Autism and Gastrointestinal (GI) disorders – Gut feelings.

Does your child suffer from stomach aches?  Or have bouts of diarrhea or constipation? Is his stomach bloated at times?  Do his bowel movements contain undigested food particles? Or does he arch his back, press his stomach against things or grit his teeth? Or scream or rock?

If so it is possible that he has any one of the most common medical conditions associated with autism, in both children and adults, that range from chronic constipation or diarrhea to irritable or inflammatory bowel conditions.

These problems affect although most of the research area has focused on children who, according to the Centers for Disease Control and Prevention (CDC), are over 3.5 times more likely to suffer from chronic diarrhea or constipation than other children. Meanwhile other research shows that the pain and discomfort caused by GI symptoms is associated with a deterioration in behavior and may even trigger regression – particularly in those who are nonverbal.

Looking back into the history of ASD we find that chronic constipation and diarrhea are age-old problems. Thus Dr William Dickinson who worked at Great Ormond Street Hospital for Children in England, from 1869 to 1874 found such problems in several of his patients – as he recorded.

One patient was Ralph (whose behaviours were indicative of ASD)  and who was suffering from constipation when admitted at the age of 2½. He had developed severe feeding and gastrointestinal problems and had had multiple bouts of diarrhea which began when he was about 8 months old, the first attack lasting 5 weeks!

Then there was Ida, who had apparently been developing quite normally until infantile epilepsy struck when she was just 3 months old. She then began to fit on a daily basis, having anywhere from one or two to as many as 30 seizures, that lasted from just a minute to a whole day.

When finally admitted to hospital at the age of 2¾ she was found to be ‘a well-nourished child . . . with a fresh colour’ but even so, she suffered from severe constipation, which staff thought might be causing her nocturnal screaming fits and disturbed sleep.

On treating both the seizures and the constipation they saw a remarkable change for, as the ward staff reported, after four bowel movements her screaming and rocking quieted noticeably, her sleep improved and she became more engaged with the world around her, appearing to notice things more than before (my italics).

At one point her symptoms worsened dramatically as did her acute constipation and she began screaming and rocking again. Eventually though the improvements returned and things stabilized, although as authors Mitzi Waltz and Paul Shattock OBE point out in their article Autistic Disorder in Nineteenth-century London whilst medication for the seizures made a difference, it was only when her constipation was controlled that her improvement was maintained.

Next to Dr Grabham, Superintendent of The Royal Earlswood Hospital in the UK, then a centre of excellence.  In January 1875 he published his observations in the British Medical Journal in which he noted that many of the children he worked with (who would fit today’s criteria for ASD) had digestive problems. As he wrote:

Assimilation is very imperfectly performed; the food, if not very digestible, sometimes passing most unchanged. diarrhea in some is the rule rather than the exception.

We’ll return to look at irritable and inflammatory bowel conditions in more depth next week.  Meanwhile always seek medical advice if the child has frequent bouts of diarrhea (once a day or more) or  is chronically constipated.  These are serious issues and the causes need to be identified.  It is also important to note that runny diarrhea can sometimes be indicative of severe constipation and impaction (a blockage of faeces).

Top Tips
Basic points:

  • If he has diarrhea make sure he drinks enough water.
  • Use a good probiotic every day.
  • Magnesium is natural laxative and is something that is often depleted (as are many vitamins and minerals) in people with autism.  Even so it is pretty powerful so always begin with a relatively low dose – see http://ibs.about.com/od/constipation/a/magnesium.htm

More useful information can be found at: http://www.tacanow.org/family-resources/the-poop-page/

If the problems are associated with Irritable Bowel Syndrome the child might benefit from the FODMAP diet: http://www.ibsdiets.org/fodmap-diet/fodmap-food-list/