A quarterly publication of the Autism Research Institute
Fall, 2018 | Number 4, Volume 32
Gastrointestinal (GI) problems are common in individuals with autism spectrum disorders (ASD), many of whom are unable to communicate their discomfort. Now, researchers have developed a screening tool that may allow doctors to quickly and easily identify the children with ASD who are most likely to have GI problems.
Kara Gross Margolis and colleagues began with a long questionnaire developed by the Autism Treatment Network. Noting that medical professionals need to assess patients in a limited amount of time, they carried out a two-stage study designed to identify the most useful questions for doctors to ask. In the first stage of the study, the researchers asked parents of 131 children with ASD to complete the long questionnaire. In the second stage, gastroenterologists unaware of the parents’ responses evaluated each child for the presence or absence of three GI disorders: gastroesophageal reflux disease (GERD), functional constipation, or functional diarrhea. (The researchers note that the term functional was used simply to indicate that no organic cause for the problem could be identified.)
Using data from both stages of the study, the researchers identified 17 items that were especially effective in spotting children with the three GI disorders. They report that “this 17-item screen identified children having one or more of these disorders with a sensitivity of 84%, specificity of 43%, and a positive predictive value of 67%.” Margolis notes that while the specificity of the test is low, this was not unexpected in a population that is largely nonverbal. In addition, she notes, “We know that GI conditions are at least fourfold more common in kids with ASD. If we can say [the screening tool] was over 80% sensitive in accurately picking that up, we are willing to take a high false positive rate to make sure we don’t miss those kids. The alternative is just referring every single child.”
If larger studies confirm the validity of the short questionnaire, Margolis says, parents and doctors will be able to use it as a “road map” for treating individuals with ASD. Positive screens, she says, should result in a referral to a gastroenterologist.
Margolis says that the high rate of GI problems in individuals with autism may be due in part to the antipsychotic medications many are taking, because these drugs can cause constipation. In addition, she notes, gut-brain miscommunication is often impaired in individuals with ASD
“Development of a brief parent-report screen for common gastrointestinal disorders in autism spectrum disorder,” Kara G. Margolis, Timothy M. Buie, J. Blake Turner, Anna E. Silberman, Judith F. Feldman, Katherine F. Murray, Maureen McSwiggan-Hardin, Joseph Levy, Margaret L. Bauman, Jeremy Veenstra-VanderWeele, Agnes H. Whitaker, and Harland S. Winter, Journal of Autism and Developmental Disorders, October 22, 2018 (online). Address: Kara G. Margolis, Department of Pediatrics, Division of Gastroenterology, Columbia University Medical Center, New York Presbyterian Hospital, Morgan Stanley Children’s Hospital, New York, NY, [email protected].
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“In kids with autism, short questionnaire may detect GI disorders,” news release, Columbia University, October 22, 2018.
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“New screen quickly identifies GI disorders in kids with autism,” Pauline Anderson, medscape.com, November 1, 2018.
