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Hidden Medical Problems Can Cause Behavior Problems

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by Temple Grandin
Autism Asperger’s Digest
 | May/June 2009

Dr. Margaret Bauman and Dr. Timothy Buie at Massachusetts GeneralHospitalhave worked with many autistic children. They both warn doctors, parents, and teachers that hidden painful or distressful medical problems must be ruled out before child is put on psychiatric medicines such as Risperdal. Some doctors may not even bother to look for problems that would have been diagnosed in a normal child. They just assume that all behavior problems are caused by autism. Dr. Buie, a pediatric gastroenterologist, explained that 24% of normal children have distressful GI (gastrointestinal) problems. The rate in children with autism is often much higher.

At the Autism 2008 Geneva Center Conference inToronto, Dr. Buie showed videos of three young nonverbal autistic children with terrible behaviors that were caused by non-obvious stomach distress. On the first video, a little girl refused to sit still to do a task. She was in constant motion and would not settle. She also had weird postures, and although strange, she did not hold her stomach. In a second video, a child was refusing to lie flat and kept flinging and flailing about. In the third video, there was severe self-injury and a weird “saluting” posture.

All three children suffered from acid reflux (heartburn), the most common GI problem. Although none of them expressed overt signs of GI distress, such as constipation, vomiting, diarrhea, or touching/rubbing their stomach or chest, their behaviors were a direct result of their severe discomfort. Being nonverbal, their behaviors were their only means of communicating their discomfort. Some of their body movements were, undoubtedly, their attempts to alleviate the pain they felt. All three children greatly improved after they were treated for acid reflux.

Acid reflux can be easily treated with over-the-counter medications such as Pepcid (famotidine) or Prevacid (lansoprazole). Not allowing a child to lay down immediately after eating, and raising the head of the bed to keep acid in the stomach and prevent it from burning the esophagus, are other common remedies. If brown stains are seen on the child’s pillow that usually is a sign of acid reflux. Other signs include chewing clothing or other objects or tapping the chest.

Other Hidden Medical Problems
Obviously acid reflux is only one of the many physical issues that can cause behavior problems. Other GI problems such as constipation or H pylori can also cause pain. H pylori is the bug that causes stomach ulcers and it can be diagnosed with a simple stool test and treated by your local doctor. I have also talked to teachers and parents who reported that their child’s behavior greatly improved after an ear infection or a toothache was treated. A severe yeast infection can also make a child feel terrible and should be treated.

Dr. Bauman described other useful observations from her clinical practice with hundreds of children with autism. She has observed that girls’ behaviors are often more likely to get worse at puberty than boys’. I can really relate to this. When puberty started, my anxiety and panic attacks exploded. Dr. Bauman has found that some girls with autism have an imbalance between the hormones of estrogen and progesterone. Treating the hormone imbalance improved behavior. This problem can be diagnosed and treated by either a very good gynecologist or an endocrinologist.

It is heartbreaking to have a child who is toilet trained lose his toilet training. If that occurs, the first step is to rule out a urinary tract infection that can be easily diagnosed with a urine sample. Other possible causes could be GI problems such as diarrhea or parasites. Dr. Bauman has found that in some pre-teen children, they lose bladder control due to a spastic bladder and sometimes the drug Ditropan is helpful.

In conclusion, it is vital to remember that with most children with autism, and especially with those who are nonverbal or have limited verbal skills, behavior is communication. Sudden or unexplained acting out behaviors that continue for days or weeks are often the result of hidden physical issues affecting the child. Before you ask for more and more powerful psychiatric drugs, you must absolutely, positively rule out a treatable distressing medical problem.

BIO
Temple Grandin is an internationally respected specialist in designing livestock handling systems. She is the most noted high-functioning person with autism in the world today.

Copyright © Autism Asperger’s Digest. 2009. All Rights Reserved. Distribution via print means prohibited without written permission of publisher.


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