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Bidirectional relationship between internalizing symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder

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Abstract

Many youth with autism spectrum disorder (ASD) experience co-occurring conditions, such as gastrointestinal (GI) problems and internalizing symptoms. However, the relationship among these co-occurring problems is not well-understood. We analyzed parent reports of GI problems and internalizing symptoms of 621 youth with ASD using path models in a structural equation modeling framework. The best-fitting model was a bidirectional model wherein internalizing symptoms, including withdrawn and anxious behavior, were correlated with GI problems, including constipation, diarrhea, nausea, and stomach pain. This study provides a better understanding of the relationship among co-occurring conditions in youth with ASD and should encourage clinicians to consider treatment of underlying internalizing symptoms or GI problems when providing services for individuals with ASD.

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References

  • Abel, K. M., Dalman, C., Svensson, A. C., Susser, E., Dal, H., Idring, S. … Magnusson, C. (2013). Deviance in fetal growth and risk of autism spectrum disorder. American Journal of Psychiatry, 170(4), 391–398

    Article  PubMed  Google Scholar 

  • Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-Age forms & profiles: An integrated system of multi-informant assessment. Burlington, VT: University of Vermont, Research Center for Children, Youth & Families

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association

    Book  Google Scholar 

  • Beversdorf, D. Q., & CONSORTIUM, M. A. S. (2016). Phenotyping, etiological factors, and biomarkers: toward precision medicine in autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 37(8), 659

    Article  PubMed  PubMed Central  Google Scholar 

  • Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in psychiatry, 9, 44

    Article  PubMed  PubMed Central  Google Scholar 

  • Buie, T., Campbell, D. B., Fuchs, G. J., Furuta, G. T., Levy, J., van de Water, J. … Winter, H. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 125S1, S1–18

    Article  Google Scholar 

  • Carr, E. G., & Owen-DeSchryver, J. S. (2007). Physical illness, pain, and problem behavior in minimally verbal people with developmental disabilities. Journal of Autism and Developmental Disorders, 37(3), 413–424

    Article  PubMed  Google Scholar 

  • Chaidez, V., Hansen, R. L., & Hertz-Picciotto, I. (2014). Gastrointestinal problems in children with autism, developmental delays or typical development. Journal of Autism and Developmental Disorders, 44, 1117–1127

    Article  PubMed  PubMed Central  Google Scholar 

  • Drossman, D. A. (2016). Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology; 148:1262–1279

  • Elliot, C. D. (2007). Differential ability scales (2nd ed.). San Antonio, TX: PsychCorp Harcourt Assessment Inc.

    Google Scholar 

  • Ferguson, B. J., Dovgan, K., Takahashi, N., & Beversdorf, D. Q. (2019). The relationship among gastrointestinal symptoms, problem behaviors, and internalizing symptoms in children and adolescents with Autism Spectrum Disorders. Frontiers in Psychiatry, 10, 194

    Article  PubMed  PubMed Central  Google Scholar 

  • Ferguson, B. J., Marler, S., Altstein, L. L., Lee, E. B., Akers, J., Sohl, K. … Beversdorf, D. Q. (2017). Psychophysiological associations with gastrointestinal symptomatology in autism spectrum disorder. Autism Research, 10(2), 276–288

    Article  PubMed  Google Scholar 

  • Ferguson, B. J., Marler, S., Altstein, L. L., Lee, E. B., Mazurek, M. O., McLaughlin, A. … Beversdorf, D. Q. (2016). Associations between cytokines, endocrine stress response, and gastrointestinal symptoms in autism spectrum disorder. Brain, Behavior, and Immunity, 58, 57–62

    Article  PubMed  PubMed Central  Google Scholar 

  • Flowers, S. A., & Ellingrod, V. L. (2015). The microbiome in mental health: Potential contribution of gut microbiota in disease and pharmacotherapy management. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 35(10), 910–916

    Article  Google Scholar 

  • Fulceri, F., Morelli, M., Santocchi, E., Cena, H., Del Bianco, T., Narzisi, A. … Muratori, F. (2016). Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Digestive and Liver Disease, 48(3), 248–254

    Article  PubMed  Google Scholar 

  • Gondalia, S. V., Palombo, E. A., Knowles, S. R., Cox, S. B., Meyer, D., & Austin, D. W. (2012). Molecular characterisation of gastrointestinal microbiota of children with autism (with and without gastrointestinal dysfunction) and their neurotypical siblings. Autism Research, 5, 419–427

    Article  PubMed  Google Scholar 

  • Hovarth, K., & Perman, J. A. (2002). Autism and gastrointestinal symptoms. Current Gastroenterology Reports, 4, 251–258

    Article  Google Scholar 

  • Jin, Y., & Kong, J. (2017). Transcutaneous vagus nerve stimulation: A promising method for treatment of autism spectrum disorders. Frontiers in Neuroscience, 10, 609

    Article  PubMed  PubMed Central  Google Scholar 

  • Kang, D. W., Adams, J. B., Coleman, D. M., Pollard, E. L., Maldonado, J., McDonugh-Means, S. … Krajmalnik-Brown, R. (2019). Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota. Scientific Reports, 9, 5821. https://doi.org/10.1038/s41598-019-42183-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Lai, K. Y. C., Leung, P. W. L., Hung, F., Shea, S., Mo, C. K. S., Che, F. … Dadds, M. R. (2020). Gastrointestinal problems in Chinese children with Autism Spectrum Disorder. Neuropsychiatric Disease and Treatment, 16, 1807–1815

