Characteristics of the autism spectrum disorder gastrointestinal and related behaviors inventory in children

Assessing Internal Consistency of the Autism Spectrum Disorder Gastrointestinal and Related Behaviors Inventory and the Frequency and Socio-Emotional Correlates of Gastrointestinal Difficulties in Children With the Autism Spectrum Disorder: A Cross-Sectional Study

Gastrointestinal (GI) difficulties are common in children diagnosed with autism spectrum disorder (ASD). However, these difficulties can frequently remain unrecognized. Therefore, we aimed to translate a newly developed instrument, The Autism Spectrum Disorder Gastrointestinal and Related Behaviors Inventory in Children (ASD-GIRBI), to assess its reliability and to explore the frequency of various gastrointestinal difficulties and related behaviors, as well as to explore the association of GI difficulties with the measures of social functioning and emotional and behavioral difficulties in children with ASD. A total of 98 children and adolescents (aged 4-18 [Mage = 10.67 ± 3.705], 82.7% male), previously diagnosed with ASD at the Institute of Mental Health in Belgrade, Serbia, took part in this research. Their parents filled out the following questionnaires: ASD-GIRBI (an assessment of gastrointestinal and related symptoms), Stanford Social Dimensions Scale (SSDS) (a measure of social functioning) and Strengths and Difficulties Questionnaire (SDQ) (a measure of emotional and behavioral problems). Our results indicate that the ASD-GIRBI is a reliable instrument for GI difficulties assessment (Cronbach's α = 0.841) with the total score successfully discriminating between the participants with and without a GI disorder diagnosis (p = 0.040). Any gastrointestinal symptom was present in 54.1% of the participants, most commonly flatulence, diarrhea, and constipation. The severity of gastrointestinal difficulties correlated to emotional problems (r = 0.261, p < 0.01), conduct problems (r = 0.219, p < 0.05), hyperactivity (r = 0.381, p < 0.01), peer problems (r = 0.266, p < 0.01), total difficulties (r = 0.454, p < 0.01) and total difficulties impact (r = 0.321, p < 0.01). Our data emphasize the potential importance of GI difficulties for various areas of functioning of individuals with ASD.

Research Tools for Eating Behavior in People with Autism Spectrum Disorder (ASD)

OBJECTIVE

To identify the tools used to assess eating behaviors in individuals with Autism Spectrum Disorder (ASD) and summarize their distribution, citation rates, journal publication, JCR scores, and psychometric properties.

METHODS

A literature review was conducted to identify studies on eating behavior in individuals with ASD. The search included various descriptors and combinations of keywords in databases such as Medline/PubMed, Science Direct, Scopus, SciELO, and Web of Science. The studies were filtered to focus on articles published in the last five years. Thirty-seven relevant studies were identified and analyzed to summarize the tools used, their distribution in the literature, citation rates, and psychometric properties.

RESULTS

Thirty-seven relevant studies were identified. The Journal of Autism and Developmental Disorders published the most studies (5). The Brief Autism Mealtime Behavior Inventory (BAMBI) was the most frequently used instrument, appearing in 15 studies, followed by the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in 8 studies. Both instruments demonstrated solid psychometric properties, with BAMBI showing good internal consistency (α = 0.88) and BPFAS a Cronbach's alpha of 0.82.

CONCLUSION

Most of the instruments used in studies on eating behavior in individuals with ASD demonstrate satisfactory psychometric properties. BAMBI and BPFAS stand out for their widespread use but are limited to covering only specific age ranges.

Conference proceedings: Inaugural meeting of the consortium for autism, genetic neurodevelopmental disorders, and digestive diseases

OBJECTIVES

Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), often experience a higher prevalence of gastrointestinal (GI) symptoms but have complex medical and behavioral comorbidities that make diagnosis and treatment difficult. A multi-stakeholder conference was convened to (a) determine patient and family experiences related to GI symptoms in NDDs, (b) review the clinicians' and researchers' perspectives, and (c) determine actionable steps for future research.

