COMPLEX CARE RESOURCE

Gastrointestinal Disorders & Autism

Behavior is communication, and sometimes it is the body’s way of signaling that something is wrong. For many autistic individuals, gastrointestinal (GI) conditions such as constipation, reflux, abdominal pain, or other digestive concerns can affect sleep, mood, attention, participation, and overall quality of life. Because some autistic individuals may have difficulty recognizing, localizing, describing, or communicating physical discomfort, they may express GI problems through behavioral changes rather than words.

Research shows that GI symptoms are significantly more common in autistic individuals than in the general population, yet these concerns are often overlooked or mistaken for behavioral challenges. Understanding the signs of GI discomfort can help families identify potential medical concerns and seek appropriate care.

Catatonia & Autism

THE MOST IMPORTANT QUESTION

Is this new or significantly
different for this person?

Look for change from the individual’s own baseline, rather than comparing them with someone else.

RECOGNIZING CHANGE

What are gastrointestinal (GI) issues?

Gastrointestinal (GI) issues are problems involving the digestive system. Common GI concerns include:

Constipation

Diarrhea

Reflux or heartburn

Abdominal (stomach) pain

Bloating or gas

Nausea or vomiting

Feeding and eating difficulties

GI issues can affect a person’s comfort, sleep, behavior, participation in daily activities, and overall quality of life.

LEARN MORE

Understanding Gastrointestinal Disorders & Autism

GI Issues & Autism

Yes. Research shows that approximately 49%–55% of individuals with Autism experience at least one GI symptom, compared to approximately 30%–33% of children in the general population.

Common GI concerns reported in autistic individuals include:

  • Constipation (37%)
  • Bloating (23%)
  • Abdominal pain (21%)
  • Diarrhea (19%)

Some autistic individuals have limited spoken language, use alternative forms of communication, or may be unable to communicate pain or discomfort in a way that others recognize.

In addition, many autistic people experience differences in interoception, the body’s ability to recognize, correctly localize, and interpret internal sensations such as hunger, thirst, pain, nausea, or the need to use the bathroom.

Because of these differences, a person may:

  • Have difficulty recognizing pain or discomfort
  • Be unable to identify where the pain is located
  • Struggle to describe what they are feeling
  • Not connect a physical sensation with a medical problem
  • Be unable to communicate that something hurts
  • Communicate pain through behavior rather than words

As a result, GI issues may go unrecognized for long periods of time.

For some individuals, pain may be expressed through:

  • Irritability or agitation
  • Aggression
  • Self-injurious behavior
  • Sleep disturbances
  • Food refusal, or over-eating/drinking
  • Chewing on non-edibles
  • Increased repetitive behaviors
  • Posturing – holding unusual body positions, such as bending over, curling up, arching the back, squatting, or lying in a specific position to relieve discomfort or pressure
  • Chinning – repeatedly pressing the chin, chest, abdomen, or upper body against furniture, countertops, cushions, or other surfaces to seek pressure, comfort, or relief from discomfort
  • Pressing the abdomen against furniture, pillows, or other objects
  • Sudden changes in mood, behavior, or activity level

Families and caregivers often know the person best and may be the first to recognize subtle changes that suggest discomfort or pain.

Important: An autistic person does not need to be able to say, “My stomach hurts” to be experiencing significant GI pain. Sometimes behavior is the only way a person can communicate that something is wrong.

GI pain does not always look like GI pain.

For individuals with limited speech, communication challenges, or interoception differences, discomfort may show up through behavior or body positioning rather than words.

