New study confirms increased prevalence of GI symptoms among children with autism


April 29, 2014
Brain & Behavior, Health

A new study conducted by researchers at Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine indicates that children with autism spectrum disorder (ASD) are more than four times more likely to experience general gastrointestinal (GI) complaints compared with peers, are more than three times as prone to experience constipation and diarrhea than peers, and complain twice as much about abdominal pain compared to peers.

The results are reported in the April 28, 2014, online early edition of the journal Pediatrics.

While parents frequently express concern regarding GI symptoms among children with ASD in pediatric settings, this study is the first meta-analysis of all published, peer-reviewed research relating to this topic.

“Our findings corroborate a history of anecdotal reports and case studies suggesting increased risk of GI concerns in autism,” says co-author William Sharp, PhD, director of the Pediatric Feeding Disorders Program at Marcus Autism Center and assistant professor of pediatrics at Emory University School of Medicine. “This analysis reinforces the need for greater clinical and research scrutiny in this area to guide best standards of care and to address important questions regarding the detection and treatment of GI symptoms among children with autism.”

The process of detecting and studying possible GI concerns in children with ASD is complicated by the unique combination of behavioral, neurological and medical issues associated with the condition. Most notably, limitations in verbal communication in patients with ASD make it difficult for them to communicate information about GI symptoms, making it more challenging for physicians to detect possible underlying GI issues. In such cases, parents and medical professionals must rely on non-verbal signs that fall outside of the routine GI diagnostic evaluation.

“In many cases, the only indication of a possible GI problem in autism may be the emergence or escalation of problem behaviors, such as self-injury, aggression, or irritability, that cannot be otherwise explained,” says co-author Barbara McElhanon, MD, pediatric gastroenterologist at Children’s Healthcare of Atlanta and assistant professor of pediatrics at Emory University School of Medicine. “Relying on these atypical signs to detect possible GI concerns can be difficult for practitioners because repetitive and stereotyped patterns of behavior occur so frequently in ASD and no guidelines exist to help parents and clinicians navigate the diagnostic process.”

For this reason, McElhanon and her colleagues emphasize the need to develop a standardized screening instrument as well as clinical guidelines for conducting GI examinations among children with ASD, particularly non-verbal children. More detailed, standardized screening procedures would enhance detection, while also increasing awareness in the ASD community regarding what to look for among children suspected of possible GI disorders.

“The important point from this research is that children with autism—who have difficulties in communicating their symptoms—need special attention from physicians to determine whether or not a child is experiencing GI distress” says Sharp. “Unfortunately for parents, the unfounded assertion that vaccinations somehow caused an inflammatory GI disease which then caused autism has significantly hindered progress in this field for years. Many studies have now shown no evidence of an association with vaccines, and vaccines are important for child health. That controversy diverted attention from the GI needs of children with ASD, and we hope that our work helps spur renewed investment for addressing these needs.”

In addition to more standardized assessment, the authors recommend studying GI symptoms in ASD with consideration to the high rates of feeding problems and related dietary issues, such as food selectivity, in this population. “If food intake becomes highly restricted, a child is likely to experience issues like GI distress and constipation or diarrhea; but for children with autism, they often can’t communicate those issues in the same way,” says McElhanon. “More research is needed to understand the best means of identifying and treating these special health needs of children with ASD.”


3 Responses to New study confirms increased prevalence of GI symptoms among children with autism

  1. HP van Schalkwyk (u14040914) April 30, 2014 at 1:30 pm #

    There is clearly a very definitive link between Autism and GI complaints. It is well proven and established as seen from this article. However there is still clearly a lot of research that needs to be done before this link can be used for effective treatment. This is a very difficult field to research as the subjects under scrutiny are very uncooperative and are not good at verbal communication. The signs and symptoms that can be used to diagnose are very unreliable. This is clearly requires a very specific and unique method of diagnosis that will still require a lot of research before it will be flawless.
    This process also has clear ethical dilemmas linked to it, that have to be addressed. As these are children with impaired social functioning there can occur problems when a process of diagnoses is formed. Practitioners will have to work around these problems.
    An important question is how long it will take to form a reliable process of diagnoses for GI complaints in ASD children? Will it not be more effective to work on possible treatment specifically aimed at people with Autism? While research is done on processes of diagnoses, children with Autism continue to struggle with GI complaints and they have no way to communicate this to a practitioner.

  2. Michelle (14006902) Wears-Taylor April 30, 2014 at 11:46 am #

    Autism spectrum disorder (ASD) is a disability that can cause behavioural, social and communication barriers. According to the article, children with ASD are more prone to have general gastrointestinal (GI) complaints than other children. The problem is that the autistic children struggle to communicate. This causes that the GI could worsen without the parents noticing. I agree with the new research that has been conducted – which suggests that a standardized screening instrument should be developed that can detect GI symptoms. This will especially help children suffering from ASD. The parents of children suffering from ASD should be thoroughly educated in the symptoms and risks of GI. They should also be given information on special diets that could possibly decrease the risk of their children developing GI symptoms.

  3. Emelina Nizere 14128846 April 30, 2014 at 12:23 am #

    EMelina Nizere 14128846

    I once had the privilege of encountering the treatment and medical interactions associated with Autistic children so I am aware of the communication difficulties that are a daily struggle in their lives.
    So in addition to probing research into a diagnostic machine I also think it is important to incorporate and take full advantage of the role a Speech and Hearing Therapist plays in the life of an autistic child’s life. They see the child on a regular basis and work with the parents to develop a communication system that will allow for the child’s basic needs to be met. So if the therapist is aware of the recurrence of Gastrointestinal symptoms in Autistic children, they can teach the child a effective way of communicating any difficulty they may be experiencing, allowing for effective treatment when required.
    With regard to the role that diet may play, the fact that Speech and Hearing Therapists pay attention to the dietary habits of their patients (due to the effect it has on the throat, which plays a role in communication)

    Treating communicative disorders like Autism is a very complex situation that requires input from all the parties that interact with the patient, so it only makes sense that any research into improvement on treatments should be just as inclusive so as to allow for effective resolutions to be reached.

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