that needs attention, feeling secure and safe etc. Good luck

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I'm wondering whether she has a functional disorder - our son developed this and was having "fits" but they weren't epileptic and paralysis on one side - after loads and tests and several weeks in hospital the doctors decided it was his brain tricking his body....he had been genuinely ill and enjoyed the attention so it was continuing to be "ill" - so whilst there is no physical cause its not a deliberate behaviour either. When I did some research functional disorders are more prevalent where there has been childhood trauma.

We managed to solve it by not giving attention during a fit (keeping an eye from a distance) but on your case that would be harde since she has an underlying condition.


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I have more time to respond today - I was on my phone yesterday and find it hard to give thorough replies.

I wanted to mention PDA because of several things that you said. I am going to comment on some of the things you said and refer to my daughter when she was younger.

First the playing, as this is key IMO. You have mentioned that your daughter seems to copy others' play and is not that interested in playing with her peers but you think she is highly imaginative. My daughter was thought to have superior play skills. She was fully immersed in imaginary play all the time but Angel it was always on her terms (b) it only involved someone else if they were a key part of her game, such as being the vet when she brought in a toy to be examined, and where she was telling them what to do/say (c) her play was actually extremely repetitive as she only ever played at being a mum or a vet or a few other favourites (d) her play was highly detailed, with all the correct accessories required for the scenario, whereas other children will make do with simple props and often will substitute props e.g. a toy brick in a purse, whereas my daughter always had a bag filled with proper play toys (e) she had absolutely no interest in anyone else's games or in anything that she didn't herself fancy, so she wasn't interested in most of the toys she received as gifts. But, to the untrained eye her playing seemed 'fine' and even 'extremely good'. She was busy, occupied, she had such a keen eye for detail, she wasn't hurting anyone, her games were very gender stereotyped which appeals to a lot of people so she got lots of praise for how she looked after her babies from neighbours etc etc.

Going into hospital like she did can be seen as a kind of role playing. My daughter got herself into hospital with a suspected serious illness twice. She had so many blood tests - I kept saying could she be making it up but they weren't taking the chance. In the end she saw specialists from three different teams as well as the A&E team and it was agreed that she had concocted it herself (she was 8). They were so astonished that they made an urgent referral to CAMHS - we went straight to the top of the queue - and she was subsequently diagnosed with PDA, partly based on this incident.

Next, you say she is obsessed with her dad. PDA is known as the 'social autism' and having fixations with people is one of the characteristics of it.

Then there is the over-friendliness. This is a key feature like the role playing. It's a kind of 'mask' which they wear to get them through life as they don't have the intrinsic social skills to manage situations, so they find a way of coping. It is hard for parents who see their child's problems while other adults are completely taken in. I had huge problems with teachers for example - children like this can be very appealing to teachers, who are used to having to deal with 30 kids avoiding eye contact, being more interested in their effect on each other etc, and then you have someone who is almost adult in demeanour. I was told that my daughter had/has no concept of hierarchies of people - to her everyone is the same, and so she would speak to a teacher like to a friend and nothing has ever changed that (except that now she is an adult herself it isn't so much of a problem, so it does get better!!). I was told that my daughter was role playing at being a competent peer - she would take a behaviour like being 'nice' and 'friendly' which would work for other children, who knew how to use it, but she would use it indiscriminately.

Next, the lack of cause and effect thinking. Kids with PDA are usually not very good at responding to rules. They actively avoid demands and will do anything to get out of doing something they don't want to do - they are not oppositional as such, but are likely to wiggle out of doing anything and this can involve refusing to do something because you want them to do it when they were quite happy to do it themselves earlier. Things can spiral out of control with a child with PDA as parents try to put in place boundaries and consequences i.e. normal parenting techniques as recommended by just about every parenting guru and course offered by CAMHS etc, as this is the opposite of what works for these kids.

Wetting and pooing - often delayed or there is a reversal. Often related to wanting to role play being younger.

I am not saying that your daughter has PDA - there can be many reasons for behaviours in young children and others have given you alternative ideas to think about. I just wanted to say that I kept thinking of my daughter when I read your post and specifically about PDA. A lot of adopters find that PDA is a good explanation for their child's behaviour - or at least that the behaviour strategies for dealing with their child are what work. There is a PDA society with a good website where you can find out about the techniques for parenting these kids and there are some useful Facebook closed groups too.

If you think that PDA might be a fit, pm me and I can give you more information. PDA is not in the diagnostic manual and so many areas won't diagnose it so it's a bit of a postcode lottery.

