Gastrointestinal Symptoms in Autism Spectrum Disorders

  • Jenna Logan Schuppener University of Florida
  • Jennifer Harrison Elder University of Florida College of Nursing
Keywords: autism spectrum disorder, gastrointestinal symptomatology, gut-brain connection

Abstract

The purpose of this study was to characterize individuals with autism spectrum disorders (ASD), who are part of a larger ASD study, in order to determine clinically useful ways to evaluate gastrointestinal (GI) symptomology. Thirty-three children (ages 3-16) were recruited from a variety of community agencies. Potential participants were screened using the Autism Diagnostic Observation Schedule (ADOS). Parental informed consent was obtained from all participants and child assent when appropriate. Parents completed the Gastrointestinal Symptom Rating Scale, Bristol Stool Chart (BSC), and sociodemographic form. Of the 33 participants, 14 were currently experiencing gastrointestinal symptoms and had abnormal bowel movements. Seven had a history of gastrointestinal symptoms and abnormal bowel movements; two parents were unsure of their gastrointestinal health. According to the BSC rescore, 13 participants reported hard stools, 14 had normal stools, and six had loose stools. Moderate correlations were found among many GI symptoms (r33= .396 - .751) indicating that these could be clustered to create a profile. These findings are clinically significant because GI symptoms in ASD are difficult to diagnose due to communication and social impairments and may go undiagnosed and untreated.  Further characterizing GI symptomology in this population is a logical role for nurse researchers since nurses are often on the front line intervening within the ASD population.

 

 

Author Biography

Jenna Logan Schuppener, University of Florida
College of Nursing, Undergraduate Research Scholar

References

Altieri, L., Neri, C., Sacco, R., Curatolo, P., Benvenuto, A., Muratori, F., . . . Persico, A. M. (2011). Urinaryp-cresol is elevated in small children with severe autism spectrum disorder. Biomarkers,16(3), 252-260. doi:10.3109/1354750x.2010.548010

Amarenco, G. (2014). Bristol Stool Chart : étude prospective et monocentrique de « l’introspection fécale » chez des sujets volontaires. Progrès En Urologie,24(11), 708-713. doi:10.1016/j.purol.2014.06.

Blake, M. R., Raker, J. M., & Whelan, K. (2016). Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Alimentary Pharmacology & Therapeutics,44(7), 693-703. doi:10.1111/apt.13746

Borborygmus. (n.d.). Retrieved February 3, 2019, from https://www.merriam-webster.com/dictionary/borborygmus

Bresnahan, M., Hornig, M., Schultz, A. F., Gunnes, N., Hirtz, D., Lie, K. K., . . . Lipkin, W. I. (2015). Association of Maternal Report of Infant and Toddler Gastrointestinal Symptoms With Autism. JAMA Psychiatry,72(5), 466. doi:10.1001/jamapsychiatry.2014.3034

Buie, T., Campbell, D. B., Fuchs, G. J., 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(Supplement 1). doi:10.1542/peds.2009-1878c

Carbotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology,203-209. Retrieved March 19, 2019.

Centers for Disease Control and Prevention. (2018). Autism Spectrum Disorder (ASD). Retrieved September 7, 2018, from https://www.cdc.gov/ncbddd/autism/data.html

Chaidez, V., Hansen, R. L., & Hertz-Picciotto, I. (2013). Gastrointestinal Problems in Children with Autism, Developmental Delays or Typical Development. Journal of Autism and Developmental Disorders,44(5), 1117-1127. doi:10.1007/s10803-013-1973-x

Chandler, S., Carcani-Rathwell, I., Charman, T., Pickles, A., Loucas, T., Meldrum, D., . . . Baird, G. (2013). Parent-Reported Gastro-intestinal Symptoms in Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders,43(12), 2737-2747. doi:10.1007/s10803-013-1768-0

DeBildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., Volkmar, F., & Minderaa, R. (2004). Interrelationship Between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Classification in Children and Adolescents with Mental Retardation. Journal of Autism and Developmental Disorders,34(2), 129-137. doi:10.1023/b:jadd.0000022604.22374.5f

Diguiseppi, C., Hepburn, S., Davis, J. M., Fidler, D. J., Hartway, S., Lee, N. R., . . . Robinson, C. (2010). Screening for Autism Spectrum Disorders in Children With Down Syndrome. Journal of Developmental & Behavioral Pediatrics,31(3), 181-191. doi:10.1097/dbp.0b013e3181d5aa6d

Durkin, M. S., Maenner, M. J., Newschaffer, C. J., Lee, L., Cunniff, C. M., Daniels, J. L., . . . Schieve, L. A. (2008). Advanced Parental Age and the Risk of Autism Spectrum Disorder. American Journal of Epidemiology,168(11), 1268-1276. doi:10.1093/aje/kwn250

Eructation. (n.d.). Retrieved February 3, 2019, from https://www.merriam-webster.com/dictionary/eructation

