Journal of Autism and Developmental Disorders

, Volume 39, Issue 3, pp 405–413 | Cite as

Gastrointestinal Symptoms in a Sample of Children with Pervasive Developmental Disorders

  • Roumen N. Nikolov
  • Karen E. Bearss
  • Jelle Lettinga
  • Craig Erickson
  • Maria Rodowski
  • Michael G. Aman
  • James T. McCracken
  • Christopher J. McDougle
  • Elaine Tierney
  • Benedetto Vitiello
  • L. Eugene Arnold
  • Bhavik Shah
  • David J. Posey
  • Louise Ritz
  • Lawrence Scahill
Original Paper

Abstract

Objective To evaluate gastrointestinal (GI) problems in a large, well-characterized sample of children with pervasive developmental disorders (PDDs). Methods One hundred seventy two children entering one of two trials conducted by the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were assessed comprehensively prior to starting treatment and classified with regard to GI symptoms. Results Thirty nine (22.7%) were positive for GI problems, primarily constipation and diarrhea. Those with GI problems were no different from subjects without GI problems in demographic characteristics, measures of adaptive functioning, or autism symptom severity. Compared to children without GI problems, those with GI problems showed greater symptom severity on measures of irritability, anxiety, and social withdrawal. Those with GI problems were also less likely to respond to treatment.

Keywords

Autism Chronic gastrointestinal problems Pervasive developmental disorders 

Notes

Acknowledgments

This study was part of research activities of the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. The RUPP network was funded by NIMH: N01MH70001 to IU, N01MH80011 to OSU, N01MH70010 to UCLA, N0MH70009 to Yale. We acknowledge the efforts of James Robinson, MED, Shirley Chuang, MS, for data management. The opinions and assertions contained in this report are the private views of the authors and are not to be construed as reflecting the views of the Department of Health and Human Services, the National Institutes of Health, or the National Institute of Mental Health.

