Nutrition Management of Gastrointestinal Symptoms in Children with Autism Spectrum Disorder: Guideline from an Expert Panel

      To take the Continuing Professional Education quiz for this article, log in to www.eatrightPRO.org, go to the My Account section of the My Academy Toolbar, click the “Access Quiz” link, click “Journal Article Quiz” on the next page, and then click the “Additional Journal CPE quizzes” button to view a list of available quizzes.
      Autism spectrum disorder (ASD) is characterized by a core deficit in social communication with concomitant repetitive/perseverative behaviors and restriction in interests,
      American Psychiatric Association
      Diagnostic and Statistical Manual of Mental Disorders: DSM-V.
      and individuals with ASD experience varying degrees of impairment.
      • Croen L.A.
      • Grether J.K.
      • Selvin S.
      • Croen L.A.
      • Grether J.K.
      • Selvin S.
      Descriptive epidemiology of autism in a California population: Who is at risk?.
      The estimated prevalence of ASD in pediatric populations has climbed dramatically during the past decade, with approximately 1 in every 68 children currently meeting diagnostic criteria in the United States.
      Centers for Disease Control and Prevention
      Prevalence of Autism Spectrum Disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010.
      High prevalence occurs against a backdrop of increased health care costs
      • Croen L.A.
      • Najjar D.V.
      • Ray G.T.
      • Lotspeich L.
      • Bernal P.
      A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model heath plan.
      and social burden.
      • Fletcher P.C.
      • Markoulakis R.
      • Bryden P.J.
      The costs of caring for a child with an autism spectrum disorder.
      Medical comorbidities are significantly overrepresented compared with other pediatric populations, and children with ASD often present with medical conditions affecting multiple organ systems.
      • Kohane I.S.
      • McMurry A.
      • Weber G.
      • et al.
      The co-morbidity burden of children and young adults with autism spectrum disorders.
      Dysfunction of the gastrointestinal (GI) tract is among the most frequently cited comorbidities. A recent meta-analysis indicated that children with ASD were four times more likely to experience general GI complaints, are more than three times more prone to experience constipation and diarrhea, and complain twice as frequently about abdominal pain compared with peers.
      • McElhanon B.O.
      • McCracken C.
      • Karpen S.
      • Sharp W.G.
      Gastrointestinal symptoms in autism spectrum disorders: A meta-analysis.
      Lack of data prevented analysis of other GI symptoms (eg, gastroesophageal reflux, celiac disease, lactose intolerance) typically associated with organic etiologies; however, a 2010 consensus report concluded that, at a minimum, rates of other GI pathophysiology in ASD should be viewed as occurring at similar levels to those observed in the general population.
      • Buie T.
      • Campbell D.B.
      • Fuchs III, G.J.
      • et al.
      Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report.
      This includes consideration of the potential contribution of factors such as GI motility, altered gut microbiome, immune abnormalities, and food allergy when GI symptoms are detected.
      • McElhanon B.O.
      • McCracken C.
      • Karpen S.
      • Sharp W.G.
      Gastrointestinal symptoms in autism spectrum disorders: A meta-analysis.
      In addition to calling for greater research scrutiny in this area, the expert panel of pediatric gastroenterologists also emphasized the need to develop evidence-based standards for the evaluation and treatment of GI symptoms in ASD.
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