Autism and the Gut Biome: What Pediatric PTs Need to Know

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Autism is a condition that affects nearly 1 in 50 children. Covering a wide spectrum of symptoms, autism is often associated with delayed milestones, difficulty socializing, and/or sensitivity to sensory stimuli. The main cause of autism still remains to be seen; however, there is compelling evidence that individuals with autism have a markedly different gut microbiome compared to normally developed children. Such thinking has lead to alternative therapies and treatments, which many parents may pursue to help their child improve their autism symptoms. Fortunately, data from a recent study in Cell sheds light on the gut biome differences and how some alternative therapies may not ideal.

Chloe Yap from Mater Research and The University of Queensland said the team examined genetic material from the stool samples of 247 children, which included 99 children diagnosed with autism. After examining the diet and stool samples the researchers did not find a clear link between the gut biome and autism spectrum disorders (ASD). Yap commented that, "We found that children with an autism diagnosis tended to be pickier eaters, which led them to have a less-diverse microbiome, which in turn was linked to more-watery stools." In essence, their data suggests that behavior and dietary preferences affect the microbiome, not the other way around.

What may drive the "picky" eating? Well, physios, occupational therapists, and dieticians all know how children with autism may restrict their diet due sensory sensitivities and restricted and repetitive interests. Some children with ASD may have strong preferences for a select few foods, while others find some aromas, tastes, or textures unpleasant or alarming. As such, the sensitivities may restrict their food variety, which in turn reduces their gut biome diversity. Check out this diagram from the Yap et al 2021 article:

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The significance of these findings is profound for those with ASD and for Doctors of Physical Therapy (DPT). Many parents are willing to trial alternative therapies like extreme diets, probiotics, and even fecal transplant in hopes to reduce the symptoms of ASD. Unfortunately most of these therapies are costly, not evidenced-based, and could potentiate harm. As such PTs need to educate family members and parents that such fad therapies are not effective and may actually cause harm. Moreover, it is important for physios to understand that children with ASD have sensory issues around food. Identifying such sensitivities and becoming creative with food choices may be vital to ensuring a child with ASD consumes are varied diet. Consulting and working with OTs and dieticians are also great options for DPTs to consider when meal planning for children with ASD.

In the end, pediatric physical therapists (PTs) are vitally important in the care and management of children with autism. Understanding the literature in regards to the gut biome, fad therapies, and sensory issues are key to managing these little guys the best way!

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