This study explores the complex relationship between health status and challenging behaviour in individuals with Autism Spectrum Disorder (ASD) in Macedonia, offering new insights into the medical and behavioural challenges faced by this population. Conducted with 72 individuals with ASD aged 3 to 24 years, alongside 75 neurotypical controls, the research highlights alarming health disparities. Individuals with ASD show significantly higher rates of neurological conditions, including epilepsy and ADHD, gastrointestinal problems such as constipation and intestinal inflammation, respiratory infections, skin conditions like eczema, and psychiatric issues, including sleep disturbances and anxiety. These medical challenges often lead to increased use of medications and supplements, which may bring their own side effects, creating a cycle of health-related complications. Crucially, this study demonstrates that changes in health status are closely linked to the emergence or exacerbation of challenging behaviours (CB). Using the ""Challenging Behaviour Questionnaire,"" the research identifies common behaviours such as loss of previously acquired skills, irritability, anxiety, agitation, aggression, self-harm, repetitive movements, sensory hyperreactivity, and unusual vocalisations. These behaviours frequently correlate with specific health issues-sleep disturbances, gastrointestinal problems, neurological disorders, and sensory sensitivities-illustrating that CB is often a form of communication when individuals cannot express discomfort or pain. Many of these behaviours persist even after health conditions improve, underlining the need for timely detection and intervention. The study emphasizes the importance of integrated approaches that address both the medical and behavioural needs of people with ASD. Early identification and treatment of comorbid conditions can significantly reduce the frequency and intensity of CB, prevent chronic behavioural patterns, and improve overall quality of life. The findings also stress the need for locally tailored services in Macedonia that combine medical care with behavioural support.
