Abstract
Epilepsy is one of the most common neurological disorders in children, with both seizures and their medical treatment associated with increased risk of neuropsychological impairments. Adaptive functioning in children with epilepsy is poorly understood. This study sought to identify the neuropsychological and medical predictors of optimal adaptive functioning in pediatric epilepsy. Forty-six children with epilepsy and 16 typically developing children and their parents participated in this study at two time points. Overall, adaptive functioning was found to be in the average to low average range in children with epilepsy. A composite measure assessing cumulative seizure history was able to significantly predict Adaptive Behavior Assessment System-II (ABAS-II) scores. Whether a child had experienced one or more seizures in the last year was the only individual seizure and treatment variable able to significantly predict adaptive functioning as measured by the ABAS-II. Verbal learning, executive functioning, and internalizing and externalizing behavior problems assessed at Time 1 predicted performance on the ABAS-II at Time 2. Verbal memory and attention, however, were not significant predictors of adaptive functioning. Consistent with what was hypothesized, executive functioning was found to mediate the relationship between seizure history and adaptive functioning when controlling for behavior problems at both Times 1 and 2. When behavior problems were the mediator and executive functioning was controlled for, mediation was not found. Executive functioning also mediated the relationship between group membership (monotherapy, polytherapy, and typically developing) and ABAS-II scores at Time 1, but not at Time 2 when a post-surgical group also was represented. Secondary analyses showed that the relationship between executive and adaptive functioning at Time 2 was moderated by whether or not a child had ever experienced seizures, such that children diagnosed with epilepsy evidenced greater correlations between these constructs than typically developing children. The results of this study suggest that a subset of children with epilepsy, those with active seizures and/or executive dysfunction, are at increased risk of adaptive deficits. These findings highlight the risk factors for suboptimal adaptive functioning in this population, and also suggest potential avenues for remediation.
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