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Journal of Autism and Developmental Disorders

, Volume 49, Issue 1, pp 349–362 | Cite as

Development of a Brief Parent-Report Screen for Common Gastrointestinal Disorders in Autism Spectrum Disorder

  • Kara G. MargolisEmail author
  • Timothy M. Buie
  • J. Blake Turner
  • Anna E. Silberman
  • Judith F. Feldman
  • Katherine F. Murray
  • Maureen McSwiggan-Hardin
  • Joseph Levy
  • Margaret L. Bauman
  • Jeremy Veenstra-VanderWeele
  • Agnes H. Whitaker
  • Harland S. Winter
Original Paper

Abstract

Gastrointestinal dysfunction in children with autism spectrum disorder (ASD) is common and associated with problem behaviors. This study describes the development of a brief, parent-report screen that relies minimally upon the child’s ability to report or localize pain for identifying children with ASD at risk for one of three common gastrointestinal disorders (functional constipation, functional diarrhea, and gastroesophageal reflux disease). In a clinical sample of children with ASD, this 17-item screen identified children having one or more of these disorders with a sensitivity of 84%, specificity of 43%, and a positive predictive value of 67%. If found to be valid in an independent sample of children with ASD, the screen will be useful in both clinical practice and research.

Keywords

Autism Screen Gastrointestinal GI Comorbidities Behavior 

Notes

Acknowledgment

This network activity was supported by Autism Speaks and cooperative agreement UA3 MC11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. This work was conducted through the Autism Speaks Autism Treatment Network. Further funding for this project came from philanthropic support: to Massachusetts General Hospital from Martin Schlaff and James Brooks; to Columbia University Medical Center and New York State Psychiatric Institute from the MJS Foundation for the Whitaker Developmental Neuropsychiatry Scholar Program; to Kara Margolis from NIH DK093786, DoD PR160365 and the Phyllis and Ivan Seidenberg Family Fund for Children’s Digestive Health,. The views expressed in this publication do not necessarily reflect the views of Autism Speaks, Inc. or the other sponsors. We appreciate the administrative assistance of Avi Masih, M.H.A. at MassGeneral Hospital for Children and the research assistance of Abigail Batchelder, M.P.H. and Erin King, MA while at Columbia University Medical Center.

Author Contributions

KGM, TMB, AHW, HSW, JL–Study conception and design; KGM, TMB, AHW, HSW, KFM, MMH–Acquisition of data; KGM, TMB, AHW, HSW, JBT, AES, JFF, JL, MLB, JVV–Analysis and interpretation of data; KGM, TMB, AHW, HSW, JBT, AES–Drafting of manuscript; KGM, TMB, JBT, AES, KFM, MMH, JL, MLB, JVV, AHW, HSW–Critical revision.

Funding

This study was funded by The Massachusetts General Hospital and Columbia University Medical Center.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10803_2018_3767_MOESM1_ESM.pdf (252 kb)
Supplementary material 1 (PDF 251 KB)

