Risk factors for child mental health problems in Lithuania: The role of parental nationality

BackgroundWe compare the mental health status of children who reside in Lithuania with parents who are either Lithuanian nationals or non-Lithuanian nationals.MethodData were drawn from the School Child Mental Health Europe survey (SCMHE), a cross-sectional survey of school children aged 6–11 years. A total of 1152 Lithuanian children participated, among them 11.7% from a non-Lithuanian family. Child mental health was assessed using the Dominique Interactive (DI) and the parent- and teacher Strength and Difficulties Questionnaire (SDQ). Parental attitudes were evaluated, and socio-demographics were collected.ResultsOverall 26.7% of non-Lithuanian versus 17.2% of Lithuanian children reported having an internalizing disorder (p = 0.01) mainly due to separation anxiety (16.4% versus 10.2%, p = 0.04). Odds ratio (OR) for child-reported internalizing disorders was 1.86 (95% CI = 1.17–2.96) once adjusted for other factors including being a girl, to be younger, parental unemployment and low caring and low autonomy parental attitudes which were associated with greater odds of internalizing disorders. In addition, 31.9% of non-Lithuanian reported suicidal thoughts versus 22.0% of Lithuanian children p = .02); OR = 1.60 (95% CI = 1.04–2.46) once adjusted for single parent, parental unemployment, parental alcohol problems and overreactivity attitude.ConclusionsBeing a non-national minority in Lithuania is a risk factor for child mental health. These findings suggest that further studies are needed to inform local policy-makers on targeted prevention and intervention programs in these children.     

Behavior problems among school-aged children with autism spectrum disorder: Associations with children's communication difficulties and parenting behaviors

Research has clearly demonstrated that behavior problems are common among children with ASD. These co-occurring behavior problems place children with ASD and their families at risk for a range of negative outcomes. This questionnaire study aimed to investigate whether and how age, gender, and communication difficulties at the child level and parenting behaviors at the family level are associated with externalizing and internalizing problems among children with ASD (n = 206) and without ASD (n = 187) aged 6–12 years. Results indicated that pragmatic language difficulties of the child and negative controlling parenting behaviors both made a significant and unique contribution to externalizing behavior problems for the ASD group. In the control group, chronological age and pragmatic language difficulties were the most robust concurrent predictors of externalizing problems. With regard to internalizing problems, pragmatic language difficulties and ASD adapted parenting behaviors were significant predictors for both the ASD and control group.     

Hours of sleep in adolescents and its association with anxiety,emotional concerns,and suicidal ideation

ObjectivesAnxiety and concerns in daily life may result in sleep problems and consistent evidence suggests that inadequate sleep has several negative consequences on cognitive performance, physical activity, and health. The aim of our study was to evaluate the association between mean hours of sleep per night, psychologic distress, and behavioral concerns.MethodsA cross-sectional analysis of the correlation between the number of hours of sleep per night and the Zung Self-rating Anxiety Scale (Z-SAS), the Paykel Suicidal Scale (PSS), and the Strengths and Difficulties Questionnaire (SDQ), was performed on 11,788 pupils (mean age ± standard deviation [SD], 14.9 ± 0.9; 55.8% girls) from 11 different European countries enrolled in the SEYLE (Saving and Empowering Young Lives in Europe) project.ResultsThe mean number of reported hours of sleep per night during school days was 7.7 (SD, ±1.3), with moderate differences across countries (r = 0.06; P < .001). A reduced number of sleeping hours (less than the average) was more common in girls (β = 0.10 controlling for age) and older pupils (β = 0.10 controlling for sex). Reduced sleep was found to be associated with increased scores on SDQ subscales of emotional (β = −0.13) and peer-related problems (β = −0.06), conduct (β = −0.07), total SDQ score (β = −0.07), anxiety (Z-SAS scores, β = −10), and suicidal ideation (PSS, β = −0.16). In a multivariate model including all significant variables, older age, emotional and peer-related problems, and suicidal ideation were the variables most strongly associated with reduced sleep hours, though female gender, conduct problems measured by the SDQ, and anxiety only showed modest effects (β = 0.03–0.04).ConclusionsOur study supports evidence that reduced hours of sleep are associated with potentially severe mental health problems in adolescents. Because sleep problems are common among adolescents partly due to maturational processes and changes in sleep patterns, parents, other adults, and adolescents should pay more attention to their sleep patterns and implement interventions, if needed.     

