Autistic Traits and Cognitive Flexibility in Adolescents With Epilepsy: A Comparative Study of Patients, Siblings, and Controls.
Teens with epilepsy—especially focal seizures—often show autism traits and rigid thinking even without an ASD diagnosis.
01Research in Context
What this study did
Şahin et al. (2026) compared teens with epilepsy to their brothers or sisters and to typical peers. They wanted to know if epilepsy brings more autism-like traits and stiff thinking.
The team gave short surveys and quick thinking tests to all three groups. None of the epilepsy teens had an autism diagnosis.
What they found
The epilepsy teens scored higher on autism traits and lower on flexible thinking. Focal seizures, not general ones, drove most of the difference.
Siblings sat in the middle: better than the epilepsy group, but not as good as the healthy controls.
How this fits with other research
Goodwin et al. (2012) mapped autism-plus-epilepsy clusters and found heavy repetitive and sensory features. Berkan now shows these traits can hide inside epilepsy alone, no autism label needed.
Wen-Wong et al. (2016) saw epilepsy raising tic risk nine-fold. Berkan widens the picture: epilepsy also raises social-communication and rigidity flags.
Goenka et al. (2023) taught us to spot real seizures in autistic kids. Berkan flips the lens: look for autism traits in kids whose main label is epilepsy.
Why it matters
You may have clients who only carry an epilepsy diagnosis yet show social quirks, sensory issues, or rule-bound behavior. Quick screens like the AQ-Teen or a simple card-sort task can flag these kids. Add visual schedules, warn before change, and teach flexibility in small steps. Share results with neurologists and families so everyone plans for both seizures and social needs.
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02At a glance
03Original abstract
BACKGROUND: Emerging evidence suggests shared neurobiological mechanisms between epilepsy and autism spectrum disorder (ASD), including alterations in GABAergic signaling, synaptic plasticity, and functional connectivity. However, the prevalence of autistic traits and cognitive flexibility impairments in adolescents with epilepsy without ASD remains underexplored. METHODS: This cross-sectional study compared 47 adolescents with epilepsy (12-18 years), 40 siblings, and 43 healthy controls. Participants were assessed using the Autism Spectrum Quotient-Adolescent Version (AQ-Adolescent) and the Cognitive Flexibility Scale (CFS). Clinical and developmental data were collected via standardized forms. Group differences were analyzed using ANOVA and Kruskal-Wallis tests, with post-hoc corrections. Correlations and logistic regression models examined associations between epileptic features, autistic traits, and cognitive flexibility. RESULTS: The epilepsy group exhibited significantly higher autistic traits (mean AQ = 31.2) compared to siblings (26.3) and controls (19.8; p < 0.001), with focal seizures linked to a 7.5-fold increased risk of clinically significant traits (AQ ≥ 30; p = 0.040). Cognitive flexibility was markedly lower in the epilepsy group (mean CFS = 48.2) versus siblings (56.5) and controls (58.2; p < 0.001). A strong negative correlation emerged between AQ and CFS scores (r = - 0.430, p < 0.001). Siblings of individuals with epilepsy had a 25-fold higher likelihood of elevated autistic traits (p = 0.012), supporting familial endophenotypes. CONCLUSIONS: Adolescents with epilepsy demonstrate elevated autistic traits and cognitive inflexibility, independent of ASD diagnosis. The sibling findings suggest shared genetic or environmental risk factors. Early screening for these traits may guide targeted interventions to improve psychosocial outcomes.
Journal of autism and developmental disorders, 2026 · doi:10.1017/s1355617722000066