November is Epilepsy Awareness Month. Epilepsy is one of the most common neurological conditions affecting children worldwide, and it is significantly more prevalent in children with autism than in the general population. Research consistently shows that somewhere between a quarter and a third of people with autism also have epilepsy, though the exact figure varies depending on the population studied and the diagnostic criteria used.
For ABA therapists working with children who have both autism and epilepsy, or with children whose primary diagnosis is epilepsy with associated developmental differences, understanding how to work safely and effectively alongside this condition is an essential clinical skill.
What Epilepsy Is and Why It Matters in ABA Practice
Epilepsy is a neurological condition characterised by recurrent seizures. A seizure is a sudden, temporary change in the brain's electrical activity. Seizures vary enormously in what they look like, how long they last, and how frequently they occur.
Some seizures are dramatic and immediately recognisable, involving loss of consciousness, convulsions, and a recovery period. Others are subtle and can easily be missed or misread. A child who suddenly goes very still, appears to stare blankly, and then resumes what they were doing a few seconds later may be having an absence seizure. A child who makes brief repetitive movements, smacks their lips, or performs automatic hand movements may be having a focal seizure. As an ABA therapist, recognising that these events may be seizures rather than behavioural responses is the first clinical requirement.
What to Know Before the First Session
Before beginning work with any child who has a known epilepsy diagnosis, the ABA therapist needs specific clinical information.
What types of seizures does this child have? What do they look like specifically? How long do they typically last? How frequently do they occur? What are the known triggers if any? What is the emergency protocol if a seizure occurs during a session? Is there rescue medication prescribed and if so, does the therapist need to know how to administer it or is that the parent's role?
This information should be gathered from the family before the first session and confirmed with the supervising clinician. It should also be documented clearly in the client file so any therapist who works with the child has access to it.
During Sessions: What to Watch For
A child with epilepsy may experience a range of events during a session that require the therapist to respond appropriately.
Preictal signs are changes in behaviour or affect that some children show before a seizure. These vary between children and may include irritability, anxiety, a change in activity level, or unusual behaviours. Families who know their child well are often the best source of information about what preictal behaviour looks like for that specific child. Knowing this allows the therapist to recognise that something may be about to happen and to ensure the environment is safe before it does.
Ictal behaviour is what happens during the seizure itself. The therapist's role during a seizure is to keep the child safe, not to restrain them or put anything in their mouth. Moving dangerous objects away, cushioning the head if the child is on the floor, timing the seizure, and staying calm and present are the appropriate responses for most seizure types. The family's emergency protocol should dictate whether and when to call for additional help.
Postictal recovery is the period immediately after a seizure. Many children are confused, fatigued, or distressed in the postictal period. This is not the time to resume therapeutic activities. The session ends when a seizure occurs. The child needs rest and the parent needs to be the primary support.
How Epilepsy Affects Learning and Session Planning
Seizure activity affects the brain in ways that are relevant to how ABA sessions are planned and delivered.
Children who have frequent seizures, including subtle absence seizures that may not be visibly apparent, may have gaps in their processing of session content that affect their ability to consolidate learning. If a child is having absence seizures during a session, the data collected during that session may not accurately reflect their skill level, because the child may not have fully processed the instruction or the context for each trial.
Antiepileptic medications commonly affect fatigue, attention, processing speed, and mood. A child who is fatigued from medication may require shorter sessions, more frequent breaks, or a reduced target load compared to what the treatment plan would otherwise specify.
Coordination With the Medical Team
Any ABA programme for a child with epilepsy should be coordinated with the child's neurologist or paediatrician. This does not mean the ABA therapist needs direct access to the medical team in every case. It means the family should be supported to share relevant clinical information across the professionals working with their child, and the ABA programme should be adapted based on that medical context.
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