Childhood adversity and psychosis: Examining whether the association is due to genetic confounding using a monozygotic twin differences approach

PurposeTo test whether the association between childhood adversity and positive and negative psychotic experiences is due to genetic confounding.MethodChildhood adversity and psychotic experiences were assessed in an ongoing sample of 226 twins from the general population. A monozygotic (MZ) twin differences approach was used to assess possible genetic confounding.ResultsIn the whole sample, childhood adversity was significantly associated with positive (β = 45; SE = 0.16; P = 0.008) and negative psychotic experiences (β = 0.77; SE = 0.18; P < 0.01). Within-pair MZ twin differences in exposure to childhood adversity were significantly associated with differences in positive (β = 71; SE = 0.29; P = 0.016) and negative psychotic experiences (β = 98; SE = 0.38; P = 0.014) in a subsample of 85 MZ twin pairs.ConclusionsIndividuals exposed to childhood adversity are more likely to report psychotic experiences. Furthermore, our findings indicate that this association is not due to genetic confounding.     

Health related quality of life in parents of six to eight year old children with Down syndrome

Raising a child with Down syndrome (DS) has been found to be associated with lowered health related quality of life (HRQoL) in the domains cognitive functioning, social functioning, daily activities and vitality. We aimed to explore which socio-demographics, child functioning and psychosocial variables were related to these HRQoL domains in parents of children with DS. Parents of 98 children with DS completed the TNO-AZL adult quality of life questionnaire (TAAQOL) and a questionnaire assessing socio-demographic, child functioning and psychosocial predictors. Using multiple linear regression analyses for each category of predictors, we selected relevant predictors for the final models. The final multiple linear regression models revealed that cognitive functioning was best predicted by the sleep of the child (β = .29, p < .01) and by the parent having given up a hobby (β = ?.29, p < .01), social functioning by the quality of the partner relation (β = .34, p < .001), daily activities by the parent having to care for an ill friend or family member (β = ?.31, p < .01), and vitality by the parent having enough personal time (β = .32, p < .01). Overall, psychosocial variables rather than socio-demographics or child functioning showed most consistent and powerful relations to the HRQoL domains of cognitive functioning, social functioning, daily activities and vitality. These psychosocial variables mainly related to social support and time pressure. Systematic screening of parents to detect problems timely, and interventions targeting the supportive network and the demands in time are recommended.     

Stress in mothers of children with autism: Trait mindfulness as a protective factor

Mindfulness-based interventions may reduce parents’ stress and improve parent–child relationships. Given the chronic nature of autism spectrum disorder (ASD) and its influence on parents’ stress, interventions to promote mindfulness may be especially helpful for parents of children with ASD. Prior to undertaking intervention development, it is first necessary to establish the relationship between mindfulness and stress, as other factors like child behavioral difficulties may overshadow the mother's regulation strategies. In a sample of mothers of children with ASD (n = 67) and a comparison sample of mothers without ASD (n = 87), mindfulness was significantly associated with the level of maternal stress above and beyond child behavior problems (non-ASD: β = −.232; F(1, 64) = 15.749, p < .000; ASD: β = −.206; F(1, 84) = 15.576, p < .000). Results suggest that interventions to promote mindfulness may be helpful in reducing parenting stress among mothers of children with ASD, as well as mothers of typically developing children. Due to the chronic nature of ASD, such interventions may be particularly applicable.     

Predictors of intellectual functioning after epilepsy surgery in childhood: The role of socioeconomic status

