In response to the article Autism, Puberty and Possibility of Seizures

by Donna Williams

Whilst I fully acknowledge the high incidence of seizures among the autistic population, many of which are not associated with convulsions but with things like Rage Attacks, involuntary compulsive self-injury or emotional ‘fits’, it is also important to consider the possibility of three other states associated with similar changes. Tourette’s, a condition causing compulsive movement and often vocal ‘tics’, is a common co-occurance in those with Autism-Spectrum conditions, particularly ADHD, and may may be present from as early as infancy or have sudden or progressive onset anywhere up to late teens and go undiagnosed by virtue of the fact the person has the label of Autism.

Tourette’s can be exaccerbated by sudden increases in stress, such as that brought about by life changes associated with puberty. In some people Tourette’s can include rage attacks, compulsive tics such as slapping or punching oneself and some people with Tourette’s have been subject to ’emotional fits’.

Similarly, the manic aspects of Bipolar can manifest as rage attacks or emotional ‘fits’ and in the case of mixed manic-depressive episodes can result in impulsive episodes of self injury. Like Tourette’s, Bipolar also has a high co-occurance in those with Autism-Spectrum conditions, sometimes cited as effecting up to 30% of this group and similarly can exist from early infancy in its Rapid Cycling form (several fluctuations a day) and become more severe under conditions of raised stress such as during the life changes of puberty. Thirdly, the involuntary avoidance, diversion, retaliation responses of the chronic fight-flight state of Exposure Anxiety is very common in those with Autism and can flare up from mild to severe in situations involving lots of change, increased social pressure and external expectations such as occurs during puberty.

Those in acute severe fight-flight states can experience rage attacks, impulses to self-injure and emotional ‘fits’ looking something akin to the meltdowns of information overload but often triggered by external attempts to promote directly confrontational interpersonal communication or social inclusion. Sometimes, someone who had previously done well in childhood may, during puberty, attempt to assert their own individuality, compulsively rejecting everything they’ve previously taken on as compliance, obviously leaving them much lower functioning. This raised chronic fight-flight state may be caused by overactivity or excess of Norepinephrine, the neurotransmitter responsible for our fight-flight states and this can be altered chemically to restore balance. In my experience, counter to often previously employed ABA compliance style approaches, an Indirectly Confrontational Approach, outlined in my book Exposure Anxiety; The Invisible Cage, has worked well in turning some of these people around so they begin to seize life again instead of defending against it as an ‘invasion’.

There is also the case that some people with Autism who progressively compliantly take on Neurotypical ways of communicating, behaving and relating can, internally feel quite out of sync and alienated from what they have ‘acquired’. This feeling of alienation can increase suddenly in puberty in the form of feeling empty or disconnected inside from their performed reality or a sudden sense of panic at realising they have lost ‘their own world’ or ‘their old world’ and this can, in some people, result in a sudden regression and abandonment of previously acquired ‘skills’ as well as resultant rage attacks, self-injurous behaviours or tantrums as the environment, often understandably, attempts to get them back ‘on track’.

It is very important to keep in mind that epilepsy may be at work, but to acknowledge that the underlying causes of regression, rage attacks, self injurous behaviours or emotional fits in puberty can be about the increased stress of change and higher (including self) expectations as much as hormones and in some cases this can trigger extreme psychological or social-emotional shifts and in those with co-occuring conditions such as Tourette’s, Obsessive Compulsive Disorder, Bipolar or Exposure Anxiety, an increased disturbance in neurotransmitter imbalance. The treatments in each case are different and its important that those who need one type of help are not given a form of help that does not fit the underlying cause/s of their challenges.


Donna Williams

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