Study Rationale
Autism spectrum disorder (ASD) is a heterogenous early-onset and lifelong neurodevelopmental disorder characterized by social communication, repetitive behaviors, and sensory-motor behaviors (Clothier & Absoud, 2020). Approximately forty percent of the cases with ASD are diagnosed with at least one anxiety disorder, contributing to the condition's complexity and risks of other medical comorbidities (Zaboski & Storch, 2018). Specifically, Autistic children with rigidities, anxiety, or sensory preferences may establish a pattern of holding urine and stool, which reduces the physiological neural stimuli for evacuation, and pruning them for the development of bladder bowel dysfunctions (Raturi et al., 2021).
However, little is known regarding how co-occurring mental conditions, like anxiety, stress, and depression, are associated with bladder dysfunctions in Autistic adults (Taylor et al., 2021). Current literature bears significant gaps in addressing urinary health in Autistic adults despite the strong association between lower urinary tract symptoms, poor quality of life, and increased risk of comorbidities (Pizzol et al., 2020).
(Source: Malik-Soni et al., 2021)
Additionally, Autistic adults face multifaceted barriers in healthcare delivery and access despite increased susceptibility to chronic health conditions, causing undiagnosed urologic issues and further complications (Nicolaidis et al., 2015)). Urinary dysfunctions, if left untreated, may lead to several acute and chronic complications like acute renal failure, bladder damage, and hydronephrosis, compromising general health status. Therefore, it is crucial to improve urinary health screening to recognize and identify voiding dysfunction in Autistic adults to avoid such complications. To assess this gap in the literature, this study seeks to investigate the role of psychopathological symptoms on voiding dysfunctions in Autistic adults.
Methodology
The International Prostate Symptom Score, the Overactive Bladder Questionnaire, Autism Quotient - Short Form, and Adult Behavior Checklist will be administered and distributed through REDCap. To analyze data, the Mann-Whitney U test will be performed to compare continuous nonparametric variables. The chi-squared test will be conducted with Fisher's exact test to assess the associations between categorical variables. Calculations will be carried out with IBM-SPSS version 25.0.
Study significance
This study serves to underscore the importance of improved urinary health screening in primary care services of autistic adults and increased holistic care of ASD, given the multifaceted challenges and comorbidities of the condition.
Information from this study can lead to the development of better urinary diagnostic tools and interventions tailored for Autistic patients and enhance the effectiveness of current treatment. Furthermore, investigating the intersection of urinary dysfunction and psychopathological symptoms broadens the understanding of neurodevelopmental and behavioral disorders.
References
Clothier, J., & Absoud, M. (2020). Autism spectrum disorder and kidney disease. Pediatric Nephrology, 36(10), 2987–2995. https://doi.org/10.1007/s00467-020-04875-y
Gubbiotti, M., Balboni, G., Bini, V., Elisei, S., Bedetti, C., Marchiafava, M., & Giannantoni, A. (2019). Bladder and bowel dysfunction, adaptive behaviour and psychiatric profiles in adults affected by autism spectrum disorders. Neurourology and Urodynamics, 38(7), 1866–1873. https://doi.org/10.1002/nau.24081
Inbaraj, L., Kant, P., Franklyn, N., & Norman, G. (2021). Prevalence, risk factors and quality of life of lower urinary tract symptoms (LUTS) among men attending primary care slum clinics in Bangalore: A cross-sectional study. Journal of Family Medicine and Primary Care, 10(6), 2241. https://doi.org/10.4103/jfmpc.jfmpc_2316_20
Malik-Soni, N., Shaker, A., Luck, H. et al. Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res 91, 1028–1035 (2022). https://doi.org/10.1038/s41390-021-01465-y
Nicolaidis, C., Kripke, C. C., & Raymaker, D. (2014). Primary care for adults on the autism spectrum. Medical Clinics of North America, 98(5), 1169–1191. https://doi.org/10.1016/j.mcna.2014.06.011
Pizzol, D., Demurtas, J., Celotto, S., Maggi, S., Smith, L., Angiolelli, G., Trott, M., Yang, L., & Veronese, N. (2020). Urinary incontinence and quality of life: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 33(1), 25–35. https://doi.org/10.1007/s40520-020-01712-y
Raturi, S., Li, F. X., & Wong, C. M. (2021). Recognition and management of bladder bowel dysfunction in children with autism spectrum disorder. BMJ Case Reports, 14(6). https://doi.org/10.1136/bcr-2021-242646
Taylor, E. C., Livingston, L. A., Callan, M. J., Ashwin, C., & Shah, P. (2021). Autonomic dysfunction in autism: The roles of anxiety, depression, and stress. Autism, 25(3), 744–752. https://doi.org/10.1177/1362361320985658
Weir, E., Allison, C., & Baron-Cohen, S. (2022). Autistic adults have poorer quality healthcare and worse health based on self-report data. Molecular Autism, 13(1). https://doi.org/10.1186/s13229-022-00501-w
Zaboski, B. A., & Storch, E. A. (2018). Comorbid Autism Spectrum Disorder and anxiety disorders: A brief review. Future Neurology, 13(1), 31–37. https://doi.org/10.2217/fnl-2017-0030