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Hi Smile

A few things have flagged for me in your post. One thing is that babies developmentally start to know the difference between physical and emotional pain at around 4mths (that’s from memory but do check it out) sonif your child suffered trauma then, this will impact their ability to know the difference between physical and emotional pain.

Odd reactions to pain - so super sensitive to the tiniest brush but equally hasn’t got a clue they actually have a broken finger is not uncommon in children with early repeated trauma.

Further babies who are premature and or have substance exposure can be super sensitive to touch or not really notice at all.

One day blossom broke her finger at school. She hid the note about it being bashed at playtime and for me to check it etc. I noticed something wasn’t right because she was hiding her hand at breakfast the next day. When I caught a glimpse I was horrified to see it was black and blue. The injury made her vulnerable- it wasn’t on her terms and that scared her, hence hiding it. She would have been about 8 then. Generally speaking blossom was never ill.

Partridge on the other hand was always poorly with something or other. Woe is me type things. Often got colds/ other bugs. But often lots of very lengthy neediness. Madrid helped me understand this was ‘learned helplessness’

I think, in retrospect seeing a sensory OT would have helped. Maybe worth scouting if there are any local to you

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Thank you for all your comments xxx I’ve been reading up more on PDA which was what I had already been thinking. It’s reassuring but terrifying to stay it out loud & have others comment but everyones oppinons, experiences and support makes me more confident it’s not in my head & that something is wrong. I love my daughter to pieces and when she’s on form it’s honestly a pleasure it’s just so short lived & with the “pain” occurring throughout the night most nights it’s just so dare I say it demanding. teamed with working full time & it all just gets a bit much.

With regards to PDA I have also been sent a PDA questionnaire from a nurture teacher/friend in which she score 46. On the form it indicated that 50 was the score to possibly inquire further however as she’s only at nursery there were a few I just couldn’t answer. I’ve decided I’m gonna contact our agency later in the week and visit the gp as well. Although I’m dreaming the masking at the docs in which she’ll seem so polite with her dimple, smiles & giggles which will leave me looking like I’ve made it up.

Thanks again for all the advice xx

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Goodness geekgirl you have a lot on your plate so not surprised it gets overwhelming at times.

Hope you get get the advice and support you need x

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Don't discount the possibility that she might be feeling pain. Might be worth adding sensory processing disorder to the list of conditions that you explore. A quick internet search came up with the following thread on mums net about SPD and pain, which bizarrely inconsistent behaviour is described:

https://www.mumsnet.com/Talk/special_needs/1177267-Sensory-Processing-Di.... https://www.reddit.com/r/SPD/comments/2vy0vy/sensory_processing_disorder...

I would be very wary of accepting that the cause of your daughter's pain is behavioural.

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Well I guess I see some different things caring for a child what also has a serious medical condition. First of all be aware that she's had a lot of attention around the medical stuff, she might have had pain and learned this came with attention. The hospital visits are quite nice again a lot of attention of mostly strangers including medical professionals.

I recognise this pretending to be very sick in my boy, an this is difficult to make the call just wait and see, potentially if I leave it too long this could mean disability or death, so I too are very aware but I wait and observe otherwhise the hospital would be my second home as he's a master in pretending he's about to die. I am convinced he has pain when he does it, but he is unable to know or it just hurt a bit or it's the beginning of a massive internal bleeding.

So I have the feeling that you might have to react a bit more neutral towards her medical needs, in a matter of fact way. Now the overfriendlyness, this can be attachment disorder, as she does it with everyone. You need to have clear rules what allowed where, mum, dad, kissing , on lap, cuddles etc, teacher, no kisses, no cuddles, doctor is stranger but need to touch, this does not mean she treat him like he's family. You have to keep her close and to an extend prevent that she's interacting too much with strangers.

The daily eating battle can just be attachment and controle related too, ofcause it can be a symptome of autisme of some sort but you need to be open at this stage for any diagnose. She's still young and when problems in school are not huge she's unlikely to be tested for anything soon unless you pay yourself.

About not caring about being wet can be the neglect, can be seeking attention, unlikely to be a medical problem as she was fine before, can be controle, attachment related.

About remorse, I think expecting this at 4 is unrealistic especially as she's developmentally delayed. This is a complex emotion and not showing it at just 4 is not too worrying I would think.

The games she plays between you and your husband are classic splitting behavious, seen often in children with attachment disorder.

