Relationship of constipation and sleep disorders with emotional and behavioral problems in children with autism spectrum disorder

Abstract:

Objective：To explore the relationship of constipation and sleep disorders with emotional and behavioral problems in children with autism spectrum disorder（ASD）. Methods：This study included 172 children with ASD who visited the Development and Behavior Center of Children’s Hospital of Chongqing Medical University and a special training institution in Chongqing from July 2017 to February 2018，as well as 129 sex-matched normal children from a kindergarten in Chongqing（as controls）. A questionnaire was used to investigate the incidence of constipation and sleep disorders as well as common problematic behaviors in the normal children and those with ASD. The autism behavior checklist（ABC） was used to evaluate the core symptoms of children with ASD，and the influence of constipation and sleep disorders on emotional and behavioral problems was analyzed in children with ASD. Results：The incidence rates of constipation and sleep disorders were significantly higher in the children with ASD than in the nor－mal children[constipation：32.6%（95%CI=25.5%-39.6%） vs. 15.5%（95%CI=9.2%-21.8%），P=0.001；sleep disorders：71.5%（95%CI=64.7%-78.3%） vs. 45.7%（95%CI=37%-54.4%），P=0.000]. ASD children with sleep disorders had higher scores on the interaction dimensions of ABC（P=0.044）. A positive correlation between constipation and sleep disorders was observed in the children with ASD（rs=0.219，P=0.004）. ASD children with constipation or sleep disorders were more prone to emotional problems including drastic emotional changes and irregular moodiness（P<0.05），as well as soliloquy，palinphrasia，constant changes in movements and postures，and other stereotyped behaviors（P<0.05）. ASD children with sleep disorders were more likely to attack people with objects（P<0.05）. The children with ASD had a significantly higher comorbidity rate of constipation and sleep disorders than the normal children[27.3%（47 cases） vs. 12.4%（16 cases），P<0.05]. ASD children with comorbidity of constipation and sleep disorders were more prone to emotional problems including drastic emotional changes，irregular moodiness，and unexplained anger（P<0.05），as well as soliloquy，palinphrasia，constant changes in movements and postures，and other stereotyped behaviors（P<0.05）. The tendency towards attack and self-harm was not observed in the children with comor－bidity of constipation and sleep disorders（P>0.05）. Conclusion：Considering the high incidence rate of constipation and sleep disorders and their impact on mood and repetitive and stereotyped behaviors，it is necessary to include the identification of comorbid diseases like constipation and sleep disorders in the diagnosis and treatment in routine child care，and to integrate the comorbidity of constipa－tion and sleep disorders as part of the chronic disease management of children with ASD，so as to meet the needs of individualized comprehensive treatment for children with ASD. All these measures will effectively control the common problematic behaviors in chil－dren with ASD and improve their social function.