The Role of Verbal Ability in the Co-Occurrence of Problem Behaviours and Gastrointestinal Symptoms in Autism Spectrum Disorders

Background: Autism Spectrum Disorders (ASD) is frequently associated with behavioural, neurological, and medical comorbidities. Maladaptive and problem behaviors are often observed in individuals with ASD and largely considered to be part of its constellation of neurological abnormalities (Horvath, Papadimitriou, Rabsztyn, Drachenberg, & Tildon, 1999). However recent studies have linked problem behaviors, anxiety and irritability with gastrointestinal (GI) symptoms, another common comorbidity for children with ASD.

The co-occurrence of maladaptive problem behaviors and GI symptoms in individuals with ASD has been examined within the literature (Gorrindo et al., 2012; Maenner et al., 2012; Mazefsky, Schreiber, Olino, & Minshew, 2013; Mazurek et al., 2013; Nikolov et al., 2009). However, although the potential contributory role of expressive language deficits has been mentioned (Gorrindo et al., 2012), it is yet to be formerly examined. In a group of disorders characterized by socio-communicative and language difficulties, it is possible that gastrointestinal pain or discomfort improperly expressed emerge as irritability, aggression, or atypical physical or self-injurious behavior (Bauman, 2010; Buie et al., 2010; Horvath et al., 1999)

Objectives: To examine the relationship between the presence of GI symptoms in children with ASD and manifest behavioral and affective problems, and investigate the possible mediating role of expressive language ability.

Methods: Children and adolescents with ASD were examined in regards to expressive language ability, GI symptomatology and maladaptive behaviors.  

Results: Children with concurrent GI symptoms exhibited significantly more problem behaviors on the CBCL compared to children without GI symptoms. No significant relationship was found between problem behaviors and expressive language and as such the mediational hypothesis was not supported. Contrary to expectations, children with GI symptoms exhibited significantly higher expressive language.

Conclusions: In accordance with previous literature, children with ASD and comorbid GI symptoms were reported to exhibit more problem behaviours. In this instance, impairments in expressive language were not found to contribute to the relationship between the presence of GI symptoms and behavioral and affective problems.