Why Might Children With Autism Engage In Fecal Smearing, And What Can You Do About It?

Fecal smearing is medically known as scatolia — but in plain English, it'd better be described as playing or otherwise messing with poop. For many of us, this topic is so taboo that it's hard to even talk about, but some people, of all ages, do it. This sometimes includes children on the autism spectrum, and this phenomenon is bound to make their parents want to pull their hair out. 

What conditions are associated with fecal smearing? 

Believe it or not, there's very little scientific research on this topic. "Inappropriate fecal handling" has been associated with a variety of conditions, however, notably dementia, developmental delay (intellectual disability), and various mental disorders, including psychosis and schizoaffective disorder. Unusual feces-related behaviors have also been linked to frontal lobe tumors, substance use disorders, epilepsy, obsessive compulsive disorder, and autism. 

Remember that the fact that fecal smearing and other inappropriate behaviors that involve poop have been documented in people with a certain condition doesn't mean that everyone, most, or even many people with those same conditions will engage in such behaviors. 

What other behaviors are related to fecal smearing?

Two things are closely associated with fecal smearing.

The first is encopresis — in which a child over four soils themselves. This is most commonly involuntary, and often caused by an underlying medical or psychological issue, but can also be voluntary in some cases.

The second is coprophagia. Itself a rare form of an eating disorder called pica in which a person repeatedly ingests non-food substances in ways that aren't considered socially appropriate within their society, this medical term means, you probably guessed it, ingesting feces. Pica is relatively common in autistic children. A much smaller subset will put feces in their mouths. 

Is fecal smearing common among autistic children?

There's really not enough evidence to determine just how prevalent scatolia is, not just in autistic children or adults, but in any group of people. One study that looked into so-called challenging behaviors in autistic people — a term that means something like "behaviors that threaten the quality of life of the person engaging in them or those around them" — had fecal smearing very low down the list of possibilities, however. 

Although fecal smearing doesn't, judging by the slim offerings currently available, appear to be a widespread problem, it definitely happens. The key to making this behavior, which is going to be incredibly uncomfortable for caregivers, stop is to figure out what is causing it. 

Why might autistic people engage in fecal smearing?

Because fecal smearing is quite poorly researched, it's difficult to make general statements about this. Several possibilities exist, however. 

Some autistic children are either nonverbal or have very limited verbal abilities. This increases the odds that they'll instead try to communicate in other ways — any way they can, actually. Research into people with dementia has found that those with this condition sometimes engage in fecal smearing when they suffer from severe constipation and are unable to communicate this to caregivers. Scatolia is, in this case, a cry for help. It quite literally shows others where the problem lies, and if this is the cause, the fecal smearing will most likely stop once its origin is addressed.

Autistic children with limited verbal skills, too, may use scatolia to communicate that they are suffering from constipation or another gastrointestinal issue. This may especially be likely if the behavior seems to appear out of nowhere. Take your child in for a physical checkup in this case. 

This is probably the right place to mention that fecal smearing may not even be a deliberate act — when someone soils themselves (a closely-related event) but isn't capable of cleaning it up, they may get feces everywhere as they attempt to deal with the mess, or just over the course of normal movement. 

Other research has identified protest and aggression as possible causes of fecal smearing; someone might do it to let others know just how unhappy they are about something, in some cases being fully aware of what kind of response playing with poop may evoke in others. If someone cannot communicate verbally, this makes some kind of sense. 

In other cases, scatolia may be a result of intellectual impairment or trauma, or a way to get attention. 

Another possibility is that some autistic children simply find the texture of poop appealing and interesting to play with — a bit like playdough. Remove social taboos around poop, which children with autism may not have picked up, and you can end up with a "why not?" situation. Many autistic people are extremely big on sensory experiences, after all.

What should parents of autistic children who engage in fecal smearing do?

Talk to your child's healthcare providers as soon as you notice this behavior. Do not assume the cause is psychological, and make sure to look at a possible medical angle, as well. Once you get to the bottom of the cause, you and your child's healthcare providers can then start working on ways to prevent this behavior in future. This may involve treating underlying phsyical conditions, in some cases medication, and in some cases therapy. Don't let the fact that this topic is taboo stop you from talking to your doctor — this is the first step to effectively tackling this problem, after all.