Gastrointestinal and Sleep Problems in Children with Autism Spectrum Disorder: Their Relationship with Problematic Behavior

Abstract

Objective: The purpose of this research is to investigate sleep and gastrointestinal problems in children with autism spectrum disorder (ASD) and their relationship with each other, autism severity and problematic behavior. Material and Methods: The children who were admitted to outpatient clinics of child psychiatry at our hospital in a 3-months period and had diagnosis of ASD according to DSM-5 were included. The parents filled Aberrant Behavior Checklist (AbBC), Rome-3 Diagnostic Questionnaire for Pediatric Functional Gastrointestinal Disorders Parent Report Form (QPGS-RIII), Children’s Sleep Habits Questionnaire (CSHQ), Autism Behavior Checklist (ABC) and sociodemographic data form. The clinician applied Childhood Autism Rating Scale (CARS). Results: Ninety-seven children with ASD were included. According to QPGS-RIII, 38.1% of the cases had probable functional gastrointestinal problems. Those were 26.8% (n=26) functional constipation, 8.2% (n=8) nonretentive fecal incontinence, 2.1% (n=2) aerofaji, 3.1% (n=3) rumination syndrome, 4.1% (n=4) irritable bowel syndrome, 1% (n=1) functional abdominal pain syndrome, 1% (n=1) functional dyspepsia, 3.1% (n=3) functional abdominal pain, 1% cyclic vomiting and 1% (n=1) abdominal migraine. According to CSHQ 58.8% of the cases had sleep problems. ASD patients with functional gastrointestinal problems, had higher total scores of CSHQ, ABC and AbBC, compared to children with no functional gastrointestinal problems. Conclusion: Our findings revealed that frequency of gastrointestinal and sleep problems were high in children with ASD. It is appropriate to evaluate patients with ASD in terms of gastrointestinal and sleep problems especially if behavioral problems accompanies. And treating gastrointestinal and sleep problems might decrease challenging behaviors that seen in ASD.

Keywords

• Autism
• Gastrointestinal diseases
• Sleep
• Problem behavior

Otizm Spektrum Bozukluğu Olan Çocuklarda Gastrointestinal Sistem ve Uyku Sorunları: Bunların Problemli Davranışlarla İlişkisi

Abstract

Amaç: Bu araştırmanın amacı, otizm spektrum bozukluğu (OSB) olan çocuklarda uyku ve gastrointestinal sorunları ve bunların birbirleriyle, otizm şiddeti ve problemli davranışlarla olan ilişkisini incelemektir. Gereç ve Yöntemler: Hastanemizde 3 aylık bir sure içinde çocuk psikiyatrisi polikliniklerine başvuran ve DSM-5’e göre OSB tanısı alan çocuklar çalışmaya alındı. Ebeveynler tarafından Sorun Davranış Kontrol Listesi (SDKL), PediatrikGastrointestinal Semptomlar Ölçeği- Ebeveyn Rapor Formu, Çocuk Uyku Alışkanlıkları Anketi (ÇUAA), Otizm Davranış Kontrol Listesi (ODKL) ve sosyodemografik veri formu dolduruldu. Klinisyen tarafından Çocukluk Otizm Derecelendirme Ölçeği (ÇODÖ) uygulandı. Bulgular: Çalışmaya 97 OSB hastası dahil edildi. Pediatrik Gastrointestinal Semptomlar Ölçeği- Ebeveyn Rapor Formuna göre vakaların %38.1’inde olası fonksiyonel gastrointestinal problem saptandı. Bunlardan %26.8’i (n=26) fonksiyonel konstipasyon, %8.2’si (n=8) retansif olmayan fekal inkontinans, %2.1’i (n=2) aerofaji, %3.1’i (n=3) ruminasyon sendromu, %4.1’i (n=4) irritabl bağırsak sendromu, %1’i (n=1) fonksiyonel karın ağrısı sendromu, %1’i (n=1) fonksiyonel dispepsi, %3.1’i (n=3) fonksiyonel karın ağrısı, %1’i siklik kusma ve %1’i (n=1) abdominal migrendi. ÇUAA’ya göre vakaların %58.8’inde uyku problemi vardı. Fonksiyonel gastrointestinal problemi olan OSB hastalarının, fonksiyonel gastrointestinal problemi olmayan hastalara göre ÇUAA, ODKL ve SDKL toplam puanları daha yüksek saptandı. Sonuç: Bulgularımız OSB’li çocuklara gastrointestinal ve uyku sorunlarının sıkça eşlik ettiğini göstermiştir. Özellikle davranış sorunları eşlik eden OSB’li hastaların, altta yatan gastrointestinal ve uyku sorunları açısından değerlendirilmesi önemli görünmektedir. Gastrointestinal hastalıkları ve uyku problemlerini tedavi etmek, OSB’ye sık eşlik eden davranış sorunlarını azaltabilir.

