Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report
Abstract
Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.
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No special treatment methods for GI problems specific to subjects with ASD currently exist.
“Currently, no special treatment methods to GI problems specific for subjects with ASD exist and clinical practice guidelines available for the general population should be used [3,62,63].”
Most occurrences of GI dysfunction in children with ASD are the result of functional causes, rather than being of anatomic or known physiologic origin.
“Most occurrences of GI dysfunction in children with ASD are the result of functional causes, rather than being of anatomic or known physiologic origin.1, 3, 6”
From Distinct Microbiome-Neuroimmune Signatures Correlate With Functional Abdominal Pain in Children With Autism Spectrum Disorder (2017) · cites this paper as [1]
A retrospective case-cohort study partially confirms the proposal that FS in ASD patients may occur because of food rejection, gastroesophageal reflux, chronic constipation, delayed gastro emptying, and functional dyspepsia.
“A retrospective case–cohort study partially confirms this proposal.”
From Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders (2022) · cites this paper as [79]
This study found a strong association between the diagnosis of FS and eosinophilic esophagitis.
“This study finds a strong association between the diagnosis of FS and eosinophilic esophagitis [79].”
From Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders (2022) · cites this paper as [79]
A variety of GI issues commonly occur in ASD, including lower GI symptoms (constipation, diarrhea) and upper GI symptoms (nausea and vomiting, stomach aches and pains).
“A variety of gastrointestinal (GI) issues commonly occur in ASD, including lower GI symptoms (i.e., constipation, diarrhea) and upper GI symptoms (i.e., nausea and vomiting, stomach aches and pains) (2–10), but the etiology is poorly understood.”
Many individuals with ASD suffer from constipation.
“However, it appears that many individuals with ASD suffer from constipation (2, 3, 11, 12).”
Young children with ASD who are non-verbal may use aggression as a means of communicating somatic complaints, such as internal abdominal pain and GI discomfort.
“One explanation for this relationship may be that young children with ASD who are non-verbal use aggression as a means of communicating somatic complaints, such as internal abdominal pain and GI discomfort (2).”
Individuals with ASD often suffer from gastrointestinal symptoms.
“Individuals with ASD often suffer from gastrointestinal (GI) symptoms [30,124].”
From Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions (2019) · cites this paper as [30]
The prevalence of GI symptoms in children with ASD varies from 9% to 91%.
“In fact, the prevalence of GI symptoms in children with ASD varies from 9-91% 14.”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [14]
Difficult and unexplained behaviors may be due in part to the inability of some children with ASD to verbalize their discomfort in response to GI distress.
“Difficult and unexplained behaviors may be due in part to the inability of some children with ASD to verbalize their discomfort in response to GI distress 14.”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [14]
Predominant GI conditions in ASD, including constipation and abdominal pain, cause abdominal discomfort which could be an impediment to good sleep hygiene.
“The predominant GI conditions seen in ASD, including constipation and abdominal pain, cause abdominal discomfort which could be an impediment to good sleep hygiene 14.”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [14]
A multi-expert consensus report outlined best practices for evaluating and treating GI disorders in children with ASD, focusing on abdominal pain, constipation, chronic diarrhea and GERD as the most common causes.
“In 2010, a multi-expert panel published a consensus report on GI disorders in ASD that outlined the best practices for evaluating and treating GI disorders in children with ASD. These guidelines focused on abdominal pain, constipation, chronic diarrhea and gastroesophageal reflux disease (GERD), which were again noted as the most common causes of GI problems in ASD 14.”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [14]
Early studies on probiotic treatment in children with ASD and GI problems show promise, but larger trials are necessary to better implicate the role of probiotics in ASD treatment.
“These early studies on probiotic treatment in children with ASD and GI problems thus show promise, but larger trials are necessary to better implicate the role of probiotics in ASD treatment 14.”
From Gastrointestinal Issues and Autism Spectrum Disorder (2020) · cites this paper as [14]
The most commonly reported GI symptoms in children with ASD include chronic constipation, diarrhea, and abdominal pain.
