Polydipsia: A Case Study of Meeting Need, Advocacy and Self-Regulation
Cite this article as: Batalla-Duran, L. (2026). Polydipsia: A case study of meeting need, advocacy and self-regulation. Ability Bridge SEND. https://www.abilitybridgesend.co.uk
Referral
Several years ago, I was contacted by an ex-colleague, now a leader in a special school, about a young person engaging in polydipsia type behaviours. At least eight times a day, they would run into the school kitchen, put their mouth around the joint tap and turn both handles on, causing water to flow at high pressure into their mouth. They would hold the water in their cheeks, then gulp and repeat this for at least five minutes. Near-identical behaviour was occurring at home, although at a slightly reduced frequency. There was understandably concern about the potential harm they could cause themselves, particularly the risk of running into a working kitchen, as well as the risk of water entering their airway. Previous attempts to divert them and prevent access to the kitchen had resulted in safeguarding incidents involving self-harm and damage to the school interior.
Professional Curiosity
Behaviour can only be changed effectively when we first understand it, identify the need it is meeting and find a way to meet that need safely. I spent the day with this young person. What became immediately evident was the urgency of getting to the kitchen and the visual relief the behaviour appeared to give them after they had filled their little cheeks like a hamster several times.
It was obvious that simply trying to stop the behaviour would be futile for two reasons:
it would be extremely difficult to do and would create an even bigger safeguarding risk, as had already been demonstrated; and
the underlying need would still not be being met.
Experience in all walks of life, not just in education, demonstrates time and time again that when we focus on stopping a behaviour without understanding why it is happening or what need it is meeting, we may either fail to stop it or see another behaviour emerge in its place; sometimes one that presents even greater challenges. If we do succeed in stopping the behaviour without addressing the underlying need, the individual may continue to experience distress because the behaviour serves a purpose. It may not be a safe purpose, but it is a needed one.
Identifying Need, Understanding Need and Meeting Need
Talking to staff and the parent, I was told that the young person experienced recurrent urinary tract infections. During these periods, the behaviours became more frequent and intense. There may have been an interaction between physical discomfort, anxiety and increased drinking. I had visited on a day when they were between infections and was therefore seeing a relatively calmer presentation. However, the level of anxiety this young person appeared to experience was palpable and uncomfortable to witness.
What was causing the anxiety?
In discussions with the OT, they felt there appeared to be a sensory element to the water ritual rather than it being driven by compulsive or ritualised behaviours. As we know, sensory needs and anxiety can often be intertwined, with each reinforcing the other. The greater the sensory need, the greater the anxiety can become, while increased anxiety can further intensify sensory experiences. Trying to separate one from the other is not always easy.
However, it was not felt that the ritualised nature of the behaviour could be easily dismissed. High anxiety, sensory needs and ritualised behaviours can also be closely interrelated, and the water ritual appeared to follow a consistent pattern. Nevertheless, as anxiety often plays a significant role in maintaining such behaviours, reducing anxiety through sensory alternatives seemed a way to start understanding and identifying the underlying need.
We discussed ways of replacing the sensory feedback the young person appeared to be seeking. Ice can be used as a source of strong sensory feedback and may also help to reduce anxiety (Cain et al., 2025; Kyriakoulis et al., 2021). Similarly, cayenne pepper can create a strong sensory experience without the burning sensation associated with chilli (O'Neill, n.d.). Crunchy foods can offer much-needed sensory feedback to the jaw, particularly for non-speaking individuals who may not receive the same regular oral and jaw sensory feedback associated with speaking.
Speaking often reduces anxiety: a problem shared is a problem halved. This highlights another disadvantage for non-speaking individuals: they may not be able to share their worries, discuss their emotions or self-advocate in the same way as their speaking peers. Self-advocacy therefore had to be part of the solution.
Their bottle was filled with ice, with the same amount of water added, so that the amount of water they were taking in each day could be measured and monitored against appropriate safety thresholds. It was decided that their water intake would not be limited unless these thresholds were exceeded, as we wanted to observe the impact of the interventions without introducing additional variables.
A pica box was also implemented, containing crunchy vegetables and a few selected spices, including rosemary leaves, cayenne pepper and small strips of ginger. The initial selection of items was made collaboratively with the parent, OT and staff who knew the young person well. As the intervention progressed, the young person began choosing what went into their pica box each morning as part of their daily routine.
The young person was also shown where the freezer was and encouraged to take part in adding ice to their bottle when it needed refilling. This was intended to support greater independence and, over time, allow them to recognise and communicate what they needed without relying entirely on adult direction.
All interventions were replicated at home.
Three month follow-up visit
The young person:
Had stopped visiting the kitchen to self-regulate.
Carried their own pica pouch and took it to staff when it was empty, choosing what they wanted to put in it.
Was consuming safe quantities of water and would take their bottle to the fridge, indicating when they wanted more ice after it had melted.
Was interacting much more with staff, seeking them out for comfort and to make requests. They were also spending more time engaged in lessons.
Was independently using the outside area to regulate, taking a blanket with them when they needed to get cold on the face and hands but wanted to keep their core warm.
Had no known UTI in the three months.
Meeting need, advocacy and self-regulation
The intervention had not simply stopped a behaviour; the young person had learned safer ways of meeting the need that the behaviour had identified. They were still regulating themselves, but now they had safe alternatives and the adult support needed to use them safely. As their ability to communicate their needs increased, so did their independence. Advocacy was therefore not something separate from self-regulation; it was part of it. The young person could indicate what they needed, make choices and seek support from familiar adults. Interestingly, this appeared to increase rather than reduce their interaction with adults.
If you’d find it helpful to explore the topic of pica and polydipsia further, I’ve created a needs‑led online course for schools. You can access it here:https://louise-s-site-a81e.thinkific.com/products/courses/pica-polydipsia-school-training
References
Cain, T., Brinsley, J., Bennett, H., Nelson, M., Maher, C., & Singh, B. (2025). Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis. PLOS ONE, 20(1), e0317615. https://doi.org/10.1371/journal.pone.0317615
Kyriakoulis, P., Kyrios, M., Nardi, A. E., Freire, R. C., & Schier, M. (2021). The implications of the diving response in reducing panic symptoms. Frontiers in Psychiatry, 12, 784884. https://doi.org/10.3389/fpsyt.2021.784884
O'Neill, B. (n.d.). Cayenne pepper. https://files.beyondpatmos.org/vid/1203/barbara_oneill/poultices/barbara_oneill_poultices_n_their_applications.pdf
