GI Symptoms Linked to Behavioral Problems in Children, Especially Those With Autism

AHA Publisher — Tue, 11 Aug 2020 07:00:50 +0000

University of California – Davis Health via EurekAlert – A new UC Davis Health study found that common gastrointestinal (GI) symptoms such as diarrhea, constipation and bloating are linked to troubling sleep problems, self-harm and physical complaints in preschool children. According to the study, published Aug. 6 in Autism Research, these GI symptoms are much more common and potentially disruptive in young kids with autism. “Clinicians and parents need to be aware of the high occurrence of GI problems in kids with autism,” said Bibiana Restrepo, assistant clinical professor of pediatrics and first author on the study. “This study highlights the link between GI symptoms and some problematic behaviors we see in preschool-aged children.” Children With Autism Experience More Gastrointestinal Symptoms Gastrointestinal concerns are frequently reported by parents of children with autism spectrum disorder (ASD). Researchers from the UC Davis MIND Institute evaluated the presence of GI symptoms in preschool-aged children with and without autism. The study included 255 (184 males/71 females) children with ASD between two and 3.5 years of age and 129 (75 males/54 females) typically developing children in the same age group. Pediatricians specializing in autism interviewed caregivers during the children’s medical evaluation. They asked the parents how often their children experienced GI symptoms such as difficulty swallowing, abdominal pain, bloating, diarrhea, constipation, painful stooling, vomiting, difficulty swallowing, blood in stool and blood in vomit. The researchers grouped children in two categories: those who experienced one or more GI symptom and those who never or rarely had GI symptoms in the last three months. They compared the children in the two groups on measures of developmental, behavioral and adaptive functioning. The study found that preschool-aged children with ASD were 2.7 times more likely to experience GI symptoms than their typically developing peers. In fact, almost 50% of children with ASD reported frequent GI symptoms – compared to 18% of children with typical development. Around 30% of the children with ASD experienced multiple GI symptoms. Problem Behaviors as an Expression of GI Discomfort in Children Multiple GI symptoms were associated with increased challenges with sleep and attention, as well as problem behaviors related to self-harm, aggression and restricted or repetitive behavior in both autistic and typically developing children. The severity of these problems was higher in children with autism. “Problem behaviors may be an expression of GI discomfort in preschool-aged children,” said Christine Wu Nordahl, associate professor at UC Davis MIND Institute and the department of psychiatry and behavioral sciences. “GI symptoms are often treatable, so it is important to recognize how common they are in children with autism. Treating their GI symptoms could potentially provide some relief to the kids and their parents.” The study found no link between GI symptoms and the children’s cognitive development or gender. GI symptoms were equally common in male and female preschool children. To read the original article click here.

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Early-Intervention Helps Parents to Manage Toddlers with Challenging Behaviors

