Episode 10: A Gut Feeling—Constipation, Anxiety, and ADHD in Children
Guest: Dr. Gretchen Hoyle

In this enlightening episode of Nimble Youth, pediatrician Dr. Gretchen Hoyle returns to tackle a topic that’s both common and frequently misunderstood: chronic constipation and stool withholding in children. What may seem like a simple digestive issue is often a complex interplay between physical discomfort, behavioral habits, and underlying mental health challenges such as anxiety and ADHD.

Dr. Hoyle unpacks how children can fall into a cycle of withholding stool—often due to discomfort, embarrassment, or fear—which leads to abdominal pain, functional constipation, and in some cases, encopresis (involuntary stool leakage). She explains how these physical symptoms are not always isolated but can be part of a broader mind-body connection, especially in children with diagnosed or emerging anxiety or ADHD.

Key Topics Covered:

• Why children may begin withholding stool and how it becomes a chronic issue

  
  

• The connection between constipation and mental health conditions like ADHD and anxiety

  
  

• Understanding the feedback loop between physical symptoms and emotional distress

  
  

• Dr. Hoyle’s step-by-step approach to treatment, including clean-outs, maintenance with MiraLAX, and behavioral retraining

  
  

• Practical toileting routines and environmental supports to prevent recurrence

  
  

• How parents, schools, and pediatricians can work as a team to support a child

  
  

• Screening for anxiety and ADHD when GI symptoms don’t resolve

  
  

• Why summer is the perfect time to build healthy bathroom habits before school resumes

  
  

Resources:

• Mind-Body Cycle of Constipation (Downloadable Graphic)

  
  

• SCAS (Spence Children’s Anxiety Scale) and other screening tools

  
  

• Sample letter for school to support flexible bathroom access

  
  

Quote of the Episode:
"For kids with anxiety or ADHD, constipation is rarely just about the gut—it’s about how the brain processes pain, embarrassment, urgency, and control. The good news? It’s highly treatable with a team approach." —Dr. Gretchen Hoyle

Next Episode Teaser:
Join us next time as we explore eating disorders in adolescents, debunking myths and examining the serious impact these conditions can have—regardless of gender.

Subscribe & Share:
If this episode resonated with you or you know a family facing these challenges, please share it. You can find all past episodes, full transcripts, and helpful resources at www.nimbleyouthpodcast.com.

🩹 Episode 9: Understanding Cutting and Non-Suicidal Self-Injury (NSSI) in Youth

Guest: Dr. Gretchen Hoyle | Host: Nimble Youth Podcast

Cutting and other forms of non-suicidal self-injury (NSSI) are difficult topics for any parent or caregiver to confront—but they’re more common than many realize. In this episode, Dr. Gretchen Hoyle returns to guide us through understanding this complex behavior. We explore why some kids turn to self-injury as a coping mechanism, how to spot signs of it, and most importantly, how to respond with empathy, structure, and support.

🧠 What We Cover in This Episode:

• What NSSI is—and what it isn’t
• Why cutting is not the same as a suicide attempt, but why both require urgent attention
• Common patterns: where injuries tend to occur and what they look like
• Why kids often don’t “grow out of it” without help
• Practical first steps when a parent discovers self-injury
• The power of remaining calm, curious, and connected
• How therapy—and sometimes medication—can help
• Creative and sensory-based coping strategies (e.g., ice cubes, journaling, mindfulness)
• The role of emotional literacy and distress tolerance in recovery
• Common triggers—such as the loss of a romantic relationship—and how they impact teens
• Why consistency matters, and how healing is rarely linear

🧰 Resources Mentioned:

• “Treating Self-Injury” by Barent Walsh (recommended by Dr. Hoyle)
• Prior podcast episodes on anxiety and depression in teens (for related context)
• Techniques like mindfulness, journaling, and sensory distractions to replace harmful behaviors

💬 A Note to Parents:

Self-injury is often misunderstood as “attention-seeking,” but in truth, it’s a call for connection and a signal of emotional overwhelm. Kids who self-injure often feel shame and want to stop—but need tools and support to do so. This episode emphasizes approaching your child with empathy, seeking professional help, and knowing that healing is possible.

🔗 Connect With Us:

Visit www.nimbleyouthpodcast.com to access:

• Full episode transcripts
• Show notes from past episodes
• Newsletter sign-up
• Resources for families and caregivers

If this episode resonated with you, please consider sharing it with a fellow parent or leaving us a review. Your support helps us reach more families who need it.

🎧 You're not alone. Better support is possible.

If you’ve ever felt like you’re the one doing all the care coordination for your child—between doctors, therapists, teachers, and insurance companies—you’re not alone. The mental health system hasn’t always made it easy. But there’s a new model that’s starting to change that: it’s called the Psychiatric Collaborative Care Model, or Collaborative Care for short.