Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.
Skip Nav Destination
Article navigation
January 2010
Supplement Articles|
January 01 2010
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report
Timothy Buie, MD;
Timothy Buie, MD
aDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
bLearning and Development Disabilities Evaluation and Rehabilitation Services, Lexington, Massachusetts
cDivision of Pediatric Gastroenterology and Nutrition
Search for other works by this author on:
Daniel B. Campbell, PhD;
Daniel B. Campbell, PhD
dDepartment of Psychiatry and the Behavioral Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
Search for other works by this author on:
George J. Fuchs, III, MD;
George J. Fuchs, III, MD
eDivision of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
Search for other works by this author on:
Glenn T. Furuta, MD;
Glenn T. Furuta, MD
fSection of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Denver, Aurora, Colorado, and Department of Pediatrics, National Jewish Health, Denver, Colorado
gDepartment of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
Search for other works by this author on:
Joseph Levy, MD;
Joseph Levy, MD
hDepartment of Pediatrics (Administration), NYU Langone LangoneMedical Center, New York University School of Medicine, New York, New York
Search for other works by this author on:
Judy VandeWater, PhD;
Judy VandeWater, PhD
iDivision of Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine, University of California, Davis, California
Search for other works by this author on:
Agnes H. Whitaker, MD;
Agnes H. Whitaker, MD
jDepartment of Psychiatry, Division of Child and Adolescent Psychiatry, New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York
Search for other works by this author on:
Dan Atkins, MD;
Dan Atkins, MD
kDivision of Ambulatory Pediatrics, Department of Pediatrics, National Jewish Health, Children's Hospital, Denver, Colorado
lDepartment of Pediatrics, University of Colorado Denver School of Medicine, Denver, Colorado
Search for other works by this author on:
Margaret L. Bauman, MD;
Margaret L. Bauman, MD
bLearning and Development Disabilities Evaluation and Rehabilitation Services, Lexington, Massachusetts
mDepartment of Pediatrics
nDepartment of Neurology, MassGeneral Hospital for Children, Boston, Massachusetts
Search for other works by this author on:
Arthur L. Beaudet, MD;
Arthur L. Beaudet, MD
oDepartment of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
Search for other works by this author on:
Edward G. Carr, PhD;
Edward G. Carr, PhD
pDepartment of Psychology, State University of New York, Stony Brook, New York
Search for other works by this author on:
Michael D. Gershon, MD;
Michael D. Gershon, MD
qDepartment of Pathology & Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York
Search for other works by this author on:
Susan L. Hyman, MD;
Susan L. Hyman, MD
rDivision of Neurodevelopmental and Behavioral Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York
Search for other works by this author on:
Pipop Jirapinyo, MD;
Pipop Jirapinyo, MD
sDepartment of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Search for other works by this author on:
Harumi Jyonouchi, MD;
Harumi Jyonouchi, MD
tDivision of Allergy/Immunology and Infectious Diseases, Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Search for other works by this author on:
Koorosh Kooros, MD;
Koorosh Kooros, MD
uDivision of Pediatric Gastroenterology and Nutrition, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York
Search for other works by this author on:
Rafail Kushak, PhD, DrSc;
Rafail Kushak, PhD, DrSc
aDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
mDepartment of Pediatrics
Search for other works by this author on:
Pat Levitt, PhD;
Pat Levitt, PhD
vZilkha Neurogenetic Institute & Dept. Cell and Neurobiology (Dr Levitt), Keck School of Medicine of University of Southern California, Los Angeles, California
Search for other works by this author on:
Susan E. Levy, MD;
Susan E. Levy, MD
vZilkha Neurogenetic Institute & Dept. Cell and Neurobiology (Dr Levitt), Keck School of Medicine of University of Southern California, Los Angeles, California
Search for other works by this author on:
Jeffery D. Lewis, MD;
Jeffery D. Lewis, MD
xChildren's Center for Digestive Health Care, LLC, Atlanta, Georgia
Search for other works by this author on:
Katherine F. Murray, BSN, RN;
Katherine F. Murray, BSN, RN
cDivision of Pediatric Gastroenterology and Nutrition
Search for other works by this author on:
Marvin R. Natowicz, MD, PhD;
Marvin R. Natowicz, MD, PhD
yInstitutes of Pathology and Laboratory Medicine, Genomic Medicine, Neurology and Pediatrics, Cleveland Clinic, Cleveland, Ohio
Search for other works by this author on:
Aderbal Sabra, MD, PhD;
Aderbal Sabra, MD, PhD
zDepartment of Pediatrics, Escola de Medicina, Universidade do Grande Rio, UNIGRANRIO, Brasilian Academy of Medicine, Rio de Janeiro, Brazil
Search for other works by this author on:
Barry K. Wershil, MD;
Barry K. Wershil, MD
aaDivision of Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University's Feinberg School of Medicine at Northwestern, Chicago, Illinois
Search for other works by this author on:
Sharon C. Weston, MS, RD, LDN;
Sharon C. Weston, MS, RD, LDN
bbDepartment of Gastroenterology and Nutrition, Children's Hospital Boston at Peabody, Peabody, Massachusetts
Search for other works by this author on:
Lonnie Zeltzer, MD;
Lonnie Zeltzer, MD
ccPediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, California
Search for other works by this author on:
Harland Winter, MD
Harland Winter, MD
aDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
cDivision of Pediatric Gastroenterology and Nutrition
Search for other works by this author on:
Address correspondence to Timothy Buie, MD, or Harland Winter, MD, Mass General Hospital for Children, Pediatric Gastrointestinal Unit, CRPZ 5-560, 175 Cambridge St, Boston, MA 02114. E-mail: [email protected] or [email protected]
Pediatrics (2010) 125 (Supplement_1): S1–S18.
