HJAR Mar/Apr 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 19 be considered if there is a new or worsening behavior, especially if sudden onset. Children with autism may not be able to indicate if they are having pain or where the pain is located. Differences in pain percep- tion or tolerance may also make evaluation and diagnosis difficult. For example, a child with a high pain tolerance may continue to walk with a fractured leg. It is also important to remember that ongoing medical issues may have previously been unrecognized or undiagnosed. If symptoms are intermittent or irregular, keeping a daily diary with infor- mation about sleep, diet, bowel habits, etc., as well as changes at home or school can be helpful when trying to identify a potential cause. Table 3 lists some behaviors that can be seen in children with autism and poten- tial medical causes of the behaviors. Please note, this list is not all inclusive and should not be used as a diagnostic tool. Many medications can have behavioral side effects, including medications used to treat common pediatric conditions includ- ing allergies, asthma, and constipation. Medications used to treat seizures and psy- chotropic medications can also have behav- ioral side effects. If a child has new onset or worsening behavior after starting a medica- tion or a dose change, consider the medica- tion as a possible cause, as well as the med- ical condition being treated. If a child has been on a medication for a prolonged period of time and has chronic behavior problems, doing a trial off of the medication or switch- ing to an alternative medicationmay need to be considered if the medication is one that is known to have behavioral side effects. n Behavior Medical Condition Headbanging or hitting head • Headache (obtain a family history; migraine triggers such as sensitivity to sound and lights can be similar to sensory triggers for behaviors) • Earache/infection • Dental pain/tooth abscess • Sinus infection Eye poking • Vision problem • Eye pain/injury • Headache Refusal to eat/changes in eat- ing habits • Dental pain/tooth abscess • Sore throat/enlarged tonsils • Constipation • Gastroesophageal reflux General increased irritability/ aggression • Urinary tract infection • Menstrual cycles • May have cramping or headaches • Hormonal changes can cause irritabil- ity/agitation • Constipation • Gastroesophageal reflux • Inadequate sleep • Pain Sleep problems • Restless leg/nighttime waking – iron/fer- ritin deficiency • Constipation, gastroesophageal reflux • Seizures • Illness, allergies, asthma, eczema • ADHD, anxiety, mood disorders • Obstructive sleep apnea • Pain Table 3: Behaviors seen in children with autism and potential medical causes of the behaviors