Girl with Alice in Wonderland Syndrome (AIWS)
  • AIWS
  • Todd's Syndrome

Alice In Wonderland Syndrome

Alice in Wonderland Syndrome (AIWS) is a temporary perceptual disturbance. A child with AIWS may experience temporary visual distortions like the character from the book Alice’s Adventures in Wonderland: a feeling that their whole body is suddenly larger or smaller, or that their surroundings have suddenly shrunk or become giant. They can also experience perceptual distortions of any of the other senses: taste, sight, hearing, or sound. Some children may also experience distortion in the perception of time, feeling as though they are moving impossibly quickly but, in fact, are barely moving at all. The syndrome is thought to have a genetic component, as it often runs in families.  

Though frightening and disorienting for a child, AIWS episodes are temporary, and most children eventually grow out of their episodes. The syndrome is also referred to as Todd’s syndrome, after the British psychiatrist who identified it in the 1950s. Lewis Carroll, the author of Alice’s Adventures in Wonderland, suffered from migraines and is thought to have based the surreal events of the book on his episodes of the syndrome. 

AIWS is a symptom of an underlying neurological disturbance rather than a disorder in of itself. These perceptual distortions may be caused by sudden abnormal neural activity or a rush of blood in an area of the brain. AIWS episodes may, in fact, be a type of aura that may precede or accompany a seizure or migraine headache.

Finding the underlying cause of AIWS episodes in children is essential for effective management of the syndrome. The most common cause in children is migraine headaches, temporal lobe epilepsy, or infection. A clinician will typically order an MRI, EEG (to detect unusual electrical brain activity) and blood tests to help determine the underlying condition. 

A child may experience temporary visual distortions like the character from the book Alice in Wonderland: a feeling that their whole body is suddenly larger or smaller, or that their surroundings have suddenly shrunk or become giant. They can also experience perceptual distortions in their awareness of time, or of any of the other senses: taste, sight, hearing, or sound.

Conventional Treatment

There is no definitive treatment for AIWS, but it can be managed by addressing possible triggers that activate episodes: headaches, migraines, stress, drugs (particularly some cough medications), and infections. Infections, such as those from the Epstein-Barr virus and infectious mononucleosis, can be treated with medications which result in a reduction of AIWS symptoms.  Lifestyle and dietary changes can be helpful, which might include regular sleep patterns and the adoption of the Migraine Diet, which we’ll discuss below.

Support

At The Brain Possible, our goal is to empower you to take a holistic approach to your child’s treatment. Below are ways in which you can support several aspects of your child’s recovery; before embarking on any, be sure to discuss them with your trusted health care providers.

Physical

Since migraine headaches are the most common cause of AIWS in children, following a migraine-preventative lifestyle is recommended. Adequate sleep is often the best preventative. You can consult this article from the National Sleep Foundation to learn the sleep recommendations for children and teens by age.

Emotional/Social

One reason AWIS has not been studied extensively is that it is believed to be widely underreported because those suffering from it don’t want to appear “crazy.” If your child is experiencing perceptual disturbances, assure them that this does not mean they’re not “normal.” Create an empathic, non-judgmental space for them to describe their symptoms. If migraines are the cause of your child’s AWIS, meditation and mindfulness training are also useful preventative tools.

Sensory

Since sensory stimulation such as noise, light and/or smell may trigger migraines, multisensory integration therapies can be prescribed to reduce the intensity and frequency of headaches. Sensory integration therapy is a customized treatment plan that helps a child better process the sensory information they’re receiving from their environment so as to use the information for improved cognitive function. These therapies can also help them better regulate the information they receive in order to prevent overwhelm. 

Intellectual

While AWIS doesn’t generally cause intellectual impairment, the intensity and frequency of episodes can impede school work. By paying attention to your child’s potential episode triggers and the routines that nourish your child, you’ll be able to create an environment that supports their intellectual development. 

Nutritional/Environmental

Some migraines can be avoided by eliminating specific food or drinks. Its estimated the 20% to 50% of people with migraines have food triggers. Common triggers including caffeine, MSG, and nitrates. Eating regularly scheduled meals is often helpful, or eating smaller and more frequent meals, as hunger is known to trigger migraines. Keeping a “migraine diary” is one way to find which foods and environmental stimuli trigger your child’s migraines. The Migraine Diet is a protocol that supports healing and limits foods known to trigger migraines. 

Physiological

The physiology of AIWS is still being discovered, but migraine medication can be helpful. Common over-the-counter pain relievers (Advil, Aleve, Tylenol) are often helpful for children’s migraines, especially at the beginning of an episode, but preventing migraines with medications is a challenge and usually involves much trial-and-error. Most migraine preventative medications have side-effects, so only children with frequent migraines should take them. Fever can be an AIWS trigger for some children, and so fever-reducing medications may be an effective preventative. Body Talk therapy, a holistic treatment process that aims to activate the body’s own healing processes, has been reported to help with migraine prevention.

We understand that the categorization of conditions on The Brain Possible may not perfectly describe your child.

Our goal is inclusivity, opening the door to dialogue and information sharing.