Incidence of gastrointestinal symptoms in children with autism: a population-based study.
TL;DR: As constipation and feeding issues/food selectivity often have a behavioral etiology, data suggest that a neurobehavioral rather than a primary organic gastrointestinal etiology may account for the higher incidence of these gastrointestinal symptoms in children with autism.
Abstract: OBJECTIVE: To determine whether children with autism have an increased incidence of gastrointestinal symptoms compared with matched control subjects in a population-based sample. DESIGN/METHODS: In a previous study including all of the residents of Olmsted County, Minnesota, aged RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and 18.7 (control subjects) years. Significant differences between autism case and control subjects were identified in the cumulative incidence of constipation (33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No significant associations were found between autism case status and overall incidence of gastrointestinal symptoms or any other gastrointestinal symptom category. CONCLUSIONS: As constipation and feeding issues/food selectivity often have a behavioral etiology, data suggest that a neurobehavioral rather than a primary organic gastrointestinal etiology may account for the higher incidence of these gastrointestinal symptoms in children with autism.
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TL;DR: A gut-microbiome-brain connection in a mouse model of ASD is supported and a potential probiotic therapy for GI and particular behavioral symptoms in human neurodevelopmental disorders is identified.
2,507 citations
Cites background from "Incidence of gastrointestinal sympt..."
...Offspring of Immune-Activated Mothers Exhibit GI Symptoms of Human ASD Subsets of ASD children are reported to display GI abnormalities, including increased intestinal permeability or ‘‘leaky gut’’ (D’Eufemia et al., 1996; de Magistris et al., 2010; Ibrahim et al., 2009)....
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...Subsets of ASD children are reported to display GI abnormalities, including increased intestinal permeability or ‘‘leaky gut’’ (D’Eufemia et al., 1996; de Magistris et al., 2010; Ibrahim et al., 2009)....
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TL;DR: This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available to help the reader identify topic areas within the report.
Abstract: Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnosticcriteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child’s function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
582 citations
TL;DR: Results indicate greater prevalence ofGI symptoms among children with ASD compared with control children, and future research must address critical questions about the causes and long-term impact of GI symptoms in ASD.
Abstract: BACKGROUND: In pediatric settings, parents often raise concerns about possible gastrointestinal (GI) symptoms in autism spectrum disorder (ASD), yet the specificity of these concerns are not well studied. OBJECTIVE: To conduct a meta-analysis of research investigating GI symptoms among children with ASD. METHODS: We searched Medline, PsycINFO, and PubMed databases (1980–2012) in peer-reviewed journals. Analysis involved studies with a comparison group presenting quantitative data on GI symptoms using combinations of terms for ASD and GI indicators. The systematic search yielded 15 studies. We calculated effect sizes and 95% confidence intervals (CIs) using a random-effects model. RESULTS: Children with ASD experience significantly more general GI symptoms than comparison groups, with a standardized mean difference of 0.82 (0.24) and a corresponding odds ratio (OR) of 4.42 (95% CI, 1.90–10.28). Analysis also indicated higher rates of diarrhea (OR, 3.63; 95% CI, 1.82–7.23), constipation (OR, 3.86; 95% CI, 2.23–6.71), and abdominal pain (OR, 2.45; 95% CI, 1.19–5.07). CONCLUSIONS: Results indicate greater prevalence of GI symptoms among children with ASD compared with control children. Identified studies involved high methodological variability and lack of comprehensive data prohibited analysis of GI pathophysiologies (eg, gastroesophageal reflux) typically associated with organic etiologies, limiting conclusions about the underpinnings of the observed association. Future research must address critical questions about the causes and long-term impact of GI symptoms in ASD. Such analyses will require more systematic research and clinical activities, including improved diagnostic screening, standardized assessment, and exploration of potential moderators (eg, dietary restrictions).
547 citations
TL;DR: Results indicated children with ASD experienced significantly more feeding problems versus peers, and future research must address critical questions regarding the cause, long-term impact, and remediation of atypical feeding in this population.
Abstract: We conducted a comprehensive review and meta-analysis of research regarding feeding problems and nutrient status among children with autism spectrum disorders (ASD) The systematic search yielded 17 prospective studies involving a comparison group Using rigorous meta-analysis techniques, we calculated the standardized mean difference (SMD) with standard error and corresponding odds ratio (OR) with 95 % confidence intervals (CI) Results indicated children with ASD experienced significantly more feeding problems versus peers, with an overall SMD of 089 (008) and a corresponding OR of 511, 95 % CI 374–697 Nutrient analyses indicated significantly lower intake of calcium (SMD: −065 [029]; OR: 031, 95 % CI 011–085) and protein (SMD: −058 [025]; OR: 035, 95 % CI: 014–056) in ASD Future research must address critical questions regarding the cause, long-term impact, and remediation of atypical feeding in this population
393 citations
TL;DR: Frequent GI problems affect young children with ASD and DD more commonly than those with TD, andMaladaptive behaviors correlate with GI problems, suggesting these comorbidities require attention.
