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Gastrointestinal (GI) problems are frequently reported among people with autism spectrum disorders (ASD). In January 2010, a multidisciplinary panel sponsored by the Autism Forum released a consensus report published in Pediatrics that reviewed the current state of knowledge and medical practice for evaluating GI disorders among individuals with ASD. The consensus report suggested that, for some individuals with ASD, exhibiting certain behaviors may be the “primary or sole symptom” of an underlying gastrointestinal problem. Included among these behaviors are aggression, self-injurious behavior, temper tantrums, and abnormalities in sleeping.
Our study used data from a population-based sample of 487 children with ASD to evaluate the feasibility of consensus panel’s recommendation that certain behaviors could help clinicians predict which children with ASD need to be evaluated for possible GI problems. We found that some behaviors were significantly associated with GI problems, but these behaviors were also very common in children with ASD who do not have medically documented GI problems. Nearly 99% of all children in the sample exhibited at least 1 of the behaviors. Therefore, as screening items, these behaviors offered very little in terms of positive predictive value for identifying GI problems.
We also observed that children with ASD and medically documented GI problems were more likely to have delayed motor milestones or seizure-like activity than children with ASD and no GI problems. This is consistent with previous research that found GI problems were more common among children with ASD who also have other developmental disabilities, including cerebral palsy and epilepsy. It’s possible that more complex medical or neurological conditions—not just autism—are associated with GI problems.
This study used population-based data from the CDC’s ADDM Network, which may only be sensitive to GI problems that were severe or persistent enough to warrant medical attention. Because this study only included children with ASD, the goal was not to determine whether GI problems occur more frequently in children with ASD than children without ASD, but to evaluate whether certain behaviors could predict GI problems.
It is possible that some people exhibit these challenging behaviors in response to–or in an attempt to communicate–the presence of GI discomfort. However, there are likely many reasons why a person with ASD might exhibit particular behaviors and, used on their own, they might not be very predictive for GI-screening purposes. Finding ways to identify and treat GI problems among those with ASD continues to be an important goal.