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Autism and Developmental Disorders
2020. Vol. 18, no. 4, 3–12
doi:10.17759/autdd.2020180401
ISSN: 1994-1617 / 2413-4317 (online)

Gastrointestinal Tract Symptomatology in Adults with Pica and Autism

340

D.D. Alexander, S.E. Lunde, D.E. Berger

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Abstract

This study investigated pica behavior in those with and without autism in relation to gastrointestinal (GI) tract symptomatology and disease. A chart review of 64 residential adults with developmental disabilities indicated that individuals with pica had more GI tract diseases, and those with autism and pica had a higher rate of GI diseases compared to those with autism and no pica behavior. These data suggest that individuals with both autism and pica disorders may be a phenotypic subgroup in the autistic spectrum characterized by GI symptomatology, requiring a clinical algorithm for categorization and effective treatment. A behavior-analytic model is presented that conceptualizes pica as part of a chain of events that begins with exploratory behavior and culminates in GI symptomatology and disease. Issues of sensory processing are addressed within this model. Individuals exhibiting pica may benefit from gastrointestinal evaluation, including assessment of the microbiome, and, if indicated, microbiota transfer therapy to

General Information

Keywords: pica, autism spectrum disorder, GI diseases, microbiome, microbiota transfer therapy, comorbidity, prevalence, phenotype, sensory processing.

Journal rubric: Research & Diagnosis of ASD

Article type: scientific article

DOI: https://doi.org/10.17759/autdd.2020180401

Acknowledgements. These data are from a Medical Quality Assurance Study conducted at Lanterman Developmental Center which closed June 30, 2015. We gratefully acknowledge the support of the Medical Staff and the Health Service Specialists of Lanterman Developmental Center. Tony Rojas, Catherine Godkins, and Anthony D. Dinardo are acknowledged for help in gathering information for the Quality Assurance Study. William M. Sparks is acknowledged for help with the statistical analysis. We also thank Kathryn Grossman and Sandy Middleton for their technical help in preparation of this manuscript. The authors would like to thank Dr. Stephen M. Edelson for his valuable suggestions on an earlier version of this manuscript. The ideas expressed are those of the authors and are not to be construed as necessarily reflecting the policy of the Department of Developmental Services.

For citation: Alexander D.D., Lunde S.E., Berger D.E. Gastrointestinal Tract Symptomatology in Adults with Pica and Autism. Autizm i narusheniya razvitiya = Autism and Developmental Disorders, 2020. Vol. 18, no. 4, pp. 3–12. DOI: 10.17759/autdd.2020180401.

