Interactive Autism Network
Date Published: January 7, 2019
When a child or teenager with autism seeks mental health treatment, do doctors and psychologists ask about gastrointestinal (GI) problems?
Perhaps they should, according to a new study. At first glance, constipation and other gastrointestinal problems may seem unrelated to anxiety, depression, aggression or disruptive behaviors. However, researchers found a link between them in youth with autism.1
A study of almost 2,800 children and teenagers with autism in the Simons Simplex Collection (SSC) research project found that GI symptoms – usually constipation, diarrhea and excessive gas – were linked to psychiatric symptoms in those youth.
Other factors linked to higher levels of psychiatric problems include having:
- more symptoms of autism
- a higher verbal IQ score
- more trouble with daily living skills, such as brushing teeth or fixing a meal, and/or
- a lower family income.1
The presence and amount of GI problems "should be considered when evaluating psychiatric and behavioral concerns among children with ASD," the researchers stated. They went a step further, noting that treating GI conditions may be important in reducing mental health problems.1
"Even though statistically this link from GI symptoms to behavioral and emotional difficulties is small, for some families it's a point of intervention. It is something we can potentially change by more careful monitoring and management of the GI side of things," explained the lead researcher for the study, Emily E. Neuhaus, PhD, a clinical psychologist at Seattle Children's Hospital in Washington.
Parents Report GI, Eating Problems in Child With Autism
Dr. Neuhaus often hears about GI problems from the parents of her patients with autism spectrum disorder (ASD). "Families come in with GI concerns a lot," she said. "I see the toll it takes."
Some families worry that something their child is eating is causing gastrointestinal distress, while others are concerned about what the child is not eating, she said. Some children with autism are extremely picky eaters who cannot tolerate the sight, smell, or texture of many foods. "There is frustration for the parents of trying to get to the bottom of their child's GI difficulties, and how to manage and treat them. Certainly for anyone, being in pain or being uncomfortable [from GI distress] is rough," she said.
As a psychologist, she encourages families to see a doctor or nurse practitioner for medical treatment of gastrointestinal problems.
Daniel L. Coury, MD, who was not involved in the study, said the research adds to evidence of a link between autism and GI troubles. "A decade ago, a lot of health professionals wondered if the parents of children with autism were exaggerating their children's GI problems, whether there was a misperception on the part of the parents – and I think researchers have dispelled a lot of that," said Dr. Coury, who is a developmental and behavioral pediatrician at Nationwide Children's Hospital, a medical professor at The Ohio State University, and medical director of the Autism Treatment Network of Autism Speaks.
This study goes a step further by exploring the link to behavioral problems. "That is something that fewer studies have pointed out, and it is of interest," he said. Dr. Coury has seen children with autism whose mood or behaviors improved after treatment for medical problems, including those involving the gastrointestinal system. "But I have not had anyone show dramatic improvement in their core autism symptoms."
Other Health Concerns in People With ASD
It is not uncommon for children and adults with autism to have other health problems. GI problems, anxiety, depression and other psychiatric concerns are more common in people with autism than in others, according to research.2-4
In its study, Dr. Neuhaus' team found that 38 percent of the SSC youth frequently experienced at least one significant GI symptom. The most common problems were constipation and diarrhea. Less frequent problems included excessive gas, severe abdominal pain, vomiting, and reflux.1 The study relied on parents' answers to questions about their child's medical histories, provided during extensive interviews at clinics across North America.
Other studies have found GI problems in anywhere from 9 to 70 percent of children with autism, with autism clinics reporting the highest percentage, according to an article in the medical journal Pediatrics.4
Links between GI problems and psychiatric problems have been reported in children who do not have autism.5, 6 And the symptoms of some conditions, such as anxiety and depression, may include changes or problems with eating or digestion.
It's not known why GI problems are so common in autism. Dr. Neuhaus' team, which included three psychologists and a medical doctor, offered a few theories. Some research has found that certain genetic changes found in some people with autism also affect the GI system. There also may be a sensory component. Many people with autism are extremely sensitive to input from their senses, such as touch, smell, hearing, or sight. So they may feel their gastrointestinal pain more intensely than others.1
For children and teenagers alike, the study found, those with more anxiety and depression had more ASD symptoms, higher verbal IQ scores, and more GI symptoms. Those with aggressive behaviors, or who hit or injured themselves, were more likely to have more ASD symptoms, more problems with daily living skills, more GI problems, and a lower family income.1
The researchers urge mental health providers, such as doctors, psychologists, counselors and therapists, to ask about GI symptoms in their young patients with autism. The GI complaints "may serve to contribute to the behavioral concerns for which a family is seeking services."1
Treating and reducing GI symptoms "may be an important part of reducing a broad array of mental health [symptoms] in this population, and may be critical in improving quality of life and overall functioning," according to the study.1
"We could have more impact on kids' well-being," Dr. Neuhaus said.
Other articles on these issues include:
- What Causes GI Problems in Autism?
- An Autism Speaks' video, "Office Hours with Dr. Tim Buie – Acid Reflux and Autism," explores possible behavioral signs of acid reflux in children who have minimal verbal skills.
- Neuhaus, E., Bernier, R. A., Tham, S. W., & Webb, S. J. (2018). Gastrointestinal and psychiatric symptoms among children and adolescents with autism spectrum disorder. Frontiers in Psychiatry, 9, 515. Abstract.
- 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. doi:10.1097/CHI.0b013e318179964f. Abstract.
- Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(6), 1916-1930. doi:10.1007/s10803-016-2722-8 [doi] Abstract.
- Buie, T., Campbell, D. B., Fuchs, G. J.,3rd, Furuta, G. T., Levy, J., Vandewater, J., . . . Winter, H. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 125 Suppl 1, S1-18. doi:10.1542/peds.2009-1878C [doi] Abstract.
- Jameson, N. D., Sheppard, B. K., Lateef, T. M., Vande Voort, J. L., He, J., & Merikangas, K. R. (2016). Medical comorbidity of attention-deficit/hyperactivity disorder in US adolescents. J Child Neurol, 31(11), 1282-1289. doi:10.1177/0883073816653782. Abstract.
- Gontard, A., Moritz, A., Thome-Granz, S., & Equit, M. (2015). Abdominal pain symptoms are associated with anxiety and depression in young children. Acta Paediatrica, 104(11), 1156-1163. doi:10.1111/apa.13134. Abstract.