Gastrointestinal Symptoms and Associated Clinical Features in Preschoolers with Autism Spectrum Disorders

Thursday, May 14, 2015: 11:30 AM-1:30 PM
Imperial Ballroom (Grand America Hotel)
F. Fulceri1, M. Morelli2, E. Santocchi3, A. Narzisi3, S. Calderoni4 and F. Muratori5, (1)Calambrone Pisa, IRCCS STELLA MARIS FOUNDATION, Pisa, Italy, (2)Stella Maris Foundation, Pisa, Italy, (3)University of Pisa – Stella Maris Scientific Institute, Pisa, Italy, (4)Magnetic Resonance Laboratory, Division of Child Neurology and Psychiatry University of Pisa; Stella Maris Scientific Institute, Pisa, PI, Italy, (5)Stella Maris Scientific Institute, Calambrone (Pisa), Italy

Parents of children with autism spectrum disorder (ASD) frequently report gastrointestinal (GI) symptoms  in their child with a higher prevalence than in typically developing peers (TD). Moreover, literature suggests that children with ASD and GI disorder(s) (ASD/GI+) may be at high risk for problem behaviors.


To investigate the clinical features of ASD/GI+ preschoolers compared to ASD children without GI symptoms (ASD/GI-) and to TD using the Child Behavior Checklist for ages 1.5 to 5 years (CBCL 1.5-5), a parent-report questionnaire for evaluating the child’s functioning during the last two months.


A total of 230 preschoolers were included in this study. The ASD group consisted of 115 subjects (95 male and 20 female; mean [SD] age =3.8 [1.1] years; age range =1,8-5,9 years) with a clinical diagnosis of Pervasive Developmental Disorders (PDD) based on the DSM-IV-TR criteria. The control group consisted of 115 TD children (95 male and 20 female; mean [SD] age =3.9 [1.0] years; age range =1,8-5,9 years) with a CBCL 1.5- 5 Total Problems T score below the clinical range and without a CBCL profile suggestive of ASD (Muratori et al., 2011). Parents of children filled out the CBCL 1.5 -5. Items responses are recorded on a Likert scale: 0 = Not True, 1 = Somewhat/Sometimes True, 2 = Very True/Often True. A Total Problem Score, the Internalizing and Externalizing Problems scores, six different syndromes scores (Emotionally Reactive, Anxious/Depressed, Withdrawn, Sleep Problems, Attention Problems, and Aggressive Behavior) and five DSM-oriented Problems scales scores (Affective, Anxiety, Pervasive Developmental, Attention Deficit/Hyperactivity, Oppositional) were evaluated. GI symptoms were identified in seven CBCL items (Costipated, Diarrea, Nausea, Noteat, PainfulBM, Stomachaches, Vomiting).


At least one GI symptom was reported by parents of 69,6% of ASD children versus 53,9% of TD peers (p<0.05). When more stringent criteria to define subjects suffering GI symptoms (at least one GI symptoms scored as “2”) were used, the prevalence of GI problems were still significantly higher in ASD (37,4%) than in TD individuals (15,7%) (p =0.0003). Specifically, “Not eat” and “Costipated” were the items more frequently reported both in ASD/GI+ and in TD with GI symptoms (TD/GI+) children, but with a significantly higher prevalence in ASD than in TD (respectively p<0.01; p<0.01 ).

Within the ASD group, ASD/GI+ showed a higher  percentage of borderline/clinical scores in Aggressive (p<0.01), Internalizing (p<0.01) and Total Problems than ASD/GI-(p<0.001) scores whereas within the TD group, TD/GI+ exhibited a higher  percentage of borderline/clinical scores in Internalizing (p <0.01) and Affective Problems (p<0.05) scores than TD/GI-.


Preschoolers with ASD had higher prevalence of at least one GI symptom than TD peers. GI symptoms were related to behavioral problems both in ASD and in TD subjects, but aggressive behaviors appeared specific to ASD/GI+ children. The observed association suggests that GI symptomatology should be systematically checked and treated in ASD patients, in order to potentially reduce not only GI symptoms, but also the emotional and behavioral associated features.