Possible signs include:

  • Increased irritability
  • Aggression
  • Self-injurious behavior
  • Head hitting or head banging
  • Biting oneself
  • Anxiety
  • Changes in sleep
  • Increased repetitive behaviors
  • Food refusal
  • Withdrawal from preferred activities
  • Restlessness or pacing
  • Guarding the abdomen
  • Pressing the abdomen against furniture or objects
  • Posturing (holding unusual body positions such as bending over, twisting of the trunk/torso, curling up, arching the back, or squatting in an attempt to relieve discomfort)
  • Chinning (repeatedly pressing the chin, chest, abdomen, or upper body against people, furniture, cushions, or other surfaces)

For some individuals, these behaviors may be their primary way of communicating pain or discomfort.

Important: A person hitting their head may not have head pain. Some autistic individuals engage in self-injurious behaviors when they are experiencing significant discomfort elsewhere in the body, including GI pain. Any sudden increase in self-injury, aggression, or distress should prompt consideration of possible medical causes.

No. A sudden behavior change should never automatically be attributed to Autism.

New or worsening behaviors may be related to:

  • Constipation
  • Reflux
  • Abdominal pain
  • Food intolerance
  • Infection
  • Sleep problems
  • Other medical concerns

When behavior changes occur, consider possible medical causes alongside behavioral and environmental factors.

Testing & Treatments

You should contact your healthcare provider if you or your loved one experiences:

  • Ongoing constipation
  • Frequent stomach pain
  • Diarrhea
  • Vomiting
  • Reflux or heartburn
  • Feeding difficulties
  • Significant changes in appetite
  • Unexplained changes in behavior
  • Self-injurious behavior that is new or worsening
  • Posturing, chinning, or other signs that suggest pain or discomfort

A healthcare provider can help determine whether GI conditions may be contributing to symptoms.

A gastroenterologist (GI specialist) is a doctor who specializes in digestive health. Your primary care provider may refer you to a GI specialist if you have ongoing constipation, diarrhea, reflux, abdominal pain, vomiting, feeding difficulties, poor growth, or unexplained behavior changes that may be related to discomfort.

During the visit, the GI specialist may:

  • Ask about bowel habits, eating patterns, sleep, and behavior
  • Review medical history and medications
  • Discuss signs of pain or discomfort
  • Assess growth, weight, and nutrition
  • Perform a physical examination
  • Recommend additional testing if needed
  • Family should provide one or more videos of associated behaviors that the GI specialist can then review

Looking for a GI Specialist with Autism Experience?

A gastroenterologist who understands Autism, sensory differences, communication challenges, and interoception can make a significant difference in the diagnostic process.

Find an Autism-Friendly GI Specialist 

While many gastroenterologists provide excellent care, not all have experience working with autistic children and adults who have communication differences, sensory sensitivities, or complex medical needs.

Families and autistic adults may benefit from a provider who understands:

  • Interoception differences
  • Communication challenges
  • Sensory sensitivities
  • Feeding difficulties
  • Behavioral presentations of pain
  • Co-occurring intellectual and developmental disabilities

An Autism-informed provider may be more likely to recognize that posturing, chinning, self-injury, food refusal, aggression, head hitting, or changes in behavior can sometimes be signs of physical discomfort rather than purely behavioral concerns.

If symptoms are ongoing, severe, or difficult to explain, a gastroenterologist may recommend testing to look for possible medical causes of pain, reflux, inflammation, constipation, diarrhea, feeding difficulties, or other digestive concerns.

Depending on symptoms, testing may include:

  • Blood tests
  • Stool tests
  • Imaging studies
  • Upper endoscopy (EGD) to examine the esophagus, stomach, and upper small intestine
  • Colonoscopy to examine the large intestine and lower digestive tract

Many families report that an endoscopy or colonoscopy is recommended when symptoms persist, when the cause is unclear, or when the physician wants to rule out conditions such as inflammation, ulcers, celiac disease, eosinophilic disorders, inflammatory bowel disease, or other digestive conditions.

Before recommending these procedures, the gastroenterologist will discuss the benefits, risks, and preparation requirements.

