Are kids with autism more likely to have gastro issues?

2 Oct

Interesting new paper in Pediatrics:

OBJECTIVE: To determine whether children with autism have an increased incidence of gastrointestinal symptoms compared with matched control subjects in a population-based sample.

So do autistic kids have more constipation, diarrhoea, reflux, bloating or feeding issues? The conclusion was:

As constipation and feeding issues/food selectivity often have a behavioral etiology, data suggest that a neurobehavioral rather than a primary organic gastrointestinal etiology may account for the higher incidence of these gastrointestinal symptoms in children with autism.

Which is self explanatory but (in my opinion) badly worded. Are the authors saying that _all_ the gastro symptoms they looked at have behavioural aetiology or just constipation and feeding issues? And if the latter, whats their conclusions about the others?

The answer can be found in the results section:

Significant differences between autism case and control subjects were identified in the cumulative incidence of constipation (33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No significant associations were found between autism case status and overall incidence of gastrointestinal symptoms or any other gastrointestinal symptom category.

OK so for the other three no real difference was found between autistic kids and non autistic kids. Thats why they weren’t mentioned in the conclusion.

Constipation (as is bloating and diarrhoea) is regularly quoted by the anti-vaccine/autism lobby as being part of a set of gastro symptoms ’caused’ by vaccines, along with their child’s autism. This paper addresses that fallacy directly and clearly shows that three issues are no different than non autistic kids and two may have a behavioural cause.

18 Responses to “Are kids with autism more likely to have gastro issues?”

  1. RethinkingAutism October 2, 2009 at 05:13 #

    My son is autistic and his digestion is fine. When he is 15 he will be so angry at me for talking about his bowel movements. Ha.

  2. Emily October 2, 2009 at 15:18 #

    Our son had significant constipation issues when he was 3 and 4 years old, and they were unquestionably because of his anxiety. We started him on flax oil, which resolved it almost immediately, and he’s never had a problem since, not once. He remains extremely anxious, but not constipated. Never have had bloating, diarrhea, etc., and he’s no neophobe, unlike our (non-autistic) three year old. In fact, the child is healthy as a horse (except for urological structural issues) and brushes off most illness faster than the rest of us.

  3. Tracey October 2, 2009 at 16:28 #

    I had some issues with this study. They didn’t do any actual “tests” they looked at records and quite frankly if you looked at my boys’ records you would comme to the same conclusion and they both do have problems. I think the wrong question is beinng asked and that is why I hate the vaccine debate. I have two sons with autism and I know it is in NOT because of vaccines. But that is the only arguement research seems to want to prove or disprove. There can be a number of reasons why a lot of these guys have issues, from sensory, stress and nutrition. It is important for the discussion and research to look beyond the vaccine arguement. I had to play detective and finally figured out that my youngest had issues because he has a sensitivity to gluten. Took gluten out of the picture and all his bowel problems went away. We think that my oldest has issues due to low tone…but there are no good studies and most parents are like me…having to play medical detective.

  4. Kev October 2, 2009 at 18:52 #

    Hi Tracey, I don’t think this study is suggesting autie kids never have GI issues. That would be a remarkable result. They’re saying that in only 2 of the 5 GI issues they looked at were said issues above the norm.

