title: Maladaptive Behavior and Gastrointestinal Disorders in Children with Autism Spectrum Disorder.
abstract: OBJECTIVE
  Various gastrointestinal factors may contribute to maladaptive behavior in children with autism spectrum disorders (ASD). To determine the association between maladaptive behavior in children with ASD and gastrointestinal symptoms such as severity, intestinal microbiota, inflammation, enterocyte damage, permeability and absorption of opioid peptides.
  
  
  METHODS
  This observational cross-sectional study compared children with ASD to healthy controls, aged 2-10 years. Maladaptive behavior was classified using the Approach Withdrawal Problems Composite subtest of the Pervasive Developmental Disorder Behavior Inventory. Dependent variables were gastrointestinal symptom severity index, fecal calprotectin, urinary D-lactate, urinary lactulose/mannitol excretion, urinary intestinal fatty acids binding protein (I-FABP) and urinary opioid peptide excretion.
  
  
  RESULTS
  We did not find a significant difference between children with ASD with severe or mild maladaptive behavior and control subjects for gastrointestinal symptoms, fecal calprotectin, urinary D-lactate, and lactulose/mannitol ratio. Urinary opioid peptide excretion was absent in all children. Children with ASD with severe maladaptive behavior showed significantly higher urinary I-FABP levels compared to those with mild maladaptive behavior (p=0.019) and controls (p=0.015).
  
  
  CONCLUSIONS
  In our series, maladaptive behavior in ASD children was not associated with gastrointestinal symptoms, intestinal inflammation (no difference in calprotectin), microbiota (no difference in urinary D-lactate) and intestinal permeability (no difference in lactulose/manitol ratio). ASD children with severe maladaptive behavior have significantly more enterocyte damage (increased urinary I-FABP) than ASD children with mild maladaptive behavior and normal children.
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Hardiono D
authors.initials: HD
authors.lastname: Pusponegoro
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Sofyan
authors.initials: S
authors.lastname: Ismael
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Sudigdo
authors.initials: S
authors.lastname: Sastroasmoro
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Agus
authors.initials: A
authors.lastname: Firmansyah
authors.affiliation: Department of Pediatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vandenplas
keywords: Autism spectrum disorder; Enterocyte damage; Intestinal inflammation; Intestinal permeability; Urinary opioids