The Relationship Among Gastrointestinal Symptoms, Problem Behaviors, and Internalizing Symptoms in Children and Adolescents With Autism Spectrum Disorder.

Bradley J Ferguson,Kristen Dovgan,David Q Beversdorf,Nicole Takahashi

doi:10.3389/fpsyt.2019.00194

Abstract

Background: Many individuals with autism spectrum disorder (ASD) have co-occurring gastrointestinal (GI) symptoms, but the etiology is poorly understood. These GI symptoms often coincide with problem behaviors and internalizing symptoms, which reduces the quality of life for these individuals.Methods: This study examined the relationships among GI problems, problem behaviors, and internalizing symptoms in a sample of 340 children and adolescents with ASD who are patients at the University of Missouri Thompson Center for Autism & Neurodevelopmental Disorders.Results: The majority of patients experienced constipation (65%), about half experienced stomachaches or stomach pain (47.9%), and others experienced nausea (23.2%) or diarrhea (29.7%). Young children with aggressive problem behaviors were 11.2% more likely to have co-occurring nausea; whereas, older children showed more complex relationships between internalizing symptoms and GI symptoms. Older children with greater anxiety symptoms were 11% more likely to experience constipation, but 9% less likely to experience stomachaches. Older children with greater withdrawn behavior were 10.9% more likely to experience stomachaches, but 8.7% less likely to experience constipation. Older children with greater somatic complaints were 11.4% more likely to experience nausea and 11.5% more likely to experience stomachaches.Conclusions: Results suggest that the presentation of externalizing problem behavior and internalizing symptoms associated with GI problems differs between young children and older children with ASD. Therefore, behavior may have different relationships with GI symptoms at different ages, which may have implications for the treatment of and clinical approach to GI disturbances in ASD.

Highlights

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts, as well as restricted and repetitive patterns of behavior, interests, and activities that occur early in life and cause clinically significant impairment [1]
The present study aimed to examine relationships among GI symptoms, externalizing problem behavior, and internalizing symptoms in a large sample of young children and older children and adolescents with ASD
The sample was parsed into two age groups based on which version of the Child Behavior Checklist (CBCL) [22] the caregivers had completed for their child: younger or older

Summary

Introduction

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts, as well as restricted and repetitive patterns of behavior, interests, and activities that occur early in life and cause clinically significant impairment [1]. One association with GI issues in ASD may be the response to stress, since some individuals with ASD show an altered stress response [13] and recent research has shown connections between lower GI symptoms, sensory over-responsivity, and anxiety [14], as well as altered psychophysiological [11] and endocrine [12] responses to stress-inducing stimuli. These associations suggest that activation of the sympathetic nervous system and the hypothalamicpituitary axis may be associated with GI disorders in ASD. These GI symptoms often coincide with problem behaviors and internalizing symptoms, which reduces the quality of life for these individuals

Objectives

Methods

Results

Discussion

Conclusion