Fulceri, F., Morelli, M., Santocchi, E., Cena, H., Bianco, T. D., Narzisi, A., . . . Muratori, F. (2016). Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Digestive and Liver Disease,48(3), 248-254. doi:10.1016/j.dld.2015.11.026

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. doi:10.1002/aur.237

Hall, S. S., Lightbody, A. A., & Reiss, A. L. (2008). Compulsive, Self-Injurious, and Autistic Behavior in Children and Adolescents With Fragile X Syndrome. American Journal on Mental Retardation,113(1), 44. doi:10.1352/0895-8017(2008)113[44:csaabi]2.0.co;2

Huguet, G., Ey, E., & Bourgeron, T. (2013). The Genetic Landscapes of Autism Spectrum Disorders. Annual Review of Genomics and Human Genetics,14(1), 191-213. doi:10.1146/annurev-genom-091212-153431

Kamp-Becker, I., Albertowski, K., Becker, J., Ghahreman, M., Langmann, A., Mingebach, T., . . . Stroth, S. (2018). Diagnostic accuracy of the ADOS and ADOS-2 in clinical practice. European Child & Adolescent Psychiatry,27(9), 1193-1207. doi:10.1007/s00787-018-1143-y

Kang, D., 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). doi:10.1186/s40168-016-0225-7

Kulich, K. R., Madisch, A., Pacini, F., Piqué, J. M., Regula, J., Rensburg, C. J., . . . Wiklund, I. K. (2008). Reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in dyspepsia: A six-country study. Health and Quality of Life Outcomes,6(1), 12. doi:10.1186/1477-7525-6-12

Lau, N. M., Green, P. H., Taylor, A. K., Hellberg, D., Ajamian, M., Tan, C. Z., . . . Alaedini, A. (2013). Markers of Celiac Disease and Gluten Sensitivity in Children with Autism. PLoS ONE,8(6). doi:10.1371/journal.pone.0066155

Luna, R. A., Oezguen, N., Balderas, M., Venkatachalam, A., Runge, J. K., Versalovic, J., . . . Williams, K. C. (2017). Distinct Microbiome-Neuroimmune Signatures Correlate With Functional Abdominal Pain in Children With Autism Spectrum Disorder. Cellular and Molecular Gastroenterology and Hepatology,3(2), 218-230. doi:10.1016/j.jcmgh.2016.11.008

Mccrimmon, A., & Rostad, K. (2013). Test Review: Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Manual (Part II): Toddler Module. Journal of Psychoeducational Assessment,32(1), 88-92. doi:10.1177/0734282913490916

McMillin, D. (2001, October). Headache Research Report. Retrieved January 27, 2019, from http://www.meridianinstitute.com/reports/headache.html

Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., Zwaigenbaum, L., . . . Stone, W. L. (2011). Recurrence Risk for Autism Spectrum Disorders: A Baby Siblings Research Consortium Study. Pediatrics,128(3). doi:10.1542/peds.2010-2825d

Schweitzer, J., James, C., Jenkins, W., Reiff, M. I., & Stein, M. T. (2016). Acute Agitation and Self-Injury in a 5-Year Old with Autism. Journal of Developmental & Behavioral Pediatrics,37(7), 592-594. doi:10.1097/dbp.0000000000000324

Simrén, M., Barbara, G., Flint, H. J., Spiegel, B. M., Spiller, R. C., Vanner, S., . . . Zoetendal, E. G. (2012). Intestinal microbiota in functional bowel disorders: A Rome foundation report. Gut,62(1), 159-176. doi:10.1136/gutjnl-2012-302167

Srikantha, P., & Mohajeri, M. H. (2018). Microbiota-Gut-Brain-Axis and Autism Spectrum Disorders. doi:10.20944/preprints201811.0171.v1

Strati, F., Cavalieri, D., Albanese, D., Felice, C. D., Donati, C., Hayek, J., . . . Filippo, C. D. (2017). New evidences on the altered gut microbiota in autism spectrum disorders. Microbiome,5(1). doi:10.1186/s40168-017-0242-1

Valicenti-Mcdermott, M., Mcvicar, K., Rapin, I., Wershil, B. K., Cohen, H., & Shinnar, S. (2006). Frequency of Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders and Association with Family History of Autoimmune Disease. Journal of Developmental & Behavioral Pediatrics,27(Supplement 2). doi:10.1097/00004703-200604002-00011

Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., . . . Walker-Smith, J. A. (1998). Ileal lymphoid nodular hyperplasia, non-specific colitis and regressive behavioural disorder: A new syndrome? Journal of Pediatric Gastroenterology & Nutrition,25, 47. doi:10.1097/00005176-199700002-00048 (Retraction published February 6, 2010, Lancet, 375. p. 9713)

Williams, B. L., Hornig, M., Buie, T., Bauman, M. L., Paik, M. C., Wick, I., . . . Lipkin, W. I. (2011). Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances. PLoS ONE,6(9). doi:10.1371/journal.pone.0024585

Published
2019-12-05