AHA Publisher — Fri, 03 Jul 2020 07:00:27 +0000

UNSW Sydney via News-Medical Net – “One of the best things a parent can do is to help their child understand and manage their emotions. We can’t expect young toddlers to do it themselves.” A play-based therapy aimed at helping parents manage children’s behavior has seen long-lasting results in a live trial. Parents of young toddlers with challenging behaviors have found support through a new early-intervention program aimed at children aged 12-24 months, a study has shown. The unique program focuses on not only addressing the child’s behavioral problems, but also enriching the relationship between the parent and the child. It was developed by researchers at UNSW Sydney and the early parenting organization, Karitane. “Having young toddlers can be hard, but it’s especially hard when your child is having multiple tantrums per day and showing aggression. It can make it difficult to enjoy parenting. Our findings are encouraging for so many parents because this program is a new way of learning how to manage these behaviors, improve the quality of your relationship with your toddler, and also to put them on a positive pathway.” Dr Jane Kohlhoff, lead author of the study and senior lecturer in UNSW Medicine’s School of Psychiatry The eight-week program takes place during weekly parent-child play sessions. The parent and child play together while a therapist – who sits behind a one-way mirror in another room – coaches the parent in how to best respond to challenging behaviors via a Bluetooth earpiece. “The therapist first helps the parent identify the source of the child’s challenging behavior and then guides them in how to respond. This instant feedback is supportive and powerful,” says Dr Kohlhoff. “As parents become better equipped to identify why the child is being disruptive, they can help the child manage and regulate their emotions. With this support, the child will gradually become better at doing this on their own.” While this style of parent coaching (called ‘Parent-Child Interaction Therapy’) has been used before, it’s the first time the method has been adapted to young toddlers as an early intervention technique. A check up with the families four months after the program, the trial’s set follow-up period, show that the benefits were long lasting. The results were published over the weekend in Infant Mental Health Journal. “Not only were there dramatic improvements in children’s behavior, but also in parenting sensitivity and the quality of the relationship between the parent and the child,” says Dr Kohlhoff. “Parents also reported feeling less stressed after the program.” These program outcomes were measured using a series of parent-report surveys and therapist observations of parent and child behavior. The long-term findings support the immediate benefits of the program, which were tested in a randomized controlled trial and published in Journal of Clinical Child & Adolescent Psychology earlier this year. While the cohort of this pilot study was small (25 parents completed the program and 18 completed the follow-up), the findings are an important first step in testing the effectiveness of Parent-Child Interaction Therapy for toddlers. Finding the Cause of the Behavior Adrienne* decided to join the program after noticing her daughter’s tantrums were a bit different to other kids her age. “Sophie* was constantly screaming, crying and throwing tantrums,” says Adrienne. Her daughter was 15 months old when they joined the program. “At that young age, she didn’t have the words to say what she wanted, so she used her voice to get attention.” During the intervention, parents are coached to identify the cause of the child’s disruptive behavior and respond accordingly. If the behavior stems from difficulty regulating emotions, the parent is coached to see the behavior as a sign that the child is having difficulty managing a ‘big emotion’. “One of the biggest benefits about the program is that it teaches parents to reconceptualise their child’s challenging behaviors. Often, the behavior isn’t a deliberate disobedience, but a result of the child’s struggle with new, big emotions, like frustration, fear and anxiety.” Dr Jane Kohlhoff When the child is struggling with a big emotion, the parent is coached to use practical techniques to help the child become calm again. “If a child starts to play roughly with their toys, it may be because they are having difficulty knowing how they work,” says Dr Kohlhoff. “For example, take a child in a play kitchen trying to get a large toy saucepan to fit into a small oven. For a young child, this can be frustrating and the feelings may escalate quickly. It may lead them to become rough and aggressive, or to have a tantrum. “In this instance, the parent would be coached to notice this change in emotion early, and then to move closer to the child and validate their emotions by saying, ‘I know you are feeling frustrated right now’. The parent could also reassure the child by saying ‘Mummy is here to help you’, while soothing them with a calm voice, showing physical comfort, and suggesting another place to put the saucepan.” Adrienne found this style of on-the-spot guidance invaluable. “It really helped getting instant advice through the headset,” says Adrienne. “My husband and I feel more at ease with knowing how to help her during meltdowns. “Our relationship with our daughter improved. We learnt important play skills, like the way we sit on mats with her and how we use our language. “I’m more mindful of what I say – for example, I’ve learnt to be specific in my praises rather than saying something general, like ‘Good girl,’ when she’s behaving well.” The Importance of Early Intervention While it’s normal for children to express aggression and irritability, persistent challenging behaviors could be a sign that a child is on a pathway towards increased psychological problems as they grow older. “Emotion regulation problems underly many adult psychological disorders. By addressing these behaviors early, it can help give children the best chance in their future mental health. A positive parent-child relationship in the early years is a key indicator for a child’s lifelong psychological health. Letting the child lead the play, using lots of specific praises, and just having fun together are really important for the child.” Dr Jane Kohlhoff Facilitating Long-Lasting Change “Children at this young age are still trying to work out what emotions are, and how to navigate them,” says Dr Kohlhoff. “One of the best things a parent can do is to help their child understand and manage their emotions. We can’t expect young toddlers to do it themselves.” This research was conducted in southwestern Sydney at parenting organisation Karitane, who contributed funding to the program. The program is now part of the suite of clinical treatments offered at the Karitane Toddler Clinic, and Dr Kohlhoff says it is the kind of program that could be taught to other clinicians and rolled out to other clinics further down the track. To build on this research, Dr Kohlhoff is conducting a larger randomized control trial to evaluate how the Parent-Child Interaction Therapy for toddlers program compares to other parenting programs. *Names of the program participants have been changed. To read the original article click here.

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GI Symptoms Linked to Behavioral Problems in Children, Especially Those With Autism

Early-Intervention Helps Parents to Manage Toddlers with Challenging Behaviors