Aim The assessment of staring episodes in children with autism spectrum disorder (ASD) is difficult due to the range of diagnostic possibilities, the increased frequency of epileptiform activity on electroencephalogram (EEG), and the inability of normal EEG to exclude seizures. We reviewed the diagnostic use of routine EEG in this setting.

Method The routine EEG database of the Royal Children's Hospital, Melbourne was searched for recordings during 2005–2010 in children with ASD below 16 years of age who were referred for staring. EEG reports and recordings were reviewed and epileptiform activity was characterised.

Results Ninety-two EEGs in children with ASD were requested for episodes of staring. No child had absence or focal dyscognitive seizures confirmed on EEG. Findings were normal or showed non-epileptiform abnormalities in 80 children. Interictal epileptiform abnormalities were recorded in 12 children, but were judged potentially significant in only three. Seven children had epileptiform activity typical of benign focal epilepsy of childhood, such discharges seen not uncommonly in developmentally normal and delayed children without seizures.

Interpretation Given the difficulties of performing EEG in children with ASD, the low yield of positive diagnostic findings and the high frequency of insignificant abnormalities, we suggest that EEG should be undertaken judiciously when evaluating children with ASD and staring episodes.