References

  1. Alabaf, S., Gillberg, C., Lundstrom, S., Lichtenstein, P., Kerekes, N., Rastam, M., & Anckarsater, H. (2018). Physical health in children with neurodevelopmental disorders. Journal of Autism and Developmental Disorders.  https://doi.org/10.1007/s10803-018-3697-4.Google Scholar
  2. Autism Treatment Network. (2005). GI symptom inventory questionnaire, vers. 3.0. New York: Autism Speaks.Google Scholar
  3. Baran, M., Cagan Appak, Y., Karakoyun, M., Yalcinkaya, S., Eliacik, K., & Dundar, B. N. (2017). The overlap of gastroesophageal reflux disease and functional constipation in children: The efficacy of constipation treatment. European Journal of Gastroenterology & Hepatology, 29(11), 1264–1268.CrossRefGoogle Scholar
  4. Bauman, M. L. (2010). Medical comorbidities in autism: Challenges to diagnosis and treatment. Neurotherapeutics, 7(3), 320–327.CrossRefGoogle Scholar
  5. Buie, T., Campbell, D. B., Fuchs, G. J. 3rd, Furuta, G. T., Levy, J., Vandewater, J., Whitaker, A. H., Atkins, D., Bauman, M. L., Beaudet, A. L., Carr, E. G., Gershon, M. D., Hyman, S. L., Jirapinyo, P., Jyonouchi, H., Kooros, K., Kushak, R., Levitt, P., Levy, S. E., Lewis, J. D., Murray, K. F., Natowicz, M. R., Sabra, A., Wershil, B. K., Weston, S. C., Zeltzer, L., & Winter, H. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 125(Suppl 1), S1–S18.CrossRefGoogle Scholar
  6. Colombo, J. M., Wassom, M. C., & Rosen, J. M. (2015). Constipation and encopresis in childhood. Pediatrics in Review, 36(9), 392–401. quiz 402.Google Scholar
  7. Drossman, D. A., Dumitrascu, D. L.. (2006). Rome III: New standard for functional gastrointestinal disorders. Journal of Gastrointestinal and Liver Diseases, 15(3), 237.Google Scholar
  8. Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists. Maheah: Lawrence Erlbaum Associates, Publishers.Google Scholar
  9. Gorrindo, P., Williams, K. C., Lee, E. B., Walker, L. S., McGrew, S. G., & Levitt, P. (2012). Gastrointestinal dysfunction in autism: Parental report, clinical evaluation, and associated factors. Autism Research, 5(2), 101–108.CrossRefGoogle Scholar
  10. Guiraldes, E., & Roessler, J. L. (2013). Functional diarrhea in toddlers (chronic nonspecific diarrhea). In C. Faure, N. Thapar, C. Di Lorenzo (Eds.), Pediatric neurogastroenterology (pp. 355–358). Cham: Springer.CrossRefGoogle Scholar
  11. Holingue, C., Newill, C., Lee, L. C., Pasricha, P. J., & Daniele Fallin, M. (2018). Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence. Autism Research, 11(1), 24–36.CrossRefGoogle Scholar
  12. Hung, K. (2016). Epilepsy comorbidity of autism in children. Epilepsy Journal, 2, e011.Google Scholar
  13. Jeste, S. S., & Tuchman, R. (2015). Autism spectrum disorder and epilepsy: Two sides of the same coin?. Journal of Child Neurology, 30(14), 1963–1971.CrossRefGoogle Scholar
  14. Kang, V., Wagner, G. C., & Ming, X. (2014). “Gastrointestinal dysfunction in children with autism spectrum disorders.”. Autism Res, 7(4), 501–506.CrossRefGoogle Scholar
  15. Lewis, M. L., Palsson, O. S., Whitehead, W. E., & van Tilburg, M. A. L. (2016). Prevalence of functional gastrointestinal disorders in children and adolescents. The Journal of Pediatrics, 177, 39–43 e33.CrossRefGoogle Scholar
  16. Maenner, M. J., Arneson, C. L., Levy, S. E., Kirby, R. S., Nicholas, J. S., & Durkin, M. S. (2012). Brief report: Association between behavioral features and gastrointestinal problems among children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(7), 1520–1525.CrossRefGoogle Scholar
  17. Mannion, A., & Leader, G. (2016). An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder: A two year follow-up. Research in Autism Spectrum Disorders, 22, 20–33.CrossRefGoogle Scholar
  18. Mannion, A., Leader, G., & Healy, O. (2013). An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder. Research in Autism Spectrum Disorders, 7(1), 35–42.CrossRefGoogle Scholar
  19. Margolis, K. G. (2017). A role for the serotonin reuptake transporter in the brain and intestinal features of autism spectrum disorders and developmental antidepressant exposure. Journal of Chemical Neuroanatomy, 83–84, 36–40.CrossRefGoogle Scholar
