Autistic Children ‘Acting Out’ May be a Sign of Digestive Problems

A new study is linking common gastrointestinal (GI) symptoms with acting out behaviors in children, especially in young kids on the autism spectrum.

The study, published Aug. 6 in Autism Research, found that GI symptoms such as diarrhea, constipation and bloating are linked to sleep and attention issues, as well as acting out behaviors related to aggression, self-harm and physical complaints in preschool children.

The symptoms are potentially disruptive in young autistic kids, UC Davis Health researchers found.

“Clinicians and parents need to be aware of the high occurrence of GI problems in kids with autism,” said Bibiana Restrepo, M.D., assistant clinical professor of pediatrics and first author on the study. “This study highlights the link between GI symptoms and some problematic behaviors we see in preschool-aged children.”

The Study Details

Researchers looked at 255 children on the spectrum and 129 typically developing children, in the 2 to 3.5 age group. Pediatricians interviewed parents about how often their kids experienced abdominal pain, bloating, diarrhea, constipation, painful bowel movements, and other GI symptoms.

Following the interviews, children were placed into two categories; kids who had never or rarely experienced the GI symptoms; and kids who had experienced one or more symptoms. Researchers then compared the children in the two groups, measuring their developmental, behavioral and adaptive functioning.

They discovered that autistic preschool-aged children were almost three times more likely to experience GI symptoms than their typically developing peers.

Almost half of the children on the spectrum had more frequent GI symptoms, compared to only 18% of children with typical development. Around 30% of autistic children experienced multiple GI symptoms.

Children ‘Acting Out’ Symptoms

Since autism can affect a child’s social skills, speech, and communication, it can be difficult for young children to tell someone about their gastrointestinal discomfort. Instead, children may act out in order to express distress or pain. Acting out behaviors can include increased irritability, aggression, self-injury, social withdrawal, sleep problems, mental health issues and affective disorders.

Such is the story of 6-year-old Kaia Rolle who was struggling with the side effects of sleep apnea and was “acting out” at school in Orlando, Florida. She was handcuffed, escorted to a police car, and charged with misdemeanor battery after kicking and punching three employees at school. The first-grade girl was treated like a criminal instead of a child who needed specialized assistance by a trained educator.

“Problem behaviors may be an expression of GI discomfort in preschool-aged children,” said Christine Wu Nordahl, associate professor at UC Davis MIND Institute and the department of psychiatry and behavioral sciences.

What Parents Should Know

Gastrointestinal issues are often reported by parents of children on the spectrum. For years, researchers have studied the link between gastrointestinal issues, acting out behaviors, sleeping issues and other disruptions among autistic children.

Parents should be aware of the common GI symptoms so they can be recognized and treated as quickly as possible. Family physicians and pediatricians should also be more aware of the high occurrence of GI problems in autistic people, and be able to recognize the association between the two instead of stigmatizing or punishing a child who may be acting out.

“GI symptoms are often treatable, so it is important to recognize how common they are in children with autism. Treating their GI symptoms could potentially provide some relief to the kids and their parents,” said Nordahl.

This study is a good reminder to parents that for children on the spectrum, their behaviors are a communication tool for how they’re feeling.