“The most commonly reported symptoms include chronic constipation, diarrhea, and abdominal pain [4–6].”
From Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms (2019) · cites this paper as [6]
A substantial number of children with ASD experience chronic gastrointestinal symptoms including constipation, diarrhea, pain associated with bowel movements and gassiness/bloating.
“A substantial number of children with ASD experience chronic gastrointestinal symptoms including constipation, diarrhea, pain associated with bowel movements and gassiness/bloating [6].”
From Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms (2019) · cites this paper as [6]
There is a wide range in the reported prevalence of GI conditions in ASD, ranging from 9-70%, and estimating the true prevalence from existing studies is difficult due to referral and ascertainment bias.
“There is a wide range in the reported prevalence of GI conditions in ASD, ranging from 9–70% [6], and estimating the true prevalence from existing studies is difficult due to referral and ascertainment bias [6].”
From Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms (2019) · cites this paper as [6]
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Nicolaidis, C., Kripke, C. C., & Raymaker, D. (2014) · Medical Clinics of North America · doi:10.1016/j.mcna.2014.06.011 · Cited by 128 · see citing works
- Authors
- Buie, T., Campbell, D. B., Fuchs, G. J., Furuta, G. T., Levy, J., VandeWater, J., Whitaker, A. H., Atkins, D., Bauman, M. L., Beaudet, A. L., Carr, E. G., Gershon, M. D., Hyman, S. L., Jirapinyo, P., Jyonouchi, H., Kooros, K., Kushak, R., Levitt, P., Levy, S. E., Lewis, J. D., Murray, K. F., Natowicz, M. R., Sabra, A., Wershil, B. K., Weston, S. C., Zeltzer, L., & Winter, H.
- Affiliations
- Harvard University (US)
- University of Southern California (US)
- Arkansas Children's Hospital (US)
- National Jewish Health (US)
- NYU Langone Health (US)
- University of California, Davis (US)
- NewYork–Presbyterian Hospital (US)
- Baylor College of Medicine (US)
- Stony Brook University (US)
- Columbia University Irving Medical Center (US)
- University of Rochester Medicine (US)
- Siriraj Hospital (TH)
- Rutgers New Jersey Medical School (US)
- Children's Center for Digestive Health Care, LLC, Atlanta, Georgia
- Cleveland Clinic (US)
- Department of Pediatrics, Escola de Medicina, Universidade do Grande Rio, UNIGRANRIO, Brasilian Academy of Medicine, Rio de Janeiro, Brazil
- Northwestern University (US)
- Boston Children's Hospital (US)
- University of California, Los Angeles (US)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2010-01-01
- Volume
- 125
- Issue
- Supplement_1
- Pages
- S1-S18
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2075918530
- Cited by
- 872
- References
- 77
- Citations by year
- 2026: 26 · 2025: 37 · 2024: 53 · 2023: 48 · 2022: 47 · 2021: 85 · 2020: 63 · 2019: 58 · 2018: 68 · 2017: 44 · 2016: 54 · 2015: 63 · 2014: 40 · 2013: 70 · 2012: 55
- FWCI
- 35.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- autism spectrum disorder, gastrointestinal diseases, gastrointestinal dysfunction, diagnostic assessment, treatment, communication difficulties, behavioral problems, evidence-based recommendations, prevalence
- MeSH terms
- Caseins, Child, Child Behavior Disorders, Child Development Disorders, Pervasive, Diagnostic Techniques, Digestive System, Food Hypersensitivity, Gastrointestinal Diseases, Genetic Testing, Health Education, Health Personnel, Humans, Intestines, Medical History Taking, Patient Care Team, Permeability, Radiography, Abdominal, Child Nutrition Disorders, Nutrition Assessment, Practice Guidelines as Topic, Diet, Protein-Restricted, Databases, Genetic, Gastrointestinal Tract, Diet, Gluten-Free
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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