Research from Alberta Children’s Hospital reveals Behaviours of concern in children with neurodevelopmental conditions often cluster with health issues like sleep and gastrointestinal problems, challenging diagnosis-specific approaches and advocating for a systems-based assessment.
A study from Alberta Children’s Hospital suggests that behaviours of concern in children with neurodevelopmental disorders are not confined to any single diagnosis and often cluster with sleep, communication and physical health problems. The research, published in Frontiers in Psychiatry, examined 600 children aged 2 to 17 who were assessed for the first time in tertiary developmental clinics over a 12-month period and used machine learning to look for patterns across diagnoses.
The sample reflected the kind of complexity clinicians often see in specialist care. Nearly three-quarters of the children had more than one neurodevelopmental diagnosis, most commonly autism alongside ADHD or intellectual disability. Physical health conditions were also common, affecting 80% of the cohort, while 21% had at least one mental health diagnosis. Sleep problems were especially widespread, appearing in 46% of children, and gastrointestinal issues were documented in 36%, reinforcing earlier research linking both sleep and gut symptoms with broader behavioural difficulties in neurodevelopmental populations.
Behaviours of concern were present in 83% of the children, with most showing more than one. Emotional dysregulation and non-cooperation were the most common categories, each affecting about 70% of those with behavioural issues, followed by aggression and self-injury. The study found that aggressive and self-injurious behaviour was often moderate or severe, while emotional dysregulation commonly appeared as tantrums and non-cooperation as resistance to transitions or elopement. Aggression and emotional dysregulation showed the strongest behavioural overlap, while non-cooperation appeared more distinct.
The machine learning analysis pointed to a set of recurring transdiagnostic features. Sleep difficulty, especially trouble falling asleep, appeared in all four of the most common behaviour models. Speech and language delay, autism-related restricted and repetitive behaviours, gastrointestinal problems and heavy service use also ranked highly. In the model predicting any behaviour of concern, ADHD, communication disorder, sensory impairments and disability supports were among the strongest signals. Earlier research has similarly linked gastrointestinal and sensory problems with behavioural difficulties, and other studies have found sleep and gut symptoms in children with non-autism developmental disorders, supporting the idea that these issues cut across diagnostic labels rather than belonging to autism alone.
The authors argue that the findings support a broader, systems-based approach to assessment. Rather than focusing only on diagnosis, they say clinicians should screen early for sleep disruption, gastrointestinal discomfort, pain-related or sensory problems, communication delays and family or service burden. They also note that the study is exploratory: it relied on retrospective chart data from a single tertiary centre, so it cannot prove causation or provide population prevalence estimates. Even so, the results suggest that many of the signals associated with difficult behaviour are potentially modifiable and may be missed in routine care.
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