References

  1. Afzal, N., Murch, S., Thirrupathy, K., Berger, L., Fagbemi, A., & Heuschkel, R. (2003). Constipation with acquired megarectum in children with autism. Pediatrics, 112, 939–942. doi: 10.1542/peds.112.4.939.PubMedCrossRefGoogle Scholar
  2. Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). Psychometric characteristics of the Aberrant Behavior Checklist. American Journal of Mental Deficiency, 89, 492–502.PubMedGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Text revision (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  4. Arnold, L. E., Aman, M. G., Martin, A., Collier-Crespin, A., Vitiello, B., Tierney, E., et al. (2000). Assessment in multisite randomized clinical trials of patients with autistic disorder: The Autism RUPP Network Research Units on Pediatric Psychopharmacology. Journal of Autism and Developmental Disorders, 30, 99–111. doi: 10.1023/A:1005451304303.PubMedCrossRefGoogle Scholar
  5. Autism Genome Project Consortium. (2007). Mapping autism risk loci using genetic linkage and chromosomal rearrangements. Nature Genetics, 39, 319–328. doi: 10.1038/ng1985.CrossRefGoogle Scholar
  6. Balzola, F., Barbon, V., Repici, A., & Rizzetto, M. (2005). Panenteric IBD-like disease in a patient with regressive autism shown for the first time by the wireless capsule enteroscopy: Another piece in the jigsaw of this gut-brain syndrome? The American Journal of Gastroenterology, 100(4), 979–980. doi: 10.1111/j.1572-0241.2005.41202_4.x.PubMedCrossRefGoogle Scholar
  7. Black, C., Kaye, J. A., & Jick, H. (2002). Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database. BMJ (Clinical Research Ed.), 325, 419–421. doi: 10.1136/bmj.325.7361.419.CrossRefGoogle Scholar
  8. Brinkley, J., Nations, L., Abramson, R. K., Hall, A., Wright, H. H., Gabriels, R., et al. (2007). Factor analysis of the Aberrant Behavior Checklist in individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1949–1959. doi: 10.1007/s10803-006-0327-3.PubMedCrossRefGoogle Scholar
  9. Brown, E. C., Aman, M. G., & Havercamp, S. M. (2002). Factor analysis and norms for parent ratings on the Aberrant Behavior Checklist-Community for young people in special education. Research in Developmental Disabilities, 23, 45–60. doi: 10.1016/S0891-4222(01)00091-9.PubMedCrossRefGoogle Scholar
  10. D’Eufemia, P., Celli, M., Finocchiaro, R., Pacifico, L., Viozzi, L., Zaccagnini, M., et al. (1996). Abnormal intestinal permeability in children with autism. Acta Paediatrica (Oslo, Norway), 85, 1076–1079. doi: 10.1111/j.1651-2227.1996.tb14220.x.CrossRefGoogle Scholar
  11. Erickson, C. A., Stigler, K. A., Corkins, M. R., Posey, D. J., Fitzgerald, J. F., & McDougle, C. J. (2005). Gastrointestinal factors in autistic disorder: A critical review. Journal of Autism and Developmental Disorders, 35, 713–727. doi: 10.1007/s10803-005-0019-4.PubMedCrossRefGoogle Scholar
  12. Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. The Journal of Clinical Psychiatry, 66(Suppl), 3–8.PubMedGoogle Scholar
  13. Fombonne, E., & Chakrabarti, S. (2001). No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics, 108, E58. doi: 10.1542/peds.108.4.e58.PubMedCrossRefGoogle Scholar
  14. Fombonne, E., Zakarian, R., Bennett, A., Meng, L., & McLean-Heywood, D. (2006). Pervasive developmental disorders in Montreal, Quebac, Canada: Prevalence and links with Immunization. Pediatrics, 118, 139–150.CrossRefGoogle Scholar
  15. Gupta, A. R., & State, M. W. (2007). Recent advances in the genetics of autism. Biological Psychiatry, 61, 429–437. doi: 10.1016/j.biopsych.2006.06.020.PubMedCrossRefGoogle Scholar
  16. Herbert, M. R., Russo, J. P., Yang, S., Roohi, J., Blaxill, M., Kahler, S. G., et al. (2006). Autism and environmental genomics. Neurotoxicology, 27, 671–684. doi: 10.1016/j.neuro.2006.03.017.PubMedCrossRefGoogle Scholar
  17. Horvath, K., Papadimitriou, J. C., Rabsztyn, A., Drachenberg, C., & Tildon, J. T. (1999). Gastrointestinal abnormalities in children with autistic disorder. The Journal of Pediatrics, 135, 559–563. doi: 10.1016/S0022-3476(99)70052-1.PubMedCrossRefGoogle Scholar
  18. Horvath, K., & Perman, J. A. (2002a). Autism and gastrointestinal symptoms. Current Gastroenterology Reports, 4, 251–258. doi: 10.1007/s11894-002-0071-6.PubMedCrossRefGoogle Scholar
  19. Horvath, K., & Perman, J. A. (2002b). Autistic disorder and gastrointestinal disease. Current Opinion in Pediatrics, 14, 583–587. doi: 10.1097/00008480-200210000-00004.PubMedCrossRefGoogle Scholar
  20. Jensen, J. A., & Armstrong, R. J. (1985). Slosson intelligence test for children and adults. East Aurora, NY: Slosson Educational Publications.Google Scholar
  21. Knivsberg, A. M., Reichelt, K. L., Nodland, N., & Hoien, T. (1995). Autistic syndrome and diet: A follow-up study. Scandinavian Journal of Educational Research, 39, 223–236. doi: 10.1080/0031383950390304.CrossRefGoogle Scholar
  22. Kuddo, T., & Nelson, K. B. (2003). How common are gastrointestinal disorders in children with autism? Current Opinion in Pediatrics, 15, 339–343. doi: 10.1097/00008480-200306000-00020.PubMedCrossRefGoogle Scholar
  23. Lawler, C. P., Croen, L. A., Grether, J. K., & Van de Water, J. (2004). Identifying environmental contributions to autism: provocative clues and false leads. Mental Retardation and Developmental Disabilities Research Reviews, 10, 292–302. doi: 10.1002/mrdd.20043.PubMedCrossRefGoogle Scholar
  24. Lecavalier, L., Aman, M. G., Scahill, L., McDougle, C. J., McCracken, J. T., Vitiello, B., et al. (2006). Validity of the autism diagnostic interview-revised. American Journal of Mental Retardation, 111, 199–215. doi: 10.1352/0895-8017(2006)111[199:VOTADI]2.0.CO;2.PubMedCrossRefGoogle Scholar
