Author’s note: Recent trends in language use within the autism community show a divide between professionals who often prefer person-first language (e.g., “person with autism”) and autistic advocates who often favor identity-first language (e.g., “autistic person”), for reasons of de-stigmatization and pride (Botha et al., 2021). In this chapter, we use “ASD” when discussing diagnostic characteristics while employing both language styles interchangeably to capture the diverse experiences of autistic individuals and their families.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects how someone interacts, communicates, and processes the world around them. ASD comes with a range of traits, including differences in social skills, repetitive behaviors, intense focus on certain specific interests, and unique sensory experiences (Balasco et al., 2020; Maenner et al., 2012; Martínez-González et al., 2022). Alongside these traits, autistic individuals also experience health-related challenges like sleep issues, anxiety, and digestive problems, which can impact their quality of life, daily functioning, and overall well-being (Ferguson et al., 2019; Maenner et al., 2012). Research shows that gastrointestinal (GI) symptoms – such as constipation, diarrhea, and stomach pains – are especially common in individuals with autism, affecting about 33% of people with ASD compared to just 13.5% of those without it (Aldinger et al., 2015; Garcia-Gutierrez et al., 2020; Lasheras et al., 2023).
GI issues are not just uncomfortable; they can contribute to behavioral challenges as well. When someone is in pain, they can become irritable, frustrated, or aggressive. For children with ASD, this discomfort can lead to meltdowns or even self-injury (Maenner et al., 2012). Some studies suggest that gut health is linked to mood regulation and ASD-related symptoms through what is called the gut-brain axis (Aldinger et al., 2015; Garcia-Gutierrez et al., 2020; Leader et al., 2020; Maenner et al., 2012). As ongoing research continues to explore this connection, it is becoming clear that addressing digestive health could play a role in improving behavioral symptoms and overall quality of life for autistic children (Lasheras et al., 2023; Leader et al., 2020).
Understanding how GI issues affect a child’s behavior, daily life, and overall well-being is important. However, it is also important to focus on a child’s strengths and positive development–this is where the concept of flourishing comes in. Flourishing looks at the whole child, highlighting their curiosity, perseverance, and emotional well-being (Lippman et al., 2014). Studies show that children with ASD may be less likely to flourish due to their challenges with social skills and behavior (Hilton et al., 2019). However, flourishing is worth exploring because it has been linked to better school engagement (Durlak et al., 2011), greater resilience (Bethell et al., 2019), and stronger mental health (Burns et al., 2022). Additionally, children who flourish develop better friendships and have more motivation in school (Bethell et al., 2019). For children with ASD, bringing the focus to flourishing helps take the focus off what they struggle with to their overall well-being and what helps them thrive.
What Did Our Study Find?
To learn more about the link between autism, GI issues, and a child’s overall well-being, we explored data from the 2022 National Survey of Children’s Health. This survey asked parents about many aspects of their children’s health, including whether their child had a diagnosis of autism, if they had any ongoing digestive problems, and how well their child was doing overall.
We used three simple questions to measure how well a child was “flourishing” by looking at their curiosity, persistence, and ability to stay calm when facing challenges. Over 33,000 children, ages 6 to 17, were included in our study. Parents reported whether their child had chronic GI problems and whether they had been diagnosed with autism.
Here’s what we found:
- About 6.9% of children had GI issues.
- About 3.2% of children had autism.
- A small group, about 0.7%, had both autism and GI problems.
- Importantly, nearly 20% of children with autism also had GI issues.
After accounting for other factors like age, gender, and family income, we discovered that children with both autism and GI issues were much less likely to be flourishing. In fact, these children were 12 times less likely to show signs of flourishing compared to children without either condition. Even when comparing children who only had autism or only had GI problems, those with both conditions fared worse. This tells us that having both autism and digestive issues together creates extra challenges that can affect a child’s overall well-being and success.
What Can Families and Advocates Do?
If you are a parent or advocate for a child with autism, there are several steps you can take to help your child thrive:
- Keep an Eye on Digestive Health – Notice any signs of stomach pain, constipation, diarrhea, or other digestive problems. Talk to your child’s doctor if you suspect that GI issues are affecting their mood or behavior, and advocate for gastrointestinal health screening.
- Talk to your Child’s Healthcare Team – Ask questions about how digestive problems might be connected to your child’s overall behavior. Sometimes, addressing stomach issues can also help improve mood and reduce irritability. Don’t hesitate to ask for referrals to specialists if needed.
- Focus on Your Child’s Strengths – Remember that every child has unique talents and abilities. Encourage your child’s interests and help them build on their strengths. Whether it’s through school, hobbies, or social activities, supporting their strengths can boost their confidence and help them flourish.
- Stay Informed – Learning more about the connection between the gut and the brain can empower you to make better decisions for your child’s health. Look for trusted sources or join support groups where you can share experiences and learn from other families.
- Advocate for Integrated Care – When speaking with healthcare providers, mention that you are interested in an approach that looks at both physical and emotional well-being. While this advice is for families, mental health professionals can also play a role by offering support that takes both digestive and emotional health into account.
What Can Mental Health Professionals Do?
For psychologists and other mental health experts, it’s important to be aware that GI issues can have a big impact on a child’s behavior and mood. Being open to collaborating with pediatricians and gastroenterologists can help ensure that children receive well-rounded care. By working together, professionals can better support children with autism, addressing both their physical discomfort and emotional needs.
In Summary
Our study shows that children with both autism and GI issues face extra challenges that can affect their ability to flourish. By staying vigilant about digestive health and working closely with healthcare professionals, families can help address these challenges. Focusing on a child’s strengths and advocating for a holistic approach to care can make a big difference in their overall well-being. With the right support, children with autism and gastrointestinal issues can not only overcome obstacles but also truly flourish.
Sonia Agarwal, MSc, Mia Angeliese, MS, CSP, and Amanda Bertsch, MS, CCC-SLP, are Clinical Psychology PhD students, and Dr. Jessica Emick, PhD, is Core Faculty at the School of Psychology, Fielding Graduate University. For more information, email sagarwal@fielding.edu.
References
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