ObjectiveThe objective of this study was to evaluate the association between socioeconomic status and intellectual functioning in children with medically refractory epilepsy, before and after resective epilepsy surgery. Family environment is a strong contributor to cognitive development in children and has been recently shown to play a significant role in intellectual outcome after surgery in children with epilepsy.MethodsOne hundred children who had undergone resective epilepsy surgery and completed preoperative and postoperative assessments of IQ as part of clinical care were included in the study. We evaluated the impact of epilepsy-related variables, income quintile, and residence location on IQ.ResultsGreater improvements in IQ after surgery were associated with an older age at surgery (β = .235, p = .018). Higher IQ scores at follow-up were associated with an older age of seizure onset (β = .371, p < .001), older age at surgery (β = .356, p < .001), unilobar epileptogenic focus (β = .394, p < .001), and mesial temporal sclerosis (β = .338, p = .001) or tumor (β = .457, p < .001) in comparison with malformation of cortical development; age at seizure onset did not remain as a significant predictor in multivariable regression analysis. Income quintile, residence location, seizure control, and antiepileptic medication use were not significant predictors.ConclusionsEpilepsy-related variables were the strongest predictors of IQ and postoperative change in IQ. We were unable to identify a significant association between IQ and socioeconomic status. Future research should evaluate the impact of multiple aspects of family environment.     

Sleep patterns and sleep disturbances among Chinese school-aged children: Prevalence and associated factors

ObjectiveThe study aimed to (1) characterize sleep patterns and sleep disturbances among Chinese school-aged children, (2) determine the prevalence of their short sleep duration and sleep disturbances based on clinical cutoffs, and (3) examine possible factors (socio-demographic factors and emotional/behavioral problems) that are associated with sleep disturbances.MethodsA large representative sample of 912 children aged 6–14 years was recruited from Shenzhen, China. Their parents completed the Children’s Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ).ResultsThe mean bedtime was 9:45 pm (SD = 1 h 11 min), mean wake-up time was 7:03 am (SD = 31 min), mean sleep duration was 9 h 14 min (SD = 46 min), and 23.8% of the children had sleep duration <9 h. Overall, 69.3% of the children suffered from global sleep disturbances (CSHQ total score >41). Bedtime resistance (22.9%), sleep anxiety (22.1%), sleep duration (21%) and daytime sleepiness (20%) were the most prevalent sleep disturbances; followed by sleep disordered breathing (12.1%), parasomnias (9.4%), sleep onset delay (6.9%), and night waking (5.2%). The prevalence of specific sleep disturbances ranged from 3.2% (falling asleep while watching television) to 81.9% (awakening by others in the morning). Correlations between most domains of sleep disturbances and emotional/behavioral problems were statistically significant (p < 0.05 or p < 0.01). Hierarchical multiple regression analysis revealed that gender (β = 0.10, p < 0.01), school grade (β = −0.09, p < 0.05), co-sleeping (β = 0.25, p < 0.01), emotional symptoms (β = 0.24, p < 0.01), conduct problems (β = 0.09, p < 0.05), and hyperactivity (β = 0.17, p < 0.01) accounted for significant variance in CSHQ total score.ConclusionsShort sleep duration and sleep disturbances are prevalent among Chinese school-aged children. Sleep disturbances are associated with gender, school grade, co-sleeping, emotional symptoms, conduct problems, and hyperactivity.     

Epilepsy,school readiness in Canadian children: Data from the National Longitudinal Study of Children and Youth (NLSCY)

PurposeUtilizing data from the National Longitudinal Survey of Children and Youth (NLSCY) we evaluated the association between childhood epilepsy and health impairments on measures of school readiness employed in the survey.MethodsStandard scores on the Peabody Picture Vocabulary Test-Revised (PPVT-R) were employed in a regression analysis to compare scores in children with and without epilepsy. We also examined the effect of impairments in any of the 8 domains of the Health Utilities index (HUI) on test scores.ResultsA total sample size of 39,130 children (20,044 males, and 19,086 female were included in the analysis, 33,560 children were administered the PPVT-R at a mean age of 4.5 years. There were 70 children with epilepsy, 21 had a score of 1 on the HUI, 21 were assessed to have a HUI < 1 (signifying health impairments in one or more of the 8 domains). In the remainder, the PPVT scores were missing. Using the Ordinary Least Squares (OLS) regression for continuous outcomes model for PPVT-R scores as the outcome variable, females scored 1.1 points higher (β = 1.1, 95%CI 0.755, 1.444, p = 0.000), children without epilepsy and HUI score of <1 scored 3.84 points lower (β = −3.843 95%CI −4.232, −3.452, p = 0.000). Children with epilepsy and a HUI score of 1 scored 9.90 points lower (β = −9.902, 95%CI −16.343, −3.461, p = 0.003) while those with epilepsy and HUI < 1 scored 17.30 lower (β = −17.308, 95%CI −23.776, −10.839, p = 0.000).ConclusionThe data provide objective evidence that children with epilepsy are at risk of scholastic underachievement at school entry, while those with additional health impairments as measured by the HUI are at greater risk of underachievement.     

