Social skills problems in children with epilepsy: Prevalence, nature and predictors

doi:10.1016/j.yebeh.2007.08.008

Epilepsy & Behavior

Volume 11, Issue 4, December 2007, Pages 499-505

https://doi.org/10.1016/j.yebeh.2007.08.008 Get rights and content

Abstract

To determine the prevalence, nature, and predictors of social skills impairment in children with epilepsy, 101 parents completed the Social Skills Rating System, the Child Behavior Checklist, a general health questionnaire for both their child with epilepsy (aged 3–17) and his or her sibling, a quality-of-life assessment for the child with epilepsy, and Family Assessment Measure III. Epilepsy-specific variables were recorded for each case. Although children with epilepsy had poorer social skills (P < 0.05) and were less assertive (P < 0.006) than their siblings, the proportion with clinically significant social skills deficits was low and did not differ between groups (13% vs 7%, P = 0.12). Neurological factors were related to social skills, but only presence of a learning disability (odds ratio = 8.64, 95% CI = 1.87–39.98) and abnormal family function (odds ratio = 8.75, 95% CI = 1.42–53.83) were strongly predictive of social skills impairment. Lower social skills were moderately correlated with epilepsy-specific and global quality of life (P < 0.001).

Introduction

Long-term follow-up studies of cognitively normal, young adults with a history of epilepsy in childhood have indicated a high prevalence of psychosocial problems [1], [2], [3]. Patients with idiopathic epilepsy or normal intelligence have lower marriage rates and higher rates of social isolation and are more likely to live in their parental homes in young adulthood [3], [4], [5]. Although the reasons for poor social outcome are not clear, social skills impairment may play a significant role. Untreated social skills deficits are associated with poor academic performance, later social adjustment problems, and serious psychopathology [6], [7].

Very few data have been published on social skills in children with epilepsy, and work to date has used the Child Behavior Checklist [8], [9]. The Child Behavior Checklist is a broadband questionnaire developed as a screener for psychopathology in children. Its Social Skills scale includes only 11 items, some of which can be confounded by neurological illness (e.g., clumsiness). Similarly, its Competence scales are not designed primarily to measure social skills. Instead, they measure the amount of time spent in activities with peers, number of structured activities outside of school, and number of friends, variables that can be affected by neurological factors rather than social deficits, per se. To date, no study has used a theoretically based tool designed specifically to assess social competence of children with epilepsy.

The goal of this study was to investigate the prevalence, nature, and predictors of social skills problems in children with epilepsy. We compared social skills of children and teens with epilepsy with social skills of their nearest-aged, nonepileptic sibling. We employed a standardized measure of social skills, the Social Skills Rating System, which provides a comprehensive assessment of social skills, specifically assessing core behaviors including cooperation, assertion, responsibility, self-control, and empathy, and is based on research on social competence in children [10]. We also examined a number of potential correlates of social skills in children with epilepsy, including epilepsy-specific neurological factors and family function, to determine which of these were predictive of social skills development. Finally, we examined the relationship between social skills and both emotional–behavioral factors and quality of life, to determine whether social skill problems were associated with functional consequences in the daily life of children with epilepsy.

Section snippets

Methods

This study was a cross-sectional, cohort survey of children with epilepsy attending the pediatric neurology clinic at Alberta Children’s Hospital and their nonepileptic siblings. This hospital is the only tertiary care pediatric center in south-central Alberta, and serves a population of approximately 1.5 million.

Results

One hundred and thirty-two children were contacted who met inclusion criteria and had an age-appropriate sibling who could act as a control. Five families refused the study, and packages were sent to the remaining 127 families. Of these, 101 patient–sibling pairs returned completed questionnaires, representing 77% of all pairs who met inclusion criteria. No significant differences were seen in seizure type or proportion with intractable epilepsy between patients who did and did not complete the

Discussion

Social skills are learned behaviors that enable a person to interact effectively with others and to avoid socially unacceptable responses [10]. Acquiring and developing these skills is one of the important goals in childhood, as social skills are not easily malleable later in life. Problematic social skills are related to poor school performance and psychological maladjustments in adulthood [6], [7]. Several studies have shown that the long-term social outcome in adults who had epilepsy in

Acknowledgment

Enrica Tse received a summer studentship from the Alberta Heritage Foundation for Medical Research.

