PREVALENCE OF GASTROINTESTINAL DYSFUNCTION AND FOOD SELECTIVITY AMONG SCHOOL-GOING CHILDREN WITH AUTISM SPECTRUM DISORDER AGED 4–16 YEARS: A CROSS-SECTIONAL STUDY
Main Article Content
Keywords
Neurodevelopmental Disorders, Gastrointestinal Motility, Sleep Disorders, Feeding and Eating Disorders of Childhood, Child Behavior Disorders, Sensory Processing, Constipation.
Abstract
Introduction: Children with Autism Spectrum Disorder (ASD) frequently experience gastrointestinal (GI) dysfunction, food selectivity, sleep disturbances, sensory reactivity, and behavioral challenges. These comorbidities often coexist, yet limited Indian data explores their prevalence and interrelationship.
Aim: To estimate the prevalence of GI dysfunction and food selectivity among school-going autistic children and assess their associations with autism severity, sensory reactivity, sleep disturbances, and behavioral problems.
Materials and Methods: A cross-sectional analytical study was conducted among 300 children with ASD aged 4–16 years attending special schools in Chennai. Standardized, validated parent-report instruments were used: ISAA for autism severity, GISSI-17 and ROME IV for GI symptoms, BAMBI for feeding behavior, CSHQ for sleep disturbances, SSP for sensory reactivity, and BPI-01 for behavioral problems. Associations between GI dysfunction and other domains were analyzed using Chi-square and logistic regression.
Results: GI symptoms (GISSI-17 ≥34) were present in 40% of children, while GI dysfunction per ROME IV was noted in 36%. Food selectivity was observed in 35%, sleep disturbances in 33%, and sensory reactivity in 52%. Although GI dysfunction prevalence did not vary significantly across ASD severity groups, it showed strong associations with food selectivity (p<0.001), sleep problems (p<0.001), sensory reactivity (p<0.001), and behavioral challenges (OR 1.08 per BPI score increase, p<0.001). Functional constipation was the most common GI disorder (47%), with a severity-linked increase.
Conclusion: GI dysfunction is highly prevalent in children with ASD and closely interlinked with feeding challenges, sleep disturbances, sensory issues, and behavioral problems. These findings support a holistic, multidisciplinary approach to assessment and management, recognizing the interplay between medical and behavioral domains in autism care.
References
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from: https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1120728/full
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https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1120728/full
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https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1116239/full
39. Madra M, Ringel R, Margolis KG. Gastrointestinal Issues and Autism Spectrum Disorder. Psychiatr Clin North Am. 2021 Mar;44(1):69–81.
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42. Valenzuela-Zamora AF, Ramírez-Valenzuela DG, Ramos-Jiménez A. Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders. Nutrients. 2022 Jun 27;14(13):2660.
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44. Distefano G, Calderoni S, Apicella F, Cosenza A, Igliozzi R, Palermo G, et al. Impact of sleep disorders on behavioral issues in preschoolers with autism spectrum disorder. Front Psychiatry [Internet]. 2023 Apr 26 [cited 2025 May 23];14. Available from: https://www.frontiersin.org/ journals/psychiatry/articles/10.3389/fpsyt.2023.1181466/full
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48. Verhoeff ME, Blanken LME, Kocevska D, Mileva-Seitz VR, Jaddoe VWV, White T, et al. The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study. Mol Autism. 2018 Jan 30;9:8.
49. van Andel DM, van Stel HF, Scheepers FE, Oostrom KJ, Haverman L, Bruining H. The sensory-reactivity PROM set: identification of a parent reported outcome measure set for autism spectrum disorder. J Patient-Rep Outcomes. 2021 Nov 17;5:123.
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51. Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder—A Population-Based Study | Request PDF. ResearchGate [Internet]. [cited 2025 Jul 15]; Available from: https://www.researchgate.net/publication/307087653_Brief_ Report_ Prevalence_of_Self-injurious_Behaviors_among_Children_with_Autism_Spectrum_Disorder-A_Population-Based_Study
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53. Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R, Alhawamdeh R. Role of gastrointestinal health in managing children with autism spectrum disorder. World J Clin Pediatr. 2023 Sep 9;12(4):171–96.
54. Wasilewska J, Klukowski M. Gastrointestinal symptoms and autism spectrum disorder: links and risks – a possible new overlap syndrome. Pediatr Health Med Ther. 2015 Sep 28;6:153–66.
2. Briot K, Jean F, Jouni A, Geoffray MM, Ly-Le Moal M, Umbricht D, et al. Social Anxiety in Children and Adolescents With Autism Spectrum Disorders Contribute to Impairments in Social Communication and Social Motivation. Front Psychiatry. 2020;11:710.
