New guidelines for diagnosing and treating digestive problems in children with Autism Spectrum Disorders (ASD) were just released by the American Academy of Pediatrics. Digestive problems such as gastroesophageal reflux (GER), constipation and diarrhea are often seen in children with Autism Spectrum Disorder and there is a great need for information on identifying the best diagnosis and treatment approach.
The guidelines (called a consensus statement) were developed by medical doctors, researchers and experts from pediatrics, gastroenterology, allergy, neurology, child psychiatry, nutrition, pain management and genetics who reviewed research studies and analyzed data. In medicine, it is a well respected and standard approach to have a group of experts meet for the purpose of developing guidelines to be used by doctors and medical professionals. A careful review of research, analysis by a group of experts and the development of treatment guidelines gives doctors state of the art information on treating a complex issue.
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals with ADS's: A Consensus Report is 18 pages long and covers 23 topics or statements. You can view the entire document from the American Academy of Pediatrics website or read the summary of the guidelines here. Hint: Even if you do not read the entire report, I suggest looking at Table 2: Behaviors That May be Markers of Abdominal Pain and Table 6: Key Take Away Messages. While the document contains information about all gastrointestinal disorders seen in children with ASD’s, I will focus on gastroesophageal reflux.
There is a great deal of useful information in the consensus statement. Here are the highlights:
· A child with ASD and gastrointestinal symptoms should receive a thorough evaluation of symptoms following the established treatment guidelines that are available. For instance, the NASPGHAN (professional organization of pediatric gastroenterologists) has treatment guidelines for Gastroesophageal Reflux Disease (GERD) and constipation.
· Gastrointestinal disorders that are seen in typically developing children are just as likely to occur in children with Autism Spectrum Disorders. However, the presentation of symptoms may be quite different. Since a child with ASD often has significant difficulty with communication, doctors and parents need to look at typical GI symptoms and symptoms that are not commonly associated with digestive issues such as irritability, sleep problems, behavioral issues, aggression, self injury and repetitive behaviors (performing an action over and over again).
· Children with Autism Spectrum Disorders and gastrointestinal issues may be at risk for behavioral issues. For instance, if a child is waking frequently at night due to painful reflux symptoms communication problems may prevent her from being able to tell her parents or the doctor where it hurts. She may communicate the distress the best way she can by protesting, fussing and refusing to lie down. It may appear that she has a behavioral problem rather than a medical problem. At the same time, there may be a delay in diagnosing and treating the underlying problem. Night waking could be caused by poor self regulation, sensory issues, constipation, illness, sleep disorder, allergies, asthma or GERD. As the medical team, educational team and the family sort out all of the symptoms and possible causes, a child will be in distress and the behaviors will escalate.
· A child with Autism Spectrum Disorders who presents with a behavioral problem needs an assessment that addresses the behavioral issues and the possibility that pain or discomfort are the underlying cause of the behavior. A behavioral change may be the only clue that a child is in pain due to gastroesophageal reflux, constipation or another medical condition. It is extremely important for the medical team and the behavioral/school team to work together to look for a possible medical cause of the behavior. If there has been a sudden change in behavior or an increase in aggression/behavioral issues, this may indicate that an underlying medical condition is causing the increase in behavioral issues. It is certainly appropriate to develop a behavioral intervention plan to deal with behavioral issues but ongoing medical monitoring and awareness of a possible medical cause is needed as well.
· Nutritional deficiencies are common in children with Autism Spectrum Disorders. Many children with ASD are very selective about what they will eat, leading to deficits in key nutrients. Further, many children are placed on a gluten and casein free diet, further restricting the variety of foods in the diet. Protein, calcium, Vitamin D and iron are often lacking, leading to bone, sleep problems and other health consequences.
· Children with ASD are at greater risk for obesity. While some children with ASD restrict their diets and are at risk for growth and bone problems, obesity is also commonly seen in older children with ASD.
Sometimes an analysis of the research reveals that more research is needed. While there has been a great deal of research on autism spectrum disorders, the committee determined that there is still a need for research on how often gastrointestinal disorders occur in children with autism. Some doctors and many parents believe that gastrointestinal disorders are more common in children with ASD’s than typically developing children. It is important to know how common these medical conditions occur so that primary care doctors such as pediatricians and family practitioners can screen for medical conditions and make a referral to a specialist if needed.
The experts also analyzed the available research on other treatments and theories including the use of a gluten/casein free diet, leaky gut, food allergies, food intolerances, intestinal inflammation and genetic causes of Autism Spectrum Disorders. After analyzing the available research, it was determined that further research is needed. While smaller studies have shown some promise, large, well controlled studies are needed.
Next: Talking to the Doctor about Digestion: When your child is non verbal.
Published On: February 16, 2010