Prevalence and factors associated with snoring in 3-year olds: Early links with behavioral adjustment

ObjectiveIdentify the prevalence of sleep disordered breathing (SDB) symptoms in a community sample of New Zealand 3-year olds. To examine sleep, demographic, health, environmental, familial, perinatal, and behavioral adjustment factors associated with habitual snoring.MethodsA cross sectional study, in which parents of 823 children aged 3 years 0 months to 3 years 12 months (M:F = 1:0.9) were recruited from the community. Participants completed questionnaires designed to assess information relevant to their children’s sleep, with a particular focus on snoring.ResultsParents reported snoring at least once a week in 36.9% of children, and habitual snoring (more than four nights per week) in 11.3% of children. Univariate analysis showed habitual snoring was more common amongst Māori (indigenous New Zealanders) (P = 0.04) and males (P = 0.05), and that habitual snorers came from more socio-economically deprived neighborhoods (P < 0.01). Several other SDB-related symptoms were significantly associated with habitual snoring: mouth breathing, sweating profusely, waking during the night, sleeping with neck extended, constant runny nose, and suffering from tonsillitis. Mouth breathing was the most strongly associated. Multivariate analyzes revealed a strong positive relationship between snoring and some health and familial factors, as well as parent reported child irritability (OR = 2.83; 95% CI 1.4–5.6) and hyperactivity (OR = 1.6; 95% CI 1.0–2.7).ConclusionsThe prevalence of habitual snoring amongst New Zealand pre-schoolers is similar to that reported elsewhere. Factors associated with habitual snoring include male gender, Māori ethnicity, and poorer deprivation neighborhood, as well as a variety of other environmental and health factors. The data provide evidence that habitual snoring associated with irritable and hyperactive behavior is evident in children as young as three.     

Napping in English preschool children and the association with parents’ attitudes

BackgroundAge-independent variability in childrens’ napping duration may be influenced by parental preference and attitudes and childrens’ availability or lack of opportunity to nap. Our study examined English preschool childrens’ napping duration, frequency and location, and the association of daily nap duration with parents’ attitudes towards napping.MethodsParents of three-year-old children in deprived and nondeprived areas of a town in North-East England were interviewed regarding their attitudes towards child napping and completed four-day and five night sleep diaries documenting their childrens’ daytime and nighttime sleep.ResultsOf 84 children, half had at least one nap during the four-day study period (median [interquartile range] daily nap duration across all children was 1 [21] min; for nappers only was 21 [34] min). Naps tended to be infrequent and short and few (6%) occurred in a bedroom. Children whose parents allowed or encouraged napping had significantly longer daily nap duration (n = 25, median [interquartile range] daily nap duration 21 [34] min) compared to those whose parents tried to prevent them from napping (n = 29, 1 [21] min), and those whose parents reported that children did not want to nap (n = 30, 0 [0] min) (U = 23.21; p < .001).ConclusionPositive parental attitude towards napping was associated with longer child nap duration. Napping appeared to be mainly sporadic and opportunistic and was negatively perceived and prevented by one-third of parents. The consequences of premature nap cessation are not known; given the importance of sufficient sleep in childhood, we should possibly consider enabling young children to nap more freely.     

Auditory event-related potentials at preschool age in children born very preterm

ObjectiveTo assess auditory event-related potentials at preschool age in children born very preterm (VP, 27.4 ± 1.9 gestational weeks, n = 70) with a high risk of cognitive dysfunction.MethodsWe used an oddball paradigm consisting of a standard tone randomly replaced by one of three infrequent deviants (differing in frequency, sound direction or duration).ResultsThe P1 and N2 latencies were inversely correlated to age (50–63 months) both in VP (r = −0.451, p < 0.001, and r = −0.305, p = 0.01, respectively) and term born controls (TC; n = 15). VP children had smaller P1 than near-term (n = 12) or TC (1.70 ± 0.17 μV vs 2.68 ± 0.41 and 2.92 ± 0.43, respectively; p < 0.05). Mismatch negativity response did not differ between groups.ConclusionsOur data suggest a fast maturation of P1 and N2 responses with fast decrease in P1 and N2 latencies around the age of 5 years. Mismatch negativity response does not seem to be a robust measure for defining abnormalities in VP children.SignificanceIn ERP studies in preschool children, even small, non-significant group differences in age at recording should be corrected for. Very preterm born children at preschool age have aERP patterns as earlier described in full-term born children with cognitive deficits.     

