EATING BEHAVIOR ISSUES, CONSTIPATION SYMPTOM SCORES, AND HYPERACTIVITY IN CHILDREN WITH AUTISM SPECTRUM DISORDER: A STATISTICAL MEDIATION ANALYSIS

Children with autism spectrum disorder often experience eating behavior issues and constipation symptoms thought to relate to hyperactivity via the microbiota-gut-brain axis. This study analyzed constipation symptom scores as a statistical mediator between eating behavior issues and hyperactivity in children aged 4–12 years. A cross-sectional correlational design involved parents or guardians of 66 children in five special schools in Bandung City, selected by total sampling. Measures were the Brief Autism Mealtime Behavior Inventory, the GSRS constipation domain, and the ABC hyperactivity subscale, analyzed with Spearman correlation and bootstrap mediation (5,000 samples, 95% CI). All three correlated positively and significantly: eating behavior–constipation (rho = 0.339; p = 0.005), eating behavior–hyperactivity (rho = 0.293; p = 0.017), and constipation–hyperactivity (rho = 0.385; p = 0.001). In the main model the indirect effect was significant (B = 0.0775; 95% CI 0.0050–0.1872); the direct effect was borderline (p = 0.048). After controlling for ADHD status, age, and sex, the indirect effect remained significant (B = 0.0637; 95% CI 0.0073–0.1468) while the direct effect did not (p = 0.195), which does not establish the absence of a direct pathway. Monitoring gastrointestinal status is recommended within holistic nursing assessment, not as a proven intervention.