Article history
Accepted:
September 04 2009
Citation
Timothy Buie, Daniel B. Campbell, George J. Fuchs, Glenn T. Furuta, Joseph Levy, Judy VandeWater, Agnes H. Whitaker, Dan Atkins, Margaret L. Bauman, Arthur L. Beaudet, Edward G. Carr, Michael D. Gershon, Susan L. Hyman, Pipop Jirapinyo, Harumi Jyonouchi, Koorosh Kooros, Rafail Kushak, Pat Levitt, Susan E. Levy, Jeffery D. Lewis, Katherine F. Murray, Marvin R. Natowicz, Aderbal Sabra, Barry K. Wershil, Sharon C. Weston, Lonnie Zeltzer, Harland Winter; Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report. Pediatrics January 2010; 125 (Supplement_1): S1–S18. 10.1542/peds.2009-1878C
Download citation file:
Citing articles via
Email alerts
Comments
Autism and Diet
Dear Authors:
Your consensus statements regarding gastrointestinal disorders in people with autism spectrum disorders (ASD) [1] were extensive but lacked information linking autism with omega-3 fatty acid (n3FA) deficiency [2- 5]. Consensus statement 9 acknowledged "potential nutritional problems" in ASD patients, but failed to mention the role of essential fatty acids in normal brain function and the potential link between their dietary deficiency and autism. Statement 11 refers to dietary interventions for ASD claiming "few studies in the literature are difficult to interpret without adequate control groups" without referencing any studies. Unfortunately, few studies have been conducted in this area, but most studies done so far support the utility of n3FAs in treating children with ASDs [6-8]. There is also good evidence for the benefit of n3FAs in treating children with attention deficit hyperactivity disorder [9] and schizophrenia [10] which are often associated with ASD. The greatest benefit of n3FAs is likely to be in the prevention of brain disorders by ensuring adequate supplies from conception through the first few years after birth during critical brain development.
References:
1. Buie T, et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics. 2010;125(suppl 1):S1-18 2. Saugstad LF. Infantile autism: a chronic psychosis since infancy due to synaptic pruning of the supplementary motor area. Nutr Health. 2008;19(4):307-317 3. Kidd PM. Omega-3 DHA and EPA for cognition, behavior and mood: clinical findings and structural-functional synergies with cell membrane phospholipids. Altern Med Rev. 2007;12(3):207-227 4. Clark-Taylor T, Clark-Taylor BE. Is autism a disorder of fatty acid metabolism? Possible dysfunction of mitochondrial beta-oxidation by long chain acyl-CoA dehydrogenase. Med Hypotheses. 2004;62(6):970-975 5. Field SS. Omega-3 fatty acids, prematurity, and autism. [letter] Pediatrics. 2008;122(6):1416-1417 6. Amminger GP, Berger GE, Schafer MR, et al. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled study. Biol Psychiatry. 2007;61(4):551-553 7. Meiri G, Bichovsky Y, Belmaker RH. Omega 3 fatty acid treatment in autism. J Child Adolesc Psychopharmacol. 2009;19(4):449-451 8. Meguid NA, Atta HM, Gouda AS, et al. Rople of poysunsaturated fatty acids in the management of Egyptian children with autism. Clin Biochemistry. 2008;41:1044-1048 9. Johnson M, Ostlund S, Fransson G, et. al. Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder. J Attn Dis. 2009;12(5):394- 401 10. Arvindakshan M, Shate M, Ranjekar PK, et al. Supplementation with a combination of omega-3 fatty acids and antioxidants (vitamins E and C) improves the outcome of schizophrenia. Schizophr Res. 2003;62(3):195-204
Conflict of Interest:
None declared
GI status and nutrients
Thank you for your combined work in evaluating the issue of gastrointestinal disorders in those with autistic disorder. My concern with GI disorders involves the number of nutrients already associated with autistic disorder. If there is poor absorption of these nutrients, then symptoms of autistic disorder may arise or worsen, depending on one's genetic predisposition. This includes low vitamin D, given possible association with autistic disorder as seen with higher rates of residence for children with autistic disorder in counties with higher rainfall in California, Oregon, and Washington. It also includes low iron, given the association between low iron measured as ferritin and sleep disorders in children with autistic disorder. Deficiencies in each could be due to lactose intolerance, celiac disease, food allergies, or small intestine bacterial overgrowth. Being alert for GI problems in those who frequently have communication difficulties is practicing wise and cost-effective healthcare.
Waldman, Michael, et al., "Autism Prevalence and Precipitaion Rates in California, Oregon, and Washington Counties", Archives of Pediatrics and Adolescent Medicine, 2008; 162 (11): 1026-34. Dosman, Cara, et al., "Children with autism: effectg of iron supplementation on sleep and ferritin", Pediatric Neurology, 2007 Mar; 36 (3): 152-58.
Conflict of Interest:
None declared