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Calls to Action

Gastrointestinal Conditions in Children with Autism Spectrum Disorders

WASHINGTON, D.C. (November 15, 2009) – One of the largest gatherings of researchers, clinicians and pediatric specialists in gastrointestinal (GI) disorders and nutrition ever assembled convene today at the Gaylord National Resort & Convention Center, National Harbor, Md., at a symposium hosted by Autism Speaks, the American Academy of Pediatrics (AAP) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN). The symposium is being held as an adjunct to the annual NASPGHAN meeting.

Ivor D. Hill, M.B., Ch.B., M.D., Chief in the Section of Pediatric Gastroenterology and Nutrition and Medical Director of the Pediatric Outpatient Clinic in the Department of Pediatrics at Wake Forest University School of Medicine, is active in NASPGHAN and the AAP. A member of the Executive Committee of the National Conference and Exhibition Planning Group of the AAP, he commented about the symposium. "The mission of the American Academy of Pediatrics (AAP) is to attain optimal physical, mental and social health and well being for all infants, children, adolescents and young adults. In this regard, the AAP views this satellite symposium on autism and the GI tract as an extremely important and much needed opportunity to review our understanding of some of the gastrointestinal conditions that affect children with autism, identify gaps in our knowledge in this area and prioritize needs for future research. The AAP anticipates this process will inevitably result in improvements in the quality of life for both the children with autism and their families."

The symposium is intended to raise awareness among specialists about GI disorders in autism; to educate clinicians and researchers on the latest scientific information on pathophysiology, evaluation, and treatment strategies for autism spectrum disorder-gastrointestinal (ASD-GI) disorders and plan new directions for research for ASD-GI disorders.

This symposium was spearheaded by the leadership of Autism Speaks' Autism Treatment Network (ATN), a network of medical centers dedicated to improving the health and healthcare of individuals with autism. Co-chairs for the meeting are George Fuchs, M.D., Chair of the ATN Gastroenterology Committee and Daniel Coury, M.D., ATN Medical Director.

"We are excited to have the researchers and clinicians assembled for this symposium," said Dr. Coury. "Some of them will be sharing new data and letting us know about their current work. They are all knowledgeable in their areas of expertise and will help us gain a better understanding of what science has shown us, what has been reported and needs to be studied further, and what new areas need to be explored."

A recent study suggests that ASDs affect up to one in 91 individuals in the U.S. and an estimated one percent of people worldwide. Although no formal studies have been published to date regarding the prevalence of GI symptoms in children with ASD, from 9 to 70 percent in children with ASD are reported to be suffering from such symptoms. GI symptoms are thought to contribute to troubling behaviors such as posturing, self injury and outbursts resulting from GI discomfort and are of significant concern to people with ASD and their families.

"Awareness and research are two cornerstones of Autism Speaks mission," said Geraldine Dawson, Ph.D., Autism Speaks chief science officer, "and we are pleased to be able to combine them here to inform pediatricians about the GI conditions that are prevalent among individuals with ASD and develop a research agenda to address them. We are hoping to improve the lives of individuals with ASD who struggle with GI conditions by improving awareness about best practices for diagnosis and treatment in the pediatric medical community."

The symposium sheds light on the many complex issues associated with GI conditions, nutrition and autism through a series of lectures presented by nationally and internationally recognized speakers. Separate sessions address Reflux and Vomiting, Constipation, Diarrhea and Nutrition in the context of children with ASD.

Many presenters are worth noting. Alessio Fasano, M.D., for example, Professor of Pediatrics, Medicine and Physiology at the University of Maryland School of Medicine, presents new data on how environmental triggers might cause a "leaky gut" and how uncontrolled passage of antigens through a leaky gut can alter metabolic pathways and in some cases lead to ASD.

Dan Atkins, M.D., Head of the Division of Ambulatory Pediatrics and Medical Director of the Pediatric Day Program at National Jewish Health in Denver, Colorado, presents a practical overview of the evaluation and management of allergic reactions to foods, differentiating between food allergies and food intolerance, and categorizing the mechanisms involved as either immunoglobulin E (IgE)-mediated, non-IgE-mediated or combined IgE- and non-IgE-mediated reactions, distinctions which guide the course of managing the symptoms through the development of individualized elimination diets.