METHODS

The Consortium for Autism, Neurodevelopmental Disorders and Digestive Diseases (CANDID; www.candidgi.com) virtually over 2 days in 2022 and consisted of four key activities: (1) an electronic family survey to assess underlying NDDs and GI symptoms, (2) a session focused on family perspectives, (3) review current clinical care and research, and (4) discussion to identify key next steps. Survey results were obtained electronically via the REDCap platform, and descriptive statistics were generated. The sessions were recorded, and themes were identified.

RESULTS

The pre-conference survey ran for ~2 months and 739 families provided responses, with 634 completing all items. 83% had a child with an NDD under age 18, and most patients were White (85%) and non-Hispanic (87%). Constipation (80%), GI reflux disease (51%), and bloating (49%) were the most frequently reported symptoms. Families gave unstructured feedback that the measures used in the surveys were often difficult to answer for patients with NDDs or who were nonspeaking. Family and clinical/scientific sessions identified several common themes, including (1) the need for less invasive diagnostic modalities, (2) the need to validate or adapt existing diagnostic measures (e.g., the Rome IV criteria) and outcome assessments, and (3) the need for enhanced attention to parent and caregiver input in treatment plans.

CONCLUSIONS

Those providing care to children with NDDs, especially those with communication and cognitive challenges, should be aware of the differing needs in this community and consider family perspectives in managing, treating, and measuring GI issues. Future research should focus on adapting or creating diagnostic and research measures for those with NDDs, developing new diagnostic methods to account for diversity in neurodevelopment and communication, and improving methods for family and caregiver engagement in the care of GI disorders.

Eating disorder in children: Impact on quality of life, with a spotlight on autism spectrum disorder

Eating behavior, which includes eating habits and preferences, frequency of eating, and other features related to diet, is a major characteristic not only of a person's nutritional status, but also of health in general. In recent years, the prevalence of eating disorders in children has tended to increase; they also require cross-system approaches in diagnosis by a variety of specialists and correction requires appropriate selection of optimal methods. Maladaptive eating attitudes formed at an early age can contribute to the formation of eating disorders, which can lead to or worsen various neuropsychiatric diseases, digestive diseases, and other related conditions. In children with autism spectrum disorder (ASD), eating disorders often appear earlier than other major symptoms of the condition. However, the clinical manifestations of eating disorders in children with ASD are varied and differ in severity and duration, whereas these disorders in neurotypical children might present as short-lived and may not lead to serious consequences. Nevertheless, cases of progressive eating disorders accompanied by a child presenting as under- or overweight and/or with macronutrient and micronutrient deficiencies cannot be excluded. Given the high prevalence of eating disorders in children, many researchers have highlighted the lack of a valid and universally accepted instruments to assess atypical eating behaviors in this population. Therefore, in this review, we wanted to highlight the problems and causes of eating disorders in children, and also to analyze the existing approaches to the validation of these problems, taking into account the existing behavioral features in children with ASD.

Role of gastrointestinal health in managing children with autism spectrum disorder

Children with autism spectrum disorders (ASD) or autism are more prone to gastrointestinal (GI) disorders than the general population. These disorders can significantly affect their health, learning, and development due to various factors such as genetics, environment, and behavior. The causes of GI disorders in children with ASD can include gut dysbiosis, immune dysfunction, food sensitivities, digestive enzyme deficiencies, and sensory processing differences. Many studies suggest that numerous children with ASD experience GI problems, and effective management is crucial. Diagnosing autism is typically done through genetic, neurological, functional, and behavioral assessments and observations, while GI tests are not consistently reliable. Some GI tests may increase the risk of developing ASD or exacerbating symptoms. Addressing GI issues in individuals with ASD can improve their overall well-being, leading to better behavior, cognitive function, and educational abilities. Proper management can improve digestion, nutrient absorption, and appetite by relieving physical discomfort and pain. Alleviating GI symptoms can improve sleep patterns, increase energy levels, and contribute to a general sense of well-being, ultimately leading to a better quality of life for the individual and improved family dynamics. The primary goal of GI interventions is to improve nutritional status, reduce symptom severity, promote a balanced mood, and increase patient independence.

