Unless you have cared for a number of patients with celiac disease, you may not realize that behavioral issues such as anxiety, depression, aggressive behaviors and sleep problems have all been associated with this important autoimmune disorder that we primarily think of as a gastrointestinal disease. Smith et al. (10.1542/peds.2016-2848) share with us the results of their study surveying mothers in a longitudinal cohort of more than 8000 children for signs and symptoms of celiac disease beginning at age 2 and continuing to also monitor these children for their psychological functioning at 3.5 and 4.5 years of age. This allows an assessment of behavioral problems before and after the diagnosis of celiac disease.
The findings are fascinating and show that when mothers are unaware that their children have celiac disease, they report more behavioral problems than a control population of mothers whose children have not tested positive for the disease. The degree of behavioral problems was greater when the diagnosis was not recognized than once it was although by 4.5 years. When the diagnosis was known, there was no difference in behavioral issues between those initially unaware and now aware of their child’s positive celiac disease status. So why does knowing that a child has celiac disease reduce the self-reporting of behavioral problems in a child and how might celiac disease be causing these behavioral concerns for parents? The authors share their perspective and provide a lot more detailed information on the nature of the behavioral problems associated with celiac disease in the discussion section of the paper. In addition, Dr. Alessio Fasano, (10.1542/peds.2016-4323) one of the world’s leading experts on celiac disease shares with us a Commentary reflecting on this study and the role of the gut-brain axis and its influence on behavior.
Have you considered celiac disease as the etiology for a child’s anxiety or depression or perhaps their over-aggressiveness? Reading this interesting study and commentary will have you “glu-tened” to your seat as you become much more aware of how celiac might present behaviorally, read the study and see what we mean.
