Recently I started seeing an 8 year old girl diagnosed with ODD and ADHD as well as impaired IQ at 6yo. 

Notable features include:

  • She has variable bowel and bladder control – often coming home from school with wet pants and a Bristol type 1 stool in her underwear.  She increasingly complains of abdominal pain and an itchy bottom in spite of being ‘wormed’. 
  • Being on Ritalin, which acts as an appetite suppressant, she has limited interest in food, often bringing home a full lunch box from school, however, she reliably drinks milk (loves) and is keen on noodles, biscuits, pancakes, toast etc and also loves salty foods. 
  • She is short in stature at 114cm and weighs 22.8kg at presentation which places her on the 10th percentile for weight and below the 5th for height on the pediatric growth charts. 
  • She also repeatedly gets styes. 


Referral for pathology testing reveals a zinc: copper imbalance, eosinophils are borderline suggesting further investigation for GIT pathogens is warranted but a tTG (tissue transglutaminase) of 32 U/mL (should be <7) as well as markedly raised anti-gliadin antibodies confirming that she is in fact suffering from Coeliac disease.