PSYCHOSOCIAL, BEHAVIORAL, AND MEDICAL OUTCOMES IN CHILDREN WITH EPILEPSY - A DEVELOPMENTAL RISK FACTOR MODEL USING LONGITUDINAL DATA

Objective. We studied factors predicting the risk of adverse long-term psychosocial, behavioral, and medical outcomes in children with epile psy. Methods. Children (N = 157, 4.5 to 13 years) were enrolled in a p rospective longitudinal study when first seen. Potential subjects were excluded if they were moderately or severely mentally retarded, had m otor or sensory handicaps interfering with testing, or did not speak e ither English or Spanish. Measures. To develop risk predictors, we col lected information regarding the child's medical and seizure history, cognitive functioning, and behavior problems, and family functioning. Children and their families were followed for a minimum of 18 months, then underwent reassessment of medical status, parent's attitudes towa rd epilepsy, and the child's behavioral and cognitive functioning. Dat a were analyzed by confirmatory factor analysis to develop baseline fa ctors (Sociocultural Risk, Seizure Risk, and Behavior Problems) and ou tcome factors (Medical Seizure Problems, Parent's Negative Attitudes T oward Epilepsy, and Behavior Problems), followed by structural equatio n modeling to determine across-time causal effects. Eighty-eight subje cts completed all baseline and outcome measures. Results. Among signif icant across-time effects, Medical Outcome was predicted by Seizure Ri sk. An increased number of stressful life events predicted better Medi cal Outcome. Low acculturation increased Parent's Negative Attitudes a nd was associated with increased Behavior Problems at baseline. Behavi or Problems were stable across time. It is interesting that IQ did not affect any of the outcomes, although its effect may have been mediate d through other baseline measures. Conclusions. Seizure history was th e best predictor of ongoing medical difficulties, whereas the most imp ortant causes of ongoing parental anxiety and negative attitudes towar d epilepsy were sociocultural. Variation in medical or attitudinal out comes was not influenced by either the child's IQ or reported behavior al problems. These findings suggest that to alter attitudes toward epi lepsy, programs should be tailored to the sociocultural background of the family. Studies of quality of life of children with epilepsy shoul d include appropriate sociocultural measures.