HJAR Mar/Apr 2025

18 MAR / APR 2025 I  HEALTHCARE JOURNAL OF ARKANSAS quality of life of children with autism and their families. 1 Changes in diagnostic crite- ria now allow for mental health conditions to be diagnosed in addition to autism. Psy- chiatric conditions are identified in 70% to 90% of children and adolescents with autism. These conditions include attention deficit hyperactivity disorder (ADHD), anxi- ety, obsessive compulsive disorder (OCD), and mood disorders. 1,2 Children with autism should be screened for behavioral and/or emotional conditions regularly, following recommended guidelines for their age. 4 Children and adolescents with autism and mental health diagnoses can be prescribed the same medications as children with- out autism; however, medication response may be variable, and children with autism may have an increased risk for side effects. 1 Referral to a developmental-behavioral pediatrician or child and adolescent psy- chiatrist for consultation about medica- tion management may be needed for some patients. Information regarding psychotropic medication options for different behaviors can be found in the American Academy of Pediatrics Clinical Report, “Identification, Evaluation, and Management of Children With Autism Spectrum Disorder.” 1 Medical Causes of Behavior As noted previously, many medical con- ditions can contribute to behavior prob- lems in children with autism spectrum disorder. It is sometimes difficult for phy- sicians evaluating the child to determine whether the behaviors are primarily due to the child’s autism or if there may be an underlying medical problem contributing to the behavior. 5 Amedical condition should problems may exacerbate daytime behav- iors or cause problems with daytime sleepi- ness. Sleep problems are often behavioral but can also be related to other underlying medical conditions including gastroesopha- geal reflux, constipation, seizures, asthma, allergies, or eczema. 1 Restless sleep and nighttime waking can be associated with low iron. 1,3 Ferritin levels in the low-normal range may be too low for children with rest- less leg syndrome, and these children may benefit from starting an iron supplement. 3 Children with snoring may need to be evalu- ated for obstructive sleep apnea, especially if they have risk factors such as obesity. 1 It is important to obtain a complete sleep his- tory to help determine any potential medical conditions that may be contributing to the sleep problems. Please refer to the article in this series on management of sleep diffi- culties for recommendations on behavioral interventions to help with sleep issues. Dental Health Children with autism spectrum disorder often have unmet dental needs. 1 This may be due to oral sensitivities impacting oral care at home and/or behavioral difficulties when being seen in a dental clinic. Dental pain can contribute to behavior problems, feeding refusal, and sleep problems. Refer- ral to a pediatric dentist with experience working with children with autism should be considered. Behavioral/Mental Health Conditions Behavioral symptoms — including hyper- activity, inattention, aggression, and self- injurious behaviors — are common in chil- dren with autism spectrum disorder and have a significant impact on the health and behavior problems, alteration in eating hab- its, and sleep problems. Seizures and Neuroimaging Incidental findings on neuroimaging are common for children with autism spec- trum disorder but rarely provide etiologic information or require intervention. There- fore, neuroimaging is not routinely recom- mended for children with autism, and the need for MRI should be guided by history and physical examination. Brain MRI may be indicated for atypical regression, micro- cephaly, macrocephaly, seizures, or abnor- mal findings on neurologic exam. 1 Children with autism have an increased risk for seizures, and EEG abnormalities are common in the absence of clinical sei- zures, but EEG is not recommended as part of the routine evaluation of asymptomatic patients. Seizures are more common in children with autism who also have intel- lectual disability, are female, and/or had lower gestational age. EEG should be con- sidered if there is concern about seizures, atypical regression, or other neurologic symptoms on history or exam that indicate the need for EEG. 1 It is sometimes difficult to differentiate between seizures and other behaviors that are commonly seen in chil- dren with autism, including staring off and abnormal or repetitive movements. Hav- ing parents record episodes if they have not been observed in clinic can be helpful when determining whether further evaluation is needed. Sleep Difficulty with sleep onset and/or sleep maintenance occurs in 50% to 80% of chil- dren with autism spectrum disorder. Sleep AUTISM CARE