    Article  PubMed  PubMed Central  Google Scholar 

  • Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., & Trifan, A. (2020). A descriptive review on the prevalence of gastrointestinal disturbances and their multiple associations in Autism Spectrum Disorder. Medicina, 56(1), 11

    Article  Google Scholar 

  • Little, P. T. D. (2013). Longitudinal structural equation modeling. Guilford Press

  • Lleras, C. (2005). Path analysis. Encyclopedia of Social Measurement, 3(1), 25–30

    Article  Google Scholar 

  • Margolis, K. G., Buie, T. M., Turner, J. B., Silberman, A. E., Feldman, J. F., Murray, K. F. … Winter, H. S. (2019). Development of a brief parent-report screen for common gastrointestinal disorders in autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(1), 349–362

    Article  PubMed  PubMed Central  Google Scholar 

  • Mazefsky, C. A., Schreiber, D. R., Olino, T. M., & Minshew, N. J. (2014). The association between emotional and behavioral problems and gastrointestinal symptoms among children with high-functioning autism. Autism, 18(5), 493–501

    Article  PubMed  Google Scholar 

  • Mazurek, M. O., Kanne, S. M., & Wodka, E. L. (2013). Physical aggression in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 7(3), 455–465

    Article  Google Scholar 

  • McAtee, M., Carr, E. G., Schulte, C., & Dunlap, G. (2004). A contextual assessment inventory for problem behavior: Initial development. Journal of Positive Behavior Interventions, 6(3), 148–165

    Article  Google Scholar 

  • Prosperi, M., Santocchi, E., Balboni, G., Narzisi, A., Bozza, M., Fulceri, F. … Muratori, F. (2017). Behavioral phenotype of ASD preschoolers with gastrointestinal symptoms or food selectivity. Journal of autism and developmental disorders, 47(11), 3574–3588. https://doi.org/10.1007/s10803-017-3271-5

    Article  PubMed  Google Scholar 

  • Prosperi, M., Santocci, E., Muratori, F., Narducci, C., Calderoni, S., Tancredi, R. … Guiducci, L. (2019). Vocal and motor behaviors as a possible expression of gastrointestinal problems in preschoolers with Autism Spectrum Disorder. BMC Pediatrics, 19, 466

    Article  PubMed  PubMed Central  Google Scholar 

  • Restrepo, B., Angkustsiri, K., Taylor, S. L., Rogers, S. J., Cabral, J., Hath, B. … Nordahl, C. W. (2020). Developmental–behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism Research, 13, 1778–1789

    Article  PubMed  PubMed Central  Google Scholar 

  • Roid, G. H. (2003). Stanford-Binet intelligence scales (5th ed: technical manual). Itasca, IL: Riverside Publishing

  • Roid, G. H., Miller, L. J., Pomplun, M., & Koch, C. (2013). Leiter international performance (3rd ed (leiter-3)). Wood Dale. IL: Stoelting

  • Schermelleh-Engel, K., Moosbrugger, H., & Muller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8, 23–74

    Google Scholar 

  • Srikantha, P., & Mohajeri, M. H. (2019). The possible role of the microbiota-gut-brain-axis in autism spectrum disorder. International Journal of molecular sciences, 20(9), 2115

    Article  PubMed  PubMed Central  Google Scholar 

  • Wechsler, D. (2002). The Wechsler preschool and primary scale of intelligence (3rd ed.). San Antonio, TX: The Psychological Corporation

    Google Scholar 

  • Wechsler, D. (2003). Wechsler intelligence scale for children (4th ed (WISC-IV)). San Antonio, TX: NCS Pearson

  • Wechsler, D. (2011). Wechsler abbreviated scale of intelligence (2nd ed (WASI-II)). San Antonio, TX: NCS Pearson

  • Wechsler, D. (2012). Wechsler preschool and primary scale of intelligence (4th ed.). Bloomington, MN: Pearson

    Google Scholar 

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Author information

Authors and Affiliations

  1. Marist College, Department of Psychology, Poughkeepsie, NY, United States

    Kristen Dovgan PhD & Kyra Gynegrowski

  2. Department of Health Psychology, University of Missouri, Columbia, MO, United States

    Bradley J. Ferguson PhD

  3. Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, Columbia, MO, United States

    Bradley J. Ferguson PhD

  4. Department of Radiology, University of Missouri, Columbia, MO, United States

    Bradley J. Ferguson PhD

Authors
  1. Kristen Dovgan PhD
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  2. Kyra Gynegrowski
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  3. Bradley J. Ferguson PhD
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Contributions

Dr. Dovgan conceptualized the study, carried out the statistical analyses, and drafted the initial manuscript and revision.

Kyra Gynegrowski helped write and revise the manuscript.

Dr. Ferguson assisted with the conceptualization of the study, coordinated and supervised data collection, and reviewed the manuscript.

Corresponding author

Correspondence to Kristen Dovgan PhD.

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Dovgan, K., Gynegrowski, K. & Ferguson, B.J. Bidirectional relationship between internalizing symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder. J Autism Dev Disord 53, 4488–4494 (2023). https://doi.org/10.1007/s10803-022-05539-6

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  • DOI: https://doi.org/10.1007/s10803-022-05539-6

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