3. Wijnhoven LA, Niels-Kessels H, Creemers DH, Vermulst AA, Otten R, Engels RC. Prevalence of comorbid depressive symptoms and suicidal ideation in children with autism spectrum disorder and elevated anxiety symptoms. J Child Adolesc Ment Health. 2019 May;31(1):77–84.
4. Masi A, Moni MA, Azim SI, Choi B, Heussler H, Lin PI, et al. Clinical and behavioral attributes leading to sleep disorders in children on the autism spectrum. Autism Res Off J Int Soc Autism Res. 2022 Jul;15(7):1274–87.
5. Schreck KA, Richdale AL. Sleep problems, behavior, and psychopathology in autism: inter-relationships across the lifespan. Curr Opin Psychol. 2020 Aug;34:105–11.
6. Penzol MJ, Salazar de Pablo G, Llorente C, Moreno C, Hernández P, Dorado ML, et al. Functional Gastrointestinal Disease in Autism Spectrum Disorder: A Retrospective Descriptive Study in a Clinical Sample. Front Psychiatry. 2019;10:179.
7. Lefter R, Ciobica A, Timofte D, Stanciu C, Trifan A. A Descriptive Review on the Prevalence of Gastrointestinal Disturbances and Their Multiple Associations in Autism Spectrum Disorder. Med Kaunas Lith. 2019 Dec 27;56(1):11.
8. Tye C, Runicles AK, Whitehouse AJO, Alvares GA. Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review. Front Psychiatry. 2018;9:751.
9. Vargason T, Frye RE, McGuinness DL, Hahn J. Clustering of co-occurring conditions in autism spectrum disorder during early childhood: A retrospective analysis of medical claims data. Autism Res Off J Int Soc Autism Res. 2019 Aug;12(8):1272–85.
10. Holingue C, Newill C, Lee LC, Pasricha PJ, Daniele Fallin M. Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence. Autism Res Off J Int Soc Autism Res. 2018 Jan;11(1):24–36.
11. Buie T, Campbell DB, Fuchs GJ, Furuta GT, Levy J, Vandewater J, et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics. 2010 Jan;125 Suppl 1:S1-18.
12. Fulceri F, Morelli M, Santocchi E, Cena H, Del Bianco T, Narzisi A, et al. Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2016 Mar;48(3):248–54.
13. Wang LW, Tancredi DJ, Thomas DW. The prevalence of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members. J Dev Behav Pediatr JDBP. 2011 Jun;32(5):351–60.
14. Krigsman A, Walker SJ. Gastrointestinal disease in children with autism spectrum disorders: Etiology or consequence? World J Psychiatry. 2021 Sep 19;11(9):605–18.
15. Restrepo B, Angkustsiri K, Taylor SL, Rogers SJ, Cabral J, Heath B, et al. Developmental-behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism Res Off J Int Soc Autism Res. 2020 Oct;13(10):1778–89.
16. Prosperi M, Santocchi E, Balboni G, Narzisi A, Bozza M, Fulceri F, et al. Behavioral Phenotype of ASD Preschoolers with Gastrointestinal Symptoms or Food Selectivity. J Autism Dev Disord. 2017 Nov;47(11):3574–88.
17. Leader G, O’Reilly M, Gilroy SP, Chen JL, Ferrari C, Mannion A. Comorbid Feeding and Gastrointestinal Symptoms, Challenging Behavior, Sensory Issues, Adaptive Functioning and Quality of Life in Children and Adolescents with Autism Spectrum Disorder. Dev Neurorehabilitation. 2021 Jan;24(1):35–44.
18. Chakraborty P, Carpenter KLH, Major S, Deaver M, Vermeer S, Herold B, et al. Gastrointestinal problems are associated with increased repetitive behaviors but not social communication difficulties in young children with autism spectrum disorders. Autism Int J Res Pract. 2021 Feb;25(2):405–15.
19. “Autistic Disturbances of Affective Contact” (1943), by Leo Kanner | Embryo Project Encyclopedia [Internet]. [cited 2025 Apr 23]. Available from: https://embryo.asu.edu/ pages/autistic-disturbances-affective-contact-1943-leo-kanner
20. Klintwall L, Holm A, Eriksson M, Carlssssson LH, Olsson MB, Hedvall A, et al. Sensory abnormalities in autism. A brief report. Res Dev Disabil. 2011;32(2):795–800.
21. Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015 Feb;45(3):601–13.
