Abstract
The objective of this study is to investigate whether parentally-reported gastro-intestinal (GI) symptoms are increased in a population-derived sample of children with autism spectrum disorders (ASD) compared to controls. Participants included 132 children with ASD and 81 with special educational needs (SEN) but no ASD, aged 10–14 years plus 82 typically developing (TD) children. Data were collected on GI symptoms, diet, cognitive abilities, and developmental histories. Nearly half (weighted rate 46.5 %) of children with ASD had at least one individual lifetime GI symptom compared with 21.8 % of TD children and 29.2 % of those with SEN. Children with ASD had more past and current GI symptoms than TD or SEN groups although fewer current symptoms were reported in all groups compared with the past. The ASD group had significantly increased past vomiting and diarrhoea compared with the TD group and more abdominal pain than the SEN group. The ASD group had more current constipation (when defined as bowel movement less than three times per week) and soiling than either the TD or SEN groups. No association was found between GI symptoms and intellectual ability, ASD severity, ASD regression or limited or faddy diet. Parents report more GI symptoms in children with ASD than children with either SEN or TD children but the frequency of reported symptoms is greater in the past than currently in all groups.
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Notes
A Statement of Special Educational Needs is a legal document issued by the local educational authority when children require significant additional support in school due to any learning and/or behavioural problems.
References
Adams, J. B., Johansen, L. J., Powell, L. D., Quig, D., & Rubin, R. A. (2011). Gastrointestinal flora and gastrointestinal status in children with autism—Comparisons to typical children and correlation with autism severity. BMC Gastroenterology, 11, 22.
Badalyan, V., & Schwartz, R. H. (2011). Feeding problems and GI dysfunction in children with Asperger syndrome or pervasive developmental disorder not otherwise specified; comparison with their siblings. Open Journal of Pediatrics, 1, 51–63. doi:10.4236/ojped.2011.14014.
Baird, G., Charman, T., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2008). Regression, developmental trajectory and associated problems in disorders in the autism spectrum: The SNAP study. Journal of Autism and Developmental Disorders, 38(10), 1827–1836.
Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP). Lancet, 368(9531), 210–215.
Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444–451.
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. British Medical Journal, 325(7361), 419–421.
Buie, T., Campbell, D. B., Fuchs, G. J., Furuta, G. T., Levy, J., Vandewater, J., et al. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 125(Suppl 1), S1–S18.
Campbell, D. B., Buie, T. M., Winter, H., Bauman, M., Sutcliffe, J. S., Perrin, J. M., et al. (2009). Distinct genetic risk based on association of MET in families with co-occurring autism and gastrointestinal conditions. Pediatrics, 123(3), 1018–1024.
Clayden, G. S., Keshtgar, A. S., Carcani-Rathwell, I., & Abhyankar, A. (2005). The management of chronic constipation and related faecal incontinence in childhood. Archives of Disease in Childhood. Education and Practice Edition, 90, ep58–ep67. doi:10.1136/adc.2004.066019.
de Araujo Sant’Anna, A. M., & Calcado, A. C. (1999). Constipation in school-aged children at public schools in Rio de Janeiro, Brazil. Journal of Pediatric Gastroenterology and Nutrition, 29(2), 190–193.
Dunn, L. M., Dunn, L. M., Whetton, C., & Burley, J. (1997). British picture vocabulary scale (2nd ed.). London: NFER-Nelson.
Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126(2), e337–e342.
Fombonne, E., & Chakrabarti, S. (2001). No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics, 108(4), E58.
Goodwin, M. S., Cowen, M. A., & Goodwin, T. C. (1971). Malabsorption and cerebral dysfunction: A multivariate and comparative study of autistic children. Journal of Autism and Childhood Schizophrenia, 1(1), 48–62.
Gorrindo, P., Williams, K. C., Lee, E. B., Walker, L. S., McGrew, S. G., & Levitt, P. (2012). Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors. Autism Research,. doi:10.1002/aur.237.
Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.
Horvath, K., Papadimitriou, J. C., Rabsztyn, A., Drachenberg, C., & Tildon, J. T. (1999). Gastrointestinal abnormalities in children with autistic disorder. Journal of Pediatrics, 135(5), 559–563.
Ibrahim, S. H., Voight, R. G., Katusic, S. K., Weaver, A. L., & Barbaresi, W. J. (2009). Incidence of gastrointestinal symptoms in children with autism: A population-based study. Pediatrics, 124(2), 680–686.
