Abstract | Summary | Original Article

Gastrointestinal symptoms in a sample of children with Pervasive Developmental Disorder

Nikolov RN, Bearss KE, Lettinga J, Erickson C, Rodowski M, Aman MG, et al.

Journal of Autism and Developmental Disorders. 2009; 39: 405-413.

Question: Are there differences in the symptoms of autism in children with stomach and bowel problems compared to children without these medical problems?

Background: Many parents report that their children with ASD have stomach pain, indigestion, diarrhea, or chronic constipation.  It is not known if children with ASD are more likely than their typical peers to have these conditions. It is also not known if treating these children will alleviate their autism symptoms. The aim of this study was to evaluate children with ASD to see whether or not there was any relationship between their stomach and bowel problems and their symptoms of autism.

Design: Two group comparison study.

Setting: Yale Child Centre, Yale University.

Participants: A group of 145 boys and 27 girls, ranging in age from 5 to 17 years, who were not receiving any medications were recruited for this research project. They were all about to enter studies of drug therapies for aggression, tantrums, self-injury and for hyperactivity. Two groups were formed based on whether or not the children had stomach and bowel symptoms.  

Main Outcome Measures: The medical histories of were assessed for stomach and bowel symptoms.  Parents were also asked about these symptoms in their children. The ADI-R was used to describe the child’s behavior according to parent report. The child’s ability to learn was assessed using different rating scales, depending upon their developmental stage. The Vineland was used to measure the child’s ability to use language, and the level of their social and daily living skills. Other tests looked for behavior problems and the symptoms seen in different types of anxiety disorders.

Main Results: Of the 172 patients who took part, about 23% had stomach or bowel problems. There were no differences between the two groups on measures of communication or social skills or stereotypic behaviours (e.g., hand flapping, twirling, etc.). There were no differences between the groups on measures of intelligence. The group who had stomach and bowel problems were more likely than the group without these symptoms to have higher scores on the measures of irritability and social withdrawal.  They were also significantly more likely to have symptoms of anxiety.

Conclusions: Right now there is no credible evidence that children with ASD have higher rates of stomach and bowel problems than do their typically developing peers. In this study there were no differences between the children with stomach and bowel problems and those without, except for measures of anxiety, irritability and social withdrawal.  The authors of this study suggest that anxiety may be responsible for the symptoms, which are also seen in typically developing children and adults with anxiety and depression. Some of the symptoms that the children with stomach and bowel problems demonstrated are seen in depression, too.

Bottom Line The only differences found between children with stomach and bowel problems compared to those without, were symptoms of anxiety, and possibly of depression.  There is no good evidence that children with ASD are more likely than their typically developing peers to have stomach and bowel problems.  These symptoms are not associated with "autistic" behaviours.