22. ResearchGate [Internet]. [cited 2025 Jul 15]. (PDF) Pratical Issues in Calculating the Sample Size for Prevalence Studies. Available from: https://www.researchgate.net/publication/ 45459002_Pratical_Issues_in_Calculating_the_Sample_Size_for_Prevalence_Studies
23. Chauhan A, Sahu JK, Jaiswal N, Kumar K, Agarwal A, Kaur J, et al. Prevalence of autism spectrum disorder in Indian children: A systematic review and meta-analysis. Neurol India. 2019;67(1):100–4.
24. Christensen DL. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ [Internet]. 2016 [cited 2025 May 23];65. Available from: https://www.cdc.gov/mmwr/volumes/65/ss/ss6503a1.htm
25. Salehi M, Jaka S, Lotfi A, Ahmad A, Saeidi M, Gunturu S. Prevalence, Socio-Demographic Characteristics, and Co-Morbidities of Autism Spectrum Disorder in US Children: Insights from the 2020–2021 National Survey of Children’s Health. Children. 2025 Feb 27;12(3):297.
26. Wang J, Ma B, Wang J, Zhang Z, Chen O. Global prevalence of autism spectrum disorder and its gastrointestinal symptoms: A systematic review and meta-analysis. Front Psychiatry [Internet]. 2022 Aug 23 [cited 2025 May 23];13. Available from: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.963102/full
27. Al-Beltagi M. Autism medical comorbidities. World J Clin Pediatr. 2021 May 9;10(3):15–28.
28. Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R, Alhawamdeh R. Role of gastrointestinal health in managing children with autism spectrum disorder. World J Clin Pediatr. 2023 Sep 9;12(4):171–96.
29. Vandana P, Simkin DR, Hendren RL, Arnold LE. Autism Spectrum Disorder and Complementary-Integrative Medicine. Child Adolesc Psychiatr Clin N Am. 2023 Apr;32(2):469–94.
30. Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R, Alhawamdeh R. Role of gastrointestinal health in managing children with autism spectrum disorder. World J Clin Pediatr. 2023 Sep 9;12(4):171–96.
31. Gan H, Su Y, Zhang L, Huang G, Lai C, Lv Y, et al. Questionnaire-based analysis of autism spectrum disorders and gastrointestinal symptoms in children and adolescents: a systematic review and meta-analysis. Front Pediatr [Internet]. 2023 Jul 26 [cited 2025 May 23];11. Available
from: https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1120728/full
32. Martínez-González AE, Cervin M, Pérez-Sánchez S. Assessing gastrointestinal symptoms in people with autism: Applying a new measure based on the Rome IV criteria. Dig Liver Dis. 2024 Nov;56(11):1863–70.
33. Bresciani G, Da Lozzo P, Lega S, Bramuzzo M, Di Leo G, Dissegna A, et al. Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder. Children. 2023 Jan 30;10(2):253.
34. Mulay KV, Karthik SV. Managing constipation in children with ASD – A challenge worth tackling. Pediatr Neonatol. 2022 May 1;63(3):211–9.
35. Bresciani G, Da Lozzo P, Lega S, Bramuzzo M, Di Leo G, Dissegna A, et al. Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder. Children. 2023 Jan 30;10(2):253.
36. Gan H, Su Y, Zhang L, Huang G, Lai C, Lv Y, et al. Questionnaire-based analysis of autism spectrum disorders and gastrointestinal symptoms in children and adolescents: a systematic review and meta-analysis. Front Pediatr [Internet]. 2023 Jul 26 [cited 2025 May 23];11. Available from:
https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1120728/full
37. Badalyan V, Schwartz RH. Mealtime feeding behaviors and gastrointestinal dysfunction in children with classic autism compared with normal sibling controls. Open J Pediatr. 2012 Jun 19;2(2):150–60.
38. Lee YF, Wu MC, Ma KSK, Huang JY, Wei JCC. Association of early childhood constipation with the risk of autism spectrum disorder in Taiwan: Real-world evidence from a nationwide population-based cohort study. Front Psychiatry [Internet]. 2023 Mar 30 [cited 2025 May 23];14. Available from:
https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1116239/full
39. Madra M, Ringel R, Margolis KG. Gastrointestinal Issues and Autism Spectrum Disorder. Psychiatr Clin North Am. 2021 Mar;44(1):69–81.
40. Al-Biltagi M, Saeed NK, Qaraghuli S. Gastrointestinal disorders in children with autism: Could artificial intelligence help? Artif Intell Gastroenterol. 2022 Feb 28;3(1):1–12.
41. Visvalingam K, Sivanesom RS. Feeding Behaviors Among Children With Autism Spectrum Disorder. Int J Clin Pediatr. 2024 Dec 2;13(3):73–85.
