GPs can actively screen for medical issues that commonly affect autistic children, which include gastrointestinal disorders, sleep disorders, dental conditions and growth and nutrition problems such as obesity.⁵ While these conditions mostly present and are treated in the same way as non-autistic children, some different clinical presentations in autistic children include:

• Constipation, disrupted sleep, or dental issues may present with unexplained, persistent or sudden-onset atypical behavioural symptoms such as agitation, head-banging, or increased stimulatory behaviours.
• A higher likelihood of being a very picky eater, contributing to constipation or growth and nutrition concerns.
• Tendency to experience more sleep disruption, necessitating good sleep hygiene measures or psychosocial interventions before any consideration of sleep supplements.⁶

Children on the autism spectrum are more likely to have co-occurring mental health conditions such as attention deficit/hyperactivity disorder (ADHD), anxiety, depression, obsessive compulsive disorder, bipolar disorders, and gender dysphoria.⁷

GPs are encouraged to screen for these concerns and make a timely referral to specialist mental health services as necessary. A comprehensive list of recommendations for mental health and other co-occurring conditions is available in Chapter 7 of the 2023 Clinical Practice Guidelines on Autism Spectrum Disorder in Children and Adolescents.

The use of complementary and alternative treatment or medicine (CAM) is common in autistic children or adolescents, despite limited evidence of benefits for the majority of CAM. Injudicious CAM use can be harmful.

GPs can greatly aid in the management of CAM use, particularly in counselling caregivers on potential harm that may result. Should caregivers have a strong preference to use a specific CAM, shared decision-making between doctors and caregivers is highly encouraged, such that any treatment trials are time-based with clear objectives and outcome measures.

GPs should also advise caregivers that CAM treatments should not replace mainstream interventions. A comprehensive list of CAM and their current recommendations are available in Chapter 6 of the 2023 Clinical Practice Guidelines on Autism Spectrum Disorder in Children and Adolescents.

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​Dr Mae Wong, Senior Consultant, Department of Child Development, KKH Dr Mae Wong is accredited as a Specialist in Paediatric Medicine and Neonatology by the General Medical Council, United Kingdom, and is a Fellow of the Academy of Medicine, Singapore, and the Royal College of Paediatrics and Child Health, UK. She also holds a PhD in Medicine. Dr Wong’s key interests include Autism Spectrum Disorder and the effect of screen time and sleep on children with developmental disorders. She leads the autism track services at KKH and has completed various research projects on autism. She is a member of the International Society for Autism Research (INSAR), Australasian Society for Autism Research (ASFAR), and the Singapore Paediatric Society. She also serves on the SingHealth research ethics Centralised Institutional Review Board.