Summary Objective To examine the influence of parent and family general and epilepsy-related stress on longitudinal generic and epilepsy-specific HRQOL for children with new-onset epilepsy, controlling for demographic characteristics, disease factors, and antiepileptic drug adherence. Methods This prospective, longitudinal study included 124 children with new-onset epilepsy (mean age=7.2 years, SD=2.9 years). Parents completed questionnaires on parenting stress, perceived stigma, fears and concerns, and HRQOL at 1, 13, and 25-months post-diagnosis. Adherence to antiepileptic medication was assessed using electronic monitors. A medical chart review was conducted at each visit to obtain seizure and side effect data. Results Higher levels of general and epilepsy-specific parent and family stress, fears and concerns, and perceived stigma negatively impacted child generic and epilepsy-specific HRQOL, above and beyond disease and demographic factors. General parenting and family stress impacted child generic and epilepsy-specific HRQOL more in the first year of disease management than at 2 years post-diagnosis. Higher fears and concerns predicted higher epilepsy-specific HRQOL at 13 months post-diagnosis, whereas 2 years post-diagnosis, higher fears and concerns predicted lower epilepsy-specific HRQOL. Several demographic (i.e., age) and disease-related variables (i.e., side effects, AED adherence) influenced child generic and epilepsy-specific HRQOL. While some findings were consistent across generic and epilepsy-specific HRQOL measures, others were unique. Significance Modifiable parent factors (i.e., general and disease-specific parent and family stress, perceived stigma) impact HRQOL for children with new-onset epilepsy differently over the first two years post-diagnosis. Psychosocial interventions to improve HRQOL within the first year post-diagnosis should address parenting and family stress, overall coping, and anticipatory guidance on managing epilepsy. Interventions targeting adherence, perceived stigma, and fears and concerns could improve HRQOL. Promoting parent management of stress, fears/concerns, and perceived stigma may lead to improved child HRQOL outcomes.

Pediatric psychologists have expertise in the assessment and management of psychosocial comorbidities in children with chronic diseases, with the goal of improving health outcomes. However, integrating pediatric psychology services into medical clinic standard of care can be challenging at both the patient, provider, and institution levels, particularly when these services are new to a preexisting clinic. Youth with epilepsy are at particular risk for psychosocial comorbidities, yet most do not receive appropriate mental health care. The purpose of this article is to describe the development and preliminary implementation of a tiered psychosocial service into a preestablished pediatric epilepsy clinic. Uptake data suggest high rates of initial service acceptability over the first 6 months, with 77% of patients (n ϭ 275 of 356) agreeing to meet with the pediatric psychologist for a screening visit. Barriers and facilitators of building a psychosocial service in the context of an interdisciplinary specialty clinic are discussed. Overall, this model of care could be adapted to other pediatric populations.

Background-Behavioral interventions targeting overweight children have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth.

Strategies to improve recruitment and recommendations for future recruitment efforts in pediatric psychology treatment outcome research for children and families from rural areas are provided.

Weight underestimation is common in children, particularly among youth who are overweight and obese. Perceived, but not actual, weight was predictive of depressive symptoms, highlighting the importance of weight perceptions among youth across the weight spectrum.

SummaryObjective: To examine baseline psychological functioning and antiepileptic drug (AED) behavioral side effects in new onset epilepsy and determine, by age, whether baseline psychological functioning predicts AED behavioral side effects 1 month following AED initiation. Methods: A retrospective chart review was conducted between July 2011 and December 2014 that included youths with new onset epilepsy. As part of routine interdisciplinary care, caregivers completed the Behavior Assessment System for Children, 2nd Edition: Parent Rating Scale to report on baseline psychological functioning at the diagnostic visit and the Pediatric Epilepsy Side Effects Questionnaire to identify AED behavioral side effects at the 1-month follow-up clinic visit following AED initiation. Children (age = 2-11 years) and adolescents (age = 12-18 years) were examined separately.Results: A total of 380 youths with new onset epilepsy (M age = 8.9 AE 4.3 years; 83.4% Caucasian; 34.8% focal epilepsy, 41.1% generalized epilepsy, 23.7% unclassified epilepsy) were included. Seventy percent of youths had at-risk or clinically elevated baseline psychological symptoms. Children had significantly greater AED behavioral side effects (M = 25.08 AE 26.36) compared to adolescents (M = 12.36 AE 17.73), regardless of AED. Valproic acid demonstrated significantly greater behavioral side effects compared to all other AEDs, with the exception of levetiracetam. Higher hyperactivity/impulsivity at baseline significantly predicted higher AED behavioral side effects 1 month after AED initiation in both age groups. Significance: Younger children seem to be more prone to experience behavioral side effects, and these are likely to be higher if youths with epilepsy have baseline hyperactivity/impulsivity. Baseline psychological screening, specifically hyperactivity, can be used as a precision medicine tool for AED selection. K E Y W O R D Santiepileptic drug side effects, hyperactivity, impulsivity, new onset epilepsy

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