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Poor Grades and Constipation

LD and ADD/ADHD Expert Advice from Jerome J. Schultz, Ph.D.

Q: Our seventh grade son is having trouble in school with his grades and constipation. When we noticed that he would go up to a month without a bowel movement, we took him to see a gastroenterologist. Our son has been this way his whole life, but not until he started to reach middle school age was he trying to hide the fact that he couldn't have a bowel movement. He had an IEP done in sixth grade. We also had him tested for any learning disabilities at school. They indicated he fell within the "normal" limits. We knew something was still wrong so we pursued some help from a psychologist. Both the gastroenterologist and the psychologist thought that our son might have some problems processing information either auditory or visual, and there might be some connection between the constipation and not being motivated in school. We have seen a neurologist who had him get an EEG and an MRI. Everything is coming up normal. However the neurologist thinks he might have ADD without the hyperactivity. She wants to put him on medication. We tried Ritalin® for three months when he was in fifth grade and we didn't like the effect it had on him. He was like a zombie. We tried Cylert® for about nine months in sixth grade and it seemed to help, but he said he felt hyper inside and we thought it was adding to his constipation. At his request we agreed to take him off it. Please help us with our son! He is twelve now and has been on Lactulose for almost a year to help have a bowel movement. Lately though, that doesn't even seem to be working. We cannot find very much information on this subject and would greatly appreciate your advice. Thanks for your time.

P.S. He says he's trying to do better on his grades yet he fails to turn stuff in or he tunes out when he doesn't understand. The schools are not very helpful when it comes to kids who are not motivated to learn.

A: Bowel and bladder problems are difficult at any age, but the worst time is middle school, when kids are so concerned about what the others will think. When you've got a bowel problem, it may show up as soiling or accidents, or excessive gas, all of which can really ruin the life of a kid in middle school. You son has had these problems for a long time, so they most certainly create some anxiety for him (not to mention the impact on the family). When your son is worried about going to the bathroom or what other kids are thinking, he's using up energy that could be used for school. I'm working with a young man who has a similar problem. In therapy with me, he disclosed that he is always worried about "f--ting" in class. What a worry! He, too, has learning problems that aren't explained by LD or ADHD.

You mentioned that professionals have suggested that your son has attention deficit disorder. That may be an accurate diagnosis (except that Ritalin® wasn't helpful), but I think the bowel problem may be playing a role. If any of us were constipated all the time, we'd probably focus on the discomfort and have a hard time paying attention to other things. His low level of motivation may be a sign that he's a bit depressed (who wouldn't be?).

It sounds to me like this problem has gone on for a very long time, without any real resolution. I think there's a need for more intensive intervention. Have you considered having your child checked into a hospital or clinic that specializes in bowel and bladder problems? They could observe him over a week or so, taking a closer look at his diet (liquid and solid intake), his emotional status, family involvement, and the effects of counseling. He could continue his schoolwork from the clinic; you could even request that he be evaluated by the school problems clinic staff while he's there. Your son needs a multi-disciplinary evaluation by professionals who can compare notes and come up with a successful treatment plan. I know this sounds a bit drastic, but it seems a real shame for this to continue, when a solution may be available.

More on: Expert Advice

Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.


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