Case Series: Constipation and Fecal Incontinence in Children with ADHD and Autism Spectrum Disorder
DOI:
https://doi.org/10.53819/81018102t4275Abstract
The comorbidity of gastrointestinal (GI) diseases is high among attention deficit and hyperactivity disease (ADHD) children with autism spectrum disorder (ASD). Previous investigations report fecal incontinence and constipation as the most prevalent GI disorders among ADHD-ASD children, posing clinical questions regarding effective management approaches. This case series investigates the incidences, symptomatology and behavioral disorders reported by children with and without histories of ADHD and ASD to inform evidence-based interventions and policy. Methods. This case series investigated gastrointestinal abnormalities among 12 preschoolers in a psychiatric clinic. The investigation considers a history of children with GI disorders and comorbidity with psychiatric illness. Parents’ and teachers’ accounts of children informed the clinical decisions. The case series reported a higher incidence of constipation and fecal retention among male than female children, 7 and 5, respectively. The international classification confirmed the signs and symptoms reported by constipated children, including high avoidance of school and public restrooms and a preference for home restrooms. Behavioral disorders like hyperfocus, which are a defense mechanism against the sensory-rich school environment, marked the incidence of the disorders. However, clinical interventions like stool softeners, including polyethylene glycol, and other laxatives were administered to stimulate defecation by enhancing bowel motility. The cognitive behavioral therapy was indicated to the children to impart coping skills necessary to handle sensory-rich environments. Preschoolers presented fundamental behavioral disorders and other symptoms, including hyperfocus, fecal incontinence at home and retention at school due to the sensory-rich environments. Medications like laxatives and stool softeners enhance bowel movement, whereas psychotherapy enhances children’s coping skills to prevent the withholding of feces in sensory-rich environments like schools and other public places. These interventions alleviated symptoms and improved the children’s quality of life.
Keywords: Pediatric Constipation, Fecal Incontinence, ADHD, Autism Spectrum Disorder (ASD), Neurodevelopmental Disorders
References
Al-Beltagi, M., Saeed, N. K., Bediwy, A. S., Elbeltagi, R., & Alhawamdeh, R. (2023). Role of gastrointestinal health in managing children with autism spectrum disorder. In World Journal of Clinical Pediatrics (Vol. 12, Issue 4). https://doi.org/10.5409/wjcp.v12.i4.171
Ali, S. R., Ahmed, S., Qadir, M., & Humayun, K. N. (2011). Fecal incontinence and constipation in children: A clinical conundrum. Oman Medical Journal, 26(5). https://doi.org/10.5001/omj.2011.94
American Academy of Child and Adolescent Psychiatry (AACAP. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 894–921. https://doi.org/10.1097/chi.0b013e318054e724
Bazmamoun, H., Momeni, A., Jahangard, L., Asnaashari, F., & Pezeshki, N. (2023). How common is attention deficit hyperactivity disorder (ADHD) in a cohort of children with functional constipation, and does ADHD treatment improve functional constipation? Archives of Medical Science, 19(2). https://doi.org/10.5114/aoms/111841
Bjørklund, G., Pivina, L., Dadar, M., Meguid, N. A., Semenova, Y., Anwar, M., & Chirumbolo, S. (2020). Gastrointestinal alterations in autism spectrum disorder: What do we know? In Neuroscience and Biobehavioral Reviews (Vol. 118). https://doi.org/10.1016/j.neubiorev.2020.06.033