Abstract: To compare gastrointestinal (GI) problems among children with: (1) autism spectrum disorder (ASD), (2) developmental delay (DD) and (3) typical development (TD), GI symptom frequencies were obtained for 960 children from the CHildhood Autism Risks from Genetics and Environment (CHARGE) study. We also examined scores on five Aberrant Behavior Checklist (ABC) subscales comparing ASD children with high versus low frequency GI symptoms. Compared to TD children, those with ASD [aOR 7.92 (4.89–12.85)] and DD [aOR 4.55 (2.51–8.24)] were more likely to have at least one frequent GI symptom. Restricting to ASD children, those with frequent abdominal pain, gaseousness, diarrhea, constipation or pain on stooling scored worse on irritability, social withdrawal, stereotypy, and hyperactivity compared with children having no frequent GI symptoms. Frequent GI problems affect young children with ASD and DD more commonly than those with TD. Maladaptive behaviors correlate with GI problems, suggesting these comorbidities require attention.
352 citations
Cites background from "Incidence of gastrointestinal sympt..."
...Research using large samples has begun to provide a better understanding of the heterogeneity of GI concerns in children with ASD (Molloy and Manning-Courtney 2003; Valicenti-McDermott et al. 2006; Ibrahim et al. 2009; Nikolov et al. 2009; Wang et al. 2011)....
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...Interestingly, food selectivity for children with ASD is a common thread in several studies (Valicenti-McDermott et al. 2006; Ibrahim et al. 2009)....
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...constipation; diarrhea; abdominal bloating, discomfort or irritability; gastroesophageal reflux or vomiting; and feeding issues or food selectivity (Ibrahim et al. 2009)....
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...charts provided data for GI symptoms from birth to 21 years of age (Ibrahim et al. 2009)....
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...…is not yet resolved, however, and a handful of recent reports provide conflicting findings, where prevalence of GI symptoms ranges from 23 to 70 % (Molloy and ManningCourtney 2003; Valicenti-McDermott et al. 2006; Ibrahim et al. 2009; Nikolov et al. 2009; Wang et al. 2011; Gorrindo et al. 2012)....
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References
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TL;DR: In this paper, the authors investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder, and identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
2,505 citations
01 Mar 1996
TL;DR: The Rochester Epidemiology Project is a unique medical records-linkage system that encompasses the care delivered to residents of Rochester and Olmsted County, Minnesota and is able to provide accurate incidence data for almost any serious condition and to support population-based analytic studies of disease causes and outcomes.
Abstract: The Rochester Epidemiology Project is a unique medical records-linkage system that encompasses the care delivered to residents of Rochester and Olmsted County, Minnesota. It is the creation of Dr. Leonard T. Kurland, who envisioned the population-based data resource that would result from combining the clinical documentation developed by the Mayo Clinic with that obtained by other community providers, most notably the Olmsted Medical Group and its affiliated Olmsted Community Hospital. Kurland built on the Mayo unit medical record system that was designed by Dr. Henry S. Plummer in 1907 and on the medical and surgical indexing systems introduced by Dr. Joseph Berkson in 1935. By affording access to details of the medical care given to local residents, the Rochester Epidemiology Project is able to provide accurate incidence data for almost any serious condition and to support population-based analytic studies of disease causes and outcomes. Thus, epidemiologic studies of a wide array of disorders have been possible and have culminated in almost 900 publications since the system was organized in 1966. Olmsted County is one of the few places in the world where the occurrence and natural history of diseases can be accurately described and analyzed in a defined population for a half century or more.
1,484 citations
TL;DR: Risperidone was effective and well tolerated for the treatment of tantrums, aggression, or self-injurious behavior in children with autistic disorder and the benefit was maintained at six months.
Abstract: Background Atypical antipsychotic agents, which block postsynaptic dopamine and serotonin receptors, have advantages over traditional antipsychotic medications in the treatment of adults with schizophrenia and may be beneficial in children with autistic disorder who have serious behavioral disturbances. However, data on the safety and efficacy of atypical antipsychotic agents in children are limited. Methods We conducted a multisite, randomized, double-blind trial of risperidone as compared with placebo for the treatment of autistic disorder accompanied by severe tantrums, aggression, or self-injurious behavior in children 5 to 17 years old. The primary outcome measures were the score on the Irritability subscale of the Aberrant Behavior Checklist and the rating on the Clinical Global Impressions — Improvement (CGI-I) scale at eight weeks. Results A total of 101 children (82 boys and 19 girls; mean [±SD] age, 8.8±2.7 years) were randomly assigned to receive risperidone (49 children) or placebo (52). Treat...
1,331 citations
1,125 citations
TL;DR: The observed increase in pancreatico-biliary secretion after secretin infusion suggests an upregulation of secretin receptors in the pancreas and liver and may contribute to the behavioral problems of the non-verbal autistic patients.
481 citations
"Incidence of gastrointestinal sympt..." refers background in this paper
...Gastrointestinal diagnoses before 21 years of age were grouped into 5 categories: (1) constipation; (2) diarrhea; (3) abdominal bloating, discomfort, or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding issues or food selectivity....
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...or vomiting; and (5) feeding issues or food selectivity....
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