The presence of bowel issues, whether functional bowel habit problems such as constipation or diarrhoea or more chronic bowel pathology, occurring alongside the presentation of at least some cases of autism have perhaps more that any other comorbidity generated some often heated discussion in both science and lay circles.
Whether due to the assertion of a connection between such bowel issues and environmental factors such as diet or other variables, or due to a perceived lack of historical research and clinical interest in such issues, bowel problems with autism in mind have to some extent divided people.
The paper by Virginia Chaidez and colleagues* adds to a growing body of research which suggests that functional bowel habits are not an uncommon issue for some on the autism spectrum. Further, they report that certain ‘maladaptive’ behaviours correlated with the presence of such bowel issues and autism research could do with channelling further resources into looking at any potential connections.
Based on a large participant group drawn from the CHARGE study, Chaidez and colleagues asked nearly a thousand families to comment on their child’s bowel habits and in the case of those children diagnosed with autism, to also report on their symptom presentation too. They found that bowel issues were more frequently reported in children with autism compared with those diagnosed with a developmental delay and typically developing children. They also suggested that where such bowel issues exist, they may have the propensity to alter behaviour either in response to the pain or discomfort such issues can bring or as part of a coping strategy.
Earlier this year, a similar conclusion on the over-representation of functional bowel issues in cases of autism was also reached by researchers in the United Kingdom utilising a similar method of analysis albeit looking at a smaller number of participants. In that study, researchers also reiterated earlier researcher suggesting that using parents as ‘non-expert’ informers of their child’s bowel issues was not necessarily fraught with as many methodological issues as one might expect. Parental reports were quoted as being sensitive to the presence of such issues if not the specifics of the type of bowel issue that may be present.
Further research is required to answer some important questions concerning how such bowel issues come about and what treatments are available to potentially solve functional bowel problems (whether medication or something like a dietary change). In 2010, an expert panel published a consensus statement on the issue of gastrointestinal issues when presented in cases of autism** concluding that functional bowel issues when present demand investigation and intervention.
* Chaidez V. et al. Gastrointestinal Problems in Children with Autism, Developmental Delays or Typical Development. J Autism Dev Disord. 2013 Nov 6.
** Buie T. et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics. 2010 Jan;125 Suppl 1:S1-18.
Further commentary on this study can be found at: http://questioning-answers.blogspot.com/2013/12/functional-gi-issues-and-autism-not.html