Associations of Autistic Traits and Autism with Incontinence and Constipation in a UK Birth Cohort.

This large study of UK children found that those with autistic traits, particularly difficulties with social communication and speech, were more likely to experience bedwetting, daytime accidents, and soiling at age 9. Children with diagnosed autism had over 3 times higher odds of daytime wetting. By age 14, these toileting issues were less common, but constipation remained more frequent in children with autistic traits. The findings suggest early assessment and treatment of toileting difficulties should be considered for children showing autistic traits.

This large UK birth cohort study examined associations between autistic traits and toileting difficulties in 4,233-4,490 children. The research tracked participants from ages 3-14 years, measuring parent-reported autistic traits and toileting outcomes. Social-communication and speech coherence difficulties showed the strongest associations with incontinence at age 9, with adjusted odds ratios of 2.21-2.34 for daytime wetting and 1.88-2.04 for soiling. Diagnosed autism was associated with increased daytime wetting (OR: 3.18).

By age 14, associations with incontinence diminished, but social-communication and coherence difficulties remained linked to constipation (OR: 1.64-1.68). The study controlled for multiple confounding factors including family socioeconomic status, maternal factors, and child developmental level.

Healthcare providers should routinely assess toileting difficulties in children with autistic traits or autism diagnosis. Early intervention for incontinence and constipation may be beneficial. Families should be prepared that toileting challenges may persist into adolescence, particularly constipation, even as incontinence issues may resolve.

The study relied on parent and self-reported measures for both autistic traits and toileting outcomes, which may introduce reporting bias. The abstract does not specify how autism diagnosis was determined or provide details about missing data handling. Long-term follow-up may have been affected by participant attrition.

There is evidence that children with autism/autistic traits have higher risks of incontinence and constipation, but no studies have examined this in a large community-based cohort. Aim/Research question: are autistic traits and diagnosed autism prospectively associated with increased odds of incontinence and constipation in children and adolescents? This was a population-based cohort study based on data from the Avon Longitudinal Study of Parents and Children (n = 4233-4490 at age 9 years; n = 3403-3697 at age 14). We used multivariable logistic regression to examine associations of parent-reported autistic traits (sociability, repetitive behaviours, social-communication, coherence) (at ages 3-9 years) and autism with incontinence (bedwetting, daytime-wetting, soiling) and constipation (parent-reported at age 9, self-reported at age 14).

We adjusted for parity, maternal age at delivery, child's sex and developmental level, maternal depression, and anxiety (antenatal and postnatal), and indicators of family socioeconomic status. Social-communication and speech coherence difficulties showed the strongest associations with incontinence, e.g., adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between social-communication difficulties and daytime-wetting was 2.21 (1.47-3.32) and for coherence was 2.34 (1.60-3.43). The odds of soiling were also higher in children with social-communication (OR: 1.88, 95% CI 1.28-2.75) and coherence difficulties (OR: 2.04, 95% CI 1.43-2.93). Diagnosed autism was only associated with an increase in the odds of daytime-wetting (OR: 3.18, 95% CI 1.44-7.02).

At 14 years, there was less evidence of associations between autistic traits and incontinence but there was evidence of associations between autistic traits and constipation: social-communication (OR: 1.68, 95% CI 1.13-2.49), coherence difficulties (OR: 1.64, 95% CI 1.11-2.41). Early assessment and treatment of incontinence/constipation should be considered for children with autistic traits.