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      Screening for autism identifies behavioral disorders in children functional defecation disorders

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          Abstract

          This study prospectively assessed whether positive screening surveys for autism spectrum disorders (ASDs) in children with functional defecation disorders (FDDs) accurately identify ASD. Parents of children (4–12 years) who met Rome III criteria for functional constipation (FC), FC with fecal incontinence (FI) and functional nonretentive FI (FNRFI) completed two ASD screening surveys. Children with positive screens were referred for psychological evaluation, and a year later, follow-up surveys were conducted. Of the 97 study participants, 30.9 % were diagnosed with FC, 62.9 % with FC with FI, and 6.2 % with FNRFI. ASD surveys were positive for 27 children (27.8 %). New DSM diagnoses were made in 10 out of the 15 children that completed further evaluation. Two (2.1 %) met criteria for ASD, and 12 (12.4 %) met criteria for other behavioral disorders. Average SRS and SCQ-L scores were higher in subjects with FC with FI as compared to FC alone and in those who reported no improvement versus those who reported improvement 1 year later.

          Conclusion: While positive ASD screening surveys did not correctly identify ASD in the majority, it did help to identify other unrecognized behavioral disorders in children with FDD. High screening scores were more common in children with FC with FI and in children with poorer responses to current medical treatments.

          What is Known:

          •A prior study found that 29 % of children with FDD scored positive on ASD screening questionnaires.

          •Whether positive screens correctly identify ASD in children with FDD is unknown.
          What is New:

          •This study shows that positive ASD screens do not correctly identify ASD in children with FDD. However, the use of ASD screening questionnaires can identify previously unrecognized and untreated behavioral/developmental disorders in children with FDD.

          •High screening scores are more common in children with FC with FI and in children with poorer responses to current medical treatments.

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          Most cited references19

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          Diagnostic and statistical manual of mental disorders.

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            Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors.

            The objectives of this study were to characterize gastrointestinal dysfunction (GID) in autism spectrum disorder (ASD), to examine parental reports of GID relative to evaluations by pediatric gastroenterologists, and to explore factors associated with GID in ASD. One hundred twenty-one children were recruited into three groups: co-occurring ASD and GID, ASD without GID, and GID without ASD. A pediatric gastroenterologist evaluated both GID groups. Parents in all three groups completed questionnaires about their child's behavior and GI symptoms, and a dietary journal. Functional constipation was the most common type of GID in children with ASD (85.0%). Parental report of any GID was highly concordant with a clinical diagnosis of any GID (92.1%). Presence of GID in children with ASD was not associated with distinct dietary habits or medication status. Odds of constipation were associated with younger age, increased social impairment, and lack of expressive language (adjusted odds ratio in nonverbal children: 11.98, 95% confidence interval 2.54-56.57). This study validates parental concerns for GID in children with ASD, as parents were sensitive to the existence, although not necessarily the nature, of GID. The strong association between constipation and language impairment highlights the need for vigilance by health-care providers to detect and treat GID in children with ASD. Medications and diet, commonly thought to contribute to GID in ASD, were not associated with GID status. These findings are consistent with a hypothesis that GID in ASD represents pleiotropic expression of genetic risk factors. © 2011 International Society for Autism Research, Wiley Periodicals, Inc.
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              The factor structure of autistic traits.

              Although DSM-IV requires symptoms in three criterion domains for a diagnosis of autistic disorder, the extent to which those domains are phenotypically independent is an unanswered and important question. The identification of 'endophenotypes' of the autistic syndrome may be very useful for genetic and neurobiologic studies of autism, but only if they represent truly independent sub domains of the disorder. In this study we examined the factor structure of autistic traits using data from 226 child psychiatric patients with and without pervasive developmental disorders, employing cluster analysis of data from the Autism Diagnostic Interview-Revised (ADI-r) and principal components factor analysis of data from the Social Responsiveness Scale (SRS, a quantitative genetic measure of autistic traits formerly known as the Social Reciprocity Scale). The results were consistent with the existence of a singular, continuously distributed underlying factor, resulting in disparate phenotypic manifestations across the three criterion domains for autistic disorder (social deficits, language deficits, and repetitive/stereotypic behaviors). The analyses generally failed to support the existence of independent sub domains of dysfunction in autism spectrum conditions. Future studies of the association between genetic/neurobiologic markers and autistic symptomatology may be enhanced by approaches which consider autistic symptoms as quantitative traits, and which are informed by ongoing research on the development and phenomenology of core deficiencies in reciprocal social behavior.
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                Author and article information

                Contributors
                +31-20-5665270 , s.wessel@amc.uva.nl
                Carlo.DiLorenzo@nationwidechildrens.org
                lnicho4@gmail.com
                Eric.Butter@nationwidechildrens.org
                Karen.RatliffSchaub@nationwidechildrens.org
                m.a.benninga@amc.nl
                Kent.Williams@nationwidechildrens.org
                Journal
                Eur J Pediatr
                Eur. J. Pediatr
                European Journal of Pediatrics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-6199
                1432-1076
                13 September 2016
                13 September 2016
                2016
                : 175
                : 10
                : 1371-1378
                Affiliations
                [1 ]Department of Pediatric Gastroenterology, Emma Children’s Hospital AMC, H7-250, PO Box 22700, Amsterdam, 1100 DD The Netherlands
                [2 ]Department of Pediatric Gastroenterology, Nationwide Children’s Hospital Columbus, Columbus, OH USA
                [3 ]Department of Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL USA
                [4 ]Department of Behavioral Health, Child Development Center, Nationwide Children’s Hospital, Columbus, OH USA
                Author notes

                Communicated by Peter de Winter

                Article
                2775
                10.1007/s00431-016-2775-x
                5031734
                27624626
                66a48aeb-8522-4651-9142-e05977583d1b
                © The Author(s) 2016

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 8 April 2016
                : 27 July 2016
                : 4 September 2016
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2016

                Pediatrics
                constipation,autism spectrum disorders,pediatrics
                Pediatrics
                constipation, autism spectrum disorders, pediatrics

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