42. Valenzuela-Zamora AF, Ramírez-Valenzuela DG, Ramos-Jiménez A. Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders. Nutrients. 2022 Jun 27;14(13):2660.
43. Yao D, Wang S, Li F, Gao M, Shao J. Analysis of sleep problem in children aged 1–3 years with autism spectrum disorder in Zhejiang province, China. Front Psychiatry [Internet]. 2022 Aug 30 [cited 2025 May 23];13. Available from: https://www.frontiersin.org/journals/psychiatry/ articles/10.3389/fpsyt.2022.923757/full
44. Distefano G, Calderoni S, Apicella F, Cosenza A, Igliozzi R, Palermo G, et al. Impact of sleep disorders on behavioral issues in preschoolers with autism spectrum disorder. Front Psychiatry [Internet]. 2023 Apr 26 [cited 2025 May 23];14. Available from: https://www.frontiersin.org/ journals/psychiatry/articles/10.3389/fpsyt.2023.1181466/full
45. Ahmed AZ. Sleep disorders, feeding problems and gastrointestinal disorders: A triangle of danger for autistic children. Int J Psychiatry Res. 2024 Jan 1;6(2):09–19.
46. Yang XL, Liang S, Zou MY, Sun CH, Han PP, Jiang XT, et al. Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder? Psychiatry Res. 2018 Jan;259:229–35.
47. Akbal Bağci K, Parlak Gözükara Ö, Çöp E, Göker Z. Gastrointestinal and Sleep Problems in Children with Autism Spectrum Disorder: Their Relationship with Problematic Behavior. Turk J Pediatr Dis. 2023 Aug 11;1–6.
48. Verhoeff ME, Blanken LME, Kocevska D, Mileva-Seitz VR, Jaddoe VWV, White T, et al. The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study. Mol Autism. 2018 Jan 30;9:8.
49. van Andel DM, van Stel HF, Scheepers FE, Oostrom KJ, Haverman L, Bruining H. The sensory-reactivity PROM set: identification of a parent reported outcome measure set for autism spectrum disorder. J Patient-Rep Outcomes. 2021 Nov 17;5:123.
50. Bhavsar M, Chaudhari M, Dhamsaniya D, Parmar A, Shah S. Clinical characteristics and socio-demographic profile of autism spectrum disorder in a paediatric population from a tertiary care hospital of Gujarat. Int J Contemp Pediatr. 2025 Feb 24;12(3):402–8.
51. Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder—A Population-Based Study | Request PDF. ResearchGate [Internet]. [cited 2025 Jul 15]; Available from: https://www.researchgate.net/publication/307087653_Brief_ Report_ Prevalence_of_Self-injurious_Behaviors_among_Children_with_Autism_Spectrum_Disorder-A_Population-Based_Study
52. The Relationship of Challenging Behaviors to Severity and Symptoms of Autism Spectrum Disorders. ResearchGate [Internet]. [cited 2025 Jul 15]; Available from: https://www.researchgate.net/publication/233293751_The_Relationship_of_Challenging_Behaviors_to_Severity_and_Symptoms_of_Autism_Spectrum_Disorders
53. Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R, Alhawamdeh R. Role of gastrointestinal health in managing children with autism spectrum disorder. World J Clin Pediatr. 2023 Sep 9;12(4):171–96.
54. Wasilewska J, Klukowski M. Gastrointestinal symptoms and autism spectrum disorder: links and risks – a possible new overlap syndrome. Pediatr Health Med Ther. 2015 Sep 28;6:153–66.
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Roshini Suha Cath A, Revathi V, & Jagadeeswari S. (2025). PREVALENCE OF GASTROINTESTINAL DYSFUNCTION AND FOOD SELECTIVITY AMONG SCHOOL-GOING CHILDREN WITH AUTISM SPECTRUM DISORDER AGED 4–16 YEARS: A CROSS-SECTIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 620-633. https://doi.org/10.53555/5402p239
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Author Biographies
Roshini Suha Cath A
Junior Resident, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chromepet - 600044, Chennai, India;
Revathi V
Assistant Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chromepet - 600044, Chennai, India
Jagadeeswari S
Professor, Department of Paediatrics, Sree Balaji Medical College and Hospital, Chromepet - 600044, Chennai, India
How to Cite
Roshini Suha Cath A, Revathi V, & Jagadeeswari S. (2025). PREVALENCE OF GASTROINTESTINAL DYSFUNCTION AND FOOD SELECTIVITY AMONG SCHOOL-GOING CHILDREN WITH AUTISM SPECTRUM DISORDER AGED 4–16 YEARS: A CROSS-SECTIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 620-633. https://doi.org/10.53555/5402p239