Psychological, behavioural and biological factors associated with gastrointestinal symptoms in autistic adults and adults with autistic traits

• Published in: Autism : the international journal of research and practice 2023-10, Vol.27 (7), p.2173-2186
• Main Authors: Warreman, EB, Nooteboom, LA, Terry, MB, Hoek, HW, Leenen, PJM, van Rossum, EFC, Ramlal, D, Vermeiren, RRJM, Ester, WA
• Format: Article
• Language: English
• Subjects: Adults; At Risk Persons; Autism; Autism Spectrum Disorders; Autistic adults; Behavior; Body Composition; Comorbidity; Confidence; Confidence intervals; Foreign Countries; Health Behavior; Health care; Human Body; Individual Characteristics; Medical diagnosis; Medical personnel; Mental Disorders; Mental Health; Original; Physical activity; Physical Health; Psychiatric symptoms; Psychological aspects; Psychological problems; Psychosomatic Disorders; Psychosomatic symptoms; Questionnaires; Risk factors; Stress Variables; Support workers; Symptoms; Symptoms (Individual Disorders)
• ISSN: 1362-3613; 1461-7005; 1461-7005
• DOI: 10.1177/13623613231155324

Gastrointestinal symptoms and their relation to physical and mental aspects in adults with an autism spectrum disorder (ASD) are poorly understood, despite their high prevalence. Therefore, the aim of this study is to examine psychological, behavioural and biological factors associated with gastrointestinal symptoms in adults with ASD (traits). We included 31,185 adults from the Lifelines Study. Using multivariable logistic regression, we analysed the association between gastrointestinal symptoms and psychological, behavioural (questionnaire-assessed) and physically measured biological factors in adults with ASD (n = 309), without ASD (n = 30,876), and in the quartiles with highest (n = 7783) and lowest (n = 7783) Autism Spectrum Quotient-10 sum scores. In the ASD-group, gastrointestinal symptoms were associated with psychiatric comorbidity (odds ratio: 2.71, 95% confidence interval: 1.51–4.85), more stress (odds ratio: 1.15, 95% confidence interval: 1.06–1.26), and worse perceived health (odds ratio: 2.32, 95% confidence interval: 1.62–3.34). In the quartile with the highest Autism Spectrum Quotient-10 sum scores, gastrointestinal symptoms were also associated with these psychological factors, and with less physical activity (odds ratio: 0.95, 95% confidence interval: 0.92–0.98). Our study demonstrates that not only adults with ASD but also adults with autistic traits are at increased risk for gastrointestinal symptoms, which is associated with psychological and behavioural factors. This suggests that an integrated psychosomatic approach of gastrointestinal symptoms in adults with ASD (traits) is needed. Lay abstract Little is known about factors related to the increased risk for gastrointestinal symptoms in adults with an autism spectrum disorder (ASD), while the negative impact of gastrointestinal symptoms is evident. Especially, the relationship between gastrointestinal symptoms and psychological, behavioural, and biological risk factors in adults with ASD (traits) is unclear. Autistic peer support workers and autism-advocates also emphasised the importance of identifying risk factors, because of the high prevalence of gastrointestinal problems in people with ASD. Therefore, our study investigated which psychological, behavioural, and biological factors are associated with gastrointestinal symptoms in adults with ASD or with autistic traits. We analysed data from 31,185 adults in the Dutch Lifelines Study. Questionnaires were used to evaluate the prese