When Behavior Isn’t The Whole Story: Medical Red Flags To Look Out For

A friend came up to me the other day and mentioned that a mom they know really needs help. Their child’s sleep is all over the place and they don’t know why. Is it behavioral? Is it medical? Is it something else entirely? They want to know where to start.

Most likely it is a combination of factors, but my first recommendation is always to get evaluated by a qualified healthcare provider if there are any red flags for a medical condition. If a child has an undiagnosed medical condition disrupting their sleep, even the best behavior plan will only get you so far. That’s why part of our role as BCBAs is knowing when it’s time to recommend a medical evaluation.

This is especially important for autistic children, who are often more susceptible to certain health issues that impact sleep.

Here are three red flags worth keeping on your radar:

1. Possible Sleep Apnea

What to look for: Loud snoring, pauses in breathing during sleep, restless movements, sweating, or frequent waking.

Obstructive sleep apnea is becoming more common in children. Studies before 2014 showed a prevalence of 3.3%–9.4%, but more recent research (2016–2023) has found rates as high as 12.8%–20.4%.

Children with autism are at an even higher risk, especially if they also have joint hypermobility or low muscle tone. Untreated sleep apnea can impact mood, learning, and overall health, making medical screening a must.

2. Co-Occurring Conditions That Cause Pain or Discomfort

What to look for: Signs of discomfort, frequent night waking, or changes in sleep patterns without an obvious environmental cause.

Pain from conditions like eczema, acid reflux, constipation, or dental issues can make falling and staying asleep nearly impossible.

For children with autism, identifying pain can be particularly tricky—they may have difficulty pinpointing or communicating the source. This makes collaboration with healthcare providers crucial.

3. Possible Nutrient Deficiencies

What to look for: Highly restricted diets, fatigue despite adequate sleep time, or unusual nighttime movements.

Between 70–90% of children with autism have atypical feeding behaviors, which can lead to nutrient deficiencies. One to watch out for is iron deficiency, which is linked to restless legs syndrome—a condition that can make sleep fragmented and unrefreshing.

💡 Pro Tip for BCBAs: Include medical screening questions in your intake process. If a red flag pops up, provide the family with a written recommendation to bring to their pediatrician.

The Takeaway

As BCBAs and parents, we’re on the same team when it comes to helping kids get the rest they need. By knowing the medical red flags—and encouraging families to seek medical evaluation when needed—we set the stage for better nights, better days, and better outcomes.

Ready to tackle sleep issues? Check out our step-by-step guide "Better Sleep, Better Sessions". You'll get the tools you need to get sleep back on track, including a medical checklist and other parent-friendly visuals. subscribepage.io/BetterSleep