Psychological Manifestations of Celiac Disease Autoimmunity in Young Children

Abstract

BACKGROUND AND OBJECTIVES Psychological symptoms can be associated with celiac disease; however, this association has not been studied prospectively in a pediatric cohort. We examined mother report of psychological functioning in children persistently positive for tissue transglutaminase autoantibodies (tTGA), defined as celiac disease autoimmunity (CDA), compared with children without CDA in a screening population of genetically at-risk children. We also investigated differences in psychological symptoms based on mothers’ awareness of their child’s CDA status. METHODS The Environmental Determinants of Diabetes in the Young study followed 8676 children to identify triggers of type 1 diabetes and celiac disease. Children were tested for tTGA beginning at 2 years of age. The Achenbach Child Behavior Checklist assessed child psychological functioning at 3.5 and 4.5 years of age. RESULTS At 3.5 years, 66 mothers unaware their child had CDA reported more child anxiety and depression, aggressive behavior, and sleep problems than 3651 mothers of children without CDA (all Ps ≤ .03). Unaware-CDA mothers also reported more child anxiety and depression, withdrawn behavior, aggressive behavior, and sleep problems than 440 mothers aware of their child’s CDA status (all Ps ≤.04). At 4.5 years, there were no differences. CONCLUSIONS In 3.5-year-old children, CDA is associated with increased reports of child depression and anxiety, aggressive behavior, and sleep problems when mothers are unaware of their child’s CDA status. Mothers’ knowledge of their child’s CDA status is associated with fewer reports of psychological symptoms, suggesting that awareness of the child’s tTGA test results affects reporting of symptoms.

Review of Celiac Disease Presentation in a Pediatric Tertiary Centre

“…In a study of children with newly diagnosed CD, approximately 20% had subclinical neurological abnormalities such as peripheral polyneuropathy and cortical atrophy (37) . A recent study showed that 3.5-year-old children with persistently positive tTG antibodies on a gluten-containing diet were more likely to manifest behavioral problems, including anxiety, depression and aggressiveness, when compared to those with negative antibody tests (38) . The pathogenesis of the neurologic symptoms is unclear but they tend to resolve on a GFD (39)(40)(41) .…”

Extra-Intestinal Manifestation of Celiac Disease in Children

“…Celiac children with persistently elevated tTG IgA scored significantly higher for anxiety, depression, aggressive behaviors, and sleep problems. Initiation of the GFD did not appear to have an impact on the psychological functioning of the patients in this study (though very young children) [ 62 ]. Another study by Simsek et al in 2015 assessed the rates of psychiatric symptoms in newly diagnosed celiac pediatric patients aged 9 to 16 years old as compared to age and sex matched healthy controls that had presented for routine checkup.…”

Psychiatric Comorbidity in Children and Adults with Gluten-Related Disorders: A Narrative Review

“…We found 15 studies that evaluated psychiatric disorders in children or young adults with CD, 11 of which were conducted in clinical-based settings and four were conducted in community-based settings ( Table 1 ). Studies were published between 1997 and 2018 [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Most studies ( n = 12) were cross-sectional, although one of them included a subsequent longitudinal phase [ 41 ].…”