Brooks, J. D., Bronskill, S. E., Fu, L., Saxena, F. E., Arneja, J., Pinzaru, V. B., Anagnostou, E., Nylen, K., McLaughlin, J., & Tu, K. (2021). Identifying Children and Youth With Autism Spectrum Disorder in Electronic Medical Records: Examining Health System Utilization and Comorbidities. Autism Research, 14(2). https://doi.org/10.1002/aur.2419
Buie, T., Fuchs, G. J., Furuta, G. T., Kooros, K., Levy, J., Lewis, J. D., Wershil, B. K., & Winter, H. (2010). Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. In Pediatrics (Vol. 125, Issue SUPPL. 1). https://doi.org/10.1542/peds.2009-1878D
Bundgaard-Nielsen, C., Lauritsen, M. B., Knudsen, J. K., Rold, L. S., Larsen, M. H., Hindersson, P., Villadsen, A. B., Leutscher, P. D. C., Hagstrøm, S., Nyegaard, M., & Sørensen, S. (2023). Children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorder share distinct microbiota compositions. Gut Microbes, 15(1). https://doi.org/10.1080/19490976.2023.2211923
Cerminara, M., Spirito, G., Pisciotta, L., Squillario, M., Servetti, M., Divizia, M. T., Lerone, M., Berloco, B., Boeri, S., Nobili, L., Vozzi, D., Sanges, R., Gustincich, S., & Puliti, A. (2021). Case Report: Whole Exome Sequencing Revealed Disease-Causing Variants in Two Genes in a Patient With Autism Spectrum Disorder, Intellectual Disability, Hyperactivity, Sleep and Gastrointestinal Disturbances. Frontiers in Genetics, 12. https://doi.org/10.3389/fgene.2021.625564
De Geus, A., Koppen, I. J. N., Flint, R. B., Benninga, M. A., Merit, ·, & Tabbers, M. (2023). An Update of Pharmacological Management in Children with Functional Constipation. 25, 343–358. https://doi.org/10.1007/s40272-023-00563-0
Esposito, D., Bernardi, K., Belli, A., Gasparri, V., Romano, S., Terenzi, L., Zanatta, M. E., Iannotti, S., & Ferrara, M. (2024). The Hidden Impact of ADHD Symptoms in Preschool Children with Autism: Is There a Link to Somatic and Sleep Disorders? Behavioral Sciences, 14(3). https://doi.org/10.3390/bs14030211
Feng, J., Zhu, T., Wanfu, L., Li, Y., Z-y, S., Y-z, B., S-c, Z., Shen, Z.-Y., Zhang, J., Bai, Y.-Z., & Zhang, S.-C. (2022). EDITED BY Diagnosis and management of fecal incontinence in children and adolescents. https://doi.org/10.3389/fped.2022.1034240
Koppen, I. J. N., Vriesman, M. H., Saps, M., Rajindrajith, S., Shi, X., van Etten-Jamaludin, F. S., Di Lorenzo, C., Benninga, M. A., & Tabbers, M. M. (2018). Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis. Journal of Pediatrics, 198. https://doi.org/10.1016/j.jpeds.2018.02.029
Mori, H., Tack, J., & Suzuki, H. (2021). Magnesium oxide in constipation. In Nutrients (Vol. 13, Issue 2, pp. 1–12). MDPI AG. https://doi.org/10.3390/nu13020421
Raturi, S., Li, F. X., & Wong, C. M. (2021). Recognition and management of bladder bowel dysfunction in children with autism spectrum disorder. BMJ Case Reports, 14(6). https://doi.org/10.1136/bcr-2021-242646
Sharma, A., Rao, S. S. C., Kearns, K., Orleck, K. D., & Waldman, S. A. (2021). Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders. In Alimentary Pharmacology and Therapeutics (Vol. 53, Issue 12, pp. 1250–1267). John Wiley and Sons Inc. https://doi.org/10.1111/apt.16369
Siegel, M., Erickson, C., Frazier, J. A., Ferguson, T., Goepfert, E., Joshi, G., Humberd, Q., King, B. H., Mao, A., Robb, A., Veenstra-Vanderweele, J., & Wang, P. (2024). Autism Parents’ Medication Guide Work Group Autism Spectrum Disorder: Parents’ Medication Guide.
Zhang, F., Hupfeld, K. E., Halldner, L., & Schachar, R. J. (2022). Hyperfocus or flow? Attentional strengths in autism spectrum disorder.