Gastrointestinal Dysfunction in Genetically Defined Neurodevelopmental Disorders

Gastrointestinal symptoms are common in most forms of neurodevelopment disorders (NDDs) such as in autism spectrum disorders (ASD). The current patient-reported outcome measures with validated questionnaires used in the general population of children without NDDS cannot be used in the autistic individuals. We explore here the multifactorial pathophysiology of ASD and the role of genetics and the environment in this disease spectrum and focus instead on possible diagnostics that could provide future objective insight into the connection of the gut-brain-microbiome in this disease entity. We provide our own data from both humans and a zebrafish model of ASD called Phelan-McDermid Syndrome. We hope that this review highlights the gaps in our current knowledge on many of these profound NDDs and that it provides a future framework upon which clinicians and researchers can build and network with other interested multidisciplinary specialties.

Prevalence of gastrointestinal symptoms among autistic individuals, with and without co-occurring intellectual disability

Gastrointestinal symptoms (GI) are very common among individuals on the autism spectrum. Prior research reports mixed findings regarding whether individuals with autism and co-occurring intellectual disability (ID) have elevated risk of gastrointestinal symptoms relative to individuals with autism alone. GI symptoms can be challenging to assess in individuals with autism spectrum disorder (ASD) and/or ID given challenges with language, communication, and interoception. Prior research has tended to only include individuals with documented presence or absence of GI symptoms or conditions, that is, to exclude observations in which there is uncertainty regarding presence of GI symptoms. Therefore, none of the prior autism studies reported the association between ID and the certainty regarding presence or absence of GI symptoms. The objective of this study was to examine differences in parental certainty and odds of reporting gastrointestinal signs and symptoms among children on the autism spectrum, with and without intellectual disability. Participants were 308 children (36% ID) with a clinical diagnosis of autism spectrum disorder (6-17 years). Parents endorsed whether their child had experienced or displayed a range of signs or symptoms related to GI problems in the past 3 months. Parents of autistic children with ID were less certain about the presence of more subjective symptoms, including abdominal pain, nausea, and bloating. Conversely, certainty regarding more objective signs (e.g., constipation, diarrhea, spitting up, etc.) was not significantly different. More accurate measures for GI signs/symptoms are needed for this population.

Questionnaire-based analysis of autism spectrum disorders and gastrointestinal symptoms in children and adolescents: a systematic review and meta-analysis

Background

Gastrointestinal (GI) symptoms are frequently experienced by children with autism spectrum disorder (ASD), and these symptoms cause difficulties for these children and their families. However, studies of GI symptom prevalence differ significantly. This meta-analysis aimed to analyze the prevalence of GI symptoms in children with ASD.

Methods and findings

PubMed, Scopus, Web of Science, EMBASE were electronically searched to collect all literature on gastrointestinal symptoms of children with ASD collected through questionnaires or scales from January 2012 to May 2021. Four researchers independently scanned the literature and extracted information on general characteristics. First author name, year of publication, geographical location, type of study, sample sizes of ASD and control (if any) children, sex and average age, number of GI cases, number of GI symptoms, GI assessment tools (gastrointestinal symptoms scale), autism diagnosis methods, and other necessary data were collected and analyzed using Stata V16. The questionnaires included the Rome, 6-GSI, GIQ, GSRS, GSIQ, ADI-R, PedsQL-GI, parent-report, GI-related, and self-administered questionnaires. Compared with typically developing (TD) children, the odds ratio for In children with ASD with at least one GI symptom was 3.64, and the total prevalence was 55%. The cumulative prevalence rates of various symptoms were summarized, showing that 37% of children with ASD had constipation, 21% had abdominal pain, 19% had diarrhea, 8% had vomiting, and 23% had abdominal distension.

Conclusions

The results of this meta-analysis on GI symptoms in ASD show that patients with ASD are more likely to develop symptoms than TD children. The prevalence of GI symptoms in In children with ASD was 55%.

Systematic Review Registration

www.crd.york.ac.uk/PROSPERO, identifier, #CRD42017080579.