  20. Margolis, K. G., Li, Z., Stevanovic, K., Saurman, V., Israelyan, N., Anderson, G. M., Snyder, I., Veenstra-VanderWeele, J., Blakely, R. D., & Gershon, M. D. (2016). Serotonin transporter variant drives preventable gastrointestinal abnormalities in development and function. Journal of Clinical Investigation, 126(6), 2221–2235.CrossRefGoogle Scholar
  21. Marler, S., Ferguson, B. J., Lee, E. B., Peters, B., Williams, K. C., McDonnell, E., Macklin, E. A., Levitt, P., Margolis, K. G., & Beversdorf, D. Q. (2017). Association of rigid-compulsive behavior with functional constipation in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(6), 1673–1681.CrossRefGoogle Scholar
  22. Mazefsky, C. A., Schreiber, D. R., Olino, T. M., & Minshew, N. J. (2014). The association between emotional and behavioral problems and gastrointestinal symptoms among children with high-functioning autism. Autism, 18(5), 493–501.CrossRefGoogle Scholar
  23. Mazurek, M. O., Vasa, R. A., Kalb, L. G., Kanne, S. M., Rosenberg, D., Keefer, A., Murray, D. S., Freedman, B., & Lowery, L. A. (2013). Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 41(1), 165–176.CrossRefGoogle Scholar
  24. McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. Pediatrics, 133(5), 872–883.CrossRefGoogle Scholar
  25. Oberlander, T. F., & Zeltzer, L. K. (2014). Pain in Children with Autism. Mental Health and Pain, Springer: 191–209.Google Scholar
  26. Sherman, P. M., Hassall, E., Fagundes-Neto, U., Gold, B. D., Kato, S., Koletzko, S., et al. (2009). A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. The American Journal of Gastroenterology, 104(5), 1278–1295. quiz 1296.CrossRefGoogle Scholar
  27. Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921–929.CrossRefGoogle Scholar
  28. Simren, M., Palsson, O. S., & Whitehead, W. E. (2017). Update on Rome IV criteria for colorectal disorders: Implications for clinical practice. Current Gastroenterology Reports, 19(4), 15.CrossRefGoogle Scholar
  29. Vakil, N., van Zanten, S. V., Kahrilas, P., Dent, J., Jones, R., & Global Consensus, G. (2006). The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. American Journal of Gastroenterology, 101(8), 1900–1920. quiz 1943.CrossRefGoogle Scholar
  30. Vandenplas, Y., Rudolph, C. D., Di Lorenzo, C., Hassall, E., Liptak, G., Mazur, L., et al. (2009). Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of Pediatric Gastroenterology and Nutrition, 49(4), 498–547.CrossRefGoogle Scholar
  31. Vandenplas, Y., Rudolph, C. D., Di Lorenzo, C., Hassall, E., Liptak, G., Mazur, L., Sondheimer, J., Staiano, A., Thomson, M., Veereman-Wauters, G., Wenzl, T. G., H. North American Society for Pediatric Gastroenterology, Nutrition, H., European Society for Pediatric Gastroenterology and Nutrition. (2009). Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of Pediatric Gastroenterology and Nutrition, 49(4), 498–547.CrossRefGoogle Scholar
  32. Whitehead, W., Palsson, O., Thiwan, S., Talley, N., Chey, W., Irvine, E., Drossman, D., Thompson, W., & Walker, L. (2006). Development and validation of the Rome III diagnostic questionnaire. In D. A. Drossman (Ed.), Rome III: The functional gastrointestinal disorders (3rd ed., pp. 835–853). McLean, VA: Degnon Associates, Inc.Google Scholar
  33. Yamasaki, T., & Fass, R. (2017). Reflux hypersensitivity: A new functional esophageal disorder. Journal of Neurogastroenterology & Motility, 23(4), 495–503.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kara G. Margolis
    • 1
    Email author
  • Timothy M. Buie
    • 2
  • J. Blake Turner
    • 3
  • Anna E. Silberman
    • 3
  • Judith F. Feldman
    • 3
  • Katherine F. Murray
    • 2
  • Maureen McSwiggan-Hardin
    • 3
  • Joseph Levy
    • 1
  • Margaret L. Bauman
    • 4
  • Jeremy Veenstra-VanderWeele
    • 3
  • Agnes H. Whitaker
    • 3
  • Harland S. Winter
    • 2
  1. 1.Department of Pediatrics, Division of Gastroenterology, Columbia University Medical Center, New York Presbyterian HospitalMorgan Stanley Children’s HospitalNew YorkUSA
  2. 2.Department of Pediatrics, Division of GastroenterologyMass-General Hospital for ChildrenBostonUSA
  3. 3.Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical CenterNew York Presbyterian Hospital and New York State Psychiatric InstituteNew YorkUSA
  4. 4.Department of Anatomy and NeurobiologyBoston University School of MedicineBostonUSA

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