Kokkonen, J., Haapalahti, M., Tikkanen, S., Karttunen, R., & Savilahti, E. (2004). Gastrointestinal complaints and diagnosis in children: A population-based study. Acta Paediatrica, 93(7), 880–886.
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(4), 492–497.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
Molloy, C. A., & Manning-Courtney, P. (2003). Prevalence of chronic gastrointestinal symptoms in children with autism and autistic spectrum disorders. Autism, 7(2), 165–171.
Mouridsen, S. E., Rich, B., & Isager, T. (2010). A longitudinal study of gastrointestinal diseases in individuals diagnosed with infantile autism as children. Child: Care, Health and Development, 36(3), 437–443.
Nikolov, R. N., Bearss, K. E., Lettinga, J., Erickson, C., Rodowski, M., Aman, M. G., et al. (2009). Gastrointestinal symptoms in a sample of children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 39(3), 405–413.
Pang, K. H., & Croaker, G. D. (2011). Constipation in children with autism and autistic spectrum disorder. Pediatric Surgery International, 27(4), 353–358.
Panksepp, J. (1979). A neurochemical theory of autism. Trends in Neurosciences, 2, 174–177.
Quigley, E. M., & Hurley, D. (2000). Autism and the gastrointestinal tract. American Journal of Gastroenterology, 95(9), 2154–2156.
Raven, J. C., Court, J. H., & Raven, J. (1990a). Standard progressive matrices. Oxford: Oxford University Press.
Raven, J. C., Court, J. H., & Raven, J. (1990b). Coloured progressive matrices. Oxford: Oxford University Press.
Richler, J., Luyster, R., Risi, S., Dawson, G., Bernier, R., Dunn, M., et al. (2006). Is there a ‘regressive phenotype’ of autism spectrum disorder associated with the measles-mumps-rubella vaccine? A CPEA study. Journal of Autism and Developmental Disorders, 36(3), 299–316.
Rome III (2006) Diagnostic criteria of functional gastro-intestinal disorders. www.romecriteria.org/criteria.
Rutter, M., Bailey, A., & Lord, C. (2003). SCQ: The Social Communication Questionnaire. Manual. Los Angeles: Western Psychological Services.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929.
Smith, R. A., Farnworth, H., Wright, B., & Allgar, V. (2009). Are there more bowel symptoms in children with autism compared to normal children and children with other developmental and neurological disorders? A case control study. Autism, 13(4), 343–355.
Stata Corporation. (2005). Stata statistical software release 9.0: Survey data manual. College Station, TX: Stata Corporation.
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(7334), 393–396.
The Editors of the Lancet. (2010). Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 375(9713), 445.
Valicenti-McDermott, M. D., McVicar, K., Cohen, H. J., Wershil, B. K., & Shinnar, S. (2008). Gastrointestinal symptoms in children with an autism spectrum disorder and language regression. Pediatric Neurology, 39(6), 392–398.
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(2 Suppl), S128–S136.
Wakefield, A. J., Anthony, A., Murch, S. H., Thomson, M., Montgomery, S. M., Davies, S., et al. (2000). Enterocolitis in children with developmental disorders. American Journal of Gastroenterology, 95, 9–95.
Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., et al. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 351(9103), 637–641.
Wakefield, A. J., Puleston, J. M., Montgomery, S. M., Anthony, A. F., O’Leary, J. J., & Murch, S. H. (2002). Review article: The concept of entero-colonic encephalopathy, autism and opioid receptor ligands. Alimentary Pharmacology & Therapeutics, 16, 4–74.
Wang, L. W., Tancredi, D. J., & Thomas, D. W. (2011). The prevalence of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members. Journal of Developmental and Behavioral Pediatrics, 32(5), 351–360.
Wechsler, D. (1992). Wechsler intelligence scale for children (III-UK edition). London: The Psychological Corporation.
Acknowledgments
We would like to thank the parents and children who participated. We would also like to thank the anonymous reviewers. The study was funded by the Department of Health, the Wellcome Trust and the National Alliance for Autism Research (NAAR).
Ethical Approval
South Thames MREC 00/1/50; Kent & Medway LREC WK153/8/02.
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Chandler, S., Carcani-Rathwell, I., Charman, T. et al. Parent-Reported Gastro-intestinal Symptoms in Children with Autism Spectrum Disorders. J Autism Dev Disord 43, 2737–2747 (2013). https://doi.org/10.1007/s10803-013-1768-0
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DOI: https://doi.org/10.1007/s10803-013-1768-0
Keywords
- Autism
- Autism spectrum disorders
- Gastro-intestinal symptoms
- Dietary intake
- Regression