Gastrointestinal Symptoms and Autism

GIWhat are gastrointestinal symptoms?

When people talk about gastrointestinal (GI) symptoms and autism they could be talking about a variety of different things including constipation, diarrhea, abdominal bloating/discomfort/irritability, gastroesophageal reflux/vomiting, or food selectivity/feeding issues.  Sometimes they may be referring to GI diseases like Crohn’s disease (an inflammatory bowel disease) or Celiac disease (an immune reaction to eating gluten).

Do children with ASD have more gastrointestinal issues than typically developing children?

Most evidence indicates that children with autism are no more likely then the general population to have GI diseases and are specifically no more likely to have ciliacs.  There is some evidence that children with autism do have higher rates of food selectivity/feeding issues and constipation.  Even though children with autism may not be more likely then typically developing children to experience tummy trouble, they still experience GI issues frequently (as many as 24% of children with ASD).  Diarrhea is the most common issue for children with ASD.  Having said that, GI issues among children with ASD may be under reported because parents or doctors may miss understand why the child is upset or uncomfortable.

GI difficulties may be particularly difficult for children with ASD.  They may not be able to communicate that they are uncomfortable or in pain.  The lack of regular bowel movements may cause disruption to important routines which may cause a child additional distress.

What causes children with ASD to have gastrointestinal issues?

It’s not clear that the causes of GI issues in children with ASD is different from typically developing children.  There are many things that  can cause GI issues in children such as anxiety, food allergies, food sensitivities, food born illnesses, and GI diseases.  There are some issues that are particularly important for children with ASD.  If a child with ASD has a very selective diet they may be missing out on vital nutrients that could lead to GI issues.  If a child with ASD is presenting with behavioral issues, GI issues, especially pain, maybe an underlying cause even if the behavioral issues appear to be unrelated to food.

There are a couple theories that are related to GI issues and ASD that don’t have much support.  The first is a theory of abnormal gastrointestinal permeability often called “leaky gut” theory.  This theory suggest that a “leaky gut” actually causes autism and autism symptoms and that gluten and casein should be completely avoided.  The research on this theory has methodological problems (like using very small sample sizes or only looking at children with ASD and a GI disease).  There’s another theory that there’s a specific GI disease only found in children with ASD called autistic enterocolitis, however the same symptoms are found in typically developing children.

Can a special diet help my child?

If your child has a food allergy or intolerance eliminating that food item can help reduce physical discomfort that maybe contributing to additional distress and even causing behavioral problems.  Similarly, if your child has a selective diet and is failing to get specific nutrients, helping your child to expand their diet could reduce GI issues.  Before making diet decisions, it’s important to talk to a doctor.  Any individual with ASD who presents with GI symptoms should have a full evaluation preferably by a GI specialist.

No diet can cure a child of autism.  A diet cannot treat the underlying causes of autism.  If you’re child has GI issues than a diet maybe a treatment option for those issues.  GI issues may be a cause of problematic behavior and therefore a diet may reduce problematic behavior.

Where can I get more information?

The book Special Diets for Special Kids is a great resource for learning how to implement a special diet.  Can’t Eat, Won’t Eat is a book the focuses on overcoming selective eating.  Web MD has a nice article explaining the Gluten Free-Casein free diet.  Autism Speaks has a regular series featuring a GI doctor with experience with autism.


Ibrahim, S. H., Voigt, R. G., Katusic, S. K., Weaver, A. L., & Barbaresi, W. J. (2009). Incidence of gastrointestinal symptoms in children with autism: a population-based study. Pediatrics, 124(2), 680-686.

Molloy, C. A., & Manning-Courtney, P. (2003). Prevalence of chronic gastrointestinal symptoms in children with autism and autistic spectrum disorders. Autism, 7(2), 165-171.

White, J. F. (2003). Intestinal pathophysiology in autism. Experimental Biology and Medicine, 228(6), 639-649.


Autism and Sleeping Problems

sleepDo children with autism have more sleeping problems then typically developing children?

Yes, studies have shown children with ASD to have as many as 10 times more sleep difficulties than typically developing children.  Problems include not falling asleep, sleeping for only short periods of time, being tired during the day, resisting going to bed, sleep walking, sleep anxiety, nightmares, and chronic insomnia.

What causes children with ASD to have sleep problems?

There is no clear cause.  Children with ASD have several different types of sleep problems; different types of problems may have different causes.  Also, it’s best not to think of ASD as one disorder but as a spectrum of disorders so different people have different things going on in their genes, gene expressions, and environments which may cause a variety of different sleep problems.  Some theories are

  1. Some children may have biological or genetic abnormalities that cause changes to the brain which then effect sleep
  2. The features of ASD (such as preoccupation) can prevent sleep
  3. There could be factors at home that make sleep more difficult (like having a TV in a bedroom)

How do experts recommend that parents deal with sleeping problems?

Research has indicated that behavioral strategies can may be effective, however there is not enough research to say so with certainty.  Right now, there is the most evidence for scheduled awakings (awaking a child at scheduled intervals to reduce night terrors) and standard extinction (ignoring all bed time disruptions- this may look like putting a child to bed and then not talking to the child until morning).  Although standard extinction may be effective, it can cause distress for the child and the parents.  Other interventions under investigation are

  • Graduated extinction (only ignoring behavior for a specific length of time)
  • Faded bedtime (setting the bedtime slightly earlier and earlier and not letting the child sleep during the day)
  • Faded bedtime with Response Cost (the same as faded bedtime, but if the child does not fall asleep, you remove them from bed for a specific amount of time- eg. 30 minutes)
  • Sleep restriction (the focus is on sleep duration not bedtime- you limit the amount of time the child spends in bed not sleeping)
  • Stimulus fading (reducing co-sleeping)
  • Chronotherapy (pushing back bed times)

Is medication recommended for sleep problems?

When behavioral interventions are unsuccessful or only partially successful, sometimes medication is prescribed, however there is no FDA approved pediatric sleep medication.    Melatonin has been the most commonly studied sleep medication for children.

Where can I get more information?

We have books on sleeping and autism in our library.  Also, the Lovaas Institute has a great article with several recommendations for establishing a good sleeping pattern.


Cortesi, F., Giannotti, F., Ivanenko, A., & Johnson, K. (2010). Sleep in children with autistic spectrum disorder. Sleep medicine, 11(7), 659-664.

Goldman, S. E., Richdale, A. L., Clemons, T., & Malow, B. A. (2012). Parental sleep concerns in autism spectrum disorders: Variations from childhood to adolescence. Journal of autism and developmental disorders, 42(4), 531-538.

Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep medicine reviews, 13(6), 403-411.

Sivertsen, B., Posserud, M. B., Gillberg, C., Lundervold, A. J., & Hysing, M. (2012). Sleep problems in children with autism spectrum problems: a longitudinal population-based study. Autism, 16(2), 139-150.

Vriend, J. L., Corkum, P. V., Moon, E. C., & Smith, I. M. (2011). Behavioral interventions for sleep problems in children with autism spectrum disorders: current findings and future directions. Journal of pediatric psychology, 36(9), 1017-1029.