Social cognition in children with epilepsy in mainstream education

Abstract

AimTo establish whether deficits in social cognition are present in children with generalized or focal epilepsy in mainstream education, and whether any relation exists between social cognition, communication, and behaviour measures.MethodIn a cross-sectional study, children with an epilepsy-only diagnoses in mainstream education (n=20 with generalized epilepsy; eight males, 12 females; mean age 11y 6mo, SD 2y 6mo; and n=27 with focal epilepsy; 12 males, 15 females; mean age 11y 8mo, SD 2y 2mo) and comparison participants (n=57; 28 males, 29 females; mean age 11y 2mo, SD 2y 4mo) were administered the Strange Stories task and the Mind in the Eyes task, as well as an IQ assessment. Parents completed the Children's Communication Checklist-2 and the Child Behavior Checklist (CBCL).ResultsBoth groups of children with epilepsy performed more poorly than control children on the Mental Stories component of the Strange Stories task, F(2,101)=3.2, p<0.001. Performance on Mental Stories was related to pragmatic communication, but only in the generalized epilepsy group (r=0.51, p=0.03, 95% CI=0.2–0.8). There were no differences between epilepsy groups or control participants in the Mind in the Eyes task, F(2,101)=0.4, p=0.4.InterpretationChildren with ‘epilepsy only’ are at risk of deficits in social cognition and may require appropriate support.What this paper addsChildren with focal and generalized epilepsy have deficits in social cognition.Social cognition was associated with pragmatic communication in generalized epilepsy.

Impaired performance on advanced Theory of Mind tasks in children with epilepsy is related to poor communication and increased attention problems

“…These studies have provided evidence of specific impairments in particular epilepsy types, often with all groups showing poorer performance when compared with unaffected controls. We have recently found, in a small group of CWE, that ToM skills did not differ between generalized and focal seizure types and that no reliable relationships between task performance, communication, and behavior could be established [19]. Cognitive, psychiatric, and social adjustment problems are neurobehavioral comorbidities in CWE with normal intelligence, irrespective of syndrome [20,21].…”

Interictal epileptiform activity and autism

“…For example, nearly all patients with autism have impairment in social skills. Several studies have revealed specific deficits in social cognition in patients with various forms of epilepsy [51][52][53].…”

Relationship between social competence and neurocognitive performance in children with epilepsy

“…Adults with frontal lobe epilepsy have diminished ability to understand other's thoughts, humor, emotions, and eye gaze expressions [17]; adults with temporal lobe epilepsy also have diminished ability to understand other's thoughts and beliefs [18]. Children and adolescents with epilepsy are at risk of deficit in social cognition by having less ability to recognize facial expressions and to understand thoughts and motivations of others [19,20]. Unfortunately, ToM studies in children with epilepsy are very limited.…”

“…Previous studies have found associations between social competence and epilepsy type [22], early onset of epilepsy [22], epilepsy etiology [25], seizure types [25], and seizure frequency [26], as well as antiepileptic treatment [26]. Behavioral problems are more associated with early onset of epilepsy [19], generalized epilepsy type, and seizure frequency [27]. Early onset refractory temporal lobe epilepsy can compromise the development of recognizing facial expressions in children and adolescents and is associated with comprehension of affects and intentions.…”