Psychiatric Disorders in Children Linked to Celiac Disease

[Yvonne (Vonnie) Mostat, RN]

This BLOG is in addition to my last posting in the Celiac Journal regarding Psychiatric Disorders in children and adolescents that can cause concern in the parents, who themselves have celiac disease, and then they read that untreated celiac disease and development of mental disorders in children and adolescents. These psychiatric symptoms, or neurologic disorders can be seen in patients with celiac disease. There is a whole range of neurologic disorders The "Journal of Pediatrics, Volume 184 is a population-based study  - https://doi.org/10.10/16/jpeds. I will also mention another excellent article by the "Psychiatric Advisor" entitled "Psychiatric Disorders in Children Linked to Celiac Disease." The objectives of the Journal of Pediatrics was to determine the risk of future childhood psychiatric disorders in celiac disease, assess the association between previous psychiatric disorders in siblings of celiac disease probands,{Meaning where could the start of the celiac disease be...in the parent/parents/ or further back than that. When I first read these two articles I was anxious with regards to my own children and what a parent should look for in  their children. The Psychiatric Advisor, Batya Swift Ysgur, MA, LSW states "Children with celiac disease were found to be at increased risk for mood disorders, anxiety and behavioral disorders, ADHA, ASD, and intellectual disability. They also suggest that NEURODEVELOPMENTAL DISORDERS ALSO SUGGESTS A "BIOLOGICAL ETIOLOGY OF PSYHIATRIC COMORBIDITY IN CELIAC DISEASE." In addition, psychological aspects of celiac disease and chronic symptoms may contribute to the effect. "Once celiac disease diagnosis is confirmed, patients and their families need to confront the diagnostic label of chronic disease and the prospect of life-long treatment. This can be particularly challenging during the developmental periods of childhood and adolescence." The gluten-free diet also requires "constant monitoring and attention", which can be stressful and taxing for patients and their families.  The researchers conclude that their study "Underscores the importance of both mental health surveillance in children with celiac disease and a medical workup in children with psychiatric symptoms."

They reference topics such as ATTENTION-DEFICIT/HYPERACTIVITYDISORDER, AUTISM SPECTRUM DISORDER, CHILD AND ADOLESCCENT PSYCHIATRY, MOOD DISORDERS, SUBSTANCE USE.

*Now, I do not want you to become over-anxious about your young children who have already been diagnosed as having celiac disease, and run around with a shorthand note-book watching your child at play with other children, or questioning their teachers with regards to their behavior in the classroom and their peers. Do not ASSUME that since you have celiac disease your child is also going to have the disease. It is one of those ."Be Aware" types of studies where your child with celiac disease needs both mental health surveillance  as well as a medical workup in children with psychiatric symptoms. The investigators also state that once a celiac disease diagnosis has been made the concern for a parent is the thought of a chronic disease for life for their child leads to self-blame for the parent., even though it is not the fault of the parents. A gluten free diet requires "constant MONITORING AND ATTENTION, which for the parents of children as young as three years of age according to the Swedish Study. The authors give credence to the fact that the parent with celiac disease can become hyper-aware of Childhood Psychiatric Disorders. It is a big leap from celiac disease to psychiatric disorders, but researchers concluded that their study "underscores the importance of both mental surveillance in children with celiac disease and a medical workup in children with psychiatric symptoms.  The Swedish Researchers conclude their research with the fact that children with celiac disease are at increased risk for MOST psychiatric disorders, apparently owing to the biological and/psychological effects of celiac disease. Are you aware that many people with celiac disease or non-celiac gluten sensitivity may be mis-diagnosed with a psychiatric illness due to some of the neurological and psychiatric symptoms that can be seen in their child's behavior.

