Food and Behaviour Research

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Bidirectional relationship between internalizing symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder

Dovgan K, Gynegrowski K, Ferguson B (2022) Journal of Autism and Developmental Disorders Apr 20 DOI: 10.1007/s10803-022-05539-6 

Web URL: Read this and related articles on PubMed


Many youth with autism spectrum disorder (ASD) experience co-occurring conditions, such as gastrointestinal (GI) problems and internalizing symptoms. However, the relationship among these co-occurring problems is not well-understood.

We analyzed parent reports of GI problems and internalizing symptoms of 621 youth with ASD using path models in a structural equation modeling framework.

The best-fitting model was a bidirectional model wherein internalizing symptoms, including withdrawn and anxious behavior, were correlated with GI problems, including constipation, diarrhea, nausea, and stomach pain.

This study provides a better understanding of the relationship among co-occurring conditions in youth with ASD and should encourage clinicians to consider treatment of underlying internalizing symptoms or GI problems when providing services for individuals with ASD.


This study found a two-way relationship between gastro-intestinal (GI) symptoms and ‘internalized’ psychological symptoms like anxiety and social withdrawal in children and adolescents with Autistic Spectrum Disorders (ASD), 

It has long been known that ‘gut-brain’ communications - which involve many different signalling systems - work in both directions – as the news article reporting this study explains.

However, in concluding that each type of symptom can affect the other, these findings provide important evidence to support the idea that dietary changes aimed at reducing GI symptoms may also help in managing ‘core’ symptoms of ASD such as social anxiety and withdrawal.

The research team also hope to develop biomarkers of both stress/anxiety and gut health that could help in devising individualised treatments. 

For the related news article please see:

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