References

  1. Ausman J., Ball T.S., Alexander D. Behavior therapy of pica in a profoundly retarded adolescent. Mental Retardation, 1974, vol. 12, no. 6, pp. 16—18.
  2. Barhrick L.E., Todd J.T. Multisensory Processing in Autism Spectrum Disorders: Intersensory Processing Disturbance as a Basis for Atypical Development. In B. Stein (ed.) The New Handbook of Multisensory Processing. Cambridge: The MIT Press, 2012. 840 p. ISBN 978-0-26201712-1.
  3. Berding K., Donovan S.M. Microbiome and nutrition in autism spectrum disorder: Current knowledge and research needs. Nutrition Reviews, 2016, vol. 74, no. 12, pp. 723—736. DOI:10.1093/nutrit/nuw048
  4. Bugle C., Rubin H.B. Effects of a nutritional supplement on coprophagia: A study of three cases. Research in Developmental Disabilities, 1993, vol. 14, no. 6, pp. 445—456. DOI:10.1016/0891-4222(93)90037-K
  5. Buie T., Campbell D.B., Fuchs G.J. et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 2010, vol. 125, no. Supplement 1, pp. S1—S18. DOI:10.1542/peds.2009-1878C
  6. Buie T., Fuchs G.J., Furuta G.T. et al. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics, 2010, vol. 125, no. Supplement 1, pp. S19—S29. DOI:10.1542/peds.2009-1878D
  7. Carbone P.S. Moving from research to practice in the primary care of children with autism spectrum disorders. Academic Pediatrics, 2013, vol. 13, no. 5, pp. 390—399. DOI:10.1016/j.acap.2013.04.003
  8. Coury D.L., Ashwood P., Fasano A. et al. Gastrointestinal conditions in children with autism spectrum disorder: Developing a research agenda. Pediatrics, 2012, vol. 130, no. Supplement 2, pp. S160—S168. DOI:10.1542/peds.2012-0900N
  9. Danford D.E., Huber A.M. Pica among mentally retarded adults. American Journal of Mental Deficiency, 1982, vol. 87, no. 2, pp. 141—146.
  10. Danford D.E., Smith J.C., Huber A.M. Pica and mineral status in the mentally retarded. The American Journal of Clinical Nutrition, 1982, vol. 35, no. 5, pp. 958—967. DOI:10.1093/ajcn/35.5.958
  11. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington: American Psychiatric Association, 1994. 886 p. ISBN 978-0-89042-061-4.
  12. DiCagno L., Castello D., Savio M.T. A case of ulcerative colitis associated with pica: Psychological and clinical study. Minerva Pediatrica, 1974, vol. 26, no. 35, pp. 1768—1777.
  13. Edelson S.M. Research issues involving the biology of autism. Autism and Developmental Disorders (Russia), 2019, vol. 17, no. 1, pp. 4—14. DOI:10.17759/autdd.2019170102
  14. Edelson S.M., Johnson J.B. (eds.) Understanding and treating self-injurious behavior in autism. London: Publ. Jessica Kinsley Publishers, 2016. 302 p. ISBN 978-1-78450189-1.
  15. Fields V.L., Soke G., Reynolds A. et al. Pica associated with autism and other disabilities, study to explore early development. Pediatrics, in press.
  16. Greenberg M., Jacobziner H., McLaughlin M.C. et al. A study of pica in relation to lead poisoning. Pediatrics, 1958, vol. 22, no. 4, pp. 756—760.
  17. Gutelius M.F., Millican F.K., Layman E.M. et al. Nutritional studies of children with pica. Pediatrics, 1962, vol. 29, no. 6, pp. 1012—1023.
  18. Holingue C., Newill C., Lee L.C. et al. Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence. Autism Research, 2018, vol. 11, no. 1, pp. 24—36. DOI:10.1002/aur.1854
  19. Horvath K., Papadimitriou J.C., Rabsztyn A. et al. Gastrointestinal abnormalities in children with autism. The Journal of Pediatrics, 1999, vol. 135, no. 5, pp. 559—563. DOI:10.1016/s0022-3476(99)70052-1
  20. Hull M. (ed.) Pica // The Recovery Village Drug and Alcohol Rehab [Web resource]. 2020. URL: https://www. therecoveryvillage.com/mental-health/pica/   (Accessed  3.12.2020).
  21. James S.J., Cutler P., Melnyk S. et al. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. American Journal of Clinical Nutrition, 2004, vol. 80, no. 6, pp. 1611—1617. DOI:10.1093/ ajcn/80.6.1611
  22. Kang D.W., Adams J.B., Coleman D.M. et al. Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota. Scientific Reports, 2019, vol. 9, article no. 5821. DOI:10.1038/s41598-019-42183-0
  23. Kang D.W., Adams J.B., Gregory A.C. et al. Microbiota transfer therapy alters ecosystem and improves gastrointestinal and autism symptoms: An open-label study. Microbiome, 2017, vol. 5, article no. 10, pp. 1—16. DOI:10.1186/s40168-016- 0225-7
  24. Kinnell H.G. Pica as a feature of autism. British Journal of Psychiatry, 1985, vol. 147, no. 1, pp. 80—82. DOI:10.1192/ bjp.147.1.80
  25. Korman S.H. Pica as a presenting symptom in childhood celiac disease. The American Journal of Clinical Nutrition, 1990, vol. 51, no. 2, pp. 139—141. DOI:10.1093/ajcn/51.2.139
  26. Krajmalnik-Brown R., Lozupone C., Kang D. et al. Gut bacteria in children with autism spectrum disorders: challenges and promise of studying how a complex community influences a complex disease. Microbial Ecology in Health and Disease, 2015, vol. 26, no. 1, article no. 26914. DOI:10.3402/mehd.v26.26914
