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.     

Idiopathic megarectum in children.

There is scant information about the management of idiopathic megarectum in childhood. Children with idiopathic megarectum referred to a single institution between 1994 and 1998 were identified prospectively. Those with Hirschsprung's disease or an anorectal malformation were excluded. The remaining patient group, 22 boys and 7 girls, had a median age of 8.0 years (range 3.5-14.0 y). Median duration of symptoms prior to referral was 2.0 years (range 0.4-11 y). Chronic soiling was the dominant complaint in 28/29 (97%) cases. 23 children had received regular stimulant laxatives for periods ranging from 1 month to 11 years, and 9 children had been treated with regular enemas. The degree of megarectum assessed by both abdominal palpation and plain radiography was: grade 1 (below umbilical level) n=6; grade 2 (at umbilical level) n=15; and grade 3 (above umbilical level) n=8. Hirschsprung's disease was specifically excluded by rectal biopsy in all cases and no patient had evidence of spinal dysraphism. Three boys with massive megarectums and intractable symptoms were treated by a staged Duhamel sigmoid pull-through with excellent functional results. Fifteen patients (52%) were treated by a single manual evacuation under general anaesthesia followed by a daily Bisacodyl 5-10 mg suppository. After a median follow-up of 16 months, 13 continue to respond well with a daily bowel action and no soiling (4 of the 13 have discontinued treatment and remain well). The remaining 11 patients (38%) have continued conventional treatment with oral laxatives but with limited success. Idiopathic megarectum is poorly described in children. It is more common in boys and is often resistant to laxative therapy alone. After appropriate preparation, treatment with stimulant suppositories can be effective. Surgery has a valuable role in selected patients with a massive megarectum.     

Constipation in children

Constipation remains a frequent presentation to paediatricians, with significant health resource implications. We present a practical guide to the management of paediatric constipation and evaluate the current evidence for treatment regimens, to help the clinician in treating a condition that can be distressing and has a significant impact on affected families.     

Constipation in children

Constipation is a common problem throughout the world. It occurs in about 10–20% of adults in Western Countries and 0.3% to 28% of children worldwide. Most childhood constipation results from intentional withholding of stool following a painful experience with defecation. Thus, an extensive evaluation is often not necessary in a child presenting with constipation. Treatment should include education, evacuation of the rectum with oral or rectal laxatives if an impaction is present, laxatives to ensure soft stools and behavior modification.     

Gangliosides in children with autism

Concentrations of the four major brain gangliosides, GM1, GDla, GDlb and GTlb, biochemical markers of neuronal membranes, were determined in the cerebrospinal fluid (CSF) of 20 children with autism and in 25 controls. In addition, the gangliosides were determined in children with different forms of non-progressive neurological disorders lacking clinical features of autism. GM1, GDla, GDlb and GTlb were significantly increased in patients with autism compared with age-matched controls and children with non-progressive neurological disorders. The gangliosides have previously been shown to have a function in synaptic transmission and increased synaptic activity leads to added release of gangliosides. Our finding of increased CSF levels of gangliosides in autism suggests increased synaptic activity in this disorder. Autism, gangliosides, mental retardation, neurological disorders, synaptic activity     

Constipation in children]

Constipation is a common pediatric problem. We propose guidelines based on an integration of expert opinion and a review of the medical literature. Physiopathology, symptoms, diagnosis for functional or organic constipation, clinical forms and treatment are considered.     

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目的探讨孤独症患儿头围发育情况。方法研究对象为中国医科大学附属盛京医院2009年9月至2011年6月确诊的孤独症患儿(孤独症组)156例,其中≤3岁74例,>3岁82例。同时选择健康儿童141名作为正常对照组,其中≤3岁58名,>3岁83名。分别测量两组头围并进行组间比较。结果孤独症组≤3岁患儿头围平均值与大头所占比例均大于正常对照组,两组差异有统计学意义(P<0.05)。孤独症组>3岁患儿头围平均值与大头所占比例与健康儿童基本相似,两组差异无统计学意义(P>0.05)。在除外大头患儿后,两组头围平均值比较差异无统计学意义(P>0.05)。结论孤独症患儿生后早期头围偏大,并且常伴大头,头围异常也是患儿重要的临床特征之一。了解孤独症头围发育可为孤独症的发病机制提供参考依据。     

