Gastrointestinal (GI) disorders are among the most common medical conditions associated with autism, according to the autism advocacy organization Autism Speaks. The problems range from chronic constipation or diarrhea to irritable and inflammatory bowel syndromes and acid reflux. While these conditions can occur at any age, they have been studied most frequently in young children with autism.
To better understand the connection between autism and GI issues, Well-Being spoke to three pediatricians from the University of Mississippi Medical Center’s Division of Child Development, Dr. Kimberlly Stringer, Dr. Barbara Saunders and Dr. Cynthia Field.
“It is true that compared to typically developing children, children with autism (ASD) or developmental delays (DD) do have more GI problems,” Dr. Stringer confirms. “If they are nonverbal either with ASD or DD, they are behind developmentally even with their fine motor skills and adaptive skills. For example, most nonverbal children have problems using a spoon or fork. The foods these children select will be limited, and they often are less likely to eat vegetables and fruits, making it difficult for parents to ensure they are getting the right balance of foods, including vital nutrients.”
The food selectivity Dr. Stringer describes can be severe and the resulting GI impact can be severe as well.
“Children with DD and ASD often have trouble communicating when they have to go to the bathroom and expressing when they are in pain,” Dr. Stringer continues. “Therefore, it’s not unusual for them to need to be prescribed stool softeners, stimulant laxatives or even have to visit the ER due to bowel impaction.”
The food selectivity and refusal is also a problem because it can put a strain on the family. It is not unusual for a child with ASD or DD to insist on eating only one brand of a food (e.g., chicken nuggets only made by Tyson). It can be difficult to introduce a child to new foods because they may cry, scream or tantrum when the food is presented, making a tense situation for the whole family. Eating out in a restaurant can be especially anxiety ridden, since there is no way of knowing how the child will react to unfamiliar foods.
GI problems may become apparent even before children are diagnosed with ASD. According to Dr. Saunders, the exact age when symptoms begin to present varies, often depending on the patient and parent’s ability to provide an accurate history, but in general most children’s GI problems (in the setting of autism) tend to begin between 18 months and 3 years of age.
“Some of the most common GI problems we see in children with ASD and/or DD include: constipation, reflux (GERD), chronic/recurrent diarrhea and food allergies, sensitivities and intolerances,” explains Dr. Saunders.
Understandably, the pain and discomfort caused by GI symptoms can worsen behavior and even trigger regression in children with autism. So it is particularly important for parents to know that their kids with ASD are at higher risk so they can be proactive in seeking the help of a pediatrician or pediatric gastroenterologist if they suspect their child is being affected by GI problems.
Any abrupt change in behavior, particularly an increase in agitation and irritability should be explored for a physical or medical cause. If there is no apparent environmental trigger for the change and it is sustained for more than a day or so, a visit with the child’s pediatrician is certainly appropriate and warranted. Under the direction of a pediatrician and often a dietary counselor, GI symptoms, depending upon the cause and severity, may be improved with a number of dietary strategies, from probiotics, to casein- and gluten-free diets.
“Although it can be more difficult to identify and diagnose specific GI issues in kids on the spectrum,” adds Dr. Field, “once an accurate diagnosis is made, treatment is the same as for a typically developing child. Of course, it will often be more challenging to get an autistic child to take oral medications for example or to comply with a toileting schedule.”
“Proper nutrition can prevent and or ameliorate many GI issues so working on attaining this is well worth the effort,” Dr. Field continues. “Parents of autistic children often must be very patient and creative in their efforts to provide their children with adequate calories, protein, fiber and micronutrients on a daily basis.”
Well-Being also reached out to Brittany Bell, M.A., BCBA, LBA and Director of Spectrum Academy in Jackson.
“At Spectrum Academy, we believe it is important to look at the whole child when working with children on the spectrum. Considering GI conditions is a part of that process,” notes Ms Bell. “Our teachers and therapists keep open communication with parents about their child’s GI conditions, especially if that child is unable to verbally express when they may be uncomfortable or experiencing pain.
We still don’t fully understand all of the factors involved in why children on the autism spectrum suffer from GI issues at a greater rate than other kids. In 2011, researchers supported by Autism Speaks reported that the GI activity of some children with autism differs from that of other children in two key ways: their intestinal cells show abnormalities in how they break down and transport carbohydrates; and their intestines are home to abnormal amounts of certain digestive bacteria. These findings may also explain why parents of some children with autism report that special diets and probiotics (nutritional supplements containing “good” bacteria) improve not only their children’s digestion but also their behavior. However, further study is needed to help us unravel the mystery of disproportionate levels of GI distress in children with autism and developmental delays.
For information and support for families of children with autism, including those with GI disorders, visit www.autismspeaks.org.