Emerging Consensus Regarding Gastro-Intestinal Issues in Children with Autism Spectrum Disorders

When children with Autism Spectrum Disorder have a stomachache, they can’t simply say, “My tummy hurts!” explains Arthur Krigsman, MD a pediatrician and board-certified pediatric gastroenterologist. They express their internal discomfort and pain in other ways that may be confused with sensory behavior issues.
Dr. Krigsman spoke on Thursday, February 17, 2011, at the Rebecca School in Manhattan as part of NAA-NY Metro Chapter’s "Cutting Edge" series of speakers of the contributing authors to the book "Cutting-Edge therapies for Autism."

Dr. Krigsman provided a broad overview of the gastrointestinal system (GI), common diseases, and how these affect children and adults both with and without ASD. He emphasized that GI disease can be distracting to interventional therapy because the child may be in pain and discomfort.

Whereas a child with no ASD is able to localize the pain, point to an area of the abdomen, express pain when swallowing, or after eating, or have stool urgency – A child with ASD would pinch the throat, poke the stomach, and show signs of irritability, tantrums, head banging, food aversion, and an inability to toilet-train. Another common way for ASD children to show discomfort is by pressing the abdomen against a chair or table.

If the child has self-injurious behavior, if interventional therapies (ABA, Greenspan, Speech, OT) are not showing progress, or if the child becomes unpredictably aggressive, “you have to wonder what else is going on,” Dr. Krigsman said, and added that often times “the behavior goes away when the GI problem is treated.”

He also included in his presentation drawings by children with ASD, which showed explicit identification of the abdomen as the problem area. For instance, before undergoing surgery unrelated to GI, a child named Joseph understood the doctor was going to ‘fix him’ and drew himself with an ‘X’ on his abdomen, which was the source of his discomfort and pain.

Dr. Krigsman emphasized that while the communication may be different, it is important to treat a child with ASD no different than anyone else, with proper testing and diagnosis, dietary avoidance and medication. If your doctor doesn’t take your GI concerns seriously, seek someone else’s advice. It is always a bad idea to treat empirically by trying this or that, without knowing what we’re treating, he said.

At the end of the presentation, Dr. Krigsman answered the audience’s questions and signed copies of the book. We also held a free-raffle, and one participant won a copy of a DVD on vaccines.

Over the past several years, Dr. Krigsman has studied 143 children with ASD, but more research is necessary in order to better understand GI disease and its effects on behavior and cognition. You can read Dr. Krigsman’s proposal for Autism and GI pilot studies here.

By: Yaniv Gafner