October 22, 2018
Though they can be difficult to detect, gastrointestinal disorders are common in kids with autism, sometimes causing anger, aggression, and other behavior problems.
Anger, aggression, and other troubling behavior problems in kids with autism are often treated as psychological issues, but in many cases the problems can be traced to gastrointestinal distress.
A new study shows that a 17-item questionnaire developed by pediatric gastroenterologists and psychiatrists could be an effective screen to identify children who may have gastrointestinal disorders and who should be referred to a specialist for a fuller evaluation.
"Gastrointestinal problems can be painful and disabling and they can have profound effects on a child's behavior," says Kara Gross Margolis, M.D., associate professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons, who has treated GI disorders in numerous children with autism.
But it's often tricky for parents and primary care providers to detect GI disorders in children with autism. Many of these children are nonverbal, and because of sensory processing impairments in autism, even some verbal children can't pinpoint the location of their discomfort.
GI disorders are four times more common in children with autism than in the general pediatric population.
Margolis, with colleagues at Columbia University Irving Medical Center, Boston University, and Massachusetts General Hospital, presented 131 parents of children with autism 35 questions designed to assess observable signs of three common GI conditions: constipation, diarrhea, and reflux disease. Such signs include gagging during meals, applying pressure to the abdomen, and arching the back.
The researchers then asked pediatric gastroenterologists, who were unaware of the parents' answers, to evaluate the children.
Based on these data, the researchers identified 17 items most likely to identify these common gastrointestinal problems. These 17 items were able to correctly identify 84 percent of kids with GI disorders.
One-third of children who screened positive for a GI disorder didn't actually have one. "For a screening device, this false-positive rate seems acceptable to us," Margolis says, "given that the test correctly identified over 80 percent of the participants who had GI problems."
The screening questionnaire needs to be validated in an independent group of children before it can be used reliably by parents and primary care providers. Further studies are underway at CUIMC.
- Kara G. Margolis, Timothy M. Buie, J. Blake Turner, Anna E. Silberman, Judith F. Feldman, Katherine F. Murray, Maureen McSwiggan-Hardin, Joseph Levy, Margaret L. Bauman, Jeremy Veenstra-VanderWeele, Agnes H. Whitaker, Harland S. Winter. Development of a Brief Parent-Report Screen for Common Gastrointestinal Disorders in Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 2018; DOI: 10.1007/s10803-018-3767-7