Recently, Dr. Barbara McElhanon gave our group a terrific update on the GI Manifestations Associated with Autism. My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of her slides.

• Even with the early descriptions of autism, dating back to Les Kanner in 1943, gastrointestinal complaints like feeding difficulties/peculiar diets were recognized.

• As autism became widely recognized, numerous advice books were published.  In 2008, Paul Offitt published Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. This book emphasized the lack of evidence for many recommendations, the out of pocket expenses, and how this is a particular problem for parents desperately searching for answers.  He also affirmed the safety of the MMR vaccine.
• In 2010, Tim Buie et al (including my partner Jeffery Lewis) published guidelines regarding evaluation of GI disorders in kids. Pediatrics. 2010 Jan:125 Suppl 1:S19-29. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs.

• Some studies have found an increase in some autistic behaviors (greater impairment in sleep, communication sensory processing and repetitive behaviors) in those with coexisting/worse gastrointestinal symptoms.

• More than 1000 genes have been associated with developing autism.  About 90% of these genes have expression outside the central nervous system including the enteric nervous system.

• No unique microbiome has been identified as being associated with autism.  Fecal microbial transplantation (FMT) studies included an open label study suggesting an improvement in gastrointestinal symptoms and mood.  However, a randomized study with oral FMT found no changes except some improvement in socialization.
• For now, FMT is not an established therapy for autism and probiotics are not recommended.

• Dr. McElhanon notes that dietary restrictions are not recommended for autism.  Children with autism often have a restricted diet at baseline and further restrictions can increase the likelihood of feeding disorders like ARFID.

• Constipation is considered the most common GI problem for children with autism. Some treatments that may be helpful included Natural Magnesium Citrate Powder and Vegetable Laxative (with Senna) (100 tablets (8.6 mg) can be purchased for less $5 and can be crushed.
• Related article: U Khalid et al. J Pediatr Gastroenterol Nutr. 2026;83:431–437 Open Access! Constipation outcomes in children with and without autism spectrum disorder: Insights from a tertiary motility service. This retrospective study (n=196) reported lower treatment response in the children (n-74) with autism. At last followup, constipation resolution in this group was 11% vs. 25% (p = 0.036) in those without ASD.

• Dr. McElhanon notes that this administration has made several recommendations regarding autism; this has increased awareness and attention to children with autism.  However, at this time, the Marcus Center does not recommend the use of Leucovorin. The studies that have purported to show benefit were small studies with varying doses.  This medication has had an increase in usage due to the increased awareness. 
• With regard to acetaminophen, recent large studies have shown that it is safe to use and has not increased the risk of autism after use by pregnant women.

• Due to atypical diets, vitamin/nutrient deficiencies are not rare in children with autism and dietary restrictions.  Disorders like scurvy (Vitamin C deficiency) need to be considered in this population.  Vitamin supplements (eg. NanoVM which is tasteless) are important to prevent these deficiencies.

• For clinical care, Dr. McElhanon prefers to get a good history before delving into the potentially extensive testing that families may bring.  Also, additional time for the visit and to discuss treatment are needed.  In children with autism, due to difficulty administering medications and diet, it can take longer to figure out the right option.

• More research on optimal treatment is ongoing.

Related blog posts:

• Why It is Hard to Do Histology EGD Studies -Case in Point: Endoscopy in Autism
• Is Intestinal Function in Children with Autism Different?
• Briefly Noted: Microscopic Duodenitis and Autism
• Is It a ‘Waste’ to Do Colonic Manometry in Kids with Autism?
• Little Evidence to Support Dietary Intervention in Autism Spectrum Disorders
• Autism, Acetaminophen, and Misleading Claims
• CDC Website Changed to Include False Claims About Autism and Vaccines
• Humor: MAHAspital

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