Years ago, boxers were thought to become “punch drunk” from too many blows to the head.  Their condition became known in boxing and medical circles as dementia pugilistica.  Today we know it as chronic traumatic encephalopathy (CTE), a progressive degenerative disease afflicting those who suffer multiple concussions.

The condition was discovered following a pattern of suicidal deaths in professional, college and high school football players.  This prompted many hospitals to integrate concussion specialists into their sports medicine divisions.  Unfortunately, medicine has completely ignored the world’s most vulnerable population for CTE – those on the autism spectrum.

One of the most difficult things parents and caregivers for the autistic face is head-banging.  It is a common trait for those at all levels of the spectrum to smack or bang their heads either by hand or against hard objects.  Repeated concussions cause CTE, so repetitive head-banging in the autistic citizen are just as likely to cause CTE in this population as in footballers or boxers.

Concussion and Autism: A Dangerous Mix

In fact, we believe autism poses a far greater risk of developing CTE than any sports or military activity.  While the brain can to some degree recover from a concussion. In a neurotypical individual, it is the repetition of concussion that causes CTE to develop.  Uncontrolled, unprotected head injuries with reduced healing time will result in signs of CTE becoming evident, even though the condition is progressive, in a short amount of time.

What Are Signs of CTE

One of the first signs is severe headache.  Parents and caregivers may also notice difficulty with vision and holding the head as if the pain is intense, which it is.  Also, physical pain and sensitivity to light, sound and touch may increase considerably.  Crying is common in children, and those who cannot verbalize.  It may indicate headaches.

Sudden, extreme mood swings and emotional responses, different, or more intense than those often found with autism can also be attributed to signs of CTE, along with difficulty sleeping.  Unlike typical autism meltdowns, CTE can cause responsive meltdowns, triggered by something directly, or indirectly, stressing the individual.  A television show, commercial, a song, or a sound, can trigger an impulsive reaction which may cause another meltdown and yet another concussion.

  • Difficulty thinking (cognitive impairment)
  • Impulsive behavior
  • Depression or apathy
  • Short-term memory loss
  • Difficulty planning and carrying out tasks (executive function)
  • Emotional instability
  • Substance abuse
  • Suicidal thoughts or behavior

Other suspected symptoms may include:

  • Irritability
  • Aggression
  • Speech and language difficulties
  • Motor impairment, such as difficulty walking, tremor, loss of muscle movement, weakness or rigidity
  • Trouble swallowing (dysphagia)
  • Vision and focusing problems
  • Trouble with sense of smell (olfactory abnormalities)
  • Dementia

Suicidal Ideations and Actions

The prevalence of suicidal thoughts and actions among those who have both concussion-related injury and autism is alarmingly high. Parents and caregivers must be on particularly diligent alert for signs, such as expressions of a wish to die, or to be dead.

Often, multiple attempts to commit suicide are undertaken by affected individuals. Such attempts may be by more common methods, such as pills or weapons, or more inventive means, such as suicide by cop. Others, particularly those harboring deep-seated anger, may elect to commit violent crimes involving others, perhaps taking vengeance against others expecting to be killed by police in the process.

These individuals need constant psychiatric care, though many anti-depressants prescribed for neurotypicals to prevent suicidal actions do not work because the pairing of autism plus concussion keeps the ideation alive in their mind. These people need a lot of sincere love, attention, and monitoring, and likely institutional care.


It is important to note that ‘concussion helmets’ and even football helmets do not prevent concussion. These only protect against wounds to the exterior of the head, but do nothing to control the momentum forcing the brain to hit the skull inside the cranium. Parents and caregivers must be particularly cautious with autistic children to prevent falls, avoid contact sports, and avoid head-banging behaviors as much as possible.

Concussion may, in fact, occur when headbanging, a common autistic habit, forces a closed head injury. We’ve observed one young male who struck his head by hand, so severely as to bruise his fingers, as well as his forehead. That injury resulted in a loss of function such that he can no longer type or write by hand with any clarity, or spell words, despite a college education. As time went by, his suicidal ideations became a daily activity, requiring constant monitoring. The slightest bad news or disappointment could trigger an action at any given moment.

It should be noted that in cases of such individuals, dogs, particularly those trained for autism care, can provide a preventative measure and help to avoid suicidal action. Trained dogs can have an amazing calming effect on the individual.