I remember when I first received this information with regards to celiac disease and psychiatric illnesses in children it sent me on a "worry path" as my husband calls them. I do not want to scare you unnecessarily. Children with celiac disease had a 1.4 fold greater risk of future psychiatric disorders. Children with celiac disease are at an increased risk for most most psychiatric disorders. For those of you not fully aware of untreated celiac disease and gluten sensitivity. There is no question that gluten can affect your neurological system. The KEY word to remember is "untreated", which of course means parents that are unaware that their child has celiac disease or gluten sensitivity, they then appear to notice that their young child seems to have an increased anxiety towards every day challenges in comparison to their other siblings or playmates.

You can go on the internet and type in "The connection between gluten and bipolar disorders". This may help alleviate some of your worries with regards to your children. I know, when you read, "Children with untreated celiac disease are at risk for psychiatric disorders, or "Children with celiac disease, statistics show, are not getting sufficient vitamins or minerals in their diets." reading this as a proven celiac parent of a child experiencing abnormal behavioral attitudes should help you become more aware of your child's early years, those years prior to the early teenager years. A higher risk of having increased levels of IgG antibodies to gluten when compared to those without Bipolar Disorder. Initially there may be a mis-diagnosis of psychiatric illness due to some of the neurological and psychiatric symptoms that can be seen in untreated celiac disease. Childhood celiac disease was identified as risk factor for mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD and intellectual disability. It concludes with the fact that "Children with celiac disease  are at increased risk for most psychiatric disorders, If one is going to say that a child deficient in their diets who have a parent with celiac disease have a 1.4 fold greaty4e5r risk of future psychiatric disorders, you can reach that diagnosis for your younger children, they say, from the age of three years of age to the adolescent years then right away you are going to be looking for signs in your children. In the Swedish Study 1.4% greater risk for future psychiatric disorders is small peanuts compared to the population of Sweden. 

An example of children who do not have an adequate diet are the children in classrooms with "normal" children often have parents who send their children to school without breakfast and no lunch packed.  My grand-daughter has a Grade 4-5 Class of mixed children from a poorer area in our City who go to school without breakfast, bring no lunch to school, and the school actually asks parents for clothing their child has outgrown, and would the teachers be prepared to have some Granola Bars available in their desk for this type of child because of course their behavior does not appear to be normal for a child of that age. A teacher not fully aware of the family history of her students could make the mistake of calling in a psychiatric consultation for a child from a broken home, whose mother is an alcoholic or carrying another addictive issue, when the child just needs a "Food Rules Diet" diet, adequate sleep, and a multi-vitamin with parents that do not know where their children are after school dismisses for the day, and, as one of the articles suggests, sibling rivalry, especially in the teen years,  One of my favorite researchers, Dr. Fasano, was part of a study paper entitled "Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. All the articles that I read appear to make specific notes with regards to the adolescent child and the pre-adolescent child.  What we need to make note of is the interaction between your eight year old child and the children of that age in your neighborhood to see if they interact in a "normal way" for childhood play in comparison to the child with a volatile  personality, one that bites or hits that are unprovoked, and has a parent with celiac disease and has been tested positive for celiac disease themselves.  If your family physician refuses a referral to a pediatrician or psychologist then you need to seek a new consultation.  Mental disorders in adolescents with celiac disease "apparently" are easier to detect a mental disorder, since a lot of the articles that I read seem to quote the number of students at the Grade 6 level are noticing changes in behavior, defiance, relationship with peers, many things that we as parents can watch out for in our teen or pre-teen children. One also needs to realize that children with celiac disease can often be mis-diagnosed with some of the neurological and psychiatric symptoms that can be seen in their child's behavior. The child who has been diagnosed with celiac disease, but is also having difficulties with concentration and attention deficit disorder should not automatically assume it is because of the "Celiac Disease" that your child misbehaves, you as the parent have the difficult task of asking for a referral to a psychologist if you feel strongly that there is also something else "AMISS" with that child. Goodness, when I first read about "Mental Disorders and Celiac Disease" I was 'running scared' as a newly diagnosed celiac about thirty years ago, I was checking every celiac site and querying my specialist with regards to my own psychological make-up. A busy person, Type A, jogger, joiner, and plainly just too busy, it does not mean I was Bi-Polar. I just had to learn to slow down a little and be very vigilant about my diet.