  5. Tracey October 2, 2009 at 21:33 #

    hey kev,
    your right. I just get annoyed with some of the rhetoric regarding this study..not here…but this study was mentioned on several news organizations when it came out and they acutally used words like, “the defentive study” “that there is absolutely no correlation between GI issues and autism” “can lay this to concern to rest”….
    My understanding is that they only looked at records, did no testing or interviewing and that there are questions regarding the criteria they used defining those with ASD in the study. I may be wrong about this.
    I personally feel that autism if anything is a genetic issue and that certain “symptoms” may be linked. I also feel that there is a flaw in the conclusion that “feeding issues often have a behavioural eitlogly”….and don’t show a connection to gastro issues. The conclusionn doesn’t take into account major sensory issues or other problems that the children may not be able to verbalize.
    My little guy is non-verbal and I knew he was in pain. We
    did every test known to man and they all came back normal. The medical profession was trying to tell us that this was a behavioral issue and I knew it wasn’t. I took a lot of data. We took the chance that it was food related and after some changes within 12 hours his BMs completely changed and his episodes have completely disappeared.
    Again, I just think that due to all the contraversy research is being done to discredit each side and studies are more about meeting agendas.
    I look at autism and GI problems like my own issue with an auto-immune disease. I have a condition that has varied forms. Not every person has the same syptoms. Some problems usually every patient has but there are other secondary diseases that some of us have and some of us don’t…but we all have the same primary condition.

  6. Ringside Seat October 2, 2009 at 22:22 #

    Well, let’s think about this:

    Some children have bowel issues; some autistic people are children -> some autistic children have bowel issues. Unreasonable?

    Some autistic children also have learning and communication challenges. Children with learning and communication challenges can be harder than usual to toilet train: a big moment for small children. This can lead to intractible encopresis. Unreasonable?

    Some autistic children, particularly in challenging families, graze compulsively on the worst kind of junk food – eg crisps – which are often high in salt, lacking in roughage, and can quickly lead to issues at both ends of the GI tract. Unreasonable?

    The digestive tract requires constant signalling from the nervous system to propel food and feces through the bowel. Brain disorders may disrupt that signalling, leading to motility failure. Unreasonable?

    Of course some autistic kids have bowel issues, and, frankly, it would be astonishing if the incidence wasn’t higher than with neurotypical, fast-learning, not-particularly-anxious kids.

    Trying to boo-hurrah, do-they-or-dont-they? – because a few crooks, first in London and Queens, NYC, and now in Austin TX, have got a scoping-for-dollars and tissue-snatching scam going – isn’t, IMO, a very productive way forward.

  7. passionlessDrone October 2, 2009 at 22:26 #

    Hello friends –

    I am of the opinion that the unfortunate reality is that we don’t have tools of sufficient precision to make informated conclusions on this; and the most clumsy of our tools is grouping of all children with the behaviors of autism into a single unit for evaluation purposes.

    By way of example, the recent flurry of research regarding a relationship to the MET alleles and an association with an autism diagnosis. The resultant protein is important in lots of places, including brain formation and gastro intestinal repair. This is a relatively common allele, but still shows up more frequently in children who have autism. Now, with studies like this one, what we have done is take a bunch of kids who have MET transcription issues and autism, and a bunch of kids without MET transcription issues and autism, throw them together as a group and look for problems in the gastro track. This type of analysis, however, does nothing to change what we have learned about HGF and gastro disorders.

    Emily makes a point that just won’t make it into headlines:

    Our son had significant constipation issues when he was 3 and 4 years old, and they were unquestionably because of his anxiety.

    The effects of stress, especially chronic stress, on gastrointestinal function are well documented. Given the observations of highly variable stress related biomarkers in the autism realm, not to mention what many people with autism will tell you about their personal levels of stress, we would need good reasons for children with autism to be demonstrably different than anyone else in regards to the interaction between stress and gastro functioning for there not to be relationships in some instances. Again, a more precise tool might be evaluations between autism, normal kids, perceived levels of stress, and gastro intestinal function. Of course, it’s simple for me to sit around and come up with exotic and difficult to implement studies.

    @Emily: Do you feel that flax seed oil made your child less anxious, or are the effects of the anxity unchanged, but you’ve just gotten the system moving?

    – pD

  8. Tracey October 2, 2009 at 22:39 #

    Ringside seat and Passionless Drone…I have to say that I agree and probably said it much better then I ever could have.

