Autism and incontinence in teenagers

My grandson is almost 14 and has been toilet trained for some time.
Lately he has moved schools and seems happy there and his father has recently started a job after being his main carer. His mum also cares for him and works as well. Recently he has stopped eating and developed bowel incontinence. He makes no effort to reach the toilet at all. He does not eat much at school and when home at weekends will eat but has the ongoing incontinence. Blood tests have so far not shown any problem but no further tests have been done yet due to the dificulty of this type of thing.
Could this be an emotional reaction to puberty changes? What can be done to manage it?

[Jessica L Thomason Sassi, Ph.D., BCBA-D]

My first recommendation would be to continue to pursue possible medical conditions – it is concerning that the bowel incontinence and reduce food intake occurred at the same time. Changes in school setting could definitely have a drastic effect on kids with developmental delays, but I would look to rule out any medical issues first.  While you are doing so, you might also take the time to find out what his routine is like at school (either by interviewing the teachers and paraprofessionals, or by actually going in to observe, if they will allow it).  With respect to meals: was there a large change in his meals across the two schools?  Are the foods different?  Was he eating in a quiet classroom before, but now is in a noisy cafeteria?  Does he have sufficient time to eat?  Are the foods served substantially different?  Were people there reminding him/helping him to eat his lunch before, whereas they expect him to be more independent now?  I would ask similar questions with respect to toileting routines: Does he have adequate access to the bathroom?  Is he prompted to go into the bathroom and sit occasionally, even if he doesn’t ask to use the bathroom?  Are there incentives for using the bathroom properly (e.g., some kind of token program)?  Asking the school to consider some of these strategies – frequent prompts, allowing adequate access to foods/bathroom facilities – might make a difference.  
I’d also look at the consequences for food refusal and toileting accidents.  Does he get a lot of attention (e.g., are teachers preoccupied during the start of the meal, but become concerned and hover over him when he doesn’t eat?  Or does he have to stay at his desk until he’s eaten a certain amount, thereby missing the next scheduled – and possibly disliked – activity?
Figuring this out can be difficult, and depending on the extent of the problem, you might find it helpful to get the advice of a certified behavior analyst.  If the school doesn’t have one on their faculty, you might look at the BACB website (http://www.bacb.com/index.php?page=100155) to find a local provider.

Best of luck to you