A researcher at the Keck School of Medicine of USC has published a study highlighting the importance of physicians listening to parental reports of gastrointestinal (GI) problems in their autistic children and screening these children for gastrointestinal dysfunction (GID).
Pat Levitt, director of the Zilkha Neurogenetic Institute at the Keck School, served as principal investigator of the study, which was published on Jan. 9 on the website of Autism Research.
“This research shows that physicians should take parents seriously when they report GI problems,” said Levitt, who was joined in the study by first author Philip Gorrindo, a Ph.D. student in neuroscience at the Vanderbilt University Medical Center. “Doctors should be especially diligent in checking children who have major language problems and who have not been identified previously with GID because there’s a higher likelihood that they could have GI problems, and these children may be less able to report their physical distress.”
The findings showed that parents and physician specialists are equally accurate in identifying GID in children with autism spectrum disorder (ASD). The behavior and communication problems in these children are more severe than in children with ASD only, and diet and medication do not appear to play a role in the gastrointestinal condition of ASD-GID children.
The study examined more than 120 children, mostly boys, both with and without ASD, whose average age was 11, at Vanderbilt in Nashville, Tenn. The most frequently reported GI problem was severe constipation, often accompanied by severe abdominal pain, and was common in both those with and without autism.
While earlier studies of the relationship between ASD and GID solely examined medical charts or previous parental reports, Levitt said this research was the first time that children with ASD have been recruited for a study in which a pediatric gastroenterologist actively was involved in diagnosing their medical condition.
All parents were asked to fill out a questionnaire to determine the accuracy of their reports of GI problems in their children, which was compared to diagnosis by a pediatric gastroenterologist. The study found that parents were 92 percent accurate in reporting such problems.
“This shows that when a pediatrician sees a mom with a child who says he has major gut problems, it’s an indication that the doctor should send the child to a specialist - a pediatric GI doctor,” Levitt said. “It dispels the myth that parents are over-reporting these types of problems.”
In addition, parents were asked to keep a seven-day diet diary for their children. The results found no difference in the kinds of food that any of the children with GID were eating. Researchers also looked at the behavioral medications taken by children with ASD and found no differences in medication use with or without GID.
The study also looked at the relationship between the severity of autism and GI symptoms. It found that six times as many children with GID had more severe language impairment than those without GID. Investigators also used a Social Responsiveness Scale (SRS), which indicated more social impairment among those with GI symptoms.
“Overall, the research is about changing the way we deal with the potential for medical problems in children with autism, a behaviorally diagnosed disorder,” Levitt said. “We think that improving a child’s GI function will have effects that reach far beyond their GI problems. It may make them more amenable to interventions focused on their autism because they’re not preoccupied with physical distress.”
Levitt now is expanding his research to Los Angeles, in collaboration with Children’s Hospital Los Angeles (CHLA).
Since the majority of CHLA patients are Latino, the partnership will enable researchers to include a large number of Latinos in an ASD-GID investigation for the first time. He also is focused on seeking unique biomarkers to identify children with autism who have the potential for GI problems before GID appears.
Gastrointestinal Dysfunction in Autism: Parental Report, Clinical Evaluation, and Associated Factors. Phillip Gorrindo, Kent C. Williams, Evon B. Lee, Lynn S. Walker, Susan G. McGrew and Pat Levitt. Autism Research, 2012. DOI: 10.1002/aur.237.
University of Southern California