Gastrointestinal and Psychiatric Symptoms Among Children and Adolescents With Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) are at heightened risk of psychiatric comorbidities across the lifespan, including elevated rates of internalizing, externalizing, and self-injurious behaviors. Identification of medical comorbidities that contribute to these concerns may elucidate mechanisms through which psychiatric concerns arise, as well as offer additional avenues for intervention. Gastrointestinal (GI) conditions are of particular interest, as they are prevalent among those with ASD, may share genetic or neurobiological etiologies with the core features of ASD, and are linked with psychiatric difficulties in the general population. In this paper, we draw on data from nearly 2,800 children and adolescents with ASD within the Simons Simplex Collection to characterize the unique contributions of (1) autism symptoms, (2) psychosocial factors (child's age, sex, verbal and nonverbal IQ, adaptive behavior, race, and household income), and (3) GI concerns with respect to multiple psychiatric outcomes. Multiple regression models revealed unique contributions of ASD symptoms and multiple psychosocial factors such as verbal IQ, adaptive behavior, and family income to internalizing, externalizing, and self-injurious behavior. In general, higher levels of psychiatric symptoms were associated with more ASD symptoms, higher verbal IQ, lower adaptive behavior skills, and lower family income. Furthermore, levels of GI symptoms accounted for unique variance in psychiatric outcomes over and above these other factors, linking increased GI problems with increased psychiatric symptoms in children with ASD. Taken together, results indicate that the presence and quantity of GI symptoms should be considered when evaluating psychiatric and behavioral concerns among children with ASD, and that treatment of GI conditions may be an important component in alleviating a broad array of mental health concerns in this group

Heart Rate Variability and Autonomic Function: A Study of Adolescents with Chronic Abdominal Pain and Healthy Adolescents

Thesis (Master's)--University of Washington, 2022Background: Chronic abdominal pain is often accompanied by autonomic dysfunction. It is hypothesized that dysregulation of the autonomic nervous system (ANS) results in poorer physiological modulation to physical and psychological stress in the context of persistent pain. Research in adults with chronic pain conditions identified decreased parasympathetic activation using heart rate variability (HRV), as a measure of ANS function. However, data are limited in pediatric chronic abdominal pain populations. Thus, the objectives were to: 1) characterize and compare the subjective and objective (HRV) assessment of autonomic dysfunction in adolescents with chronic abdominal pain to pain-free adolescents, 2) investigate the association of psychological factors (anxiety, depression and pain catastrophizing) with the subjective and objective autonomic dysfunction in adolescents with chronic abdominal pain, and 3) quantify and compare HRV under a psychologically stressful condition between adolescents with chronic abdominal pain and pain-free adolescents.Methods: This was a prospective study of adolescents with chronic abdominal pain and pain-free adolescents. Adolescents with chronic abdominal pain were recruited from Seattle Children’s Hospital’s (SCH) Gastroenterology and Pain Medicine Clinics; pain-free adolescents were recruited through mailings from Seattle Children’s Hospital (October 2019 to April 2022). Adolescents completed questionnaire measures on abdominal pain severity, pain-related disability, autonomic dysfunction, anxiety, depression, and pain catastrophizing. Adolescents also underwent continuous monitoring of HRV in the laboratory whilst undergoing the Trier Social Stress Test which included a baseline relaxed state, and an experimentally induced psychological stress state. The HRV parameters tested were the time-domain index root mean square of the successive differences of NN intervals (RMSSD) and frequency-domain index of the proportion of HRV occurring at low frequency (LF). Results: There were 60 adolescents, 33 with chronic abdominal pain, and 27 pain-free peers (females = 68.3%, mean age = 16.3 years, SD = 0.2) enrolled in the study. The groups were similar with respect to age, race, and ethnicity, with proportionately more females in the group with chronic abdominal pain. Adolescents in the chronic abdominal pain group reported an average pain intensity of 5.0 (SD = 2.2) on the 0 to 10 Numerical Rating Scale, and had clinically high levels of anxiety, depression, and pain catastrophizing. Multivariable analysis revealed that adolescents with chronic pain had, on average, a 22.3-point higher COMPASS31 scores compared to pain-free adolescents (p < 0.001, 95% confidence interval (CI): 14.1, 30.5) after adjusting for age and sex. For objective measures of HRV, adolescents with chronic pain had lower RMSSD by 157 msec2 (95% CI: -331, 17.5), and lower LF by 337 (95% CI: -1023, 350), however these differences were not statistically significant (RMSSD: p = 0.07, LF: p = 0.33) when adjusting for age and sex. Specific to adolescents with chronic abdominal pain, tests of the associations between anxiety, depression, and pain catastrophizing with self-reported autonomic dysfunction or HRV parameters (RMSSD, LF) were not statistically significant after accounting for age, sex, and abdominal pain severity. In a linear mixed model for RMSSD, the impact of induced stress (compared to baseline) for adolescents with chronic abdominal pain was not significantly different than what was seen in pain-free adolescents (130.9 msec2 higher, 95% CI: -159, 240), p = 0.37). LF was 1243.73 higher (95% CI: 374, 2113) for adolescents with chronic abdominal pain due to the impact of induced stress (from baseline assessment; p = 0.006) compared to pain-free adolescents. Conclusion: Adolescents with chronic abdominal pain evidenced greater autonomic symptomatology on subjective report compared to pain-free adolescents, however HRV parameters (RMSSD, LF) were not significantly different between groups. For adolescents with chronic abdominal pain, there was no statistically significant association between self-reported autonomic dysfunction or HRV parameters with the tested psychological factors. Compared to pain-free peers, adolescents with chronic abdominal pain had significantly higher increases in LF but not RMSSD from baseline to induced stress compared to pain-free peers. Findings in this study need to be replicated given the small sample sizes, and the differences identified with regard to time- versus frequency-domain HRV parameters

