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Gastrointenstinal problems more prevalent in autistic children

Children with autism spectrum disorder (ASD) are much more likely to general gastrointestinal (GI) complaints than their peers, says study conducted by researchers at Marcus Autism Center, Children’s Healthcare of Atlanta and Emory University School of Medicine. The findings were reported in the April 28, 2014, online early issue of the journal Pediatrics.

William Sharp, director of the Pediatric Feeding Disorders Program at Marcus Autism Center and assistant professor of pediatrics at Emory School of Medicine
Photo of William Sharp by the Emory School of Medicine

Parents frequently express concerns to clinicians in pediatric settings regarding GI symptoms in their autistic children. The study is the first meta-analysis of all published, peer-reviewed research on 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."

Behavioral, medical, and neurological issues associated with autism complicate the detection and study of GI concerns in autistic children. Since autistic children have difficulty communicating verbally, medical professionals must interpret non-verbal signs that are not a part of a 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 the 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."

Study findings:

  • Autistic children are more than four times more likely to experience general gastrointestinal (GI) problems than their peers
  • They are more than three times as prone to experiencing diarrhea and constipation than their peers
  • They complain twice as much about abdominal pain compared to their peers
  • The researchers emphasized the need for medical professionals to develop a standardized screening instrument and clinical guidelines for GI examinations in autistic children, particularly for kids who are non-verbal. More detailed procedures could also help the ASD community to be more aware of the symptoms of GI disorders.

Food restrictions can also affect autistic children with GI conditions. "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."

"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."

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