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For children with epilepsy that do attend school, studies have shown that they have higher rates of behavioral problems when compared to their typically developing peers (Gebauer-Bukurov et al., 2015; Stewart et al., 2019; Lew et al., 2015; Zhao et al., 2014; Raud et al., 2015). However, other studies have shown that while children with epilepsy experience more difficulty understanding sarcasm, intentional lying, and false belief, their overall social skills are not significantly different than those of their typically developing peers (Tse et al., 2007). Some have proposed that verbal intelligence, parental anxiety, learning disability, and family function are better predictors of social skills in children with epilepsy than their epilepsy diagnosis (Tse et al., 2007; Carson and Chapieski, 2016).
Children experiencing epileptic seizures (ES) and children experiencing non-epileptic seizures (NES) may experience deficits in both executive functioning and in social skills, but little research has examined differences in executive functioning between the two groups and no studies have examined the relationship between executive functioning and social skills in pediatric ES and NES groups. The purposes of this study were to determine if ES/NES group differences exist for executive functioning and to determine if executive functioning was related to social skills in these groups. Children (N = 43) were recruited from epilepsy monitoring units (EMU) at Primary Children’s Medical Center and Phoenix Children’s Hospital. The NES group consisted of 15 participants (67 % female, M age at test = 12.62, SD = 3.33), and the ES group consisted of 28 participants (50 % female, M age at testing = 11.79, SD = 3.12). Parents and children completed the Social Skills Improvement System (SSIS) Rating Scales, and the Behavior Rating Inventory of Executive Function (BRIEF). No significant differences on measures of executive functioning were observed between ES and NES groups. Parent reports of poorer behavioral regulation correlated to parent reports of poorer social skills in both groups, but neither parent nor child ratings of executive functioning correlated with child-reported social skills. This finding suggests there may be differences between parent and child self-observations of executive functioning and social skills in both NES and ES groups. Limitations to this study and directions for future research are discussed.
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This study aimed to explore the clinical and neuropsychological characteristics—cognition, behavior, parenting-related stress, and sleep—of children with epilepsy, attention-deficit/hyperactivity disorder (ADHD), or both.
We retrospectively reviewed the electronic medical records of 33 children with epilepsy and ADHD, 113 with epilepsy alone, and 294 with ADHD alone. The children were required to complete the Advanced Test of Attention (ATA), and their parents completed the ADHD Rating Scale (ARS), Child Behavior Checklist (CBCL), Children's Sleep Habits Questionnaire (CSHQ), Disruptive Behavior Disorder (DBD) Scale (DBD), Social Responsiveness Scale (SRS), and Parenting Stress Index-Short Form (PSI-SF).
Auditory Commission Errors made during the ATA were higher in children with epilepsy and ADHD than in those with epilepsy alone. On the SRS, all the subscales except Social Awareness were significantly higher in children with epilepsy and ADHD or ADHD alone than in those with epilepsy alone. The Oppositional Defiant and Conduct Disorder subscales on DBD, Attention Problems, and Aggressive Behaviors on CBCL were significantly higher in children with both epilepsy and ADHD than in those with epilepsy alone. The Parent-Child Dysfunctional Interaction subscales on the PSI-SF were significantly greater in children with both epilepsy and ADHD than in those with epilepsy alone. The subscales on the CSHQ did not significantly differ between children with both epilepsy and ADHD and those with epilepsy alone.
In children with epilepsy, comorbid ADHD was associated with negative effects on response inhibition, aggressive behavior, and parenting-related stress.
Social brain networks: Resting-state and task-based connectivity in youth with and without epilepsy
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Individuals with epilepsy often experience social difficulties and deficits in social cognition. It remains unknown how disruptions to neural networks underlying such skills may contribute to this clinical phenotype. The current study compared the organization of relevant brain circuits—the “mentalizing network” and a salience-related network centered on the amygdala—in youth with and without epilepsy. Functional connectivity between the nodes of these networks was assessed, both at rest and during engagement in a social cognitive task (facial emotion recognition), using functional magnetic resonance imaging. There were no group differences in resting-state connectivity within either neural network. In contrast, youth with epilepsy showed comparatively lower connectivity between the left posterior superior temporal sulcus and the medial prefrontal cortex—but greater connectivity within the left temporal lobe—when viewing faces in the task. These findings suggest that the organization of a mentalizing network underpinning social cognition may be disrupted in youth with epilepsy, though differences in connectivity within this circuit may shift depending on task demands. Our results highlight the importance of considering functional task-based engagement of neural systems in characterizations of network dysfunction in epilepsy.
Deficits in all aspects of social competence identified in children who have undergone epilepsy surgery
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Citation Excerpt :