Treatment depends on the cause of the symptoms. Common recommendations may include:

  • Treating constipation with medication, hydration, dietary changes, fiber, or bowel management plans
  • Managing reflux, heartburn, or upper GI symptoms
  • Addressing feeding difficulties and nutritional concerns
  • Treating identified medical conditions such as celiac disease, inflammatory bowel disease, or eosinophilic gastrointestinal disorders
  • Developing a plan for ongoing monitoring and follow-up care

For some autistic individuals, treatment can lead to improvements in comfort, sleep, mood, attention, participation, and behavior because the underlying source of pain or discomfort has been identified and addressed.

Parents, caregivers, and autistic individuals are often the most important source of information, especially when symptoms are difficult to describe.

Consider bringing:

  • A list of current medications and supplements
  • Information about bowel habits, constipation, diarrhea, reflux, or other digestive concerns
  • Notes about changes in sleep, appetite, or behavior
  • Previous medical records or GI test results
  • Videos of behaviors that concern you

Videos can be especially helpful if they show:

  • Posturing
  • Chinning
  • Abdominal pressing
  • Grimacing or signs of pain
  • Self-injurious behavior
  • Head hitting or head banging
  • Sudden agitation or distress
  • Repetitive behaviors that appear linked to discomfort

Many autistic individuals experience differences in interoception and may have difficulty identifying or communicating pain. Because of this, videos can provide healthcare providers with important information that may not be visible during an office visit.

LEARN MORE

Parent & Self-Advocate Tip

If you think a behavior may be related to discomfort or pain, record it. A short video on your phone can help a specialist better understand what is happening and may provide valuable information that a written description alone cannot capture.

Emergency Warning Signs

Seek immediate medical care if there is:

  • Severe abdominal pain
  • Blood in the stool
  • Persistent vomiting
  • Signs of dehydration
  • Difficulty swallowing
  • Unexplained weight loss
  • A sudden and dramatic change in functioning or behavior
Needing More Prompts

Sleep Problems Are Not Always a “Behavior Problem.” For people with Autism, sleep difficulties may be related to:

  • Sensory differences
  • Body awareness challenges
  • Anxiety
  • Sleep apnea
  • Acid reflux
  • Constipation
  • Seizures
  • Pain
  • Medication side effects
  • Other medical conditions

Before assuming a child, teen, or adult is simply refusing to sleep, consider whether they may be experiencing discomfort, anxiety, illness, sensory challenges, or an untreated sleep disorder.

The good news is that many sleep problems are treatable. Identifying and addressing the underlying cause can improve sleep, health, behavior, learning, independence, and quality of life for both the individual and their family.

Need Help Finding a Gastroenterologist?

When someone is in pain or discomfort, they may show it through increased anxiety, irritability, meltdowns, self‑injury, food refusal, or changes in sleep, especially if communicating discomfort with words is difficult. Because of this, finding GI doctors experienced with complex Autism is essential for identifying underlying medical issues and ensuring compassionate, accessible care.

View Our Gastroenterologist Provider Directory

Find Gastroenterologist & Clinics

Medical Disclaimer

The information on this page is provided for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment. Always consult your physician, gastroenterologist, or other qualified healthcare provider regarding questions

or concerns about a medical condition. If you believe you or your loved one is experiencing a medical emergency, call 911 or seek immediate medical care.

Because some autistic individuals may have difficulty recognizing, communicating, or localizing pain, families and caregivers should seek medical evaluation whenever there are unexplained changes in behavior, sleep, eating, toileting, or overall functioning.

Sources

  • Wang J, et al. (2022). Global Prevalence of Autism Spectrum Disorder and Its Gastrointestinal Symptoms: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry.
  • Gan H, et al. (2023). Questionnaire-Based Analysis of Autism Spectrum Disorders and Gastrointestinal Symptoms in Children and Adolescents: A Systematic Review and Meta-Analysis. Frontiers in Pediatrics.
  • Lasheras I, et al. (2023). Prevalence of Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-Analysis. Anales de Pediatría.