Relationships Among Parent-Reported Gastrointestinal Factors and Social Behaviors in Children With Autism Spectrum Disorder: An Exploratory Study

BACKGROUND: Autism Spectrum Disorder (ASD) entails a wide range of symptomatology and is accompanied by high occurrences of co-morbid conditions including gastrointestinal (GI) symptoms, such as abdominal pain and runny or hard stools, and food selectivity. Recent studies indicate the existence of the microbiota-gut-brain axis and its potential to influence the brain and behavior through multiple pathways. Observed differences in the gut microbiota of children with ASD has been suggested to exacerbate GI factors and influence behavior (Wasilewska & Klukowski, 2015). Diet has been identified as a possible factor in the alteration of the gut microbiota (Li & Zhou, 2016).

PURPOSE: This study explored relationships among clinically reportable GI factors (i.e., stool status, abdominal pain, and diet status) and social behavior in children with ASD.

DESIGN: This one-group cross-sectional study was used to explore relationships among parent-reported GI factors and social symptomatology in 33 children with ASD, ages 3–14 years. Participants' ASD condition were confirmed by Autism Diagnostic Observation Schedule (ADOS-2) or Autism Diagnostic Interview, Revised (ADI-R).

METHOD: A parent questionnaire was used to ascertain status of GI factors, specifically stool, abdominal pain, and diet. Parents provided open-ended descriptions of GI factor statuses. Two coders independently categorized open-ended responses; coding categories for GI factors were as follows: stool was categorized as typical or atypical; abdominal pain was rated as absent or present; diet was coded as typical or limited. Cohen's κ was used to assess coding level of agreement. Social behaviors were measured using the Social Responsiveness Scale 2 (SRS-2) parent report form. The SRS-2 yielded overall and subscale T-scores. Fisher's exact test was used to determine the association between stool status, abdominal pain, and diet. Mann-Whitney U tests were used to determine differences in SRS-2 scores when compared among GI factor groups (e.g., typical versus atypical). Multiple linear regression was used to test relationship among the three GI factors and overall SRS-2 scores.

RESULTS: Very good levels of coding agreement were achieved for stool (κ = .879, p < .001), abdominal pain (κ = .956, p < .001), and diet (κ = 1.00, p < .001). There was a significant association between stool and abdominal pain (p < .05), with 44% of individuals with atypical stool reporting abdominal pain. A significance difference in overall SRS-2 score was observed between abdominal pain groups (U = 182, z = 3.010 p < 0.05); mean rank overall SRS-2 score was 13.92 for the group reporting absent abdominal pain, and 25.22 for the group reporting abdominal pain. The regression model significantly predicted the amount of variance in the overall SRS-2 scores (F(3,32) = 3.257, p < 0.05, R ² = .252 ) with only abdominal pain significantly predicting SRS-2 scores (Beta = 0.487, p < 0.05).

CONCLUSION: Abdominal pain was associated with atypical stool status and predicted higher overall SRS-2 scores; higher SRS-2 scores indicate more severe social symptomatology. Significant associations among parent-reported abdominal pain and stool status, as well associations among abdominal pain and social symptomatology indicate a potential importance of inquiring as to abdominal and stool status for clinicians working with children with ASD in supporting development of social behaviors.

IMPACT: Study findings illuminate the need for further investigations using larger samples and measures of gut microbiota profile, which may ultimately inform development of enhancements to behavioral and occupational therapy interventions strategies.

References

Li, Q., & Zhou, J.-M. (2016). The microbiota-gut-brain axis and its potential therapeutic role in autism spectrum disorder. Neuroscience, 324, 131-139. https://doi.org/org/10.1016/j.neuroscience.2016.03.013

Wasilewska, J., & Klukowski, M. (2015). Gastrointestinal symptoms and autism spectrum disorder: links and risks- a possible new overlap syndrome. Pediatric Health, Medicine,and Therapeutics, 6, 153-166. https://doi.org/org/10.2147/PHMT.S85717

Loening-Baucke, V., & Swidsiniski, A. (2007). Constipation as a cause of acute abdominal pain in children. The Journal of Pediatrics, 151(6), 666-669. https://doi.org/org/10.1016/j.jpeds.2007.05.006