When a child has extreme tantrums and meltdowns it can be hard for some people to see past the behaviors. ADHD, anxiety, or a history of trauma can be common contributors to behavior, but sometimes there is a medical explanation.  If behavioral strategies aren’t working for you, consider these possible medical issues that may be contributing. 



One of the most common causes of attention and behavior issues is sleep deprivation.  This may be the case even if your child gets to bed early and wakes up late. An obstructed airway or sleep apnea may be keeping your child from getting quality sleep. This can have a significant effect on how he functions during the day. 


Again, this is something that can affect sleep. I heard a story about a child who, after years and years of professional intervention for behaviors (significant enough to warrant a residential behavior facility) was ultimately seen by a myofunctional therapist, who looks at the structures around the face and mouth, and realized the child had a tongue tie. This poor child was not getting quality of sleep because when his tongue would fully relax it would block his airway. 

Check out this story, which relates to some of the areas mentioned above:

Connor’s Story


  • Food
  • Environment
  • Seasonal

Allergies affect everyone differently and the physical symptoms may be less obvious than the behavioral ones. If nasal passages are blocked because of allergies it may obstruct the airway, affecting sleep.  


Do you have lead paint in your home or the home of a relative where your child spends time?  You may need to consider testing for lead poisoning. 


PANS is Pediatric Acute-Onset Neuropsychiatric Syndrome. PANDAS is a subset of this due to streptococcal infection. It is not uncommon for children to have symptoms that look like autism and children may be diagnosed
with a mental health disorder. If symptoms have a fairly sudden onset and occur after an infection it would be wise to have your child assessed for this. Awareness is growing about this condition, but not all medical professionals are trained and aware in how to address it. 



While behavior can be influenced by many things, medical reasons are often not considered. If your child has a sudden onset or persistent behaviors despite interventions, you may need to consider whether there is a medical reason behind it. 

 Written by Alicia Kollmar, MS, OTR/L