Keywords

• Otizm
• Gastrointestinal Hastalıklar
• Uyku
• Sorunlu Davranış

References

1. APA. Association, Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub 2013.
2. Maenner MJ, Shaw KA, Bakian AV, Bilder DA, Durkin MS, Esler A. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ 2021;70:1-16.
3. Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet 2018;392:508-20.
4. McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics 2014;133:872-83.
5. Mannion A, Leader G. Gastrointestinal symptoms in autism spectrum disorder: A literature review. Review Journal of Autism and Developmental Disorder 2014;1:11-7.
6. Grossi E, Melli S, Dunca D, Terruzzi V. Unexpected improvement in core autism spectrum disorder symptoms after long-term treatment with probiotics. SAGE Open Med Case Rep 2016 ;4:2050313X16666231.
7. Irwanto, Rehatta NM, Hartini S, Takada S. Sleep Problem of Children with Autistic Spectrum Disorder Assessed by Children Sleep Habits Questionnaire- Abbreviated in Indonesia and Japan. Kobe J Med Sci 2016;62:E22-6.
8. Gisbert Gustemps L, Lugo Marín J, Setien Ramos I, Ibañez Jimenez P, Romero Santo-Tomás O, Jurado Luque MJ. Sleep disturbances in autism spectrum disorder without intellectual impairment: relationship with executive function and psychiatric symptoms. Sleep Med 2021;83:106-14.

9. Hsiao EY. Gastrointestinal issues in autism spectrum disorder. Harv Rev Psychiatry 2014;22:104-11.
10. Gorrindo P, Williams KC, Lee EB, Walker LS, McGrew SG, Levitt P. Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors. Autism Res 2012;5:101-8.
11. Chaidez V, Hansen RL, Hertz-Picciotto I. Gastrointestinal problems in children with autism, developmental delays or typical development. J Autism Dev Disord 2014;44:1117-27.
12. Buie T, Campbell DB, Fuchs GJ 3rd, Furuta GT, Levy J, Vandewater J. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics 2010;125 Suppl 1:S1-18.
13. Leader G, Abberton C, Cunningham S, Gilmartin K, Grudzien M, Higgins E. Gastrointestinal Symptoms in Autism Spectrum Disorder: A Systematic Review. Nutrients 2022;14:1471.
14. Mazurek MO, Vasa RA, Kalb LG, Kanne SM, Rosenberg D, Keefer A. Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. J Abnorm Child Psychol 2013;41:165-76.
15. Roussis S, Richdale A L, Katz T, Malow B A, Barbaro J, Sadka N. Behaviour, cognition, and autism symptoms and their relationship with sleep problem severity in young children with autism spectrum disorder. Res. Autism Spectr. Disord 2021;83:101743
16. Schreck KA, Richdale AL. Sleep problems, behavior, and psychopathology in autism: inter-relationships across the lifespan. Curr Opin Psychol 2020;34:105-11.
17. Gosling CJ, Cortese S, Konofal E, Lecendreux M, Faraone SV. Association of Parent-Rated Sleep Disturbances With Attention-Deficit/Hyperactivity Disorder Symptoms: 9-Year Follow-up of a Population-Based Cohort Study. J Am Acad Child Adolesc Psychiatry 2023;62:244-52.