News The latest developments in autism research.

Some behavioral problems in autism may stem from poor health

by  /  11 June 2015

Iakov Filimonov/ Making connections: In children with autism, having one medical condition increases the odds that one or two others will also occur.

Many children with autism have gastrointestinal problems, seizures and sleep disorders. A new study, published 24 May in Autism Research, suggests that these seemingly disparate conditions are interconnected and may lead to the children’s behavioral issues1.

The findings underscore the ramifications of medical conditions that accompany autism. These conditions often go untreated, as doctors tend to home in on psychiatric issues in children with autism and have limited time to probe further.

“Everyone is focusing on the autism symptoms,” says lead researcher Pat Levitt, Simms/Mann Chair in Developmental Neurogenetics at the Children’s Hospital Los Angeles. “Addressing medical symptoms in children with autism may have a watershed effect on other parts of their life in terms of the effectiveness of treatments.”

Most previous work has focused on single medical conditions, rather than possible links between them. Knowing such connections exist could help doctors identify the health problems a child has.

“We were able to see if one condition predicted another, which is the first time that’s been documented,” Levitt says.

Levitt and his colleagues analyzed health information from more than 3,300 children. The information came from two large datasets: the Autism Genetic Resource Exchange (AGRE), which includes ‘multiplex’ families, in which two or more children have autism, and the Simons Simplex Collection (SSC), in which the families have just one affected child. (The SSC is funded by the Simons Foundation,’s parent organization.)

Both datasets detail the children’s autism symptoms and note any other medical problems they may have. The SSC, for example, contains information about allergies, gastrointestinal problems, seizures and sleep disorders. The AGRE covers these conditions and 10 others, from asthma to dental problems. It also includes medical data for parents and siblings.

Multiple maladies:

A statistical analysis of data from the AGRE group as a whole unveiled no obvious connections between the conditions. But separately probing the way that each of the 14 conditions related to the others was more revealing.

The researchers found that in several cases, having one medical condition increases the odds that one or two others will also occur. Children with gastrointestinal conditions are more likely to have sleep disorders or seizures than are those without gut problems, they found. Conversely, having a sleep disorder also raises the chances of having gastrointestinal troubles.

All three health problems are more prevalent in children with autism than they are in their unaffected family members, suggesting the problems are linked to autism. Allergies and asthma, in contrast, are equally common in their unaffected siblings, indicating no connection between these conditions and autism.

The findings highlight the need for an interdisciplinary approach to address the complex health problems of people with autism, says Margaret Bauman, research associate professor of anatomy and neurobiology at Boston University, who was not involved in the study. “Individuals with autism need and deserve this kind of high-quality care.”

Levitt and his colleagues found similar patterns in the SSC data. By comparing multiplex families — in which genetic risk factors are strong — with simplex families, the researchers could see whether health problems track with the disorder, regardless of its root cause.

Because the findings held up across both databases, Levitt says, “There may be some commonalities in why some conditions occur irrespective of genetic risk.”

Levitt and his colleagues did not investigate the biological mechanisms that link one condition with another. However, there is no evidence of a consistent pattern of causality — a stomachache preventing a child from falling asleep, for example, or a seizure waking the child up. “Sleep disruption in children with [autism] is chronic and not mediated by the fluctuations in medical symptoms,” he says.

In a study published last year in Pediatrics, researchers tried to identify links between medical conditions accompanying autism by examining medical records2. That study revealed that 42 percent of children with medical problems such as gastrointestinal issues, ear infections and asthma also have seizures. But the researchers did not know the children’s family histories, nor did they investigate possible relationships between various individual conditions.

The new study also looked at the relationship between health problems and behavior. The researchers found that children with more than one co-occurring condition tend to be less socially engaged, have more behavioral problems and struggle more with everyday life skills than those who have autism alone or have only one co-occurring condition.

The researchers suggest that some social and behavioral problems in children with autism stem from painful health issues that go unnoticed and untreated. “A typically developing child who has a medical condition is likely to be less functional, and life will be more challenging,” Levitt says. “It’s the same thing for a child with autism.”

