People who can tell us about their GI symptoms might report severe heartburn, vomiting, or abdominal pain. This pain can interfere with appetite, with participation in desired activities, or with restful sleep. If a person with CdLS cannot accurately report symptoms, they might only demonstrate changes in behaviour that reflect chronic pain, such as irritability or even self-injurious behaviours. It is common, therefore, for behaviour based practitioners who are evaluating patients with self-injury to ask if all causes of chronic pain have been properly evaluated. GERD with esophagitis is commonly suspected in patients with difficult behaviours.