Gastrointestinal Manifestations and Associated Comorbidities in Children with Autism Spectrum Disorder: A Cross-sectional Analysis from South India.

Background: Gastrointestinal (GI) symptoms are frequently reported in children with autism spectrum disorder (ASD) and may significantly impact behavior, sleep, adaptive functioning, and the severity of autism. This study aims to explore the relationship between GI symptoms and these factors in children with ASD. Methods: We investigated 96 children and adolescents with ASD aged 3-18 years attending an autism clinic in South India. Parents were interviewed using a semi-structured proforma that gathered information on GI symptoms, sociodemographic details, medical history, and treatment history. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire-2 (SDQ-2), ASD severity was measured using the Indian Scale for Assessment of Autism (ISAA), and sleep issues were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) for autism. Statistical analyses were conducted to determine the predictive value of assessment scores on GI symptoms in two groups: (a) those with mild to moderate ASD and (b) participants aged less than or equal to six years versus more than six years. Results: Constipation and dietary problems were the most commonly reported (82.29%), followed by dyspepsia and reflux (44.79%), pica (36.46%), abdominal pain (26.04%), and diarrhea (14.58%). Holding all other predictor variables constant, constipation increased by 20% (odds ratio [OR] = 1.201) for unit increases in speech-language communication scores. Abdominal pain decreased by 24.5% (OR = 0.755) for unit increases in peer problems scores. Excessive flatulence decreased by 64.2% (OR = 0.358) for unit increases in conduct problems score. Finally, pica was found to increase by 23.2% (OR = 1.232) for unit increases in the sensory patterns score. Conclusions: The GI symptoms can negatively impact sleep and behavior in children with ASD, spotlighting the importance of routine GI screening in this population. Clinicians should be particularly vigilant in cases where symptoms suggest a higher likelihood of GI issues to enhance the quality of care for children with ASD.