The January edition of the journal Pediatrics features findings from an important panel study on the relationship between gastrointestinal diseases and autism spectrum disorders (ASD’s).
From the National Autism Association:
“ The panel's findings point out not only the existence of underlying GI disturbances that can manifest as behavioral problems, but also notes that such medical issues have often gone undiagnosed or been ignored in the past by physicians treating patients diagnosed with autism.
‘We are finally getting mainstream acknowledgement that our kids are physically sick, and not the victims of some mysterious genetic behavioral disorder,’ commented Lori McIlwain, National Autism Association (NAA) board chair. ‘With one in 110 children now diagnosed with autism, we are in the midst of a national health emergency. Physicians must address the underlying medical conditions involved in this epidemic if they are to help us find answers and relief for our children.’"
The consensus statement issued found the increased prevalence of GI tract symptoms and GI disorders in children with ASD’s ranged from 9%-70%.
Despite limited research and evidence-based guidelines, authors issued their own expert recommendations for diagnosing and treating GI conditions in children with ASD’s and other autism like behaviors.
From Medscape Medical News:
“The recommendations pertain to chronic abdominal pain (intermittent or constant abdominal pain that lasts more than 1 or 2 months), chronic constipation (delay or difficulty in defecation for approximately 2 weeks), chronic diarrhea (loose stool persisting for at least 2 weeks), and symptoms of gastroesophageal reflux disease (passage of gastric contents into the esophagus). The study authors provide information on differential diagnosis, evaluation, and treatment considerations for these GI tract conditions.
Primary care clinicians can use these recommendations as a ‘guide’ when evaluating a child with ASD who presents with symptoms and/or signs that suggest abdominal distress.
Clinicians should be alert to behavioral manifestations of GI tract disorders in patients with ASDs who may have impaired language skills, the study authors state. These children might indicate the presence of GI tract discomfort by, for example, pressing on their abdomen or exhibiting self-injurious behavior.”
Similarly, the practitioners who conducted the study found limited research based evidence available to suggest the highly popular nutritional therapy for ASD’s, a gluten-free casein-free diet, can be considered an effective treatment for patients who suffer.
"Probably 90 percent of parents of children with autism try dietary intervention," said Dr. Fred Volkmar, director of the Child Study Center at Yale University.
"The sad reality of it is that with any complementary alternative treatment -- there is no evidence. It's what makes it [a] complimentary alternative treatment," said Volkmar.
Currently, only one high quality double blind crossover study of the gluten-free casein free diet has been conducted. While increased pressure to focus additional research efforts on the treatment has been generated by national autism awareness and advocacy groups; doctors and scientists presently face many challenges preventing the launch of further studies in this area.
"For many researchers, this would be a lower priority. The problem is there's limited federal dollars, it's an amazing amount of work to get these [treatment] studies done," said Volkmar.
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report,is available for download on the American Academy of Pediatrics website.