She prefers adults over children this can be as simple that she gets more out of it, I would start with bounderies as I did with my child who was totally adult focussed after six years orphanage. Not allowed to play with adults, only children. If she goes to that adult while there are children call her back and as quietly 'are you allowed to play with adults?' than direct her to the child. If she goes again she has to stay close with you on your lap. Soon she will play with children as it's boring otherwhise. If you did this for a while and she doesn't come to play than look into autisme. It might be good to use some resources for autistic children to learn to play together, even if she's not autistic it wouldn't harm.

Again as she's young you are unlikely to get answers any day soon, but in the mean time talk to the hospital in order to find out when you can leave it a bit longer. I can skype with the hospital dr. so they can see how serious it is when I'm not sure, this might just give you the confidence that it's fine to stay home and give a painkiller or whatever is appropiate.

I do not know or you give in when she wants to be cared for by dad or mum, but I would not give her her way. In fact if daddy needs to remember her to be kind to mummy than it's important he pulls back from her emotionally and does not give attention in the form of doing things together, caring for her, this should be done by mum that day. It is better when the adults decide who does the caring and if she says daddy say 'maybe tomorrow, today mummy puts you in bed'. Do not be afraid to take controle over the situation, do not forget she's very young and her brain is far from develloped. It is better when children 'go with the flow', so parents decide most up until around 7. How more choices she gets, how more controle she gets how less safe she will feel.

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That's interesting that you were already considering PDA, Geekgirl. I do think that your mummy radar is important - there are indeed lots of possibilities for her behaviour and it's a case of teasing them out. It's hard when they are 4. When my daughter was 4 we went to one of the top attachment centres in the UK for family therapy (funded mainly for her big sister as no one could put their finger on what was up with our younger daughter but it was family therapy so everyone was seen). They were convinced that she had attachment related difficulties and she was a lot better in some respects after the attachment therapy they delivered there - she was much better with me for example. But lots of behaviours remained stuck and I became convinced that it wasn't attachment at all.

PDA was a great alternative diagnosis for us. It is on the autistic spectrum and so attracts all the help you get from an autism diagnosis (and she got a LOT of help from it including DLA and a then Statement, now EHC Plan, place at a specialist speech and language school, access to ASD clubs, I got on an ASD parenting course...). But also it helped us to look at her needs in a very different way and to have the courage to parent her in a very different way to what everyone seems to think looks like 'good' parenting. She is now 18 and working and I suspect that this would not have happened if we had kept imposing lots of boundaries and making her do things she didn't want to do.

I personally parented her according to what she could cope with and then I found that a lot of the tricky behaviours disappeared. PDA is primarily about demand avoidance and so if you remove unnecessary demands, these kids can be regulated and much easier to parent. It can look a lot like 'giving in' to other people but if you have a good understanding of PDA and know your child, you can make it work. My daughter always had lots of boundaries, just not necessarily the ones that other people think are important (like having a tidy bedroom for example or not watching lots of TV).

I would like to make one point about making her play with other children. IMO it's not as easy as that, partly because the other children have a say in who they want to play with and generally speaking they won't tolerate children with poor social skills. It is much easier with boys, where there may be a daily football game going and anyone can take part, or where there are other boys on the periphery with odd social skills who will be more tolerant of each other. With girls social interactions can be extremely sophisticated from a much younger age and any deviation is not tolerated. The only help out there is Speech and Language therapy, where they have social skills groups and other interventions, but it's very much used as an aid - it's not a cure. My daughter appears incredibly able socially but she has never been good with other girls and in fact nowadays has one other female friend (and she's autistic spectrum). It's not something that can be fixed by making them play.

Anyway, 4 is young to be diagnosing anything tbh. Often girls in particular are picked up later. I would say to take lots of notes so you have plenty of evidence when you do see someone. Sometimes it can be damaging to see a professional early on if assessments turn out to say there is nothing wrong - people often revisit this a few years later when the problems are more easily seen. My daughter had a girl in her class who was diagnosed with Aspergers on the last day of year 6. Often girls are not diagnosed until secondary school or even once they have left. My nephew was diagnosed with Aspergers at Uni. With these young people, they can have found a way of coping which meant everyone left them alone - it is when they can no longer cope and their attempts to cope (like eating disorders) get them seen professionally by someone who understands that the diagnosis comes. Now, I am not suggesting you wait until she is a teenager (!) but sometimes it does pay to wait a year or so until you have good evidence.

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