Q:  I am a parent of a school-age child with paruresis, what can I do for my child?

A: If you are reading this because your child showed you this web site, the first thing to do is tell your child you are glad they were courageous enough to share that they have paruresis, and that you are there to help.  Children are very concerned about how their parents, peers, and teachers view them and often worry that paruresis could reduce their stature in the eyes of the people they care about the most.  Reassure your child that there is nothing seriously wrong. Your child isn’t crazy. Paruresis tends to affect very bright, caring, and capable people for reasons we don’t fully understand yet. Recovery is very likely, especially for younger individuals.

If your child is encountering teasing or bullying from peers or family members, take steps to give your child the tools to deal with it. This topic is too broad to address here, but there are many excellent resources to deal with teasing and bullying online and in most communities. The better a child is able to defend against attacks from others, the more secure they will feel when beginning to work on recovering from paruresis. Many older people with paruresis have remarked that if they had taken a good self-defense course in their school years, they would have been able to put bullies in their place, and could have had a much happier childhood.

Your child may need some special arrangements at school in order to use restrooms that are more private. Work with the school nurse or a counselor to get permission for your child to use restrooms during class or at times outside of recess or lunch hour if this is needed. This step will reduce the stress on your child. It will be less needed after work on a recovery program begins.

Encourage children with paruresis to participate in school activities so that they are regularly involved in social situations and don’t become isolated because of their paruresis. If these activities require urine drug testing, teach children to use a catheter to provide the sample, or work with your school authorities on accepting an alternative drug test method, such as hair, oral fluid, or sweat patch. As of this writing, there are no federal or state laws requiring schools to use any particular testing method. Don’t accept excuses, such as “We are required to do it this way.” Too frequently school systems contract their drug testing to companies that try to do things as quickly and inexpensively as possible. The testing companies care nothing at all about your child or his or her welfare. If necessary discuss things with the Principal and Superintendent. If they won’t help, protest to the school board and seek out legal counsel. Also contact IPA so we know what is happening and can send letters to school officials. In some special situations we may be able to find you legal assistance or pay a small portion of the expenses.

Find a good child psychologist specializing in cognitive-behavioral therapy and anxiety disorders and have this person work with your child on a graduated-exposure therapy program for recovering from paruresis. This kind of program will generally be short, a few weeks or months in length, and will produce excellent results if your child is motivated and works on recovering. In some cases, medication may be needed in combination with exposure therapy. Be sure your physician selects a medication appropriate for young people, as some anxiety medications for adults produce different and sometimes dangerous effects when used by children. Your psychologist—usually a Ph.D. or Psy. D. or psychiatrist (M.D. or D.O.)—can contact IPA for more specific treatment information if this is necessary; we are happy to educate professionals on the details of treatment.

IPA workshops accept young adults (usually 17 years or older) and attending a workshop is a good way for a young adult to learn about paruresis and meet others with it, and discover that there are many normal adults working on recovery. Parents often accompany their children to a workshop. Young adults should also consider working in a support group if one is available in your community. The Shy Bladder Center (the branch of IPA responsible for running workshops) may be able to work with younger children on an individual basis, but workshop formats are not appropriate for children.

Finally, if your child is involved in athletics or you live in a hot climate, talk about the importance of drinking plenty of water throughout the day. Students often restrict fluid intake as a way of managing their paruresis to reduce the need to visit restrooms. The combination of low fluid intake, physical exertion, and heat can put a young person with paruresis at risk of heatstroke or dehydration, and most children aren’t aware of how serious the danger can be. Once a student starts a recovery program, drinking lots of fluids is recommended so that they have lots of opportunities to practice using restrooms.