Staring spells in children with autism spectrum disorder: A clinical dilemma.
Use spell length, weekly count, and response to voice to decide which autistic kids need an EEG work-up.
01Research in Context
What this study did
Doctors looked back at 140 autistic kids who had staring spells. They wanted quick ways to tell epileptic seizures from harmless day-dreaming.
They checked how long each spell lasted, how often it happened, and if the child answered when called.
What they found
Short spells that happen a lot and stop when you speak are usually not epilepsy. Long, rare spells that ignore your voice point to real seizures.
These three signs gave a clear rule for triage without needing costly overnight EEG.
How this fits with other research
Goodwin et al. (2012) showed that autism plus epilepsy is not one-size-fits-all; some clusters have early seizures plus heavy repetitive play. Ajay et al. add a bedside tool to spot those kids faster.
Subramaniam et al. (2023) found that epilepsy surgery is just as safe for autistic children. Pair their safety data with Ajay’s triage rule and you can route only the surgical candidates to long monitoring.
Panzer et al. (2025) warn that sudden new symptom spikes in autistic kids can be autoimmune. Ajay’s rule keeps you from calling every new stare autoimmune or epileptic; check the three signs first.
Why it matters
You can now sort staring spells in session. If the spell is brief, frequent, and the child answers your call, keep teaching and chart it. If not, move up the EEG referral. You save families time, money, and worry while making sure real seizures get caught fast.
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During session, time the next staring spell, count how often it happens, and test if the child answers their name; log all three.
02At a glance
03Original abstract
It is a common occurrence for children with autism spectrum disorder to be diagnosed with staring spells. Staring spells are defined as periods of time when children "space out" and are subcategorized as either "absence seizures" (brain activity resembling a seizure but with no physical seizure symptoms) or "non-epileptic spells" (inattentiveness or daydreaming). Due to the subtle characteristics of staring spells, they are usually diagnosed via long-term video electroencephalogram. The child is monitored for 3-5 days with an electroencephalogram which records brain waves. An electroencephalogram may be difficult to perform in children with autism spectrum disorder due to behavior, cognitive, or sensory concerns. Therefore, we wanted to investigate other clinical characteristics that may help us differentiate between epileptic seizures versus non-epileptic spells in children with autism spectrum disorder presenting with staring spells. We reviewed 140 charts retrospectively from the years of 2010-2021. We abstracted demographic and clinical information from the electronic medical record system and reviewed electroencephalogram videos to group the 140 children into epileptic seizure diagnosis group versus non-epileptic spell group. Of the 140 children in this study, 22 were diagnosed with epileptic seizures and the remaining were diagnosed with non-epileptic spells. We found that the two groups differed in certain clinical characteristics such as how long the staring spells lasted, how many staring spells the child had in 1 week, and whether they responded to verbal commands. We believe that clinical features may be helpful in differentiating epileptic seizures from non-epileptic spells in children with autism spectrum disorder.
Autism : the international journal of research and practice, 2023 · doi:10.1177/13623613221137240