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Management of constipation in children and adolescents with autism spectrum disorders

TitleManagement of constipation in children and adolescents with autism spectrum disorders
Publication TypeJournal Article
Year of Publication2012
AuthorsFuruta, GT, Williams, K, Kooros, K, Kaul, A, Panzer, R, Coury, DL, Fuchs, G
JournalPediatrics
Volume130
PaginationS98-105
Date PublishedNov
KeywordsAdolescent, AIM, Algorithms, arirp, Child, Child Development Disorders, Constipation/di [Diagnosis], Constipation/et [Etiology], Constipation/th [Therapy], Female, Humans, IM, Male, Pervasive/co [Complications], Prospective Studies
Abstract

OBJECTIVES: To develop a practical, readily applied algorithm for primary health care providers to identify, evaluate, and manage constipation in children with autism spectrum disorders (ASDs). METHODS: The Gastroenterology Committee of the Autism Speaks Autism Treatment Network (ATN), a multisite consortium of centers dedicated to improving standards of medical care for children with ASDs, guided the development of the constipation algorithm through expert opinion and literature review. The algorithm was finalized based on results of field testing by nongastrointestinal, ATN autism medical specialists at 4 ATN sites. A systematic review and grading of the literature pertaining to constipation and children with ASDs was also performed. RESULTS: Consensus among the ATN Gastroenterology Committee identified that in children with ASDs, (1) subtle or atypical symptoms might indicate the presence of constipation; (2) screening, identification, and treatment through a deliberate approach for underlying causes of constipation is appropriate; (3) diagnostic-therapeutic intervention can be provided when constipation is documented; and (4) careful follow-up after any intervention be performed to evaluate effectiveness and tolerance of the therapy. Literature review revealed limited evidence for the clinical evaluation or treatment strategies of children with ASD and constipation. CONCLUSIONS: Constipation and its underlying etiology have the potential to be effectively identified and managed using a systematic approach. Lack of evidence on this topic in the literature emphasizes the need for research.

Summary

Lead Author
Glenn T. Furuta

Study Aims/Objectives
To develop a practical, readily applied guide for primary care providers to identify, evaluate and manage constipation in children with Autism Spectrum Disorders (ASD).

Methods - Sample, Procedure, Study Measures, Analysis
The guide was created through expert opinion and a review of the relevant literature. The guide was finalized based on the results of testing by medical professionals who do not specialized in digestive issues. These professionals all worked at one of four Autism Treatment Networks (ATN) Sites: University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Cincinnati Children’s Hospital Medical Center, University of Colorado Denver School of Medicine, and the University of Rochester Medical Center.

Results – Main Finding(s)
Consensus among the ATN experts identified that children with ASD’s subtle or atypical symptoms might indicate the presence of constipation. Additionally, the experts found that screening, identification, and treatment through a deliberate approach for underlying causes of constipation is appropriate and interventions can be provided when constipation is document. Careful follow-up after any intervention should be conducted to evaluate effectiveness and tolerance of the therapy. The literature review revealed that very little already exists for the clinical evaluation or treatment strategies of children with ASD and constipation.

Conclusion – Summary Statement
Constipation and its underlying causes may be effectively identified and managed using a systematic approach. Lack of evidence on this topic in the literature emphasized the need for further research.

PubMed ID23118260