  9. livsparents October 3, 2009 at 04:36 #

    My problem with the study is that they admit to 40% of the issues they investigated(1) constipation; (5) feeding issues or food selectivity;
    they discounted the other 60 % ( (2) diarrhea; (3) abdominal bloating, discomfort, or irritability; (4) gastroesophageal reflux or vomiting), which may have some significant possibility of being underreported because of communication issues. We have personally had a doctor discount reflux as ‘stimming’; diarrhea and irritabilty may not be readily appent to a parent of an autistic child.
    I am under the impression, whether real or not, that the medical community may use autism as a ‘crutch’ to explain away potential problems as just ‘part of the autism”

  10. dr treg October 3, 2009 at 08:16 #

    It would be interesting to study at what part of the natural history of autism do the g-i symptoms appear i.e. do they precede the onset of the changes in behavior or do they tend to appear later on after behavioral changes have been noticed.
    It seems that somatic symptoms may appear later than the psychiatric symptoms in a range of psychiatric diseases.

  11. Mildred October 3, 2009 at 11:25 #

    I entirely agree with Ringside Seat. There are simply hundreds of sites covering the problem of constipation in children. Quoted in one paper from the US (Evaluation and Treatment of Constipation in Infants and Children, Biggs W and Dery W 2006)constipation accounts for an estimated 3-5 percent of visits to the doctor. Of these children with constipation 95 percent are described as “functional constipation”. It seems then, that a large majority of the time, constipation in children although problematic and unhealthy, is not a symptom of serious underlying bowel conditions. If allowed to continue over a protracted period, constipation will, in everyone, autistic or not, progress into far more serious conditions including physical changes in the bowel. Poor diet, obsessive eating traits (again common in lots of children autistic or not)and pica all contribute to the problems. Autistic children however,have an additional problem which may in turn influence the levels of recorded bowel problems in their group.In 1988 Dalrymple J and Angrist M in a paper “Toilet Training A Sixteen Year Old With Autism In A Natural Setting” speculated “that because a successful toilet training program depends so heavily on communication and social interaction, people with autism may require specialized training programs built on positive communication of expectations”. “Betsy” the teenager in the paper, had functional constipation from early childhood and displayed many of the symptoms discribed by the parents of autistic children including, constipation, seepage, bowel impaction etc with the usual list of treatments including laxatives, suppositories and enemas.She was diagnosed with megacolon and a large rectal vault which the doctors readily associated with “years of bowel retention”. When commenced on an intense toilet training programme encompassing all her difficulties, Betsy’s problems all but disappeared.

    Although over 20 years old, this study conveys a willingness to acknowledge that Betsy’s characteristic traits, behavioural issues, poor social interaction skills, diet etc rather than any underlying bowel disease (and subjecting her to invasive clinical procedures), were major contributors to her constipation and associated problems, something which gains support from the impressive changes brought about via the toilet training regime.

    Biggs and Dery put it in a nutshell… “many caregivers worry that a child’s constipation is the sign of a serious medical problem”. Sadly for some, autistic or not, that will be the case. It is that very real worry however,which may be exploited, by those in the “scoping-for-dollars” brigade.

  12. shanna October 3, 2009 at 17:03 #

    I live in Austin, so I have been encouraged since my son’s diagnosis by friends, other parents, and even therapists as to the great benefits of GFCF diet. In the beginning, you as a parent really try to explore all the options. I read Jenny McCarthy’s book. I happened to not find it to be terribly compelling. We didn’t share a point of view.

    I decided to go ahead and contact the Thoughtful House and hear what they had to say. The first thing I was struck with, other than the expense, was that they said they may determine that my son may need a scope. And if so, they required you to use their facilities and most insurances do not cover it. So to expect to pay in the range of $5,000 for their initial services. It just set off alarm bells in my head. You should know that my son has never had any bowel problems. He is a happy child who has a regular movement twice a day (almost clockwork). When you tell someone this though they assure you that he could be having problems and you do not even know it.

