TCFD’s Chief of Psychology Explores Co-Occurring Conditions & Behavioral Indicators for Pain

Individuals with autism spectrum disorders are more likely to have certain health problems, compared to those who are typically developing. Common co-occurring conditions include:

  • Seizure Disorders
  • Gastrointestinal Disorders
  • Psychiatric Disorders
  • Nutritional Deficiencies
  • Metabolic Conditions
  • Sleep Irregularities
  • Obesity

At TCFD, we examined the prevalence of these conditions in our resident’s medical history. With the exception of sleep disorder, rates of these conditions are higher in our residents, who present with the most severe forms of ASD, than what has been reported in previous studies that included more diverse groups of children with ASD. Our results suggest that those with more severe impairments are more likely to have co-occurring medical conditions, although more research needs to be done in this area. Our holistic approach at The Center is designed to address this complexity.

Prevalence of Co-Occurring Conditions in 100 Children with ASD at The Center for Discovery®

  • Gastrointestinal Disorders: 74%
  • Psychiatric Disorders: 68%
  • Motor Differences: 63%
  • Seizure Disorders: 34%
  • Sleep Disorders: 26%

Medical issues in those with ASD are often misdiagnosed or underdiagnosed. One reason for this is that challenging behaviors may interfere with both examination and diagnostic medical procedures. In addition, many people with ASD have limited communication skills and therefore may not have the ability to communicate pain and discomfort. Furthermore, caregivers and doctors may not recognize challenging behaviors as a sign of pain or discomfort.

The following are possible behavioral indicators of a medical issue in those who are nonverbal:

  • Sudden onset, increased frequency, or intensification of challenging behavior or change from baseline functioning.
  • Motor Pain Behavior (e.g., facial grimacing, gritting teeth, pulling ear, wincing, sensitivity to touch/flinching, clenching jaw, holding and/or rubbing body parts).
  • Vocal Pain Behavior (e.g., sighing, whining/sobbing, moaning, hacking/gagging, groaning, screaming, verbalizations: “ow”, “hurts”).
  • Change in activity level, eating, or sleep.

Sometimes the combination of a medical problem and an immediate trigger can result in a challenging behavior. A medical condition could be referred to as a setting event. A child who has a stomach ache (setting event) and then is asked to run (trigger) may have a difficult behavior because he is not able to verbally communicate that he doesn’t feel well. Other times the pain itself may serve as a trigger for a behavior. For example, a child may get a sudden stomach pain and then hit himself in the head. In fact, it has been suggested that in some cases, self-injurious behaviors are a way for a person to deflect pain to another area of the body. This is similar to the popular parenting strategy of tapping a child on the leg when she is getting a shot on the arm.

Here are some helpful tips:

  • Be aware of co-occurring health conditions in those you work with or care for.
  • Alert your medical provider of changes to baseline functioning as this may indicate a possible health condition or worsening of an existing condition.
  • Be familiar with signs of pain and illness in those who have difficulties communicating, and report these signs to appropriate medical personnel.

Written by Johanna Lantz, Ph.D., BCBA, Chief of Psychology at The Center for Discovery®. 

For more information about supporting our Psychology Department, please contact Richard Humleker, Vice President of Development, at