The study used the same instrument to measure social skills as we did. We noticed, however, that compared with the normative mean, the score obtained on the measure of social skills was much lower in our study (1.33 SD < normative mean) relative to the study by Tse and colleagues [55] (0.11 SD < normative mean). Further, the rates of social skills impairments in our study (46%) were almost 3 times the rate of social skills impairment (13%) found in the study by Tse and colleagues.
Research on social competence of children who undergo epilepsy surgery is limited. This cross-sectional study aimed to determine the frequency and pattern of impairments in social competence (domains: social skills, social adjustment, and social performance) in a cohort of children who underwent surgery for intractable epilepsy at a single epilepsy surgical center. In addition, we explored the relationships between social competence with epilepsy variables, surgical variables, and seizure outcomes. Fifteen children (5 to 16 years) who underwent focal cortical resection for intractable epilepsy more than 2 years ago (2.58–7.42 years) participated. Parents completed standardized, age-normed questionnaires, assessing three domains of social competence. Demographic and clinical information were obtained from parents and medical records and verified by Pediatric Neurologists and Clinical Nurse Consultant. Individual and group analyses were conducted. Seventy-three percent (n = 11/15) of children were seizure-free. Individual analyses revealed high rates of impairments (scores > 1 standard deviation of the mean); 11 out of 15 children (73.3%) obtained a score that fell in the impaired range on at least one domain of social competence, with 5 of these 15 children (30.0%) obtaining impaired scores across domains. Conversely, group analyses of questionnaires completed by parents revealed that compared with norms, children had significant difficulties in all domains of social competence: social skills, social adjustment, and social performance. No significant relationships were found between domains of social competence and epilepsy and surgical variables. In conclusion, children who underwent epilepsy surgery have significantly reduced social competence relative to the norms. Longitudinal studies examining social competence pre- and postsurgery are needed to determine whether surgery improves social competence and whether this is dependent on epilepsy outcomes.
SOCIAL COGNITION IN CHILDHOOD EPILEPSY WITH CENTROTEMPORAL SPIKES
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Social cognition is involved in the perception, processing, and interpretation of social information. For this reason, social cognition is a crucial domain for successful communication and interpersonal relationships. With this in mind, we aimed to assess social cognition in children with Self-Limited Childhood Epilepsy with Centrotemporal Spikes (CECTS) and its association with traditional executive function tests and clinical variables of epilepsy.
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Neurobehavioral comorbidities, particularly attention-deficits, are common in children with epilepsy (CWE). Neurobehavioral problems are manifested in school performance, peer relations, and social competence. Although the high prevalence of these comorbid behavioral problems is fully recognized, there remains to be a lack of studies on the interventions targeted for CWE. A manualized neuropsychological group intervention, Rehabilitation of EXecutive Function and ATtention (EXAT) has been developed for school-aged children (aged 6–12 years) with executive function (EF) and attention-deficits. This study aimed to explore the effects of EXAT on parent- and teacher-rated attention and behavior problems in CWE compared with children with the diagnosis of attention-deficit hyperactivity disorder (ADHD) and children with no formal diagnosis but prominent deficits in EF and attention. Forty-two children attending in neuropsychological group rehabilitation EXAT between the years 2006 and 2017 participated in this retrospective registry study. The CWE group consisted of 11 children, the ADHD group with 16 children, and EF/attention group consisted of 15 children with EF attention and/or problems without diagnosis of ADHD. The CWE group did not differ from the other two study groups (ADHD and no formal diagnosis) before the EXAT intervention. This indicates that attention problems in CWE are similar to those with diagnosed ADHD. The results were promising for applying structured multilevel intervention for CWE and neurobehavioral comorbidities. Lack of group differences between the groups participating EXAT suggests similar intervention effects between CWE, ADHD, and those with less severe EF and attention problems. In parent ratings, intervention effects were higher in hyperactivity and oppositional behavior for children with attention problems and without epilepsy. Parents in the CWE group reported no effects except for one subscale related to hyperactivity. However, teachers reported consistently positive intervention effects for both inattention and hyperactivity–impulsivity along with anxiety and emotional lability. The results suggest that neurobehavioral comorbidities in CWE could be targeted in neuropsychological group intervention. In conclusion, CWE seem to benefit from interventions and behavior modification techniques first developed for children with ADHD.

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Social skills problems in children with epilepsy: Prevalence, nature and predictors

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgment

J Pediatr

Epilepsy Res

Epilepsy Behav

Epilepsy Behav

J Am Acad Child Adolesc Psychiatry

Social adjustment and competence 35 years after onset of childhood epilepsy: a prospective controlled study

Epilepsia

Long-term psychosocial outcome in typical absence epilepsy: sometimes a wolf in sheeps’ clothing

Arch Pediatr Adolesc Med

Psychosocial outcome of young adults with epilepsy in childhood

J Neurol Neurosurg Psychiatry

Long-term medical, educational and social prognoses of childhood-onset epilepsy: a population-based sudy in a rural district of Japan

Brain Dev

Long-term follow-up of early detected vulnerable children

J Consult Clin Psychol