Longitudinal Relations Among Anxiety, Sensory over-Responsivity and Abdominal Pain in Children with ASD

Friday, May 16, 2014
Atrium Ballroom (Marriott Marquis Atlanta)
M. O. Mazurek1, A. Shui2, R. A. Vasa3 and A. Keefer3, (1)Health Psychology, University of Missouri, Columbia, MO, (2)Massachusettes General Hospital for Children, Boston, MA, (3)Kennedy Krieger Institute, Baltimore, MD

Children with autism spectrum disorder (ASD) often experience co-occurring medical and psychiatric symptoms.  Among the most common are gastrointestinal (GI) problems, anxiety, and sensory over-responsivity (SOR).  Although children with ASD are at greater risk for all three of these conditions, few studies have examined how these problems may inter-relate.  Recent cross-sectional evidence indicates that SOR and anxiety are highly correlated among children with ASD, and that both of these problems are more common in those with ASD and chronic abdominal pain.  There is also evidence that these problems may share similar underlying mechanisms, including HPA-axis involvement. These previous findings stress the importance of investigating these related problems jointly, and the need to examine the timing of symptom onset among children with ASD.  Longitudinal associations among these variables in children with ASD have not been previously examined, however.


The purpose of this study was to examine the longitudinal relations among anxiety, SOR and chronic abdominal pain in a large, well-characterized sample of children and adolescents with ASD.  Based on previous research among the general population, we hypothesized that anxiety and SOR would jointly predict the longitudinal occurrence of abdominal pain among children with ASD.


Participants included 225 children and adolescents (ages 2-17) with ASD enrolled in the Autism Speaks Autism Treatment Network (AS-ATN) clinical registry database.  Data were collected at baseline (T1) and at 1-year follow-up (T2).  Measures included a demographic questionnaire, GI Symptom Inventory Questionnaire, Autism Diagnostic Observation Schedule (ADOS), Child Behavior Checklist (CBCL), Short Sensory Profile, and IQ testing.


Across the sample, 25.8% experienced chronic abdominal pain at T1 (defined as current abdominal pain, lasting 3 or more months), and of those 86.7% continued to experience abdominal pain at T2.  An additional 23.8% of children without T1 abdominal pain went on to develop abdominal pain by T2.  Baseline anxiety and SOR were significantly correlated (p < .001), and compared to children without abdominal pain, those with chronic abdominal pain had greater problems with anxiety (p = .01) and SOR (p = .01).  Ordinal logistic regression models were used to examine longitudinal relations among variables. Among those without T1 abdominal pain, SOR was a significant predictor of developing chronic abdominal pain at T2 (p = .002).  Among those with chronic abdominal pain at TI, neither anxiety nor SOR were significant predictors of abdominal pain at T2 (chronic vs. acute/no pain or chronic/acute vs. no pain). 


This was the first study to examine longitudinal associations among three common co-occurring problems in children with ASD.  The results are consistent with emerging evidence that anxiety, SOR, and GI problems are inter-related for some children with ASD.  In addition, SOR was a significant predictor of future development of abdominal pain, offering some preliminary information about the timing of these relationships and potential underlying mechanisms.  Future work will continue to benefit from the use of longitudinal designs to examine these issues, as well as treatment studies to determine if targeted treatments can prevent or ameliorate all three conditions.