The behavior of children with epilepsy predicts those who are at higher risk to develop multiple and severe psychiatric conditions, according to an analysis of information gathered from their parents.
The report, “Identification of risk for severe psychiatric comorbidity in pediatric epilepsy,” was published in Epilepsia.
Mental health problems, including suicidal tendencies, are an important concern and an unmet healthcare need in children with epilepsy. Between 37% and 77% of those children suffer from at least one psychiatric condition, but only a third receive treatment.
Epilepsy in childhood and adolescence carry a complex interplay between seizures and medication side effects, as well as behavioral, cognitive and social difficulties. It is well documented that psychiatric diagnoses and problem behaviors in children with epilepsy remain under-diagnosed. These problems often are brought into adulthood, with severe consequences on quality of life and increased risk of suicide.
Clinicians need quick and effective screening tools to identify youth with epilepsy – at an early stage – who are at risk for severe psychiatric conditions and need treatment.
A research team sought to determine if a subset of items from the common screening scale, Child Behavior Checklist (CBCL) could help identify the children with epilepsy at higher risk for multiple psychiatric conditions, including depression, anxiety disorders and attention deficit/hyperactivity disorder (ADHD).
The team recruited 328 children with epilepsy at ages 5–18, and their parents, enrolled from several different centers in southern California and Wisconsin. The children were divided into a younger group (5-12 years) and an older group (13-18 years).
To assess the behaviour of the children, parents completed the CBCL, which addresses 113 behavioral problem items. Both children and parents separately participated in a psychiatric interview and, if present, a diagnosis was made and defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria.
Results demonstrated an age-related effect. Seven of the CBCL items (clingy, cruel/bully, perfectionist, nervous, poor school work, inattentive, and sulks) correctly identified the younger children with multiple psychiatric diagnoses, compared to those with a single or no psychiatric diagnosis. In the older group, three items (disobedient at school, loner, lying/cheating) had high diagnostic accuracy.
Among the children with a single psychiatric diagnosis, 54% had depressive or anxiety disorders and 38.1% had ADHD. In addition, among the children with multiple psychiatric diagnoses, 81.6% had depressive or anxiety disorders and 68.4% had ADHD.
In addition, the study confirms higher rates of psychiatric diagnoses and problem behaviors in children with epilepsy, compared to healthy peers and even compared to other children with chronic conditions like diabetes and asthma.
Previous studies show that suicidality (completed suicide, suicide attempt, and suicidal ideation) is more frequent among people with epilepsy. The risk of suicide in patients with epilepsy is about 13% compared to 1.4% in the general population, and severely increases if one or multiple psychiatric conditions are present.
With those facts in mind, the evidence for good diagnostic accuracy of CBCL is particularly important, because it serves an easy and effective strategy to identify and treat those children at highest risk for bringing chronic mental health problems, functional impairments and suicidal behavior into adulthood.