Abstract
Gastrointestinal (GI) disturbances are among the most frequent comorbidities associated with autism spectrum disorder (ASD). The extent to which GI issues are causally related to autism or are strictly comorbid conditions of ASD remains to be defined. Clinical and research experience indicates an important role for GI conditions in autism and their impact on children with ASD and their families. While the reported prevalence of GI symptoms among children with ASD varies widely, consensus exists that GI problems including constipation, diarrhea, and abdominal pain are frequent and manifest in common as well as unusual symptoms compared to symptoms in neurotypical children. The microbiome-gut-brain axis in children with ASD is an emerging area of interest and research, although the exact mechanisms and clinical implications in the context of ASD remain to be defined. Intestinal microbial dysbiosis is currently being evaluated in children with ASD yielding conflicting results. Some studies have shown improvement in behavior and decreased severity of GI symptoms in children with ASD with the use of prebiotics, probiotics, and other dietary interventions. Studies using rigorous methodology to better characterize GI pathophysiology and repercussions in children with ASD can be expected to result in more effective interventions. Effective management of specific GI issues and potential underlying causes is often best achieved through a multidisciplinary, coordinated approach in which the primary care provider or gastroenterologist interacts closely with other disciplines such as psychology, neurology, dietetics, child development, and social work. It is important for the clinic environment to be welcoming and supportive, with individualized accommodations made as needed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abhishek, A., & Doherty, M. (2013). Mechanisms of the placebo response in pain in osteoarthritis. Osteoarthritis and Cartilage, 21(9), 1229–1235. https://doi.org/10.1016/j.joca.2013.04.018
Adams, J. B., Johansen, L. J., Powell, L. D., Quig, D., & Rubin, R. A. (2011). Gastrointestinal flora and gastrointestinal status in children with autism--comparisons to typical children and correlation with autism severity. BMC Gastroenterology, 11, 22. https://doi.org/10.1186/1471-230X-11-22
Afzal, N., Murch, S., Thirrupathy, K., Berger, L., Fagbemi, A., & Heuschkel, R. (2003). Constipation with acquired megarectum in children with autism. Pediatrics, 112(4), 939–942.
Al-Farsi, Y. M., Al-Sharbati, M. M., Waly, M. I., Al-Farsi, O. A., Al-Shafaee, M. A., Al-Khaduri, M. M., … Deth, R. C. (2012). Effect of suboptimal breast-feeding on occurrence of autism: A case-control study. Nutrition, 28(7–8), e27–e32. https://doi.org/10.1016/j.nut.2012.01.007
Aroniadis, O. C., & Brandt, L. J. (2013). Fecal microbiota transplantation: Past, present and future. Current Opinion in Gastroenterology, 29(1), 79–84. https://doi.org/10.1097/MOG.0b013e32835a4b3e
Ashwood, P., Anthony, A., Pellicer, A. A., Torrente, F., Walker-Smith, J. A., & Wakefield, A. J. (2003). Intestinal lymphocyte populations in children with regressive autism: Evidence for extensive mucosal immunopathology. Journal of Clinical Immunology, 23(6), 504–517.
Autism Research Institute. (2009). Parent ratings of behavioral effects of biomedical interventions. Pub 34.
Black, C., Kaye, J. A., & Jick, H. (2002). Relation of childhood gastrointestinal disorders to autism: Nested case-control study using data from the UK general practice research database. BMJ, 325(7361), 419–421.