  25. Levy, S. E., Souders, M. C., Ittenbach, R. F., Giarelli, E., Mulberg, A. E., & Pinto-Martin, J. A. (2007). Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biological Psychiatry, 61, 492–497. doi: 10.1016/j.biopsych.2006.07.013.PubMedCrossRefGoogle Scholar
  26. Lord, C., Pickles, A., McLennan, J., Rutter, M., Bregman, J., Folstein, S., et al. (1997). Diagnosing autism: Analyses of data from the Autism Diagnostic Interview. Journal of Autism and Developmental Disorders, 27, 501–517. doi: 10.1023/A:1025873925661.PubMedCrossRefGoogle Scholar
  27. Lucarelli, S., Frediani, T., Zingoni, A. M., Ferruzzi, F., Giardini, O., Quintieri, F., et al. (1995). Food allergy and infantile autism. Panminerva Medica, 37, 137–141.PubMedGoogle Scholar
  28. Molloy, C. A., & Manning-Courtney, P. (2003). Prevalence of chronic gastrointestinal symptoms in children with autism and autistic spectrum disorders. Autism, 7, 165–171. doi: 10.1177/1362361303007002004.PubMedCrossRefGoogle Scholar
  29. Mullen, E. (1995). The Mullen scales of early learning. Circle Pines, MN: American Guidance Service.Google Scholar
  30. Mussel, M., Kroenke, K., Spitzer, R. L., Williams, J. B., Herzog, W., & Löwe, B. (2008). Gastrointestinal symptoms in primary care: Prevalence and association with depression and anxiety. Journal of Psychosomatic Research, 64, 605–612. doi: 10.1016/j.jpsychores.2008.02.019.CrossRefGoogle Scholar
  31. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. (2002). Risperidone in children with autism and serious behavioral problems. The New England Journal of Medicine, 347, 314–321. doi: 10.1056/NEJMoa013171.CrossRefGoogle Scholar
  32. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. (2005a). Randomized, controlled, crossover trial of methylphenidate in children with pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62, 1266–1274. doi: 10.1001/archpsyc.62.11.1266.CrossRefGoogle Scholar
  33. Research Units on Pediatric Psychopharmacology (RUPP) Autism Network. (2005b). Risperidone treatment of autistic disorder: Longer term benefits and blinded discontinuation after six months. American Journal of Psychiatry, 162, 1361–1369.Google Scholar
  34. Roid, G. H., & Miller, L. J. (1997). Leiter international performance scale-revised: Examiner’s manual. Wood Dale, IL: Stoelting Co.Google Scholar
  35. Saps, M., Sztainberg, M., & Di Lorenzo, C. (2006). A prospective community-based study of gastroenterological symptoms in school-age children. Journal of Pediatric Gastroenterology and Nutrition, 43, 477–482. doi: 10.1097/01.mpg.0000235979.41947.f6.PubMedCrossRefGoogle Scholar
  36. Scahill, L. (2005). Diagnosis and evaluation of pervasive developmental disorders. The Journal of Clinical Psychiatry, 66(Suppl), 19–25.PubMedGoogle Scholar
  37. Scahill, L., McDougle, C. J., Williams, S. K., Dimitropoulos, A., Aman, M. G., McCracken, J. T., et al. (2006). Children’s Yale-Brown Obsessive Compulsive Scale modified for pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1114–1123. doi: 10.1097/01.chi.0000220854.79144.e7.PubMedCrossRefGoogle Scholar
  38. Sparrow, S., Balla, D., & Cicchetti, D. (1984). Vineland Adaptive Behavior Scales. Circle Pines, MN: American Guidance Service.Google Scholar
  39. Sukhodolsky, D.G., Scahill, L., Gadow, K.D., Arnold, L.E., Aman, M.G., McDougle, C.J., et al. (2007). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology; Epub ahead of print.Google Scholar
  40. Taylor, B., Miller, E., Lingam, R., Andrews, N., Simmons, A., & Stowe, J. (2002). Measles, mumps and rubella vaccination and bowel problems or developmental regression in children with autism: Population study. British Medical Journal, 324, 393–396. doi: 10.1136/bmj.324.7334.393.PubMedCrossRefGoogle Scholar
  41. Valicenti-McDermott, M., McVicar, K., Rapin, I., Wershil, B. K., Cohen, H., & Shinnar, S. (2006). Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease. Journal of Developmental and Behavioral Pediatrics, 27, S128–S136. doi: 10.1097/00004703-200604002-00011.PubMedCrossRefGoogle Scholar
  42. Wakefield, A. J., Anthony, A., Murch, S. H., Thomson, M. A., Montgomery, S. M., Davies, S., et al. (2000). Enterocolitis in children with developmental disorders. The American Journal of Gastroenterology, 95, 2285–2295. doi: 10.1111/j.1572-0241.2000.03248.x.PubMedCrossRefGoogle Scholar
  43. Wechsler, D. (1989). Manual for the Wechsler preschool and primary scale for children—revised. San Antonio, TX: Psychological Corporation.Google Scholar
  44. Wechsler, D. (1991). Manual for the Wechsler intelligence scale for children—Third edition. San Antonio, TX: Psychological Corporation.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Roumen N. Nikolov
    • 1
  • Karen E. Bearss
    • 1
  • Jelle Lettinga
    • 2
  • Craig Erickson
    • 3
  • Maria Rodowski
    • 4
  • Michael G. Aman
    • 5
  • James T. McCracken
    • 6
  • Christopher J. McDougle
    • 3
  • Elaine Tierney
    • 4
  • Benedetto Vitiello
    • 7
  • L. Eugene Arnold
    • 5
  • Bhavik Shah
    • 6
  • David J. Posey
    • 3
  • Louise Ritz
    • 7
  • Lawrence Scahill
    • 1
  1. 1.Yale Child Study CenterYale UniversityNew HavenUSA
  2. 2.University of GroningenGroningenThe Netherlands
  3. 3.Indiana UniversityIndianapolisUSA
  4. 4.Kennedy Krieger InstituteBaltimoreUSA
  5. 5.Ohio State UniversityColumbusUSA
  6. 6.University of CaliforniaCaliforniaUSA
  7. 7.National Institute of Mental Health(NIMH)BethesdaUSA

Personalised recommendations