In Pediatric Epilepsy, Links Found Between Parental Factors, Emotional and Behavioral Issues

Adolescents with epilepsy (AWE) commonly experience emotional and behavioral problems, which vary depending on demographic, clinical, and parental factors, according to a study published in Epilepsy & Behavior. The parental factors included how they perceived others treated their child.

Due to these findings, the study authors emphasized it is crucial to identify and properly manage these problems early to decrease comorbid psychopathology in AWE.

The cross-sectional multicenter study included 289 adolescents—180 boys and 109 girls—aged between 11 and 18 years, with a mean (SD) age of 15.4 (1.9) years.

The authors explained that psychopathology among this group was evaluated using the Youth Self-Report scale, consisting of 8 narrowband and 3 broadband syndrome scales, and the raw score and T-score of each syndrome scale was analyzed.

The study found 18.3% of AWE had at least 1 emotional or behavioral problem in the clinical range.

Social problems were most common (10.0%), followed by attention problems (6.9%) and aggressive behaviors (4.2%), and externalizing problems (11.8%) were twice as common as internalizing problems (6.2%).

Externalizing problems included rule-breaking and aggressive behaviors, and internalizing problems included being withdrawn, having somatic complaints, and feeling anxious or depressed.

Female participants and older AWE experienced higher levels of internalizing problems, and social problems were more common among girls (15.6%) than boys (6.7%). However, thought problems were more common among boys (3.9%) than girls (0%).

The study also included 225 mothers and 64 fathers of the AWE involved in the study.

Feelings of stigma among these parents were assessed using the modified 3-item Epilepsy Stigma Scale, which showed 72 (24.9%) of the 289 parents reported feeling epilepsy-related stigma. Specifically, 32 (11.1%) answered ‘‘yes’’ to 1 item, 20 (6.9%) answered ‘‘yes’’ to 2 items, and 20 (6.9%) answered ‘‘yes’’ to all 3 items.

Consistent with findings of prior studies, this study showed 1 in 4 parents of AWE said they perceived that other people felt uncomfortable with their child, treated their child as inferior, or preferred to avoid their child because of their epilepsy.

“Adolescents whose parents perceived stigma had higher levels of all types of emotional and behavioral problems, except for withdrawal and anxiety/depression than those whose parents perceived no stigma,” the authors explained further. “Specifically, these adolescents were more likely to have externalizing problems and social problems.”

The authors noted that parental perception of stigma is more likely linked to the parent’s psychosocial status—including factors such as depression, anxiety, economic status, educational level, and marital status—than the child’s epilepsy-related factors

They also found that male sex, antiseizure medication polytherapy, and longer duration of epilepsy were more likely to be associated with parental perception of stigma, and stigma was significantly associated with psychopathology in AWE, especially externalizing and social problems.

“Despite the high frequency and severity of psychopathology in AWE, these problems often go unrecognized in the clinic,” the authors wrote. “Therefore, early identification of the risk of emotional and behavioral problems in AWE is crucial for enabling more timely referrals for intervention, decreasing comorbid psychopathology, and increasing quality of life.”

The authors noted that the lack of a control group, on top of other factors surrounding the study’s design, warrant caution when interpreting these results.

Reference

Jin Young S, Lee SA, Eom S, Kim HD; Korean QoL in Epilepsy Study Group. Emotional and behavioral profiles of adolescents with epilepsy: Associations with parental perception of epilepsy-related stigma. Epilepsy Behav. 2023;138:109014. doi:10.1016/j.yebeh.2022.109014