Can an autistic adult bang or hit their head hard enough to trigger a brain bleed?
Bleeding in the brain from head impact can be either acute or chronic.
Justin Donne was diagnosed with autism at 34. He hits his head, though he doesn’t recall how early in his childhood this goes back.
But as an accomplished businessman with experience in private and nonprofit sectors, he often finds himself deliberately hitting his head.
Just how hard has Justin hit his head? He says, “Never to the point of bruising nor dizziness, but have caused myself headaches and neck pains.”
When he begins striking his head, it’s usually a few times. However, it “can be peppered throughout the day,” he says. “Like today. Had roughly seven to eight episodes.”
The banging comes in the form of using his hand rather than a wall or floor. Stress, foods and odors can trigger an episode.
However, these episodes are not involuntary. This is why Justin is able to confine them to when he’s by himself.
“In public, I just don’t seem to get the urge,” he says. “Or I do it when I sneak off and nobody is looking.
“I’m worried about damaging my eyesight, for example, I heard a blow to the head can disrupt the ocular nerve. I’m also worried I’ll lower my IQ.”
Acute Brain Bleed
This is more likely to occur in an elderly person, because with age, the brain shrinks. A risk factor for adults under 60, though, is the use of blood thinners.
Younger people not on blood thinners, though, can certainly sustain an acute (sudden) hemorrhage in their brain.
In adults younger than 60, an immediately life threatening bleed in the brain is usually caused by severe blunt force trauma – the type sustained in a vehicular accident, a sporting accident, a fall or during the commission of a crime.
This is a level of force that does not occur when an autistic adult bangs their head into a wall, and especially when the strike is from their hand.
It may seem that way when we think about it. But if we compare banging one’s head into a wall with the impact that occurs when one’s head penetrates the windshield of a car in an accident, we see that the latter is far more forceful.
When my elderly father fell in the middle of the night en route to the bathroom, a “goose egg” quickly formed on his temple.
His mentation was altered from the blow. We didn’t know exactly where he had struck his head, but it had occurred either against a wooden door frame or the carpeted floor.
Interestingly, the CT head scan, despite altered cognition and some amnesia, showed no brain bleed.
And subsequent to this injury, which resulted in massive bruising, there was never any latent bleeding.
But what about a chronic brain bleed from repeated head banging over a course of time?
Chronic Brain Bleed
A chronic subdural hematoma can start producing symptoms up to three months after trauma.
“Small subdurals may not cause many (or any) symptoms,” says Dr. David Beatty, MD, a retired general practitioner with 30+ years of experience and an instructor of general medicine for 20 years.
A slow or chronic brain bleed may cause an obvious limb weakness, says Dr. Beatty.
“They can, however, cause more subtle symptoms which are less likely to be picked up by the doctor or the patient,” continues Dr. Beatty.
“The onset is often more gradual and the symptoms may fluctuate; a person may be quite normal one day but have memory loss or confusion the next.
“Headache, personality change, speech problems, drowsiness or dementia may also feature.
“A chronic subdural can grumble on for days or weeks before being diagnosed.”
The million-dollar question is if banging one’s head enough times over a course of time, or even in one episode, could lead to any gradual leaking of blood from the bridging veins between the skull and the brain.
“I think every episode of trauma to the head needs assessment in its own right,” says Dr. Beatty.
“If someone takes a 10 yard run at a concrete wall it’s a hospital problem.
“Most self-inflicted slaps to the head probably aren’t going to cause significant damage.
“Obviously, it’s important to try to get to the cause of the behavior and prevent it.
“Protective gear, such as a helmet, can be used — I’ve seen these used in children with head banging and epilepsy.”
To date, research is lacking on whether or not repeated head banging into a wall or floor, or strikes to the head from one’s hand, are predictive of future slow brain bleeds or future cognitive decline in autistic adults.
One could easily surmise that the autistic adult will instinctively not strike their head to the point of agonizing pain.
In fact, the typical scenario is that the autistic adult (or child) stands close to a wall (thus limiting velocity of the strike) and hits from that point, rather than takes a run from 25 feet out and, with head lowered, slams its top into the wall from the heightened velocity.
Nevertheless, one may wonder about a cumulative effect of all the hitting or banging, even if there’s no bleeding in the brain, even if there’s no headaches, dizziness or neck pain.
Perhaps an autistic person can work on aiming their hand to a shoulder next time the urge surfaces.
Perhaps they can mount a pillow to a wall, and use that to bang their head against.
• Scientific data, let alone meta-analyses, is lacking on future cognitive abilities in autistic people as a direct result of banging or hitting their head.
• The force with which an autistic adult bangs or hits their head is extremely unlikely to cause a gradual slow brain bleed (chronic subdural hematoma), and is EXTREMELY unlikely to cause an acute brain bleed (acute subdural hematoma or other fast hemorrhage).
• It’s possible for a chronic SDH to develop in an elderly person, especially if on blood thinners, who forcefully hits their head.
In fact, a slow bleed can result in elderly people from just a whiplash motion of the neck.
• An injury to the eye from a hand is reasonably possible.
Justin Donne is an accomplished leader with experience across private and nonprofit sectors, including roles at Disney Parks & Resorts and Autistic Nottingham. He excels in team leadership, budget management and driving growth. Justin is an advocate for positive change and has a strong belief in the power of community, and is a passionate advocate for diversity, equity and inclusion.
Dr. Beatty has worked in primary medicine, surgery, accident and emergency, OBGYN, pediatrics and chronic disease management. He is the Doctor of Medicine for Strong Home Gym.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.