We have so much to remember, research and endeavor to classify, such as Non-Classical Celiac Disease and Silent Celiac Disease.  I Believe the Celiac Journal of Gluten Sensitivity was one of the first magazines to identify that not all people testing negative for celiac disease, do not have a mental disorder just because they can check off all the signs and symptoms of celiac disease but with a negative outcome. Now, finally, doctors are "changing their minds", studying further evidence and coming up with a legitimate diagnosis of Non-Classical Celiac Disease and Silent Celiac Disease. A parent with proven celiac disease  is becoming aware of abnormal levels of IgG antibiotics to gluten when compared to those without bipolar disorder. Initially, there may be a mis-diagnosis of psychiatric illness due to some of the neurological and psychiatric symptoms that can be seen in untreated celiac disease. Did you know that there is a range of neurologic disorders in patients with celiac disease? Although this article is is twelve years old 34% of the children in the study had at least one mental disorder compared to 13% of children in the general population. *IT IS NOT CLEAR WHETHER MENTAL HEALTH DISORDERS IN CHIDREN STEM FROM SOME PYSICAL CHANGE CAUSED BY CELIAC DISEASE IN ADDITION TO THE STRESSORS THAT CAN BE CREATED BY THE NEED TO FOLLOW THE GLUTEN FREE DIET. Both of these disorders can be as a result of celiac disease or the home environment, (as my grand-daughter is finding out.) The University of Chicago Celiac Disease Centre indicates that you can become gluten intolerant, yes, at any age. The study also poses the question of whether there may be an as yet undiscovered physiological reason. The study also poses the question of whether there may be an as yet undiscovered physiological reason or psychological distress.

One thing I know for sure, I want to advise any newly diagnosed celiac person to "Get On Board" with The Celiac Journal Blog site, and the Author's Site. I really feel for the newly diagnosed celiac, but you have your queries  and also worries, and being able to communicate with other people with celiac disease who write on the BLOG. It a lot quicker and more certain than we "oldies" who have had celiac disease for most of their lives. We did not know where to turn to for help.  Now I know that if the Celiac Journal does not list a topic that I am wanting to know more about, I can just type in the "TOPIC" that I am struggling with, and Scott Adams, our editor, will e-mail me back the Journal Web Site that addresses my question/s, and it will be accurate, and contain the Web Site Address {Be sure to go to the Web Page and type in case examples of children and adolescents with diagnosed celiac disease who would benefit from mental health evaluation and treatment.

Blessings on you all. Let's pray for a quick release of the new injectable medication that has a close to 90% successful recovery rate.  Stay healthy. The diet for the celiac person is a lot healthier than the average adult, or child for that matter, so be reassured that the average "John Doe" is no further ahead with his body health than the celiac person, or the dermatitis herpetiformis person.

Do not want to bore you further but please look up davidperlmutter,M.D. who has a published a study on celiac disease and non celiac gluten sensitivity indicating that both are treated with a gluten-free diet, Patients with celiac disease should be followed up closely for dietary adherence, nutritional deficiencies, and the development of possibly comorbidities. The clinical variability and the lack of validated biomarkers for nonceliac gluten sensitivity make establishing the prevalence, reaching a diagnosis, and further study of this condition difficult. Nevertheless, it is possible to differentiate specific specific gluten-related disorders. Celiac disease screening may occur before a gluten-free diet is implemented, since once a patient initiates a gluten-free diet, testing for celiac disease is no longer accurate.

Respectfully,

Vonnie Mostat, R.N., Journalist

 

[trents]

Wow! Without a doubt the longest post I have seen on this forum. But lots of good information there. Thanks.

[Scott Adams]

Hi Vonnie,

Mental issues including behavior issues caused by celiac disease is quite common, and here are some articles on this:

https://www.celiac.com/celiac-disease/celiac-disease-amp-related-diseases-and-disorders/schizophrenia-mental-problems-and-celiac-disease/