Case Series: Constipation and Fecal Incontinence in Children with ADHD and Autism Spectrum Disorder

The comorbidity of gastrointestinal (GI) diseases is high among attention deficit and hyperactivity disease (ADHD) children with autism spectrum disorder (ASD). Previous investigations report fecal incontinence and constipation as the most prevalent GI disorders among ADHD-ASD children, posing clinical questions regarding effective management approaches. This case series investigates the incidences, symptomatology and behavioral disorders reported by children with and without histories of ADHD and ASD to inform evidence-based interventions and policy. Methods. This case series investigated gastrointestinal abnormalities among 12 preschoolers in a psychiatric clinic. The investigation considers a history of children with GI disorders and comorbidity with psychiatric illness. Parents’ and teachers’ accounts of children informed the clinical decisions. The case series reported a higher incidence of constipation and fecal retention among male than female children, 7 and 5, respectively. The international classification confirmed the signs and symptoms reported by constipated children, including high avoidance of school and public restrooms and a preference for home restrooms. Behavioral disorders like hyperfocus, which are a defense mechanism against the sensory-rich school environment, marked the incidence of the disorders. However, clinical interventions like stool softeners, including polyethylene glycol, and other laxatives were administered to stimulate defecation by enhancing bowel motility. The cognitive behavioral therapy was indicated to the children to impart coping skills necessary to handle sensory-rich environments. Preschoolers presented fundamental behavioral disorders and other symptoms, including hyperfocus, fecal incontinence at home and retention at school due to the sensory-rich environments. Medications like laxatives and stool softeners enhance bowel movement, whereas psychotherapy enhances children’s coping skills to prevent the withholding of feces in sensory-rich environments like schools and other public places. These interventions alleviated symptoms and improved the children’s quality of life. Keywords: Pediatric Constipation, Fecal Incontinence, ADHD, Autism Spectrum Disorder (ASD), Neurodevelopmental Disorders