Cognitive functions in children exposed to antiepileptic drugs in utero - Study in Georgia

ObjectiveThe cognitive teratogenicity of antiepileptic drugs (AEDs) has gained increasing attention in the last decade. The objective of the current study was to assess the effects of AED fetal exposure on the cognitive development of children of mothers with epilepsy from Georgia in a controlled study taking into consideration major confounding factors.MethodsA prospective cohort group was formed from children and mothers registered in the Georgian National AED-Pregnancy Registry. The study group's age- and gender-matched control children without fetal AED exposure were selected retrospectively. The Intelligence Quotient (IQ) using the Wechsler Adult Intelligence Scale – revised (WAIS-R) was assessed in mothers. The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-4) were used to assess intellectual functioning for children of both study and control groups. Linear regression analysis was performed to detect association of AED exposure on the cognitive performance of children.ResultsIn total, 100 children aged 36 to 72 months were evaluated. The IQ of WWE was significantly lower compared to women without epilepsy in all modalities. Exposure to valproate (VPA) (n = 18) was associated with lowest cognitive performance regarding Full Scale IQ (FSIQ) (β, − 12.04; p = 0.006) and verbal comprehension (VCI) (β, − 8.89; p = 0.019). Maternal FSIQ, maternal performance IQ (PIQ), and child's age at first phrases were independent factors associated with the cognitive development of children.ConclusionsMultivariate analysis showed VPA to be an independent predictor for decreased cognitive performance. Maternal FSIQ, PIQ, and child developmental achievements were significant confounders for cognitive performance in children.     

A longitudinal study of neurocognitive function in individuals at-risk for psychosis

IntroductionClinically defined prodromal diagnostic criteria identify at-risk individuals with a 35–40% likelihood of developing a psychotic disorder within a year. The time course and predictive value of cognitive deficits in the development of psychosis has not been established.MethodsA comprehensive neurocognitive battery and clinical assessments were administered to 37 subjects meeting Criteria of Prodromal States (COPS) criteria for being at risk for psychosis, and two comparison groups: 59 first episode and 47 healthy subjects. Subjects were also evaluated at 6-month and 1-year follow-up periods. Primary analyses used a neurocognitive composite score derived from individual neurocognitive measures, including measures of vigilance, verbal memory, working memory, and processing speed.ResultsAt-risk subjects performed more poorly than healthy subjects (t = 2.93, P = 0.01), but better than first episode subjects (t = 4.72, p < 0.0001). At-risk subjects were particularly impaired on measures of vigilance and processing speed. Cognitive composite scores were significantly lower in at-risk subjects who progressed to psychosis (N = 11; z = − 1.2), while those at-risk subjects who did not progress to psychosis (N = 17) performed better (z = − 0.5), and not significantly different from controls. Poor CPT performance combined with better WAIS-R digit symbol performance predicted progression to psychosis. Severity of neurocognitive deficits was not related to duration of prodrome or to time to development of psychosis and neurocognitive function improved in all subjects except those who progressed to psychosis.ConclusionNeurocognitive impairment emerges early in the course of psychotic illness. Performance on tests of neurocognition may prove to be an early risk predictor for subsequent development of psychotic disorders.     

