Monday, November 23, 2015

Autism & High Prevalence of GI Problems




Dear Melissa,
My 5 year old grandson has Autism, and he has a lot of trouble with constipation. Is this common in the children you treat?

YES! One of the problems with Autism that is not often discussed are chronic issues with the gastrointestinal (GI) system. Constipation, abdominal pain, difficulty toilet training, and severely picky eating are some of the troubles that I see most commonly. When you add in the facts that many children with Autism have low or poor verbal skills AND the fact that many of them have decreased sensitivities to pain, my patients are often in real GI distress before their caregivers realize that there is a problem.

I researched this topic heavily this week so that we could find some real numbers and answers to the topic of Autism and constipation. So lets get started!
Autism & High Prevalence of GI Problems
Frequency
A large meta-analysis study published from Emory University in 2014 looked at previous research on the topic of Autism and gastrointestinal disorders. This study found that individuals with Autism Spectrum Disorder had a greater than 3-fold prevalence of diarrhea and constipation, greater than 2-fold prevalence of abdominal pain, and greater than 5-fold prevalence of “general gastrointestinal concerns” compared to the control population.

When you add food sensitivities into the mix, Virginia Chaidez and fellow researchers at the UC Davis MIND Institute found that individuals with Autism are six-to-eight times more likely to have GI issues than children who are developing typically. In contrast, they found that children with other developmental delays had only a five times more likely to exhibit various GI concerns.

Causes
There are 2 different theories as to why children on the Autism Spectrum tend to have higher rates of constipation and other forms of GI distress:
1. Behavioral: Individuals with Autism are often prone to sub-optimal diets to say the least. Between defensiveness toward taste, smell, and texture, as well as ritualistic behaviors surrounding foods, many people on the Autism Spectrum have extremely limited diets that are generally high in simple carbohydrates, and low in fruits and vegetables. This combined with often having defensiveness surrounding toileting, can be a recipe for chronic constipation.
2. Biological: Preliminary research has also provided some support for such biological factors as altered flora of intestinal microbes, altered patterns of intestinal contractions, food allergies, and gastroesophageal reflux disease. 

 Why do we care?
Besides generally wanting to know when our kiddos are not feeling well, why do we care so much that people with Autism have such a high incidence of GI problems? Well…children with Autism often present with “problem behaviors”. Quite frankly, children are often referred to me as an occupational therapist for these negative behaviors long before they are sent to a neuropsychologist for a diagnosis of Autism. But think about it, when your stomach hurts, you generally have poor attention, are irritable, and don’t want to work. Sound familiar? 

 Many of my “cranky kids” have negative behaviors that are greatly exasperated by medical causes such as GI distress. Individuals with more severe forms of Autism might also be more likely to engage in self-injury or aggression at times of GI distress as well. AND…When you have low verbal skills, how else do you let those around you that you are in pain?! 

 Chaidez's UC-Davis GI Study also found that parents who reported that their child with Autism had abdominal pain, gaseousness/bloating, constipation, and diarrhea also reported significantly more incidences of irritability, social withdrawal, repetitive behavior, and hyperactivity than did those without GI symptoms. As a pediatric occupational therapist dealing with kiddos who have negative behaviors, I always like to rule out medical causes for these negative behaviors such as difficulties with sleep, allergies, or GI distress in combination with my behavioral interventions.

 How do you treat it?
If you have concerns that your child has chronic constipation, you should discuss this with your pediatrician, especially if your child is on the Autism Spectrum. While diet modifications alone would be optimal, they are not often effective enough for children with more severe chronic constipation, nor are they practical for children with severe food defensiveness. The recommendations for primary care physicians and pediatricians regarding children with ASD and constipation involve a very complicated algorithm involving medication, diet assessment, behavior therapy, abdominal exam, x-rays, etc, etc., etc. 

Bottom line...chronic constipation in children with ASD is complicated and needs professional help. Don’t hesitate to talk to your child’s pediatrician, and request a pediatric gastrointestinal specialist if you don’t see relief.

Do you have a question you would like me to address? 
Please don't hesitate to share: www.share@childrenstherapyteam.com

 If this week's blog didn't answer your questions thoroughly enough, feel free to delve into the matter further with the links below.
Resources
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report, Pediatrics (Jan 2010) 
Children with Autism Spectrum Disorder May Have Increased Rates of Gastrointestinal Symptoms, Jill Jin, News@JAMA, Journal of the American Medical Association (April 2014)
Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis, McElhanon et al, Pediatrics (April 2014)
Children who have autism farm more likely to have tummy troubles, Virginia Chaidez, et al., UC Davis Health System (November 2013), summarized in the UC Davis News (2013)
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