Marina Sarris

Date Updated: September 24, 2021

When someone with autism seeks mental health treatment, do doctors and psychologists ask about gastrointestinal (GI) problems?

Perhaps they should, according to one study. Constipation and other GI problems may not seem related to anxiety, depression, or aggressive behavior. But researchers have found a link between them in youth with autism.¹

A study of almost 2,800 children and teenagers with autism found that GI symptoms were linked to psychiatric symptoms. The GI symptoms included constipation, diarrhea, and excessive gas. The youth in this study were part of the Simons Simplex Collection research project.

The presence and amount of GI problems “should be considered when evaluating psychiatric and behavioral concerns among children with ASD,” the researchers stated. They went a step further, noting that treating GI problems may be important in reducing mental health problems.¹

“Even though statistically this link from GI symptoms to behavioral and emotional difficulties is small, for some families it’s a point of intervention. It is something we can potentially change by more careful monitoring and management of the GI side of things,” explains the lead researcher for the Simons study, Emily E. Neuhaus, Ph.D., at Seattle Children’s Hospital in Washington.

GI symptoms are fairly common in autism. A wide range of people on the spectrum have at least one GI symptom, according to a review of 144 studies that were published from 1980 to 2017.² The median, or middle rate, for GI symptoms is 47 percent of people who have autism. Calliope Holingue, Ph.D., was the lead researcher for this review.

She discusses how to identify and help manage GI symptoms in autism in this recorded webinar.

Parents Report GI, Eating Concerns in Children who have Autism

Neuhaus, a clinical psychologist, often hears about GI problems from the parents of her patients with autism spectrum disorder (ASD). “Families come in with GI concerns a lot,” she says. “I see the toll it takes.”

Some families worry that something their child is eating is causing GI distress, while others are concerned about what the child is not eating, she says. Some children with autism are extremely picky eaters who cannot tolerate the sight, smell, or texture of many foods. “There is frustration for the parents of trying to get to the bottom of their child’s GI difficulties, and how to manage and treat them. Certainly for anyone, being in pain or being uncomfortable [from GI distress] is rough,” she says.

Neuhaus encourages families to see a medical doctor for treatment of GI problems.

Daniel L. Coury, M.D., who was not involved in the study, says that Neuhaus’ research adds to the evidence of a link between autism and GI troubles. “A decade ago, a lot of health professionals wondered if the parents of children with autism were exaggerating their children’s GI problems, whether there was a misperception on the part of the parents ― and I think researchers have dispelled a lot of that,” says Coury, a developmental and behavioral pediatrician at Nationwide Children’s Hospital and a medical professor at The Ohio State University.

This study goes a step further by exploring the link to behavioral problems. “That is something that fewer studies have pointed out, and it is of interest,” he says. Coury has seen children with autism whose mood or behaviors improved after treatment for medical problems, including those involving the GI system. “But I have not had anyone show dramatic improvement in their core autism symptoms.”

Other Health Concerns in Autism

It is not uncommon for children and adults on the spectrum to have other health problems. GI problems, anxiety, depression, and other psychiatric concerns are more common in people who have autism than in others, according to research.^3-5

Neuhaus’ team found that 38 percent of the youth in the study frequently experienced at least one GI symptom. The most common problems were constipation and diarrhea.

Less frequent problems included excessive gas, severe abdominal pain, vomiting, and reflux.¹ The study relied on parents’ answers to questions about their child’s medical histories, provided during extensive interviews at clinics across North America.

Links between GI problems and psychiatric problems have been reported in children who do not have autism.^{6, 7} And the symptoms of some conditions, such as anxiety and depression, may include changes or problems with eating or digestion.

It’s not known why GI problems are common in autism. Neuhaus’ team, which included three psychologists and a medical doctor, offered a few theories. Some research has found that certain genetic changes found in some people with autism also affect the GI system. There may also be a sensory component. Many people with autism are extremely sensitive to input from their senses, such as touch, smell, hearing, or sight. So they may feel their GI pain more intensely than others.¹

The study found other factors1 that are linked to higher levels of psychiatric problems in children and teens, such as having:

• more symptoms of autism
• a higher verbal IQ score
• more trouble with daily living skills, such as brushing teeth or fixing a meal
• a lower family income

The researchers urge mental health providers, such as doctors, psychologists, and therapists, to ask about GI symptoms in their young patients with autism. The GI complaints “may serve to contribute to the behavioral concerns for which a family is seeking services.”¹

Treating and reducing GI symptoms “may be an important part of reducing a broad array of mental health [symptoms] in this population, and may be critical in improving quality of life and overall functioning,” according to the study.¹

“We could have more impact on kids’ well-being,” Neuhaus says.

Interested in joining SPARK? Here’s what you should know.

A version of this article appeared on the Interactive Autism Network website in 2019. SPARK updated it in 2021.

Resources

• Read a SPARK article, What Causes GI Problems in Autism?

References

1. Neuhaus E.et al. Front. Psychiatry 9, 515 (2018) PubMed
2. Holingue C. et al. Autism Res. 11, 24-36 (2018) PubMed
3. Lai M.C. et al. Lancet Psychiatry 6, 819-829 (2019) PubMed
4. Lever A.G. and H.M. Geurts J. Autism Dev. Disord. 46, 1916-1930 (2016) PubMed
5. Buie T. et al. Pediatrics 125, S1-S18. (2010) PubMed
6. Jameson N.D. et al. J. Child Neurol. 31, 1282-1289 (2016) PubMed
7. Gontard A. et al. Acta Paediatr. 104, 1156-1163 (2015) PubMed