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diagnosed among the developmental disabilities and it presents differently in children affected by the disorder. This is because it is a spectrum disorder which manifests in varied ways and degrees in each individual leading to unique experiences. Thus, no two children with autism are the same therefore, their unique abilities as well as challenges direct the type of support required to meet their needs including their healthcare needs.25 Children with autism often face complex and diverse physical and mental health challenges including co-morbidities such as schizophrenia and bipolar disorders, sleep disturbances, seizures, eating and feeding challenges.26 Also, they frequently experience gastrointestinal problems, epilepsy, obesity, ADHD, anxiety and depression. These are serious conditions that are experienced throughout life and which often impact the health and quality of life of individuals with autism negatively as well as resulting in an increased rate of premature death.12 These conditions and their treatments are described in the subsection below. Gastrointestinal Disorders Gastrointestinal disorders (GI) are problems that most commonly affect children with autism when compared to their typically developing peers. Literature reveals that children with autism are about eight times more likely to be diagnosed with one or more chronic GI problems than are their typically developing peers.23 Common examples of GI conditions include recurrent abdominal pain, diarrhea, gaseousness, bowel inflammation, gastroesophageal reflux, painful stooling and chronic constipation. Studies have revealed an association between chronic GI issues and increased severity of the behavioral symptoms of autism. These include social withdrawal, repetitive behaviors, hyperactivity and irritability. It is stated that the link is mostly strong among children with autism who are nonverbal and often have problems communicating pain and distress. It is believed that unhealthy changes in the normal flora (the microbiome) in the intestinal tract cause both behavioral and GI problems in some individuals with autism. Also, it has been shown that the brain could be affected directly by spikes in toxinproducing bacteria in the intestines through the vagus nerve that runs between the digestive tract and the brain.27 The following paragraphs examine GI problems commonly affecting children with autism. CHRONIC CONSTIPATION Constipation can be defined as difficulties producing bowel motions due to hard stools. According to CDC children with autism are more than 3.5 times likely to be affected by chronic constipation or diarrhea compared to normally developing children.21 Chronic constipation (lasting two-weeks or more) in patients with autism are mostly linked to insufficient fiber intake and some behavioral medications such as Risperidone. Also, sensory and/or behavioral issues that hamper regular toileting are implicated. Furthermore, metabolic, anatomic, or neurological problems and a sluggish intestinal tract are less common but potentially more serious factors that may predispose a child with autism to chronic constipation. Constipation is effectively treated using a mixture of medical and behavioral interventions. Medications such as soluble fiber and/or laxatives for example, mineral oil, magnesium hydroxide or sorbitol could be used to manage constipation.27 On the other hand, behavioral treatment entails modifications in diet for instance, eating more fiber producing foods, avoiding foods that cause constipation as well as instructing the individual to increase fluid intake and make attempts to defecate after each meal by sitting on the toilet pot. CHRONIC DIARRHEA Chronic diarrhea refers to the passing out of frequent watery stools more than three times a day for two or more weeks. Possible medical causes may include immune dysfunction, inflammatory bowel and irritable bowel diseases, intestinal infection. Recently, researchers have reported unusually high-levels of several kinds of toxin-producing Clostridia bacteria among children with autism.27 It is believed that diarrhea in persons with autism is most often caused by severe constipation. This occurs when hard, impacted stool results in a backup of
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