The impact of an exercise therapy on psychosocial health of children with benign epilepsy: A pilot study

ObjectivesThe purposes of the current study were to test the feasibility of exercise therapy for children with benign epilepsy with centrotemporal spikes (BECTS) and to collect pilot data about the impact of exercise therapy on neurocognitive, emotional, and behavioral outcomes.MethodsTen children with BECTS (9.7 ± 1.42 years) participated in a therapeutic exercise program consisting of ten supervised exercise sessions and home-based exercises for five weeks. Electroencephalography (EEG), seizure frequency, and neurocognitive and psychological factors, including attention, executive function, depression, anxiety, behavioral problems, and quality of life, were assessed before and after the exercise program.ResultsNo clinical symptoms were observed to worsen during the study, demonstrating that the exercise therapy was safe and also feasible. After five weeks of exercise therapy, significant improvements in neurocognitive domains such as simple visual and auditory attention, sustained attention, divided attention, psychomotor speed, and inhibition–disinhibition were observed. Furthermore, parent ratings of internalizing behavioral problems and social problems and mood-related well-being from quality of life improved after exercise therapy. Although not statistically significant, trends were noted toward improvement in children's self-reports of negative mood/somatization, parent reports of somatic complaints, and general health on a quality-of-life measure.ConclusionsA five-week structured exercise program was successfully implemented, with preliminary data suggesting beneficial impact on neurocognitive and psychobehavioral function. Exercise therapy should be further evaluated as a part of a comprehensive treatment program for children with benign epilepsy.     

Stability and change of cognitive attributes in children with uneven/delayed cognitive development from preschool through childhood

As part of an ongoing clinical service program for children with developmental delay in an Asian developing country, we analyzed the cognitive attributes of 362 Taiwanese children (average age 48.5 ± 12.9 month-old) with uneven/delayed cognitive development as they were assessed repeatedly with average duration of 39.7 ± 22.6 months from preschool through early childhood. The objectives were to determine the stability and related factors in cognitive scores of these 362 children belonging to three diagnostic subgroups: 181 children with non-autistic mental retardation (MR), 95 children with autism spectrum disorder (ASD) and 64 children with mixed type developmental language disorder (DLD); and to contribute to the accumulation of data on cognitive outcome in preschool children with developmental delay. Analysis revealed that mean initial cognitive score (IQ1) was 64.9 ± 16.9 while mean cognitive measure at follow-up (IQ2) was 72.2 ± 19.7. Whole group analysis showed the correlation between IQ1 and IQ2 was moderate (r = 0.73, p < 0.001). Analysis by a general linear model showed only male gender (β = 4.95, p = 0.02, C.I. = 0.8–9.1) and IQ1 (β = 0.79, p < 0.001, C.I. = 0.68–0.90) to be significant predictors of IQ2. There were differences among three groups in IQ1 (p < 0.001), IQ2 (p < 0.001) and IQ change (p < 0.001). Correlation coefficients of IQ1 and IQ2 were 0.6 for ASD group, 0.7 for MR group and 0.4 for DLD group respectively. The greatest proportion of children remained within the same cognitive range for both assessment points, however, it is noted that a substantial minority of children changed IQ ranges drastically from preschool through early childhood. Our results suggest that measurements of cognitive function at preschool age for children with developmental delay were valid in the context of a developing country, and the observed change in cognitive scores during follow-up emphasized the need to interpret the initial results of cognitive tests with caution.     

Sleep quality and cognitive performance in 8-year-old children

ObjectiveThe present study examined how sleep duration and sleep quality are associated with cognitive performance in 8-year-old children using standardized neurocognitive tests.MethodsTwo hundred ninety children aged 7.4–8.8 years participated in the study. Sleep duration and quality were measured using actigraphs and the Sleep Disturbance Scale for Parents. Cognitive performance was measured using four subtests of the Wechsler Intelligence Scale for Children III, the Beery Developmental Test of Visual-Motor Integration (VMI), and the Narrative memory subtest of the Developmental Neuropsychological Assessment for Children.ResultsWhen adjusting for age, sex, and maternal education, shorter sleep duration, but not sleep quality, was associated with lower visuospatial abilities (p-values ?0.043). Sleep duration and quality were not associated with verbal abilities (p-values ?0.18). With regard to the individual test results, shorter sleep duration was associated with worse performance in Visual-Motor Integration (p = 0.028), and when excluding children with high depression scores the same was also true with Block Design (p-values ?0.047). Moreover, poor sleep efficiency was associated with worse performance in Similarities (p = 0.004).ConclusionsIn a community sample of 8-year-old children, those who slept less or had poorer sleep quality had lower test scores in cognitive tasks, particularly those pertaining to visuospatial performance, although the association was not very strong.     

