An elevated anxiety level among prepubertal autistic boys with non‐treatment‐seeking functional gastrointestinal disorders: A case–control study

Abstract

Children with autism commonly suffer from comorbid functional gastrointestinal disorders (FGID) and anxiety. The raised prevalence of both conditions in autism suggests complex reciprocal relationships, which are seldom explored in non-treatment-seeking FGID. The relationships between subtypes of FGID and anxiety are also unclear. This study recruited boys with autism and age-matched typically developing (TD) boys, aged 4-11 years, who were not actively seeking help for gastrointestinal problems. Their parents completed the Rome IV Diagnostic Questionnaires for Pediatric FGID. Four groups of children with and without autism/FGID were identified and compared on their anxiety level using the Spence children's anxiety scale. In 69 boys with autism and 69 age-matched TD boys, FGID were identified in 22 and 16 boys, respectively. ANCOVA demonstrated a significant interaction effect of autism and FGID on anxiety (F[1, 129] = 5.43, p = 0.021), while conditional logistic regression identified an interaction effect of autism and anxiety on the odds of FGID (OR 1.038, 95% CI 1.002-1.075, p = 0.038). Explorative post hoc analysis showed higher anxiety in functional nausea and vomiting disorder (p = 0.033) and functional abdominal pain disorder (p = 0.029) among boys with autism than TD boys with the same respective subtypes of FGID. In summary, among prepubertal boys with autism, the presence of FGID that are non-treatment-seeking in nature, has a significantly stronger association with higher levels of anxiety than TD boys. The strength of association may be more prominent in subtypes of FGID. Possible pathomechanisms including the underlying microbiota spectra and inflammatory paths should be explored in future studies. Lay summaryAnxiety and gastrointestinal problems are common symptoms in autism. Given that gut health could be linked to emotions, their association in young boys with autism was studied. The presence of nausea vomiting, or abdominal pain were associated with raised anxiety among boys with autism, yet this was not observed in typically developing boys. This suggests that anxiety among autistic children could be partly explained by the presence of FGID.

Disentangling the relationship of gut microbiota, functional gastrointestinal disorders and autism: a case–control study on prepubertal Chinese boys

“…Furthermore, autistic symptoms (AQ-10), anxiety (SCAS-P) and overall psychopathology (SDQ) levels were highest among the ASD FGID+ and explorative analyses also showed that lower alpha diversity and microbiota composition at the phylum level (F:B ratio) correlated with higher SDQ and AQ-10. Our results thus corroborated the reported potential correlations between microbiota, GI and neuropsychiatric symptoms in ASD [10][11][12] . Notwithstanding the rigorous attempts made to control for possible confounders and optimize the characterization of psychopathology and FGIDs in this study, our findings should be interpreted from the wider perspective of mixed results in published studies.…”

“…Hence, the gut microbiome could contribute to the pathogenesis of ASD. Furthermore, as ASD children with comorbid FGID have a higher severity of rigid-compulsive behavior 10 , sensory over-responsivity 11 , and anxiety, even at prepubertal ages 12 , the altered gut microbiome in FGID may also mediate neuropsychiatric and behavioral symptoms.…”

Questionnaire-based analysis of autism spectrum disorders and gastrointestinal symptoms in children and adolescents: a systematic review and meta-analysis

“…Children with ASD are more likely to experience constipation than TD children ( Supplementary Figure S2 , see the Supplementary Material ). Twelve articles ( 19 , 21 , 22 , 24 , 25 , 32 , 34 – 37 , 39 , 41 ) recorded cases of children with ASD complaining of simple abdominal pain. Seven studies ( 18 , 18 , 20 , 23 , 29 , 30 , 38 ) reported cases of defecation-related abdominal pain, and two ( 26 , 28 ) found no abdominal pain.…”

“…All 25 articles provided information on constipation in children with ASD, with an prevalence of 37% (95% CI: 0.30, 0.43), I 2 = 96.00%, p = 0.00 ( Supplementary Figure S7 , see the Supplementary Material ). A total of 22 articles ( 18 – 27 , 29 – 32 , 34 – 37 , 39 – 41 ) documented diarrhea in children with ASD, with a combined prevalence of 19% (95% CI: 0.14, 0.24), I 2 = 96.86%, p = 0.00 ( Supplementary Figure S8 , see the Supplementary Material ). Data on abdominal pain in children with ASD were reported in 21 articles ( 18 – 26 , 28 – 30 , 32 , 34 – 37 , 39 , 41 ), with an prevalence of 21% (95% CI: 0.14, 0.28), I 2 = 96.55%, p = 0.00 ( Supplementary Figure S9 , see the Supplementary Material ).…”

Occurrence of bruxism in individuals with autism spectrum disorder: A systematic review and meta‐analysis

“…We may also cite changes in the facial muscles seen in this group, which may contribute to the establishment of harmful oral habits 25,28 . However, other factors can influence the occurrence of bruxism in individuals with ASD, such as anxiety, 29–32 stress 29 and the side effects of continuous‐use medications, which can have repercussions for the oral cavity 25,28 …”