Sep 28, 2012 0 Share

Illness and Behavior

Illustration of three similar figures experiencing illness or pain.

Yesterday was a very rough day for Cody. When he got up he seemed to be fine. But it wasn’t long before he started having behavior issues. Grumbles and groans started to emerge. Then he began hitting his head. Trying to get him to tell us what was wrong was useless. And no amount of warnings of consequences if he didn’t stop did any good whatsoever. But sometimes behavior issues are indicative of something more than a bad mood.

When Stephen arrived they began their chores as usual. Cody continued to engage in negative talk and acting out. I intervened at that point and told him a timeout was in order. He sat on the sofa for five minutes and seemed to calm down. So he and Stephen went on their outing as usual.

A couple hours later they arrived back home. Stephen promptly asked for some Tylenol. Cody had done nothing but complain the entire time they were gone and this left Stephen with a headache.

They struggled through the rest of the day, but it was less than productive. This was a very off day for Cody, and poor Stephen was at a loss as to what to do.

Stephen went home and we went about our normal routines, cooking and cleaning, taking showers and attempting to settle in for the night. Cody was still no happy camper.

When it was time to go to bed, Cody was more than happy to get there. But I could hear him getting up and down over and over again to use the restroom. That’s when it dawned on me that perhaps he had a Urinary Tract Infection (UTI).

Communication barriers like this are extremely frustrating—not only to the individual with autism, but to families and caregivers as well. It’s so easy to assume that behavior issues that arise because of them are just acting out and that redirecting or a stern talking to should rectify the problem. When typically useful behavior management techniques don’t work, everyone is left frustrated and confused. And when the parent or caregiver finally figures out there is physical discomfort at the heart of the matter, you are often left feeling about two inches tall.

But how do we overcome this kind of scenario? It’s important to those in charge of caring for a person who has difficulty communicating not to beat themselves up when they miss the mark on what the real issue was all along. Instead, use this experience to learn and think in terms of pre-emptive strikes for future events like this. Don’t automatically assume that a bad attitude is at the root of bad behavior.

Watch for signs and symptoms that may indicate an illness or unseen injury. I learned that sometimes when Cody hits his head it is because he has a headache. Sometimes his grumbles and groans are a sign of lack of sleep the night before. Once, he kept procrastinating when I told him to come upstairs. It would have been very easy to write that off to inattention or being lackadaisical. But upon closer examination I noticed him limping. A trip to the doctor and an x-ray later we learned he had fractured the metatarsal bone in his right foot. Imagine how I would have felt, had I not been paying attention then!

As always, continue to work with these individuals on proper communication. Use visuals and practice this part of communication on a frequent basis. Cody and I have a ritual we do when I see certain behaviors beginning to surface. I start at the top and work my way down. “Cody, do you have a headache?” “Cody does your neck hurt?” And I continue on from there.

One thing I haven’t often thought about asking him, however, is whether it hurts when he goes to the bathroom. We tend to think of UTIs as a problem unique to women, but men can get them too. (At the time of this writing, we haven’t found out if Cody has one.)

Being unable to verbalize pain creates a difficult situation. But looking beyond the surface of inappropriate behaviors to find hidden clues of illness or discomfort may just save everyone a lot of unnecessary grief and heartache in the long run.