The Medical and Psychiatric Evaluation of the Nonverbal Child

onverbal children and adolescents with autism spectrum disorder (ASD), intelN lectual disabilities, or communication disorders who are nonverbal with co-occurring medical problems can present with a change in behavior and little other indication that they are experiencing illness or pain. For clinicians, first considering new or worsening medical problems in the nonverbal child or adolescent rather than a change in psychiatric statusmight lower the risk of ongoing suffering and impairment. Such consideration also, importantly, might decrease the likelihood of patient exposure to inappropriate psychiatric care, including hospital admission and unneeded psychotropic medication. Although child and adolescent psychiatrists are aware of and consider medical issues first in the differential diagnosis, we are increasingly reliant on other medical professionals to “medically clear” our patients for psychiatric care. The ability of the child psychiatrist to advocate for the medical assessment of behavior change in nonverbal patients is of particular importance given higher than expected rates of medical conditions in those with ASD or other developmental disorders. Specifically, children with ASD are 1.8 times more likely to have asthma, 1.6 times more likely to have eczema or skin allergies, 2.2 timesmore likely to have chronic severe headaches, and 3.5 times more likely to have chronic diarrhea or colitis compared with typically developing children. The medical evaluation of a behavior change can be more complicated with the nonverbal child and even challenging for pediatricians. Here we discuss 4 patient examples in various psychiatric treatment settings to illustrate how infection, foreign body insertion, medication side effects, and pain can present as aggression and irritability that would not have been managed appropriately without a primary medical focus in the initial psychiatric workup. In these examples, the diagnosis of a medical condition leading to an acute