title: Autism spectrum disorders in children with functional defecation disorders.
abstract: OBJECTIVE
  To prospectively assess the prevalence of autism spectrum disorder (ASD) symptoms in children presenting with functional defecation disorders.
  
  
  METHODS
  Children (age 4-12 years) with functional constipation or functional non-retentive fecal incontinence according to the Rome III criteria referred to a specialized outpatient clinic were included. Parents completed 2 validated ASD screening questionnaires about their child; the Social Responsiveness Scale (SRS) and the Social Communication Questionnaire-Lifetime (SCQ-L). A total SRS score of ≥ 51 is a strong indicator for the presence of ASD. On the SCQ-L, a score of ≥ 15 is suggestive for ASD.
  
  
  RESULTS
  In total, 242 patients (130 males, median age 7.9 years) were included. Of these, 91% were diagnosed with functional constipation and 9% with functional non-retentive fecal incontinence. Thirteen children (5.4%) had previously been diagnosed with ASD. Twenty-six children (11%) had both SRS and SCQ-L scores at or above cutoff points, strongly suggestive for the presence of ASD. Solely high SRS were present in 42 children (17%), whereas two children (1%) only had high SCQ-L scores. Altogether, 29% had ASD symptoms, indicated by SRS and/or SCQ-L scores at or above the cutoff values. These children were older than children without ASD symptoms and presented with a longer duration of symptoms.
  
  
  CONCLUSIONS
  A substantial number of children (29%) presenting with a functional defecation disorder at a tertiary hospital has concomitant ASD symptoms. Clinicians should be aware of ASD symptoms in children with functional defecation disorders.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. b.peeters@amc.uva.nl
authors.forename: Babette
authors.initials: B
authors.lastname: Peeters
authors.forename: Ilse
authors.initials: I
authors.lastname: Noens
authors.forename: Elise M
authors.initials: EM
authors.lastname: Philips
authors.forename: Sofie
authors.initials: S
authors.lastname: Kuppens
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D002648:Child; D002659:Child Development Disorders, Pervasive / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D003248:Constipation / Q000150:complications* / Q000175:diagnosis; D005242:Fecal Incontinence / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: ADHD; ASD; Attention deficit-hyperactivity disorder; Autism spectrum disorder; FC; FI; FNRFI; Fecal incontinence; Functional constipation; Functional non-retentive fecal incontinence; GP; General practitioner; SCQ; SCQ-L; SRS; Social Communication Questionnaire; Social Communication Questionnaire-Lifetime; Social Responsiveness Scale