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.

In this episode, we’re talking about a mental health crisis that is quietly, and sometimes invisibly, reshaping the lives of millions of young people—particularly adolescent girls. Anxiety and depression have been on the rise among teens for over a decade, but the numbers for girls are especially stark—and deeply concerning. Our guest today is Dr. Gretchen Hoyle, a pediatrician with 25 years of experience and a focus on child and adolescent mental health.

In this episode of Nimble Youth, host Matt Butterman and pediatrician Dr. Gretchen Hoyle explore how anxiety presents in young children — often in ways that can be mistaken for defiance, avoidance, or behavioral issues. Dr. Hoyle discusses how anxiety can show up as tummy aches, refusal to go to school, or resistance to routine activities, and why understanding the root of these behaviors is so important.

Topics Covered:

• How anxiety in young children differs from what we typically see in older kids or adults
• The role of “felt safety” in helping kids navigate their emotions
• How caregivers can serve as co-regulators for their children
• Signs that anxiety might require intervention
• Evidence-based approaches including therapy and, when appropriate, medication
• Why early intervention is key to better outcomes

Dr. Hoyle also walks us through the treatment landscape, including when therapy alone may be enough, and when medications—specifically SSRIs like Prozac, Zoloft, or Lexapro—might be helpful. She addresses common parental concerns about medication and emphasizes that most kids just want to feel well enough to function, connect with others, and thrive in everyday settings like school.

The conversation also touches on how anxiety and depression can be interconnected over time, and why addressing anxiety early can prevent the development of more serious issues down the line.

Key Takeaways:

• Anxiety in children is common and treatable
• Therapeutic approaches like play therapy can be especially useful for younger kids
• SSRIs are sometimes used in pediatric populations and have been shown to be effective
• Parental instincts are important—don't wait to ask for help if something feels off
• Anxiety and depression can be closely linked; early support can prevent escalation

“Kids don’t want to feel this way. They want to go to school, see their friends. They want to thrive.” — Dr. Gretchen Hoyle

Looking Ahead:

In our next episode, we’ll explore anxiety and depression in adolescent girls. The following episode will focus on boys and young men. These next two parts will dig deeper into how anxiety shows up differently across genders and developmental stages.

Subscribe at www.nimbleyouthpodcast.com so you don’t miss an episode. Show notes and links from each episode are also posted there.

Thanks for joining us. Until next time, remember: raising a mentally nimble child isn’t just about preparing them for the world — it’s about helping them thrive in it.

In the final installment of our three-part ADHD series, we explore the real-world challenges and decision-making processes behind ADHD medication management in children. Dr. Gretchen Hoyle returns to guide us through:

🧠 Topics Covered

• Medication combinations and why stimulants are often paired with alpha-2 agonists

  
  

• How insurance formularies influence medication choices more than many parents realize

  
  

• Age-specific prescribing, including alternatives for children who can't swallow pills

  
  

• Navigating medication shortages and supply chain disruptions

  
  

• The role of trial and error in ADHD medication—and how to manage it

  
  

• Introducing genetic testing tools like GeneSight to guide personalized treatment

  
  

• Managing co-occurring conditions such as anxiety and depression alongside ADHD

  
  

• Importance of close monitoring, including questionnaires and side effect screening

  
  

• Why collaborative care between families and physicians leads to the best outcomes

  
  

🧪 Mentioned in This Episode

• GeneSight® – A pharmacogenomic test that analyzes how genes may affect medication response

  
  

• Vanderbilt ADHD Diagnostic Rating Scales – Used to monitor symptoms and side effects

  
  

• Alpha-2 agonists – Medications like guanfacine and clonidine, often used in combination with stimulants

  
  

📝 Key Takeaways

• ADHD treatment is not one-size-fits-all; medication choice depends on medical, practical, and systemic factors

  
  

• Parents play a critical role in observing and reporting how medications are affecting their child

  
  

• While most children respond well to first-line medications, new tools like genetic testing can provide valuable insights—especially in complex cases

  
  

• Regular follow-ups, screening tools, and open communication are essential to long-term success

  
  

📌 Resources

• www.nimbleyouthpodcast.com – Access episode transcripts, past recordings, and more

  
  

• Learn more about GeneSight Testing
  
  
• Read about ADHD Medication Shortages (CDC)
  
  

🔜 Next Up on Nimble Youth

We're launching a new series on Anxiety in Children:

• Part 1: Anxiety in younger children

• Part 2: The unique experience of teenage girls

• Part 3: Addressing the growing crisis among adolescent boys

Episode Summary:

In this third episode of our special series on ADHD, we’re back with Dr. Gretchen Hoyle to explore the collaborative care model—a modern, team-based approach to managing ADHD in children. Dr. Hoyle walks us through how pediatricians, behavioral health care managers, and mental health specialists work together to provide holistic, accessible, and proactive care for families navigating ADHD.

We discuss the real-world challenges parents face—like communicating with schools, accessing therapists, and getting insurance to cooperate—and how collaborative care lifts the burden. Dr. Hoyle shares actionable tips for parents, including how to support ADHD at home, the importance of routines, and why keeping phones out of kids’ bedrooms might be one of the most powerful changes you can make.

This is an insightful, honest, and practical conversation for any caregiver raising a child with ADHD.

🔑 Key Topics Covered:

• What is collaborative care and why it matters

  
  

• The role of behavioral health care managers

  
  

• Challenges with accessing therapy and insurance hurdles

  
  

• Parent coaching and support between appointments

  
  

• Why sleep (and screen time) is central to ADHD management

  
  

• Quantifying mental health outcomes using data and registries

  
  

• How to set realistic expectations for kids with ADHD

  
  

• The evolving landscape of pediatric mental health post-pandemic

  
  

🛠️ Resources Mentioned:

• Russell Barkley’s ADHD parenting resources

  
  

• The Anxious Generation by Jonathan Haidt

  
  

📌 Takeaway Tip for Parents:

Knowledge is power. Understanding ADHD and creating supportive, structured environments can transform the day-to-day experience for both you and your child.