    I decide to consult with my pediatric developmentalist, who I trust, I suspect she has aspberger’s and has a son on the spectrum. She says she would never preform an evasive and potientially dangerous procedure when the treatment was a GFCF diet. The diet is not evasive and if he shows improvements then fine. What you do not hear about is children like mine, when talking about the diet. I tried it. Logan is so unbelievable picky. He has an incredible since of smell. He smells everything before he will even open his mouth. He refused to drink anything. (He drinks only milk. I add water to it) He would not drink the milk if there was even a hint of soy milk in there. And it didn’t matter how long you held out giving him any. He would dehydrate and die before giving in.

    Anyway so in the end, I decided to listen to what my head was saying all along. He does not have any bowel problems. I would never dream of saying that there are not children with autism out there who have real bowel issues. And I have no idea what causes these issues. My thought is they are probably caused by a number of reasons some of which have been discussed in the earlier comments. I do know first hand the kind of pressure you can get from others that bowel issues are at the heart of his problems. I just got an email this week from my mother in law about the miracles of the GFCF diet.

  13. Kev October 3, 2009 at 18:29 #

    Shanna, well done to you for having the sense to see whats in front of you. SO many don’t. I do think that more parents are assuming your point of view. I know a mum whos autie child is GF due to a G intolerance. She holds no water with the idea that GF or CF ‘cures’ or in any way betters the ‘severity’ of autism. To her she simply has an autie child with a gluten intolerance. End of story.

    Oh and my commiserations that TH is so close to you :S

  14. Visitor October 3, 2009 at 19:15 #


    “The first thing I was struck with, other than the expense, was that they said they may determine that my son may need a scope…You should know that my son has never had any bowel problems.”

    Your decision will have been a disappointment to Drs Krigsman and Wakefield. Apart from your money, what they will have wanted was small pieces of tissue, ripped from your son’s bowels. Usually about a dozen pieces suit their purposes.

  15. Emily October 4, 2009 at 03:04 #

    @Kev…when I read “My commiserations that TH is so close to you…,” at first, I thought you meant MY TH, because we live in Austin, too. Actually, very close to the TH you really meant.

    @pD: You asked, “@Emily: Do you feel that flax seed oil made your child less anxious, or are the effects of the anxity unchanged, but you’ve just gotten the system moving?”
    I think it mostly got things moving, although we tried it also for its alleged brain-beneficial effects. I can’t state unequivocally that it affected his anxiety–he remains highly anxious. But we keep giving it to them all.

    Everyone in our house is on some kind of oil (flax, omega 3 or something). My husband is our fats dealer; he does all the investigations and picks them for us (krill is the latest thing). And his other latest thing is theanine, especially for our Tourette’s child. It does seem to ameliorate his agitation for a few hours.

  16. trrll October 5, 2009 at 17:58 #

    ” I think the wrong question is beinng asked and that is why I hate the vaccine debate. I have two sons with autism and I know it is in NOT because of vaccines. But that is the only arguement research seems to want to prove or disprove.”

    The vaccine issue has a big public profile, both because of some vocal antivaccine groups and also because many purveyors of quack autism remedies exploit vaccine fears, but this is not representative of the science. All autism researchers I know agree that the vaccine hypothesis was never very plausible, and that the evidence against it is decisive. I was at an autism research conference last year, and vaccines were barely mentioned–mainly in the context of dealing with the concerns of parents who are obsessed about vaccines.

  17. navi October 7, 2009 at 04:11 #

    opposite here! Eat’s a ton and poops a lot. disaccharidase deficiency, not autism. dingdingding!


  1. Tweets that mention Autism Blog - Are kids with autism more likely to have gastro issues? « Left Brain/Right Brain -- - October 2, 2009

    […] This post was mentioned on Twitter by Autism Hub and Alexandre Costa. Alexandre Costa said: Crianças autistas são mais propensas a ter distúrbios gástricos? checa essa, @gables_! […]

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