Constipation in children with autism and autistic spectrum disorder

Background: Children with autistic spectrum disorders (ASDs) have long been known to suffer from GIT symptoms. We planned to quantify the contribution of this group to our constipation clinic workload, and to discover defining group characteristics. Methods: The characteristics of the bowel habit of children with autism ± neuro-developmental psychiatric (NDP) diagnoses were compared with 'normal' children by retrospective chart review. Data were entered into an Excel spreadsheet (Microsoft Office 2007), and compared between groups. Results: One hundred and eighteen patients presented to the Paediatric Surgical Constipation clinic between April 2003 and May 2008. 90 patients were otherwise normal; 18 patients had NDP; 6 patients had ASD alone and 4 had ASD with other neurodevelopmental features. The median [interquartile range] age at onset in the ASD + NDP and normal groups was 2.5 (1-6) and 14 (4-36) months, respectively (p = 0.03) and the median duration of history in the ASD ± NDP and normal groups was 61 (47-89) and 27 (13-53) months, respectively (p = 0.007). Conclusions: Autism spectrum disorders are an order of magnitude more common in the constipation clinic than in the general population. 8.5% of patients who attended our Paediatric Surgical Constipation clinic had autism with or without NDP deficits. Children with autism ± NDP deficits have an earlier onset of symptoms, longer history, and some possess signs similar to those of slow transit constipation. These features may be inborn. A common genetic origin of gut and behavioural abnormalities suggests that specific targeted investigation and treatment for the constipation of ASD may in time be developed.