Introduction
Autism is a neurodevelopmental disorder of the brain function that affects the person’s speech, communication, interaction, learning, and behavior. It is a complex disease with diverse etiology and multiple factors. They are neurodevelopmental disorders because it generally occurs in the first two years of life. It is called a spectrum because of the wide variation in the types and severity of autism.
What Is Autism Spectrum Disorder (ASD)?
It is a developmental disorder due to differences in the brain. Genetic factors contribute to the disease. Genetics, biology, and environment are some of the critical factors. Having older parents, infections during birth can increase the chance of ASD. It is more common in males than females. People with Down’s syndrome, fragile X syndrome, and tuberous sclerosis are more likely to have autism spectrum disorder. There are high chances of autism in a person with a family history of autism spectrum disorder. Fragile X syndrome is one of the causes of intellectual disability. 1 in 200 people with autism has fragile syndrome. It has a vital genetic component with the interaction of many genes. Some of the genes of autism related to brain metabolism are AVPR1a, DISC1, DYX1C1, ITGB3, SLC6A4, RELN, RPL10, and SHANK3.
What Are the Signs and Symptoms of Autism?
The characteristics of ASD include:
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Gastrointestinal issues such as constipation.
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Gastrointestinal symptoms such as diarrhea and abdominal pain.
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They have poor diets and weight-related health issues.
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More fear than usual or lack of fear.
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Abnormal sleeping and eating habits.
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Not making eye contact with others.
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The trouble with change in routine.
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Delay in learning and communication.
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Unusual or no response to gestures.
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Repeated body movements such as spinning, locking, and flapping hands.
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Obsession with specific objects.
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They have delayed language skills.
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Unusual emotional disturbances.
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Repetitive or restricted behaviors include children repeating the exact words or phrases repeatedly (echolalia).
Why Are Mealtime Issues More Common in Autistic Children?
The mealtime issues in autistic children are:
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Gastrointestinal (GI) disorders are the most common comorbid conditions in autism. Left untreated can lead to sleep, behavioral and psychiatric disorders.
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Gastrointestinal disorders are more prevalent in ASDs. For example, children with ASD are five times more likely to develop food refusal, poor oral intake, and food selectively.
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It is more common in patients, with 46 percent to 84 percent standard in autistic individuals. The most common gastrointestinal problems observed in children are chronic diarrhea, gastroesophageal reflux, nausea, vomiting, abdominal discomfort, inflammatory bowel disease, and food intolerance.
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Signs of gastrointestinal inflammation, stools, vomiting, and gaseousness are increased in some autistic individuals. They have altered carbohydrate digestion.
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Increased gastrointestinal permeability is linked to autism which has detrimental effects on intestinal barrier integrity with the potential translocation of intestinal bacteria and consequent immune activation.
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For example, GI disturbances can influence the production of serotonin from the gut enterochromaffin cells and leakage of bacterially modulated metabolites across the intestinal epithelium and into the blood, suggesting elevated levels of bacterial metabolites seen in the urinary and serum metabolites.
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The mechanisms of gastrointestinal problems include microbiota dysregulation, dietary metabolites, and gut inflammation. In addition, some medications, such as beta-blockers, can cause diarrhea, stomach irritation, and constipation.
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The GI disorders cause pain and discomfort and interfere with learning in individuals with ASD. The behavioral problems present as odd posturing and self-injury with no apparent causes. Lactate deficiency associated with intestinal inflammation or injury is common in children with autism and may contribute to abdominal discomfort, pain, and behavioral patterns.
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Healthcare professionals should consider the possibility of gastrointestinal dysfunction in patients with ASD with odd postures or movements, sleep disturbances, and self-injurious behaviors.
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The symptoms are difficult to diagnose in ASD because no clinical practice guidelines provide routine consideration of possible gastrointestinal symptoms and other medical conditions in patients with ADS.
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Children with severe autism are more likely to have gastrointestinal symptoms. In addition, they are associated with food intolerances and sleep disturbances. Therefore it is crucial to consider the association between the comorbidities and primary disease before treating it.
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The history of eating patterns, food allergies, and stool patterns are assessed before treating the disease. Vocal and motor disturbances reflect the presence of GI disturbances. Seeking belly pressure, neck or body posture, certain repetitive behaviors, and aggressive behaviors are associated with gastrointestinal disorders.
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A widespread finding in ASD is a measurement of intestinal permeability, a significant blood marker to evaluate abnormal intestinal permeability.
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Overall, changes in the GI system can influence brain function through the gut-brain axis and by the indirect connections of the gut to the brain through alterations in immunity and metabolism.
What Are the Sleep Disturbances in Autism Spectrum Disorders?
The sleep disturbances in autism are:
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Sleep disorder is a significant problem in autism. Sleep affects not only children but parents as well. The sleep disorders in autism include the inability to sleep in a flat position, nighttime awakenings, inattention, learning problems, and sleepwalking. It can be due to sleep apnea (sleeping disorder) or the side effects of some medications.
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An irregular sleep pattern affects the overall functioning of the body. In addition, sleep disorders are associated with gastrointestinal disturbances in many individuals.
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The etiologies of sleep disorders in ASD children are multifactorial, with genetic, environmental, immunological, and neurological factors thought to play a role in the development of ASD. In addition, there is evidence of an association between sleep and melatonin rhythms, with alterations in this synchronization of the melatonin rhythm causing sleep problems.
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Neurotransmitters such as serotonin, GABA, and melatonin are required for establishing a regular sleep-wake cycle. Therefore, any impairment in the production of these neurotransmitters may disrupt sleep.
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Melatonin is a hormone that helps maintain and synchronize the circadian (sleep) rhythm. Melatonin regulation may be abnormal in autism. Exogenous therapy of melatonin has been shown to improve sleep patterns in ASD children.
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For melatonin, the body needs tryptophan which is higher or lower than normal levels in autistic children.
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Vitamin D is required for embryogenesis, neural development, and activating specific genes; deficiency in this vitamin during pregnancy could be an environmental risk factor for the development of ASD.
What Is the Treatment for Sleep and Mealtime Issues in ASD?
The parents should work with a dedicated team that cares for the child. The group involves a dietician or nutritionist. They will assess the child’s food pattern and nutritional requirements. The deficiencies are present even if the growth appears appropriate. The dietician should address the problems like food selectivity and food allergies. A diet plan is made to avoid constipation, diarrhea, and abdominal pain. Coaching should be given to parents regarding preparing a nutritious meal. Establishing a nighttime routine, such as reading stories and bathing before bed, can help. Prescribing melatonin to the child before bedtime. It can help normalize the sleep-wake cycle in autistic children with sleep issues. Exposing the child to bright light in the morning will help regulate melatonin levels that make them feel active and awake throughout the day.
Conclusion
Parents are encouraged to create environmental factors such as proper diet, regular sleep, and limited screen time to minimize the symptoms of autism. They can use white noise and dark curtains to engage them in sound sleep. Parents can sit together while eating, encouraging the child to eat through imitation. Eating in front of the television should be avoided.