The influence of patient,caregiver, and family factors on symptoms of anxiety and depression in children and adolescents with intractable epilepsy

ObjectiveThe objective was to evaluate the association of caregiver and family factors with symptoms of anxiety and depression in children and adolescents with medically refractory localization-related epilepsy (i.e., failed at least two epilepsy medications).MethodForty-four children (ages 6–11 years) and 65 adolescents (ages 12–18 years) and their parents participated in this multicentered, observational, cross-sectional study. Univariable and multivariable linear regressions were used to evaluate the influence of multiple patient, caregiver, and family characteristics on self-reported symptoms of anxiety and depression in the children and adolescents.ResultsAmong children, depressive symptoms were associated with a lower proportion of life with seizures (β = .344, p = .022), caregiver depression (β = .462, p = .002), poorer family relationships (β = .384, p = .010), and poorer family mastery and social support (β = .337, p = .025); in multivariable analysis, proportion of life with epilepsy and parental depression remained significant. No significant predictors of anxiety were found among children. Among adolescents, depressive symptoms were associated with caregiver unemployment (β = .345, p = .005) and anxiety (β = .359, p = .003), low household income (β = .321, p = .012), poorer family mastery and social support (β = .334, p = .007), and greater family demands (β = .326, p = .008); in multivariable analysis, caregiver unemployment and anxiety remained significant. Greater anxiety symptoms among adolescents were associated with females (β = .320, p = .009) and caregiver depression (β = .246, p = .048) and anxiety (β = .392, p = .001) and poorer family mastery and social support (β = .247, p = .047); in multivariable analysis, female sex and caregiver anxiety remained significant.SignificanceThese findings highlight the central role of caregiver psychopathology, which is amenable to intervention, on children and adolescents' symptoms of anxiety and depression. Addressing caregiver psychopathology may improve children and adolescents' quality of life even if seizure control is not attained.     

Socioeconomic deprivation is an independent risk factor for behavioral problems in children with epilepsy

AimThe aim of this study was to examine whether socioeconomic deprivation in children with epilepsy (CWE) increases risk for behavioral problems independent of seizure factors.MethodsA cross-sectional study was done in which parents of children attending a specialist epilepsy clinic were invited to complete a child behavior checklist (CBCL) questionnaire about their child. Medical and sociodemographic data on CWE were obtained through their pediatric neurologists. Home postal code was used to obtain quintiles of Scottish Index of Multiple Deprivation 2012 (SIMD2012) scores for individuals. Lower (1–3) quintiles correspond to higher socioeconomic deprivation. Regression analysis was used to investigate whether a lower quintile was an independent risk factor for scores > 63 (significant behavioral problem).ResultsParents of 87 children (42 male, mean age of 10.5 years) were enrolled. Fifty-nine percent had total scores > 63. A higher proportion of children from quintiles 1–3 compared to those from quintiles 4–5 had externalizing (49% vs. 25%, p = 0.02) and total (54% vs. 30%, p = 0.02) scores > 63. Adjusted OR of quintiles 1–3 vs. 4–5 for scores > 63 = 14.8, 95% CI = 3.0, 68.0. Fewer children with scores > 63 and from quintiles 1–3 were known to the child and adolescent mental health service (CAMHS) compared to those in quintiles 4–5 (p = 0.01).InterpretationSocioeconomic deprivation was an independent risk factor for behavioral problems in CWE. Children with epilepsy and behavioral problems who lived in socioeconomically deprived areas received less help.     

Trouble stress post traumatique,dépression et anxiété chez les parents d’enfant(s) atteint(s) d’épilepsie

IntroductionPost-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy.ObjectivesWe aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy.MethodsA survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model.ResultsResults revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P = 0.026, ORa = 13.1), insufficient involvement of partner in disease management (P < 10^?3, ORa = 12.1) and duration of epilepsy less than 12 months (P = 0.001; ORa = 0.1). Female gender (P = 0.006, ORa = 18.1) and restriction of social life (P = 0.006, ORa = 4.1) were associated with depression. Factors associated with anxiety were insufficient involvement of partner in disease management (P = 0.03, ORa = 4.6) and PTSD (P = 0.005, ORa = 9.1).ConclusionThese findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.