GI Troubles Common, Linked to Negative Behaviors in Autism

Megan Brooks

November 14, 2013

Children with autism spectrum disorder (ASD) are far more likely to have gastrointestinal (GI) problems such as constipation, diarrhea, and food sensitivities than their typically developing peers, a new study shows.

The researchers from the University of California, Davis, MIND Institute in Sacramento also found that GI issues may contribute to behavioral problems, including social withdrawal, irritability, and repetitive behaviors.

"The take-away message for clinicians is to pay attention to GI function of their patients with ASD," Virginia Chaidez, PhD, RD, who led the study while at UC Davis Department of Public Health Sciences, told Medscape Medical News. She is now with the State Office of the UC CalFresh Nutrition Education Program.

"A big step in helping families get the appropriate treatment and improving their quality of life can start simply by asking parents of young children about their bowel habits and helping them understand what kinds of things to look for related to GI function," Dr. Chaidez said.

The study is published in the November issue of the Journal of Autism and Developmental Disorders.

Unanswered Question

There have been anecdotal reports of GI problems in children with ASD for quite some time, "but the question about whether GI problems are truly more prevalent in children with an ASD remained unanswered," said Dr. Chaidez.

"This analysis set out to help answer that question, and because this was a population-based study, it provides a better representation of the true prevalence of GI problems in children with ASD. Furthermore, it suggests that GI problems are associated with more problematic behaviors," she added.

Dr. Virginia Chaidez

Participants included 960 children aged 24 and 60 months at enrollment in the ongoing Childhood Autism Risks from Genetics and the Environment (CHARGE) Study in Northern California. The cohort included 499 children with ASD, 137 with developmental delay (DD), and 324 typically developing (TD) children. Their parents completed the CHARGE Gastrointestinal History Questionnaire (GIH) and the Aberrant Behavior Checklist (ABC).

Comparison of parent reports suggests that children with either ASD or DD are far more likely than TD children to "frequently" have a variety of GI symptoms, in particular, diarrhea and constipation, as well as sensitivity to foods.

After adjusting for use of medications with potential GI side effects, compared with TD children, children with ASD were 6 to 8 times more likely to report frequent gas/bloating, constipation, diarrhea, and sensitivity to foods. Reported food allergies, food restrictions, and food dislikes were also most common in children with ASD.

Children with DD were significantly more likely to report constipation, difficulty swallowing, and vomiting.

Maladaptive Behavior Link

Importantly, the researchers note, there was a "consistent relationship" between GI symptoms and maladaptive behavior in children with ASD.

"It is plausible that a chronic GI symptom, which can cause pain, discomfort and anxiety, could contribute to increased irritability and social withdrawal, particularly in someone with deficits in social and communicative skills," they write. "Furthermore, for a child with ASD, increased stereotypy and hyperactivity may represent coping mechanisms for an uncomfortable and unpredictable GI condition."

"Until clinicians and therapists consider a thorough GI history as a possible explanation for adverse behaviors, GI disorders in this population will continue to be overlooked and insufficiently treated. Appropriate treatment of GI symptoms may help alleviate at least some problematic behaviors and improve the quality of life in children with ASD along with their families," the investigators conclude.

They note that the mechanisms or contributing factors for the GI problems in kids with ASD remain to be flushed out.

The study was funded by the National Institute of Environmental Health Sciences, the US Environmental Protection Agency, Autism Speaks, and the UC Davis MIND Institute. The authors report no relevant financial relationships.

J Autism Dev Disord. Published online November 6, 2013. Abstract

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