Lonnie K. Zeltzer, M.D., Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at the University of California at Los Angeles describes the behavioral responses to pain in children with ASD, arguing that apparent decreased pain reactivity noted by some researchers does not represent real analgesia in children with ASD but rather different modes of pain expression. These differences in pain expression are related to difficulties with verbal communication, body representation and certain cognitive disorders, including learning disorders, problems representing sensations and emotions, and problems establishing cause-effect relationships. She also poses that there is some evidence for a significant relationship between certain self-injurious behaviors and pain perception, and that this finding calls attention to the role of stress in general and behavioral responses, especially self-injurious ones, in children with ASD.

Maureen Geraghty, Ph.D., R.D., L.D., Assistant Professor in Medical Dietetics of the School of Allied Medical Professions in the Ohio State University College of Medicine presents the latest research into nutrition and ASD. She reviews recent studies regarding the nutrient intake among children with ASD, discussing their respective methodologies and describing conflicting findings in comparing the nutritional status of children with ASD and typically developing children and studies which found that unconventional diets could put boys with ASD at greater risk for reduced bone density and thickness. She also discusses the medical and nutritional factors that affect nutrient intake in children with ASD, including GI issues, food allergies, metabolic abnormalities, pre-existing nutrient deficiencies and nutrition-related medication side-effects.

Dr. Fuchs summed up the importance of the symposium this way: "At present, there is considerable confusion and misunderstanding about the nature and treatment of GI issues in children with autism spectrum disorders. We anticipate that the convening of this group of highly regarded clinicians and scientists to review the existing evidence, both what is known and what is not known, will provide a degree of clarity for health care providers, researchers, and parents and ultimately improve care of these children and define areas of further research that hold the most promise."

About Autism
Autism is a complex brain disorder that inhibits a person's ability to communicate and develop social relationships, and is often accompanied by behavioral challenges. Autism spectrum disorders are diagnosed in one in 150 children in the United States, affecting four times as many boys as girls. The prevalence of autism has increased tenfold in the last decade. The Centers for Disease Control and Prevention have called autism a national public health crisis whose cause and cure remain unknown.

About Autism Speaks
Autism Speaks is the nation's largest autism science and advocacy organization, dedicated to funding research into the causes, prevention, treatments and a cure for autism; increasing awareness of autism spectrum disorders; and advocating for the needs of individuals with autism and their families. Autism Speaks funds more than $30 million each year in new autism research, in addition to supporting the Autism Treatment Network, Autism Genetic Resource Exchange, Autism Clinical Trials Network, Autism Tissue Program and a range of other scientific and medical programs. Notable awareness initiatives include the establishment of the annual United Nations-sanctioned World Autism Awareness Day on April 2 and an award-winning, multi-year national public service advertising campaign with the Ad Council. Autism Speaks' family services efforts include the Autism Video Glossary, a 100 Day Kit for newly-diagnosed families, a School Community Tool Kit and the distribution of community grants to local service providers. Its government relations department, through its Autism Votes initiative, has played a critical role in securing federal legislation to advance the federal government's response to autism, and has successfully advocated for insurance reform to require insurers to cover medically-necessary autism therapies. Each year, Autism Speaks Walk Now for Autism Speaks fundraising events are held in more than 80 cities across the country, as well as Canada and the United Kingdom. To learn more about Autism Speaks, please visit www.autismspeaks.org. For more information on the Autism Treatment Network, go to www.autismspeaks.org/atn or www.autismspeaks.org/airp.

About NASPGHAN
The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, founded in 1972, is the only society in North America and the largest in the world, dedicated to serving the Pediatric Gastroenterology and nutrition communities. NASPGHAN was established to advance the understanding of the normal development and physiology of diseases of the gastrointestinal tract and liver in infants, children, and adolescents, and to foster the dissemination of this knowledge through scientific meetings, professional education, public education, and interaction with other organizations concerned with Pediatric Gastroenterology and nutrition. To learn more about NASPGHAN, please visit www.naspghan.org.

About the American Academy of Pediatrics
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. To learn more about the American Academy of Pediatrics, please visit www.aap.org.