title: Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder.
abstract: BACKGROUND
  Gastrointestinal (GI) symptoms are frequently reported in children with Autism Spectrum Disorder (ASD), and an impact of GI comorbidity on ASD behavioral problems has been hypothesized.
  
  
  OBJECTIVE
  To explore the type and the prevalence of GI symptoms in ASD patients and typical development (TD) controls, and to investigate their possible association with behavioral problems.
  
  
  METHODS
  A total of 230 preschoolers were included in this study. Specifically, four groups of children were evaluated: ASD individuals suffering from GI symptoms (ASD/GI+), ASD subjects without GI symptoms (ASD/GI-), TD peers with (TD/GI+) and without (TD/GI-) GI symptoms. Parental report of behavioral problems and GI symptoms were assessed through the Child Behavior Check List 1½-5.
  
  
  RESULTS
  A significant higher percentage of ASD (37.4%) versus TD (14.8%) with GI symptoms was observed. 'Constipated' and 'Not-Eat' were the most frequent GI symptoms both in ASD and in TD groups, but they were evaluated as more severe in ASD patients. ASD/GI+ children had more anxiety problems, somatic complaints, externalizing and total problems than ASD/GI- individuals. TD/GI+ did not show more behavioral problems than TD/GI-.
  
  
  CONCLUSIONS
  Development of evidence-based guidelines for identification of GI problems in ASD preschoolers is warranted. GI symptomatology should be accurately assessed, especially in ASD children with anxiety and/or externalizing behavioral problems.
authors.affiliation: IRCCS Stella Maris Foundation, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fulceri
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Italy; Speciality School of Nutritional Sciences, University of Milan, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Morelli
authors.affiliation: IRCCS Stella Maris Foundation, Pisa, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Santocchi
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Italy.
authors.forename: Hellas
authors.initials: H
authors.lastname: Cena
authors.affiliation: ODFlab, Department of Psychology and Cognitive Science, University of Trento, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Del Bianco
authors.affiliation: IRCCS Stella Maris Foundation, Pisa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Narzisi
authors.affiliation: IRCCS Stella Maris Foundation, Pisa, Italy. Electronic address: scalderoni@fsm.unipi.it.
authors.forename: Sara
authors.initials: S
authors.lastname: Calderoni
authors.affiliation: IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Muratori
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology* / Q000523:psychology; D000374:Aggression / Q000523:psychology; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D000067877:Autism Spectrum Disorder / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D002675:Child, Preschool; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology* / Q000523:psychology; D003967:Diarrhea / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D000066553:Problem Behavior / Q000523:psychology*
keywords: Anxiety problems; Child Behavior Checklist 1½–5; Externalizing problems; Gut-brain axis