Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors.
Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors.
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DOI：
10.1002/aur.237
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发表时间：
2012-04
期刊：
影响因子：
4.7
通讯作者：
Levitt, Pat
中科院分区：
文献类型：
--
作者：
Gorrindo, Phillip;Williams, Kent C.;Lee, Evon B.;Walker, Lynn S.;McGrew, Susan G.;Levitt, Pat
关键词：
自闭症谱系障碍 (ASD) 儿童的胃肠功能障碍 (GID) 尚不清楚。据报道，自闭症谱系障碍人群和非自闭症谱系障碍人群之间与 GID 相关的因素（例如饮食习惯）存在差异，但这些因素与 GID 之间的关系尚未得到研究。还有一种可能性是，我们对自闭症谱系障碍中 GID 的了解可能会受到父母对孩子 GID 的看法的影响。尽管父母最了解自己的孩子，但他们不一定是确定 GID 的专家。这项研究调查了父母和儿科胃肠临床医生对儿童 GID 的看法，以及被认为与自闭症谱系障碍 (ASD) 中 GID 相关的因素实际上如何与 GID 相关。研究人员对 121 名儿童进行了研究，分为三组：同时发生 ASD 和 GID、ASD 不伴 GID、GID 不伴 ASD。儿科胃肠病学家的临床评估验证了 ASD 中 GID 的父母报告，其中便秘是 ASD 中 GID 的主要类型。 ASD 中 GID 的存在与饮食或药物的差异无关，但与语言和社交障碍有关。这些研究结果表明，自闭症儿童的医疗保健提供者应该对 GID 保持警惕，特别是对于缺乏口头交流能力的儿童。本研究的目的是描述自闭症谱系障碍 (ASD) 中胃肠功能障碍 (GID) 的特征，对照儿科胃肠病学家的评估检查家长对 GID 的报告，并探讨与 ASD 中 GID 相关的因素。 121 名儿童被分为三组：同时发生 ASD 和 GID、ASD 不伴 GID、GID 不伴 ASD。一位儿科胃肠病学家对两个 GID 组进行了评估。所有三组的家长都完成了有关孩子行为和胃肠道症状的调查问卷以及饮食日记。功能性便秘是 ASD 儿童最常见的 GID 类型 (85.0%)。任何 GID 的家长报告与任何 GID 的临床诊断高度一致 (92.1%)。自闭症谱系障碍 (ASD) 儿童中 GID 的存在与独特的饮食习惯或药物状态无关。便秘的几率与年龄较小、社交障碍增加和缺乏表达性语言有关（非语言儿童的调整比值比：11.98，95% CI 2.54 – 56.57）。这项研究证实了父母对自闭症谱系障碍儿童 GID 的担忧，因为父母对 GID 的存在（尽管不一定是本质）很敏感。便秘和语言障碍之间的密切联系凸显了医疗保健提供者需要保持警惕，以检测和治疗 ASD 儿童的 GID。通常认为药物和饮食会导致自闭症谱系障碍 (ASD) 的 GID，但它们与 GID 状态无关。这些发现与 ASD 中的 GID 代表遗传风险因素的多效性表达的假设是一致的。
Gastrointestinal dysfunction (GID) in children with autism spectrum disorder (ASD) is not well understood. Differences in factors associated with GID, such as eating habits, have been reported between ASD and non-ASD populations, but relationships between these factors and GID have not been examined. There is also the possibility that what we do know about GID in ASD is influenced by parents’ perceptions of GID in their children. Although parents know their children best, they are not necessarily experts in determining GID. This study examined how well parents and pediatric gastrointestinal clinicians agree on GID in children, and how factors thought to relate to GID in ASD, actually do relate to GID. 121 children were studied, in three groups: co-occurring ASD and GID, ASD without GID, and GID without ASD. Clinical evaluations by pediatric gastroenterologists validated parental reports of GID in ASD, with constipation the leading type of GID in ASD. Presence of GID in ASD was not associated with differences in diet or medications, but was associated with language and social impairments. These findings suggest that healthcare providers of children with ASD should be vigilant for GID, particularly in children who lack the ability to communicate verbally. The objectives of this study were to characterize gastrointestinal dysfunction (GID) in autism spectrum disorder (ASD), to examine parental reports of GID relative to evaluations by pediatric gastroenterologists, and to explore factors associated with GID in ASD. 121 children were recruited into three groups: co-occurring ASD and GID, ASD without GID, and GID without ASD. A pediatric gastroenterologist evaluated both GID groups. Parents in all three groups completed questionnaires about their child’s behavior and GI symptoms, and a dietary journal. Functional constipation was the most common type of GID in children with ASD (85.0%). Parental report of any GID was highly concordant with a clinical diagnosis of any GID (92.1%). Presence of GID in children with ASD was not associated with distinct dietary habits or medication status. Odds of constipation were associated with younger age, increased social impairment, and lack of expressive language (adjusted odds ratio in nonverbal children: 11.98, 95% CI 2.54 – 56.57). This study validates parental concerns for GID in children with ASD, as parents were sensitive to the existence, although not necessarily the nature, of GID. The strong association between constipation and language impairment highlights the need for vigilance by healthcare providers to detect and treat GID in children with ASD. Medications and diet, commonly thought to contribute to GID in ASD, were not associated with GID status. These findings are consistent with a hypothesis that GID in ASD represents pleiotropic expression of genetic risk factors.
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