In a follow-up study, Levitt and his colleagues are treating children with autism for gastrointestinal problems and assessing the treatment’s effects on autism symptoms and behavioral problems. If easing the gut issues leads to better behavior, children might not need behavioral medications, such as risperidone for aggression, which can have serious side effects.

Continued work in this area is likely to bring other benefits, says Beth Ann Malow, professor of neurology and pediatrics at Vanderbilt University in Nashville, Tennessee, who was not involved in the study. “Future studies examining the role of co-occurring medical conditions in affecting health, daytime behavior and family functioning in autism spectrum disorder are sorely needed.”


1. Aldinger K.A. et al. Autism Res. Epub ahead of print (2015) PubMed

2. Doshi-Velez F. et al. Pediatrics 133, e54-63 (2014) PubMed

8 responses to “Some behavioral problems in autism may stem from poor health”

  1. AmandaFL says:

    None of this information is new. Haven’t these researchers read the work of D. MacFabe, Horvath, Perman, Frye or Adams…They have essentially been discussing theses issues for a decade. Of course GI/ sleep and other medical issues are often found together. The authors of this study should read the works of the researchers above. We need treatment, not just general guidelines and more information every parent knows.

  2. Jennifer says:

    FORGET about the genetics! Yes, there is most likely a genetic predisposition for autism – otherwise everyone would be autistic – but just because siblings have autism does NOT mean that it is genetic. Altered gut acetic can occur from elective c-sections by mom, not nursing, diet and most importantly altered gut bacteria in pregnant mom. In other words, there is a real chance that there is a congenital predisposition that is more important than a genetic predisposition. Genetics is NOT going to solve the autism puzzle.

  3. keep in mind says:

    SFARI is focused on genetics. Not sure why, but it is his prerogative since it is his money. I think there is a genetic component to autism, but I agree with Jennifer that genetics isn’t going to give us any solutions. I’m starting to think if you want a solution based approach you need to go with N of One’s research. My oldest child is not autistic. Very social and very smart. However, there is autism in extended family on both sides, but they are all Aspies who talk non-stop. My autistic child is not super verbal and has some aggression issues. B-12 = aggressive. Ritalin = aggressive. I need my own N of one research group to figure out what is up with him. No digestive issues. I nursed. I was 29 when I had him and my husband is 2 years older than I am. I did not develop gestational diabetes, although I think I was “close” after they made me eat a candy bar. No hypertension. He made eye contact and was babbling. Meeting all typical development targets, but I think he might have skipped the crawling piece, or only crawled for a very brief time period. Babies were 20 months apart. Basically, every study that has come out has not been me. But, I also would like to see a more solutions based approach to autism.

    • Payman says:

      Unfortunately, its not their money. Its government grants in addition to millions given by charities for research. A research direction misled. All in name of autism. With zero results.

  4. Payman says:

    Oh my god, so prehistoric these findings. Have you as parents ever noted a variation in your child behavior during day and night. I have a typical kid (regressive type) on autism with no speech. For me autism starts at night? There is a physical cycle of some sorts. At night autism is 10 times worse and the lack of connection and being grounded is 100 folds more absent. Do other parents experience the same observations. Could this have any link to gut bacteria, some bacteria species dynamic activity. Researchers and doctors would miss these autism clues as they dont live with autism 24/7

  5. Rachel says:

    Amazingly late in the day with this research!! Totally agree with Payman. Autism hates sleep and is a pain in backside after midnight!

  6. thankgodforthe internet says:

    Agree with earlier comments. Gastrointesintal issues obviously involved in many cases – I worked that one out 13 years ago. Thank you to Lynne Hamilton who wrote Facing Autism which started us on our journey of discovery. If like me you read it and unlike other books thing that her son ryan is just like your child with an asd then consider trying what she did. We did. My Son’s story is too long to tell here and involves ABA and a LOT of hard work from dozens of people but glutenfree caseinfree diet (for 7 yrs), mega doses of probiotics, nystatin then diflucam and multivits and omega 3s all seemed to help, normalized poop and sleep and made huge difference in ability to learn. He’s now 16 you wouldn’t guess he has pddnos, expect will be going to 4yr college.

Leave a Reply

Your email address will not be published. Required fields are marked *