20th May 2011 at 01:00
The problem: One of our teenage pupils has epilepsy, is autistic and has significant learning difficulties. His seizures are controlled but he shows aggressive behaviour with no obvious cause. He is at risk of permanent exclusion - how can we avoid this?

What you said

"I doubt the epilepsy has much to do with the behaviour. He may be at risk of permanent exclusion, but unfortunately his teachers and fellow pupils are in danger from him. It is up to the larger education authority to provide a more appropriate place for him."


"I agree that the whole caboodle (of problems) could be the cause, but some epilepsy medicines can lead to aggressive behaviour."

Miss Pious

The expert view

It would appear that this pupil's behaviour is expressive and a form of communication. As he has significant learning difficulties he will not be able to communicate well or manage his anxiety. He will communicate his fear, frustration and needs in inappropriate ways - by hitting others or self-harming. Increased aggression can be attributed to frontal lobe epileptic seizures, so some of the challenging behaviour may have a biological cause.

As a result of his autism, he is likely to have high levels of anxiety, which can be associated with changes in routine, unfamiliar staff and hypersensitivity to noise and other sensory issues.

It is important to appreciate the correlation between epilepsy, autism and learning difficulties. The occurrence of epilepsy is 20 times higher in those with learning difficulties than those without. The co-morbidity (that is, how they affect each other) between epilepsy and autism is higher still, so it is not surprising the pupil is presenting challenging behaviours that you would not associate with epilepsy.

The following strategies may help to reduce his anxiety and improve communication. At first sign of anxiety do not try to use verbal language to calm him. Use pictures of enjoyable activities or safe spaces. You could also provide a visual "now and next" board to communicate his routine and any necessary changes. Avoid difficult transitions and reduce unstructured waiting time.

Consider sign-language systems such as Makaton or Signalong to communicate non-verbally, as verbal language could cause confusion and anxiety. Give him time to process requests and repeat if necessary, and ensure there is a proper end to an activity and that the activity planned is suitable for the time available.

Also, think about providing appropriate emergency medication and epilepsy awareness training in school. Emergency hospital admission for epileptic seizures is not always necessary and can affect school attendance and learning.

Jon Sharpe is principal of St Piers School and Further Education College at the National Centre for Young People with Epilepsy. This week is National Epilepsy Week. For details, visit For more behaviour advice, go to



Reduce any sudden transitions or changes to this pupil's routine, as this will cause more anxiety.

Try to use non-verbal communication, because this will help calm him.

Consider providing epilepsy training in school.


Assume this challenging behaviour should automatically lead to exclusion.

Underestimate the link between epilepsy, autism and learning difficulties, and how the combination of all three is affecting his behaviour.

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