Gastrointestinal Symptoms linked to Autism

Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, however, it can be difficult to recognize and characterize gastrointestinal dysfunction due to the communication difficulties experienced by many affected individuals. Watch this presentation by Dr. Alessio Fasano, pediatric gastroenterologist at the University of Maryland School of Medicine (UMDSOM), from a recent ARI Conference discussing the impact of GI problems in children with ASD.

Emerging research is aimed at developing recommendations for diagnostic evaluation and management of gastrointestinal problems for individuals on the spectrum. Valicenti-McDermott, 2006, evaluated children with ASD and two control groups matched for age, sex and ethnicity (one with non-autism-related developmental disorders, and the other developmentally normal).  There were 50 children in each group – findings concluded:

• 70% of the children with ASD had GI Issues compared to 42% of the children with developmental disorder other than ASD
• 28% of children with typical development.

Just like everyone else, people with autism may suffer:

• Gastritis
• GERD
• Colitis
• Irritable Bowel Syndrome
• Constipation
• Motility-based disorders
• Food allergy and sensitivity
• Overgrowth syndromes

Food allergy in this population is common - food allergy can affect any site in the GI tract. Research points to the following food allergy prevalence rates in children:

• 5-8% of neurotypical children without autism (Sampson, 1999) suffer  food allergies
• 36% of autistic children (Lucarelli, 1995) suffer food allergies

If your child complains of stomachaches, or if he/she adopts unusual positions to put pressure on his/her lower abdomen, try to identify underlying conditions when possible.  Baseline testing might help identify factors such as infection, allergy or food sensitivity, and evidence for constipation.

http://www.autism.com/gastrointestinal 

Prevalence of Autism in a United States Population: The Brick Township, New Jersey, Investigation

Objective. This study determined the prevalence of autism for a defined community, Brick Township, New Jersey, using current diagnostic and epidemiologic methods.

Methods. The target population was children who were 3 to 10 years of age in 1998, who were residents of Brick Township at any point during that year, and who had an autism spectrum disorder. Autism spectrum disorder was defined as autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger disorder. The study used 4 sources for active case finding: special education records, records from local clinicians providing diagnosis or treatment for developmental or behavioral disabilities, lists of children from community parent groups, and families who volunteered for participation in the study in response to media attention. The autism diagnosis was verified (or ruled out) for 71% of the children through clinical assessment. The assessment included medical and developmental history, physical and neurologic evaluation, assessment of intellectual and behavioral functioning, and administration of the Autism Diagnostic Observation Schedule—Generic.

Results. The prevalence of all autism spectrum disorders combined was 6.7 cases per 1000 children. The prevalence for children whose condition met full diagnostic criteria for autistic disorder was 4.0 cases per 1000 children, and the prevalence for PDD-NOS and Asperger disorder was 2.7 cases per 1000 children. Characteristics of children with autism in this study were similar to those in previous studies of autism.

Conclusions. The prevalence of autism in Brick Township seems to be higher than that in other studies, particularly studies conducted in the United States, but within the range of a few recent studies in smaller populations that used more thorough case-finding methods.

By: J

acquelyn Bertrand, PhD, 

Audrey Mars, MD, 

Coleen Boyle, PhD,  

Frank Bove, ScD, 

Marshalyn Yeargin-Allsopp, MD, 

Pierre Decoufle, ScD

PEDIATRICS Vol. 108 No. 5 November 1, 2001 
pp. 1155 -1161 

From: Pediatrics, the official journal of the American Academy of Pediatrics 

The Quite Victims of Bullying

On this blog I will wrap up my description and analysis on victims of bullying as discussed within the journal article “Bullying in School: An Overview of Types, Effects, Family Characteristics, and Intervention Strategies”, by Paul R. Smokowski and Kelly Holland Kopasz.

According to the journal article victims are often more quite, cautious, anxious, insecure, and sensitive than their peers. In addition, they usually have poor communication skills and problem-solving skills. The poor communication skills exhibited by victims often deter them from conversing with their peers, which consequently results in fewer friends. In fact, Smokowski and Kopasz report that a study found that “victims of bullying demonstrated poorer social and emotional adjustment, greater difficulty making friends, few relationships with peers, and greater loneliness.” Another study found that many victims relate much better to adults, than their own peers. This last finding may prove to be extremely critical towards understanding victims of bullying. It seems that victims of bullying are in a way reaching towards help. However their lack of social and communicative skills seems to be the factor that prevents victims from expressing their needs. As a result, anti-bullying strategies should aim to improve the communication that exists between bullies and the corresponding authoritative figure. However it should be noted that the improvement of communicative skills should be focused on all age groups, not only children.

