What's the Story About Gastrointestinal Problems in Kids With Autism?

Research shows no higher risk in autistic children, nor any evidence that a special diet might help.


What's the story about gastrointestinal problems in children with autism? I'm wondering about the recent news showing little evidence that special diets do any good.

Judith Palfrey, M.D.

Families of children with autism face many challenges day in and day out. One of the toughest problems is trying to figure out how to make their children comfortable when they have the inevitable ups and downs of childhood. Recent studies show that children with autism are at no higher risk of having gastrointestinal problems than are children without autism. But that means they also have no fewer GI upsets. And when they are having stomach aches or are refusing to eat, it can be really tough for them and their parents. I asked William Barbaresi, director of the Developmental Medicine Center at Children's Hospital in Boston and associate professor of pediatrics at Harvard Medical School, to comment on the question of how parents can best comfort their children with autism when they have GI disturbances. Here is his answer:

"The recently published reports on the evaluation and treatment of gastrointestinal disorders in children with autism spectrum disorders provide useful information for clinicians who care for children with ASDs. Most importantly, the reports emphasize the fact that children with ASDs deserve careful, high-quality attention to common medical problems that affect all children. It can be a challenge to diagnose and treat medical problems in children who have difficulty communicating about symptoms such as pain.

"The reports accurately describe the current state of knowledge about gastrointestinal problems and ASDs; specifically, there is no current research that proves that there are any gastrointestinal problems that are unique to children with ASDs or that gastrointestinal problems can cause a child to develop autism. Since the 2008 meeting that led to the publication of these reports, there has been additional research published on this topic. This research reported on the rate of gastrointestinal disorders throughout childhood in a group of children with autism versus a group without autism in a population-based cohort in Rochester, Minn. Children with autism were found to have the same overall rate of gastrointestinal problems as children without autism. Children with autism were more likely than children without autism to have two types of gastrointestinal problems: constipation and "picky eating." These findings reinforce the importance of treating gastrointestinal problems in children with autism just as we do in children without autism. However, there is currently no evidence that children with autism are more likely to have gastrointestinal problems in general or that they have unique gastrointestinal problems. Children with autism deserve the same high-quality medical care that should be provided to all children, but we should not expect that treatment of gastrointestinal problems will improve core symptoms of autism.

"Constipation and picky eating can be very frustrating problems for parents and particularly difficult when the child cannot tell us exactly what is going on. There is very helpful advice on these two conditions on the recently launched American Academy of Pediatrics website. Also, the book Food Fights by Laura Jana and Jennifer Shu, two pediatrician mothers, has wonderful, down to earth suggestions for picky eaters. Parents of children with autism may want to check out these resources as well as the materials available about autism at the AAP site and at the Children's Hospital Boston website.

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