Authors: Kent Williams, MD1, George J Fuchs, MD2, Glenn Furuta, MD3, Margaret Marcon, MD4, Daniel L Coury, MD5 and Autism Treatment Network GI Committee5. 1Vanderbilt University, Nashville, TN, United States; 2University of Arkansas for Medical Sciences, Little Rock, AK, United States; 3University of Colorado at Denver, Denver, CO, United States; 4Hospital for Sick Children, Toronto, Canada and 5Nationwide Children's Hospital, Columbus, OH, United States.
Background: While various studies disagree about the prevalence of GI symptoms in children with ASD, most agree that GI complaints are relatively common in ASD children. However, whether GI symptoms in children with ASD are associated with other biological, behavioral, and clinical factors is unknown.
Objectives: To determine the frequency of GI symptoms as reported by parents in a large ASD registry, and to identify factors associated with GI symptoms in children with ASD.
Methods: Autism Treatment Network Registry enrolled 1420 children with an ADOS-confirmed ASD diagnosis (autism, Asperger disorder, or PDD-NOS) at 15 sites in the US and Canada. Parents completed a GI symptom inventory, as well as Child Behavior Checklist (CBCL), Child Sleep Health Questionnaire (CSHQ) and Pediatric Quality of Life (PedsQL) at time of enrollment.
Results: GI data was available for 1185 children. At time of enrollment 45% of children displayed GI symptoms. For GI complaints occurring < 3 months, constipation was most common (32%) followed by abdominal pain (27%), diarrhea (26%), other (18%), nausea (14%) and bloating (12%). For GI complaints occurring >3 months), constipation was most common (22%) followed by other (14%), abdominal pain (14%), diarrhea (12%), bloating (9%) and nausea (5%). GI symptoms increased with age, ranging from 39% in those under 5 years to 51% in those 7 years and older (p<0.0001). Children ages 1 to 5 years with GI symptoms had higher CBCL t-scores for total problems and for the emotionally reactive, anxious/depressed, somatic complaints, sleep problems, internalizing problems, affective problems, and anxiety problems subscales, all p<0.05. Children ages 6 to 18 years with GI symptoms had higher CBCL t-scores for total problems and for all subscales (p<0.01). Sleep problems occurred more frequently in children with than those without GI symptoms (50% versus 37%, p<0.0001). Children with GI symptoms had lower PedsQL scores (overall score and all five subscales, p<0.01) compared to children without GI problems. Presence of GI problems did not differ by gender, ASD subtype, race, or IQ.
Conclusions: Parents of children with ASD report a high prevalence of GI symptoms in their children. GI complaints are associated with age, behavioral abnormalities, sleep disturbances and decreased health-related quality of life. Further investigation is needed to clarify these associations and whether treatment of GI disorders improves behaviors, sleep, and quality of life in ASD children.