Autistic Traits and Cognitive Flexibility in Adolescents With Epilepsy: A Comparative Study of Patients, Siblings, and Controls

BACKGROUND: Emerging evidence suggests shared neurobiological mechanisms between epilepsy and autism spectrum disorder (ASD), including alterations in GABAergic signaling, synaptic plasticity, and functional connectivity. However, the prevalence of autistic traits and cognitive flexibility impairments in adolescents with epilepsy without ASD remains underexplored. METHODS: This cross-sectional study compared 47 adolescents with epilepsy (12-18 years), 40 siblings, and 43 healthy controls. Participants were assessed using the Autism Spectrum Quotient-Adolescent Version (AQ-Adolescent) and the Cognitive Flexibility Scale (CFS). Clinical and developmental data were collected via standardized forms. Group differences were analyzed using ANOVA and Kruskal-Wallis tests, with post-hoc corrections. Correlations and logistic regression models examined associations between epileptic features, autistic traits, and cognitive flexibility. RESULTS: The epilepsy group exhibited significantly higher autistic traits (mean AQ = 31.2) compared to siblings (26.3) and controls (19.8; p < 0.001), with focal seizures linked to a 7.5-fold increased risk of clinically significant traits (AQ ≥ 30; p = 0.040). Cognitive flexibility was markedly lower in the epilepsy group (mean CFS = 48.2) versus siblings (56.5) and controls (58.2; p < 0.001). A strong negative correlation emerged between AQ and CFS scores (r = - 0.430, p < 0.001). Siblings of individuals with epilepsy had a 25-fold higher likelihood of elevated autistic traits (p = 0.012), supporting familial endophenotypes. CONCLUSIONS: Adolescents with epilepsy demonstrate elevated autistic traits and cognitive inflexibility, independent of ASD diagnosis. The sibling findings suggest shared genetic or environmental risk factors. Early screening for these traits may guide targeted interventions to improve psychosocial outcomes.