Prevalence of gastrointestinal symptoms among autistic individuals, with and without co-occurring intellectual disability.
Parents of autistic kids with ID are markedly less sure about subjective tummy complaints—use objective GI indicators and direct measures.
01Research in Context
What this study did
Holingue et al. (2023) asked parents about tummy trouble in autistic kids. Some kids also had intellectual disability (ID). Parents rated how sure they were about each GI sign.
The team compared certainty levels between the two groups. They looked at both subjective complaints (pain, nausea, bloating) and objective signs (constipation, diarrhea).
What they found
Parents of autistic kids with ID were far less certain about subjective GI complaints. Yet they were just as sure about visible signs like constipation or diarrhea.
This gap means clinicians may miss hidden pain in youth who cannot speak clearly.
How this fits with other research
Lu et al. (2025) meta-analysis shows probiotic or synbiotic supplements cut GI distress in autistic children. Calliope’s data warn that kids with ID may still hurt even if parents do not report it, so use objective outcome measures in these trials.
Andreo-Martínez et al. (2022) found lower Bifidobacterium in autistic children. Calliope’s survey supports the need for such biological markers, because parent report alone can under-count symptoms in the ID subgroup.
Wong et al. (2025) mapped distinct Rome-IV GI subtypes in autism and linked pain subtypes to worse repetitive behaviors. Calliope extends this by showing that pain reports themselves may be unreliable when ID is present, strengthening the case for multi-informant and direct assessment.
Why it matters
If you work with autistic clients who have limited speech, do not rely only on parent report for tummy pain. Add direct probes: bowel logs, meal response charts, or belly palpation during sessions. Also track hard signs you can see or measure—stool type, eating speed, or night waking. When you consult med-providers, share both the objective data and the uncertainty level so treatment decisions are not delayed.
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02At a glance
03Original abstract
Gastrointestinal symptoms (GI) are very common among individuals on the autism spectrum. Prior research reports mixed findings regarding whether individuals with autism and co-occurring intellectual disability (ID) have elevated risk of gastrointestinal symptoms relative to individuals with autism alone. GI symptoms can be challenging to assess in individuals with autism spectrum disorder (ASD) and/or ID given challenges with language, communication, and interoception. Prior research has tended to only include individuals with documented presence or absence of GI symptoms or conditions, that is, to exclude observations in which there is uncertainty regarding presence of GI symptoms. Therefore, none of the prior autism studies reported the association between ID and the certainty regarding presence or absence of GI symptoms. The objective of this study was to examine differences in parental certainty and odds of reporting gastrointestinal signs and symptoms among children on the autism spectrum, with and without intellectual disability. Participants were 308 children (36% ID) with a clinical diagnosis of autism spectrum disorder (6-17 years). Parents endorsed whether their child had experienced or displayed a range of signs or symptoms related to GI problems in the past 3 months. Parents of autistic children with ID were less certain about the presence of more subjective symptoms, including abdominal pain, nausea, and bloating. Conversely, certainty regarding more objective signs (e.g., constipation, diarrhea, spitting up, etc.) was not significantly different. More accurate measures for GI signs/symptoms are needed for this population.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1016/j.cell.2021.10.015