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, age 2-18 years, 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 tailored to the needs of nonverbal children, as well as Child Behavior Checklist (CBCL), Child Sleep Health Questionnaire (CSHQ) and Pediatric Quality of Life (PedsQL) at time of enrollment.
Results: GI symptom data were available for 1185 children. Overall 45% of children were reported to have GI symptoms at time of enrollment. Of GI complaints that occurred within the 3 months prior to enrollment, abdominal pain was most common (59%) followed by constipation (51%), diarrhea (43%), other (40%), nausea (31%) and bloating (26%). Reports of 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 (70% versus 30%, 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. This prevalence increases with age. GI complaints are significantly associated with behavioral abnormalities in all age groups. GI symptoms are also significantly associated with sleep disturbances and decreased health-related quality of life. Further definition is needed on the role and potential impact of treatment of GI disorders on behavior, sleep disturbance, and quality of life in children with ASD.