Smokowski and Kopasz point out that the lack of communication skills often hinders victims from reporting their bullying incidents. This is particularly concerning because when victims neglect to report bullying incidents, it may encourage and cause bullies to continue to target these individuals as victims. As I have stated before, bullies seem to have a false sense of invisibility. On this occasion bullies see their victims as easy target. The journal article also highlights that victims of bullying often suffer from poor self-esteem and see themselves as failures, unattractive, unintelligent, and insignificant. This ends up creating for victims an erroneous sense of self-blame. As result, anti-bullying strategies should not only focus on the remediation of bullies and correcting their behaviors. Anti-bullying strategies should also pay attention towards the remediation of the victims of bullying, since they may suffer deep and invisible mental wounds.

Victims of Bullying

On this blog I will begin my analysis victims of bullying as discussed within the journal article “Bullying in School: An Overview of Types, Effects, Family Characteristics, and Intervention Strategies”, by Paul R. Smokowski and Kelly Holland Kopasz.

According to Smokowski and Kopasz most victims of bullying are passive or submissive, however one-third of bullying victims exhibit aggressive attitudes. The journal article only briefly mentions this tendency. However, I believe that this statement is of critical importance and demands further investigation. Researchers may be neglecting a critical sub-population of victims. It may be that these victims are in the process of becoming the bully-victims I have previously discussed in the past. These victims may provide critical revelations to researchers investigating the factors that trigger aggressive behaviors within people. In fact, it may be that the aggressive behavior exhibited by certain victims provides one answer for the existence of bully-victims. It may be that these victims have found that their only route of escape or temporarily relief from bullying is to bully other individuals themselves. In this manner these victims may at least deter some individuals from bullying them all of the time.

Smokowski and Kopasz describe victims of bullying as being physically small, weak, and frail when compared to bullies. In fact, the journal article states that the physical composure of victims is what often leaves them vulnerable and “unable to protect themselves from [the] abuse [of bullies].” The journal article goes on to state that victims of bullying may exhibit “body anxiety” and fear towards getting hurt. In fact, when victims of bullying are attacked, Smokowski and Kopasz report that victims usually react by crying or withdrawing.  Although all the aforementioned characteristics are typical of victims, it would be erroneous to believe that they are always true. In fact, I believe it would be erroneous to think of bullying as being based exclusively on physical characteristics. For example, individuals can be marginalized based on their mental capabilities. This phenomenon can be observed within school settings during the formation of groups for school based projects. Students considered “smart” will often marginalize certain students and prevent them from joining their groups. In fact, on some occasions, “smart” students can be seen making fun of students who are not as knowledgeable as they are.

Bullying – A Gateway for Problems

On this blog I will finish my analysis on bullies as discussed within the journal article “Bullying in School: An Overview of Types, Effects, Family Characteristics, and Intervention Strategies”, by Paul R. Smokowski and Kelly Holland Kopasz.

On this occasion I will discuss the effects of bullying, in regards to those exhibited by the bullies themselves. According to Smokowski and Kopasz, bullying has been linked to mental health difficulties, including: attention-deficit disorder, depression, and oppositional-conduct disorder. In fact, bullies have been linked to engage in excessive drinking other substance use more frequently than victims and bully-victims. According to Smokowski and Kopasz, “children who bully others often experience long-term effects and consequences as a result of their bullying.” For example, the National School Safety Center has reported reports that a high number of bullies under achieve in school and perform below their potential within employment settings. In addition, other studies have found that by the age of thirty, bullies are more likely to have committed more criminal offenses and traffic violations than their less aggressive peers. Adult bullies are also more likely to display aggression towards their spouse and are more likely to use “severe physical punishment” on their children. The most concerning research finding reported by Smokowski and Kopasz is that “research suggests that adults who were bullies as children tend to have children who become bullies.”

In blogs of the past, I have referred to bullying as a “gateway” form of violence. In those blogs I have pointed out how bullying seems to serve as a starting point for other forms of aggression that are increasingly violent. This article also hints towards this tendency when it states that bullies often have “a positive attitude [towards] physical aggression” and that bullies are more likely to commit criminal offenses in the future.  However, this article has also made me realize that bullying not only serves as a “gateway” form of violence, but rather serves as a “gateway” for a variety of social problems. What is particularly concerning is that these social problems do not simply disappear as some individuals tend to think. As I have previously pointed out, with the passage of time, bullying and its accompanying or resulting problems seem to become so engrained within our daily lives that they become part of our normal daily lives, leading to a phenomenon which I have referred to as “normalization.”  Interestingly, Smokowski and Kopasz seem to hint that parents may bear part of the blame or at least have some influence over bullying. Perhaps anti-bullying strategies should focus on strengthening family bonds, especially with bullies who are children.