Executive functioning in high-functioning children with autism

Executive functioning was investigated in 34 children (24 boys and 10 girls) with developmental language disorder (DLD) and 21 children (18 boys and 3 girls) with high-functioning autistic disorder (HAD) matched on Full Scale IQ, Nonverbal IQ, age (mean age 9 year, 1 month), and SES. The DLD group had a Verbal IQ that was 10 points higher than the HAD group. These children were given the Wisconsin Card Sorting Test (WCST), the Mazes subtest from the WISC-R, the Underlining test, and the Rapid Automatized Naming test. In addition, these children were given the Vineland Scales of Adaptive Functioning and the Wing Diagnostic Symptom Checklist in order to assess severity of autistic symptomatology. Results indicated that the only significant difference between the two groups on the cognitive tasks was perseverative errors on the WCST; there was no significant difference on total number of categories achieved or total number of errors on the WCST or on the other executive function measures. There was also significant overlap in the scores between the two groups and the difference in perseverative errors was no longer significant when Verbal IQ was partialled out. Executive functioning was strongly related to all IQ variables in the DLD group and particularly related to Verbal IQ in the HAD group. Although there was a relationship in the HAD group between executive functioning and adaptive functioning, as well as between executive functioning and autistic symptomatology, these relationships were generally no longer significant in the HAD group after the variance due to Verbal IQ was accounted for. The results are interpreted to indicate that although impaired executive functioning is a commonly associated feature of autism, it is not universal in autism and is unlikely to cause autistic behaviors or deficits in adaptive function.     

Abnormal intestinal permeability in children with autism

We determined the occurrence of gut mucosal damage using the intestinal permeability test in 21 autistic children who had no clinical and laboratory findings consistent with known intestinal disorders. An altered intestinal permeability was found in 9 of the 21 (43%) autistic patients, but in none of the 40 controls. Compared to the controls, these nine patients showed a similar mean mannitol recovery, but a significantly higher mean lactulose recovery (1.64%± 1.43 vs 0.38%±0.14; P < 0.001). We speculate that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.     

Conductive hearing loss in children with autism

Infantile autism is a serious comprehensive developmental disorder. The diagnosis of hearing loss or its exclusion, which often suggests suspected autism, is very important for early ENT, psychotherapy, and psychiatric treatment. One hundred children diagnosed with autism aged from 3 to 18 years, with a median age of 5 years, were evaluated. The control group of healthy children consisted of 100 children, aged from 3 to 18 years, with a median age of 6 years. Anamnesis and physical examination, including pediatric assessment and otoscopic examination, were carried out on children in both groups. Each child underwent bilateral otoacoustic emission examination in the 0.7, 1, 2, and 4 kHz bands and impedance audiometry examination. The data obtained were subjected to a basic statistical assessment. Chi² Pearson's test was used to compare results of tests in both groups. The absence of otoacoustic emission for the 1 and 2 kHz bands was significantly more frequent in the group of autistic children than in the control group. Furthermore, types B and C2 tympanometric curves were significantly more common in the group of autistic children than in the group of healthy children.     

Discrimination of temporal synchrony in intermodal events by children with autism and children with developmental disabilities without autism

BACKGROUND: This project examined the intermodal perception of temporal synchrony in 16 young children (ages 4 to 6 years) with autism compared to a group of children without impairments matched on adaptive age, and a group of children with other developmental disabilities matched on chronological and adaptive age. METHOD: A preferential looking paradigm was used, where participants viewed non-linguistic, simple linguistic or complex linguistic events on two screens displaying identical video tracks, but one offset from the other by 3 seconds, and with the single audio track matched to only one of the displays. RESULTS: As predicted, both comparison groups demonstrated significant non-random preferential looking to violations of temporal synchrony with linguistic and non-linguistic stimuli. However, the group with autism showed an impaired, chance level of responding, except when presented with non-linguistic stimuli. CONCLUSIONS: Several explanations are offered for this apparently autism-specific, language-specific pattern of responding to temporal synchrony, and potential developmental sequelae are discussed.