Gastrointestinal issues with behavior problems and sleep issues in children and adolescents with Autism spectrum disorder (ASD): A preliminary estimate

Background - Individuals with ASD have higher than expected rates of medical conditions including gastrointestinal problems. There in paucity of research of association between gastrointestinal and behavioral problems in ASD. Objectives - To study the prevalence of gastrointestinal symptoms in children diagnosed with ASD and the association between gastrointestinal symptoms, autistic symptoms, behavior and sleep symptoms. Methods - It is a cross sectional study of 58 children and adolescents with ASD referred to our child clinic for disability assessment. Indian Scale for Assessment of Autism (ISAA) was applied and IQ assessment was done. Presence of gastrointestinal (GI) symptoms based on ROME 4 criteria was documented. Behavior Problems Inventory (BPI) and abbreviated Children's Sleep Habit Questionnaire (CSHQ) scales were used to assess behavioral issues and sleep behavior respectively. Results - 34.5% of the study participants had gastrointestinal(GI) symptoms.Constipation was the most common GI symptom (60%) followed by abdominal pain (35%) and abdominal pain associated with bowel symptoms (15%). Those children with GI symptoms had lower age of diagnosis of ASD and higher family history of autoimmune disorders. Children with GI symptoms had higher autism scores, lower mean IQ, higher behavioral problems including higher self injurious behavior and aggression. Total sleep issues including sleep behavior problems and night waking were higher among children with GI symptoms.They also had a higher history of preterm delivery and family history of autoimmune diseases. Conclusion - There is a high prevalence of gastrointestinal symptoms in children with ASD. Those with GI symptoms have higher autism severity, behavior problems and sleep issues. Further research is warranted in this area to understand this association, which may pave way for developing specific treatment options.