Whenever there are changes in behavior, we've learned it's a good idea to rule out any possible health or medical issues. Ever since Kellen was a baby, his mood has been largely determined by whether or not he is "backed up" because he has Hirschsprung disease .
We work with his diet and were giving him an over the counter laxative as necessary since he was a toddler. Still, he had occasional bouts of "tummy trouble." Kellen doesn't tell us verbally when he is hurting, but we can usually tell as he gets grumpy and won't eat. Since he loves to eat, when he refuses food, we are clued in that he is definitely backed up.
Just after Kellen's fifteenth birthday, he went from having difficulty with transitions, to literally refusing to move. He didn't want to go to school and when he got there, he wouldn't leave his desk all day and wouldn't come home after school. We didn't know if this was a new puberty "surprise", or something entirely different. Finally, there was a day that he wouldn't sit down, wouldn't walk, and literally stood in the doorway of his classroom all morning, half in and half out. Even though we had recently been to his pediatrician for a check-up, I was positive that there had to be something seriously wrong.
I called Kellen's dad from the school and asked him to leave work, meet us at the school and take Kellen straight to the doctor. I know that sweet husband is not much for strong advocacy, but I begged him to not leave the doctor's office until they had xrayed his colon. Sure enough, they could see in the x-ray that his bowels were full with a large gas bubble trapped behind. He had been in so much pain, but had not been able to verbalize it to us.
Kellen's dad is a nurse and had strong feelings about Kellen not being dependent on a laxative. After that day we had a long conversation about putting Kellen on a daily dose of Miralax indefinitely. I feel that he has the right to feel well and that he had enough trouble dealing with puberty without also having to deal with pain. Miralax is insurance so we won't need to guess whether or not Kellen is backed up. Does it solve all of our problems? No. Addressing Kellen's medical issues are simply a piece of the puzzle that is puberty.