Buie, T., Campbell, D. B., Fuchs, G. J., 3rd, Furuta, G. T., Levy, J., Vandewater, J., … Winter, H. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 125(Suppl 1), S1–S18. https://doi.org/10.1542/peds.2009-1878C
Buie, T., Fuchs, G. J., 3rd, Furuta, G. T., Kooros, K., Levy, J., Lewis, J. D., … Winter, H. (2010). Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics, 125(Suppl 1), S19–S29. https://doi.org/10.1542/peds.2009-1878D
Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. (2006). Evaluation and treatment of constipation in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 43(3), e1–e13. https://doi.org/10.1097/01.mpg.0000233159.97667.c3
Coury, D. L., Ashwood, P., Fasano, A., Fuchs, G., Geraghty, M., Kaul, A., … Jones, N. E. (2012). Gastrointestinal conditions in children with autism spectrum disorder: Developing a research agenda. Pediatrics, 130(Suppl 2), S160–S168. https://doi.org/10.1542/peds.2012-0900N
Douglas-Escobar, M., Elliott, E., & Neu, J. (2013). Effect of intestinal microbial ecology on the developing brain. JAMA Pediatrics, 167(4), 374–379. https://doi.org/10.1001/jamapediatrics.2013.497
Egan, A. M., Dreyer, M. L., Odar, C. C., Beckwith, M., & Garrison, C. B. (2013). Obesity in young children with autism spectrum disorders: Prevalence and associated factors. Childhood Obesity, 9(2), 125–131. https://doi.org/10.1089/chi.2012.0028
Elder, J. H., Shankar, M., Shuster, J., Theriaque, D., Burns, S., & Sherrill, L. (2006). The gluten-free, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, 36(3), 413–420. https://doi.org/10.1007/s10803-006-0079-0
Fasano, A., Sapone, A., Zevallos, V., & Schuppan, D. (2015). Nonceliac gluten sensitivity. Gastroenterology, 148(6), 1195–1204. https://doi.org/10.1053/j.gastro.2014.12.049
Fulceri, F., Morelli, M., Santocchi, E., Cena, H., Del Bianco, T., Narzisi, A., … Muratori, F. (2016). Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Digestive and Liver Disease, 48(3), 248–254. https://doi.org/10.1016/j.dld.2015.11.026
Furuta, G. T., Williams, K., Kooros, K., Kaul, A., Panzer, R., Coury, D. L., & Fuchs, G. (2012). Management of constipation in children and adolescents with autism spectrum disorders. Pediatrics, 130(Suppl 2), S98–S105. https://doi.org/10.1542/peds.2012-0900H
Gondalia, S. V., Palombo, E. A., Knowles, S. R., Cox, S. B., Meyer, D., & Austin, D. W. (2012). Molecular characterisation of gastrointestinal microbiota of children with autism (with and without gastrointestinal dysfunction) and their neurotypical siblings. Autism Research, 5(6), 419–427. https://doi.org/10.1002/aur.1253
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. https://doi.org/10.1002/aur.237
Horvath, K., & Perman, J. A. (2002). Autism and gastrointestinal symptoms. Current Gastroenterology Reports, 4(3), 251–258.
Hsiao, E. Y. (2014). Gastrointestinal issues in autism spectrum disorder. Harvard Review of Psychiatry, 22(2), 104–111. https://doi.org/10.1097/HRP.0000000000000029
Ibrahim, S. H., Voigt, R. G., Katusic, S. K., Weaver, A. L., & Barbaresi, W. J. (2009). Incidence of gastrointestinal symptoms in children with autism: A population-based study. Pediatrics, 124(2), 680–686. https://doi.org/10.1542/peds.2008-2933
Kang, D. W., Adams, J. B., Gregory, A. C., Borody, T., Chittick, L., Fasano, A., … Krajmalnik-Brown, R. (2017). Microbiota transfer therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: An open-label study. Microbiome, 5(1), 10. https://doi.org/10.1186/s40168-016-0225-7
Klukowski, M., Wasilewska, J., & Lebensztejn, D. (2015). Sleep and gastrointestinal disturbances in autism spectrum disorder in children. Developmental Period Medicine, 19(2), 157–161.
Koves, K., Kausz, M., Reser, D., & Horvath, K. (2002). What may be the anatomical basis that secretin can improve the mental functions in autism? Regulatory Peptides, 109(1–3), 167–172.
Li, Q., & Zhou, J. M. (2016). The microbiota-gut-brain axis and its potential therapeutic role in autism spectrum disorder. Neuroscience, 324, 131–139. https://doi.org/10.1016/j.neuroscience.2016.03.013
Mangiola, F., Ianiro, G., Franceschi, F., Fagiuoli, S., Gasbarrini, G., & Gasbarrini, A. (2016). Gut microbiota in autism and mood disorders. World Journal of Gastroenterology, 22(1), 361–368. https://doi.org/10.3748/wjg.v22.i1.361
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. https://doi.org/10.1177/1362361313485164
Mazurek, M. O., Vasa, R. A., Kalb, L. G., Kanne, S. M., Rosenberg, D., Keefer, A., … 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. https://doi.org/10.1007/s10802-012-9668-x
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. https://doi.org/10.1542/peds.2013-3995
Molloy, C. A., & Manning-Courtney, P. (2003). Prevalence of chronic gastrointestinal symptoms in children with autism and autistic spectrum disorders. Autism, 7(2), 165–171.
