Gut mobilization improves behavioral symptoms and modulates urinary p-cresol in chronically constipated autistic children: A prospective study.

Researchers studied 21 autistic children with ongoing constipation problems. After treating their constipation, the children showed significant improvements in social skills, repetitive behaviors, anxiety, and hyperactivity over 6 months. The improvements didn't seem to be related to changes in a particular gut chemical. This suggests that helping constipated autistic children with their bowel problems might also help with their autism symptoms and anxiety.

This prospective study examined 21 autistic children aged 2-8 years with chronic constipation to assess whether gut mobilization (treatment to improve bowel movements) could improve behavioral symptoms. Participants were evaluated at baseline, 1 month, and 6 months after treatment. Results showed progressive and highly significant decreases in social interaction deficits, stereotypic behaviors, anxiety, and hyperactivity over the 6-month period. Urinary p-cresol levels (a bacterial compound that may affect brain function) showed variable changes that were not significantly correlated with behavioral improvements.

The study suggests gut mobilization may be a simple strategy to improve ASD symptoms and comorbid conditions in constipated children.

Treating constipation in autistic children may improve behavioral symptoms beyond just gastrointestinal relief. Clinicians should consider comprehensive bowel management as part of autism care. However, larger controlled studies are needed before establishing this as standard practice.

Small sample size (21 participants), no control group, short follow-up period (6 months), unclear methodology for gut mobilization treatment, and lack of randomization. The study design limits ability to establish causation and generalize findings.

Chronic constipation is common among children with ASD and is associated with more severe hyperactivity, anxiety, irritability, and repetitive behaviors. Young autistic children with chronic constipation display higher urinary, and foecal concentrations of p-cresol, an aromatic compound produced by gut bacteria, known to negatively affect brain function. Acute p-cresol administration to BTBR mice enhances anxiety, hyperactivity and stereotypic behaviors, while blunting social interaction. This study was undertaken to prospectively assess the behavioral effects of gut mobilization in young autistic children with chronic constipation, and to verify their possible correlation with urinary p-cresol.

To this aim, 21 chronically constipated autistic children 2-8 years old were evaluated before (T0), 1 month (T1), and 6 months (T2) after intestinal mobilization, recording Bristol stool scale scores, urinary p-cresol concentrations, and behavioral scores for social interaction deficits, stereotypic behaviors, anxiety, and hyperactivity. Gut mobilization yielded a progressive and highly significant decrease in all behavioral symptoms over the 6-month study period. Urinary p-cresol levels displayed variable trends not significantly correlated with changes in behavioral parameters, mainly increasing at T1 and decreasing at T2. These results support gut mobilization as a simple strategy to ameliorate ASD symptoms, as well as comorbid anxiety and hyperactivity, in chronically constipated children.

Variation in p-cresol absorption seemingly provides limited contributions, if any, to these behavioral changes. Further research will be needed to address the relative role of reduced abdominal discomfort following mobilization, as compared to specific modifications in microbiome composition and in gut bacteria-derived neuroactive compounds.