Subjective and Objective Assessment of Sleep in Adolescents with Mild Traumatic Brain Injury

There is increased recognition that sleep problems may develop in children and adolescents after mild traumatic brain injury (mTBI). However, few studies have utilized both subjective and objective measures to comprehensively assess sleep problems in the pediatric population following the acute post-TBI period. The aims of this study were to compare sleep in adolescents with mTBI to healthy adolescents using subjective and objective measures, and to identify the clinical correlates associated with sleep problems. One hundred adolescents (50 adolescents with mTBI recruited from three to twelve months post-injury and 50 healthy adolescents) completed questionnaires assessing sleep quality, depression, and pain symptoms, and underwent 10 day actigraphic assessment of sleep patterns. Adolescents with mTBI reported poorer sleep quality and demonstrated significantly shorter actigraphic-measured sleep duration, poorer sleep efficiency, and more wake time after onset of sleep, compared with healthy adolescents (all, p <0.05). For both groups of adolescents, poorer self-reported sleep quality was predicted by greater depressive symptoms. Poorer actigraphic sleep efficiency was predicted by membership in the mTBI group after controlling for age, sex, depressive symptoms, and presence of pain. Our findings suggest that adolescents may experience subjective and objective sleep disturbances up to one year following mTBI. These findings require further replication in larger samples. Additionally, research is needed to identify possible mechanisms for poor sleep in youth with mTBI

Subjective and Objective Assessment of Sleep in Adolescents with Mild Traumatic Brain Injury

There is increased recognition that sleep problems may develop in children and adolescents after mild traumatic brain injury (mTBI). However, few studies have utilized both subjective and objective measures to comprehensively assess sleep problems in the pediatric population following the acute post-TBI period. The aims of this study were to compare sleep in adolescents with mTBI to healthy adolescents using subjective and objective measures, and to identify the clinical correlates associated with sleep problems. One hundred adolescents (50 adolescents with mTBI recruited from three to twelve months post-injury and 50 healthy adolescents) completed questionnaires assessing sleep quality, depression, and pain symptoms, and underwent 10 day actigraphic assessment of sleep patterns. Adolescents with mTBI reported poorer sleep quality and demonstrated significantly shorter actigraphic-measured sleep duration, poorer sleep efficiency, and more wake time after onset of sleep, compared with healthy adolescents (all, p<0.05). For both groups of adolescents, poorer self-reported sleep quality was predicted by greater depressive symptoms. Poorer actigraphic sleep efficiency was predicted by membership in the mTBI group after controlling for age, sex, depressive symptoms, and presence of pain. Our findings suggest that adolescents may experience subjective and objective sleep disturbances up to one year following mTBI. These findings require further replication in larger samples. Additionally, research is needed to identify possible mechanisms for poor sleep in youth with mTBI

Household Food Insufficiency and Chronic Pain among Children in the US: A National Study

This study aimed to determine the prevalence of pediatric chronic pain by household food sufficiency status and examine whether food insufficiency would be associated with greater risk for chronic pain. We analyzed data from the 2019&ndash;2020 National Survey of Children&rsquo;s Health of 48,410 children (6&ndash;17 years) in the United States. Across the sample, 26.1% (95% CI: 25.2&ndash;27.0) experienced mild food insufficiency and 5.1% (95% CI: 4.6&ndash;5.7) moderate/severe food insufficiency. The prevalence of chronic pain was higher among children with mild (13.7%) and moderate/severe food insufficiency (20.6%) relative to children in food-sufficient households (6.7%, p &lt; 0.001). After adjusting for a priori covariates (individual: age, sex, race/ethnicity, anxiety, depression, other health conditions, adverse childhood events; household: poverty, parent education, physical and mental health; community: region of residence), multivariable logistic regression revealed that children with mild food insufficiency had 1.6 times greater odds of having chronic pain (95% CI: 1.4&ndash;1.9, p &lt; 0.0001) and those with moderate/severe food insufficiency, 1.9 higher odds (95% CI: 1.4&ndash;2.7, p &lt; 0.0001) relative to food-sufficient children. The dose&ndash;response relationship between food insufficiency and childhood chronic pain highlights the importance of further research to identify underlying mechanisms and evaluate the impact of food insufficiency on the onset and persistence of chronic pain across the lifespan

Household Food Insufficiency and Chronic Pain among Children in the US: A National Study

This study aimed to determine the prevalence of pediatric chronic pain by household food sufficiency status and examine whether food insufficiency would be associated with greater risk for chronic pain. We analyzed data from the 2019–2020 National Survey of Children’s Health of 48,410 children (6–17 years) in the United States. Across the sample, 26.1% (95% CI: 25.2–27.0) experienced mild food insufficiency and 5.1% (95% CI: 4.6–5.7) moderate/severe food insufficiency. The prevalence of chronic pain was higher among children with mild (13.7%) and moderate/severe food insufficiency (20.6%) relative to children in food-sufficient households (6.7%, p p p < 0.0001) relative to food-sufficient children. The dose–response relationship between food insufficiency and childhood chronic pain highlights the importance of further research to identify underlying mechanisms and evaluate the impact of food insufficiency on the onset and persistence of chronic pain across the lifespan