  27. Lourie R.S., Layman E.M., Milhican F.K. et al. A study of the etiology of pica in young children, and early pattern of addiction. In Hoch P.H., Zubin J. (eds.) Problems of addiction and habituation. New York: Publ. Grune & Stratton, 1958. 262 p.
  28. Matson J.L., Belva B., Hattier M.A. et al. Pica in persons with developmental disabilities: Characteristics, diagnosis, and assessment. Research in Autism Disorders, 2011, vol. 5, no. 4, pp. 1459—1464. DOI:10.1016/j.rasd.2011.02.006
  29. McAdam D., Cole L., Howell L. Provider’s Guide to Managing Pica in Children with Autism / Autism Speaks Autism Treatment Network [Web resource]. 2014. 7 p. URL: http://www.autismspeaks.org/sites/default/files/docs/ sciencedocs/atn/pica_professionals_guide.pdf  (Accessed 3.12.2020).
  30. Miao D., Young S.L., Golden C.D. A meta-analysis of pica and micronutrient status. American Journal of Human Biology, 2015, vol. 27, no. 1, pp. 84—93. DOI:10.1002/ajhb.22598
  31. Miller L.J., Misher K. Sensory processing disorder and self-injurious behavior. In Edelson S.M., Johnson J.B. (eds.) Understanding and treating self-injurious behavior in autism. London: Publ. Jessica Kinsley Publishers, 2016. pp. 138- 150. ISBN 978-1-78450189-1.
  32. Morozov S.A. On the issue of comorbidity in autism spectrum disorders. Autism and Developmental Disorders (Russia), 2018, vol. 16, no. 2, pp. 3—8. DOI:10.17759/autdd.2018160201
  33. Ousley O., Cermak T. Autism spectrum disorder: Defining dimensions and subgroups. Current Developmental Disorders Reports, 2014, vol. 1, no. 1, pp. 20—28. DOI:10.1007/s40474-013-0003-1
  34. Pace G.M., Toyer E.A. The effects of a vitamin supplement on the pica of a child with severe mental retardation. The Journal of Applied Behavior Analysis, 2000, vol. 33, no. 4, pp. 619—622. DOI:10.1901/jaba.2000.33-619
  35. Pangborn J.B., Baker S.M. Autism: Effective biomedical treatments: Have we done everything we can for this child?: Individuality in an autism epidemic. Boston, 2005. 118 p. ISBN 978-0-97403609-0.
  36. Polyakova S.I. The pathophysiological rationale for personalized metabolic therapy of ASD: Promising treatments. Autism and Developmental Disorders (Russia), 2019, vol. 17, pp. 55—70. DOI:10.17759/autdd.2019170106
  37. Ratey J.J., Hagerman E. Spark: The revolutionary new science of exercise and the brain. New York: Publ. Little, Brown & Co., 2008. 303 p. ISBN 978-0-31611350-2.
  38. Ristori M.V., Quagliariello A., Reddel S. et al. Autism, gastrointestinal symptoms and modulation of gut microbiota by nutritional interventions. Nutrients, 2019, vol. 11, no. 11, pp. 1—21. DOI:10.3390/nu11112812
  39. Russo A.J., deVito R. Analysis of copper and zinc plasma concentration and the efficacy of zinc therapy in individuals with Asperger’s Syndrome, Pervasive Developmental Disorder-Not Otherwise Specified (PDD/NOS) and autism. Biomarker Insights, 2011, vol. 6, pp. 127—133. doi: 10.4137/BMI.S7286
  40. Sayar S.N., Sarlatti R., Naficy M. Studies on clinical, haematological aspects and pathological changes of gastric mucosa in geophagia [Web resource]. Acta Medica Iranica, 1975, vol. 18, no. 3-4, pp. 137—147. URL: https://acta.tums.ac.ir/index. php/acta/article/view/4197 (Accessed 3.12.2020).
  41. Spek A.A., van Riijnsoever W., van Laarhoven L. et al. Eating problems in men and women with an autistic spectrum disorder. Journal of Autism and Developmental Disorders, 2020, vol. 50, pp. 1748—1755. DOI:10.1007/s10803-019-03931-3
  42. Srikantha P., Mohajeri M.H. The possible role of the microbiota-gut-brain-axis in autism spectrum disorder. International Journal of Molecular Science, 2019, vol. 20, no. 9, article no. 2115. DOI:10.3390/ijms20092115
  43. Toguleva V.K. Current Correction Techniques of Food Selectivity in Children with Autism Spectrum Disorders (ASD). Autism and Developmental Disorders (Russia), 2018, vol. 16, no. 4, pp. 21—27. DOI:10.17759/autdd.2018160404
  44. Valicenti-McDermott M., McVicar K., Rapin I. et al. Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease. Journal of Developmental and Behavioral Pediatrics, 2006, vol. 27, no. 2, pp. S128—S136.  DOI:10.1097/00004703-200604002-00011
  45. Williams D.E., McAdam D. Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners. Research in Developmental Disabilities, 2012, vol. 33, no. 6, pp. 2050—2057. DOI:10.1016/j.ridd.2012.04.001
  46. Xu M., Xu X., Li J. et al. Association between gut microbiota and autism spectrum disorder: A systematic review and meta- analysis. Frontiers in Psychiatry, 2019, vol. 10, pp. 1—11. DOI:10.3389/fpsyt.2019.00473

Information About the Authors

Dean D. Alexander, PhD, Principal Investigator, Quality Assurance Study, Lanterman Developmental Center, ORCID: https://orcid.org/0000-0003-3562-9573, e-mail: deanalexanderphd@gmail.com

Stanley E. Lunde, PhD, Director of Research, Lanterman Developmental Center, USA, ORCID: https://orcid.org/0000-0002-5836-4486, e-mail: stanlunde@gmail.com

Dale E. Berger, PhD, Professor of Psychology, Claremont Graduate University, USA, ORCID: https://orcid.org/0000-0002-5595-9492, e-mail: Dale.Berger@cgu.edu

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