HealthCert Blog

Nutrition research summary: Bidirectional relationship between internalising symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Medical Nutrition Management.

Please note: The reviewed study uses person-first language (e.g., “children with autism” which has the potential to enhance stigma (Gernsbacher, 2017). As such, I have used identity-first language (e.g., “autistic children” in this review, which aligns with majority preference of the autistic community (Kenny et al., 2016).

What comes first: gastrointestinal problems or internalising symptoms in autistic kids?

GI problems are associated with increased internalising and externalising symptoms in the general population (dos Santos et al., 2021; Restrepo et al., 2020). Given that rates of GI problems are much higher in autistic children than allistic children (for example, Restrepo et al. 2020), it makes sense that this association holds for autistic children too (e.g., Holingue et al., 2018).

Differing suggestions have been put forward as to the direction of the relationship between GI problems and internalising symptoms (see for example, Prosperi et al., 2019 and Ferguson et al., 2019).

Dovgan and colleagues (2022) aimed to further elucidate the relationship between GI problems and internalising symptoms in a sample of 621 autistic US children. Caregiver’s provided demographic information, and answered a range of questions, including those assessing their concern re: GI symptoms (four dichotomous questions on constipation, diarrhoea, nausea and vomiting, and abdominal pain) and their impression of their child’s internalising symptoms. Internalising symptoms were assessed via two 3-point Likert scale questions from the Child Behavior Checklist: withdrawn/depressed and anxious/depressed.

Participants were aged between 1.5 to 17 years of age, 81% were male and the same proportion were Caucasian. Forty five percent of caregiver’s reported their child experienced GI symptoms, with most (54.5%) only experiencing one symptom.

Structural equation modelling was utilised to perform path analysis. Whilst when this is applied in cross sectional studies, it is unable to determine the definitive directionality of a relationship, it may infer hypothesis directionality.

The results of this study suggest that in this group of predominantly male, Caucasian autistic youth, that internalising symptoms covaried with GI problems. The implications are that autistic youth who face challenges with expressing emotion or report increased anxiety may also experience GI problems, and vice versa.

Clinically this points to the importance of exploring supports for both GI problems and anxiety/mood disorders in autistic youth who present with both GI problems and internalising symptoms. Treating the GI problems alone, or alternately, only the internalising symptoms, may not be effective in producing durable improvements in quality of life and wellbeing.

– Anna Millichamp APD, Senior Teaching Fellow & PhD Candidate, Bond University

Full paper

Dovgan, K., Gynegrowski, K. & Ferguson, B.J. Bidirectional relationship between internalizing symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder. J Autism Dev Disord (2022). https://doi.org/10.1007/s10803-022-05539-6

References

Dos Santos, I. R., de Abreu, G. E., Dourado, E. R., Martinelli Braga, A., Lobo, V. A., de Carvalho, I., Bastos Netto, J. M., & Barroso, U., Jr (2021). Emotional and behavioural problems in children and adolescents: The role of constipation. Journal of paediatrics and child health, 57(7), 1003–1008. https://doi.org/10.1111/jpc.15368

Dovgan, K., Gynegrowski, K. & Ferguson, B.J. Bidirectional relationship between internalizing symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder. J Autism Dev Disord (2022). https://doi.org/10.1007/s10803-022-05539-6

Ferguson, B. J., Dovgan, K., Takahashi, N., & Beversdorf, D. Q. (2019). The Relationship Among Gastrointestinal Symptoms, Problem Behaviors, and Internalizing Symptoms in Children and Adolescents With Autism Spectrum Disorder. Frontiers in psychiatry, 10, 194. https://doi.org/10.3389/fpsyt.2019.00194

Gernsbacher M. A. (2017). Editorial Perspective: The use of person-first language in scholarly writing may accentuate stigma. Journal of child psychology and psychiatry, and allied disciplines, 58(7), 859–861. https://doi.org/10.1111/jcpp.12706

Holingue, C., Newill, C., Lee, L. C., Pasricha, P. J., & Daniele Fallin, M. (2018). Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence. Autism research : official journal of the International Society for Autism Research, 11(1), 24–36. https://doi.org/10.1002/aur.1854

Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism : the international journal of research and practice, 20(4), 442–462. https://doi.org/10.1177/1362361315588200

Prosperi, M., Santocchi, E., Muratori, F., Narducci, C., Calderoni, S., Tancredi, R., Morales, M. A., & Guiducci, L. (2019). Vocal and motor behaviors as a possible expression of gastrointestinal problems in preschoolers with Autism Spectrum Disorder. BMC pediatrics, 19(1), 466. https://doi.org/10.1186/s12887-019-1841-8

Restrepo, B., Angkustsiri, K., Taylor, S. L., Rogers, S. J., Cabral, J., Heath, B., Hechtman, A., Solomon, M., Ashwood, P., Amaral, D. G., & Nordahl, C. W. (2020). Developmental-behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism research : official journal of the International Society for Autism Research, 13(10), 1778–1789. https://doi.org/10.1002/aur.2354

Read more recent research: Association between dietary patterns & chronic inflammation