Mouridsen, S. E., Isager, T., & Rich, B. (2013). Diseases of the gastrointestinal tract in individuals diagnosed as children with atypical autism: A Danish register study based on hospital diagnoses. Autism, 17(1), 55–63. https://doi.org/10.1177/1362361312455110
Mulle, J. G., Sharp, W. G., & Cubells, J. F. (2013). The gut microbiome: A new frontier in autism research. Current Psychiatry Reports, 15(2), 337. https://doi.org/10.1007/s11920-012-0337-0
Navarro, F., Liu, Y., & Rhoads, J. M. (2016). Can probiotics benefit children with autism spectrum disorders? World Journal of Gastroenterology, 22(46), 10093–10102. https://doi.org/10.3748/wjg.v22.i46.10093
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. (2006). Evaluation and treatment of constipation in children: Summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 43(3), 405–407. https://doi.org/10.1097/01.mpg.0000232574.41149.0a
Parracho, H. M., Bingham, M. O., Gibson, G. R., & McCartney, A. L. (2005). Differences between the gut microflora of children with autistic spectrum disorders and that of healthy children. Journal of Medical Microbiology, 54(Pt 10), 987–991. https://doi.org/10.1099/jmm.0.46101-0
Partty, A., Kalliomaki, M., Wacklin, P., Salminen, S., & Isolauri, E. (2015). A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: A randomized trial. Pediatric Research, 77(6), 823–828. https://doi.org/10.1038/pr.2015.51
Peeters, B., Noens, I., Philips, E. M., Kuppens, S., & Benninga, M. A. (2013). Autism spectrum disorders in children with functional defecation disorders. The Journal of Pediatrics, 163(3), 873–878. https://doi.org/10.1016/j.jpeds.2013.02.028
Rosenfeld, C. S. (2015). Microbiome disturbances and autism spectrum disorders. Drug Metabolism and Disposition, 43(10), 1557–1571. https://doi.org/10.1124/dmd.115.063826
Samsam, M., Ahangari, R., & Naser, S. A. (2014). Pathophysiology of autism spectrum disorders: Revisiting gastrointestinal involvement and immune imbalance. World Journal of Gastroenterology, 20(29), 9942–9951. https://doi.org/10.3748/wjg.v20.i29.9942
Santocchi, E., Guiducci, L., Fulceri, F., Billeci, L., Buzzigoli, E., Apicella, F., … Muratori, F. (2016). Gut to brain interaction in Autism Spectrum Disorders: A randomized controlled trial on the role of probiotics on clinical, biochemical and neurophysiological parameters. BMC Psychiatry, 16, 183. https://doi.org/10.1186/s12888-016-0887-5
Sathe, N., Andrews, J. C., McPheeters, M. L., & Warren, Z. E. (2017). Nutritional and dietary interventions for autism spectrum disorder: A systematic review. Pediatrics, 139(6), e20170346. https://doi.org/10.1542/peds.2017-0346
Schultz, S. T., Klonoff-Cohen, H. S., Wingard, D. L., Akshoomoff, N. A., Macera, C. A., Ji, M., & Bacher, C. (2006). Breastfeeding, infant formula supplementation, and autistic disorder: The results of a parent survey. International Breastfeeding Journal, 1, 16. https://doi.org/10.1186/1746-4358-1-16
Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., … Jaquess, D. L. (2013). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature. Journal of Autism and Developmental Disorders, 43(9), 2159–2173. https://doi.org/10.1007/s10803-013-1771-5
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., … North American Society for Pediatric Gastroenterology. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
Vandenplas, Y., Rudolph, C. D., Di Lorenzo, C., Hassall, E., Liptak, G., Mazur, L., … European Society for Pediatric Gastroenterology Hepatology 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. https://doi.org/10.1097/MPG.0b013e3181b7f563
Vuong, H. E., & Hsiao, E. Y. (2017). Emerging roles for the gut microbiome in autism spectrum disorder. Biological Psychiatry, 81(5), 411–423. https://doi.org/10.1016/j.biopsych.2016.08.024
Wang, L., Christophersen, C. T., Sorich, M. J., Gerber, J. P., Angley, M. T., & Conlon, M. A. (2013). Increased abundance of Sutterella spp. and Ruminococcus torques in feces of children with autism spectrum disorder. Molecular Autism, 4(1), 42. https://doi.org/10.1186/2040-2392-4-42
Wang, L. W., Tancredi, D. J., & Thomas, D. W. (2011). The prevalence of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members. Journal of Developmental and Behavioral Pediatrics, 32(5), 351–360. https://doi.org/10.1097/DBP.0b013e31821bd06a
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ofei, S.Y., Fuchs, G.J. (2019). Gastroenterology. In: Rieske, R.D. (eds) Handbook of Interdisciplinary Treatments for Autism Spectrum Disorder. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-030-13027-5_16
Download citation
DOI: https://doi.org/10.1007/978-3-030-13027-5_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-13026-8
Online ISBN: 978-3-030-13027-5
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)