(PS11-D92) Relations Between Gender, Gastrointestinal Symptoms, and Poor Sleep Quality in Autistic Youths

Gastrointestinal (GI) symptoms (e.g., constipation, abdominal pain, flatulence, and diarrhea) and sleep problems (e.g., insomnia, nightmares, daytime sleepiness) are common in autistic youths. Challenges in these areas are related to daily function and result in maladaptive behaviors (e.g., poor transitions, increased meltdowns, and decreased participation in daily routines). However, there has been relatively little work that has examined how these health problems are linked and if there are sex differences in these domains. Examining the relation between sleep and GI problems and identifying for which youth these symptoms are most prevalent may have important implications for clinical practice. 

Participants were 2,142 caregivers of autistic youths ( age 6-17; M age = 11.00, SD = 3.18; 81.9% male). Caregivers completed the Gastrointestinal Severity Index (6-GSI) to assess six GI symptoms: constipation, diarrhea, stool consistency, stool smell, flatulence, and abdominal pain. Caregivers also completed items assessing the degree to which their youth’s overall GI symptoms was perceived to (1) be impairing in any domain (2) impact the youth’s daily functioning. Sleep quality was assessed using the Children’s Sleep Habits Questionnaire. Bivariate correlations showed that poor sleep and all GI symptoms were positively correlated (r’s .154 - .406, p’s < .001 for all), except constipation (r =-.092, p < .001). Results of ANOVAs showed main effects for gender and impairment, F(1, 2140) = 12.20, p < .001, daily function F(1, 2140) = 14.307, p < .001, flatulence, F(1, 2140) = 11.07, p < .001) and abdominal pain F(1, 2140) = 29.73, p < .001), with girls having more frequent problems across these items. No main effects were observed for the other symptoms. Sleep quality was dichotomized at the average number of nights/week with sleep problems (cutoff =1.51 for adequate and poor sleep groups). ANOVAs showed that youths with poor sleep had higher scores on impairment, F(1, 2140) =146.59, p < .001, function, F(1, 2140) = 155.98, p < .001 and all 6-GSI items (p < .001 for all) Youths were then classified into one of four groups based on gender and sleep quality: girls with poor sleep, girls with adequate sleep, boys with poor sleep, boys with adequate sleep. ANOVAs were then performed to examine group differences across all GI symptoms. Across almost all symptoms, youths with poor sleep showed worse GI symptoms, regardless of gender. Girls with poor sleep reported more abdominal pain than all other groups. 

Results suggest that certain GI symptoms, as well as impact and impairment associated with GI symptoms, occur more frequently in girls than boys.The findings also suggest that sleep problems and GI symptoms are closely related, such that youths experience problems in these domains simultaneously. Further research is needed to examine reasons for gender differences in sleep and GI symptoms in autistic youths, and to determine the temporal relation between these health problems. Examining these differences may have implications for clinical practice, specifically related to increased success in functional participation in activities of daily living.