Neuropsychological Predictors of Academic Underachievement in Pediatric Epilepsy: Moderating Roles of Demographic, Seizure, and Psychosocial Variables

Abstract

Summary:Purpose: Academic underachievement is common in pediatric epilepsy. Attempts to identify seizure and psychosocial risk factors for underachievement have yielded inconsistent findings, raising the possibility that seizure and psychosocial variables play a complex role in combination with other variables such as neuropsychological functioning. This study crossvalidated a neuropsychological measurement model for childhood epilepsy, examined the relation between neuropsychological functioning and academic achievement, and tested the degree to which demographic, seizure, and psychosocial variables moderate that relation.Methods: Children with chronic epilepsy (N = 173; ages 8 to 15 years; 49% girls; 91% white/non-Hispanic; 79% one seizure type; 79% taking one medication; 69% with active seizures) completed a comprehensive neuropsychological battery. Children diagnosed with mental retardation were excluded.Results: Structural equation modeling identified a threefactor measurement model of neuropsychological function:Verbal/Memory/Executive (VME), Rapid Naming/Working Memory (RN/WM), and Psychomotor (PM). VME and RN/WM were strongly related to reading, math, and writing; PM predicted writing only. Family environment moderated the impact of neuropsychological deficits on writing (p ≤ 0.01) and possibly for reading (p = 0.05); neuropsychological deficits had a smaller impact on achievement for children in supportive/organized homes compared with children in unsupportive/disorganized homes.Conclusions: These findings lend partial support for our theoretical model showing direct effects of neuropsychological function on achievement and the moderating role of family factors. This study suggests that a subgroup of children with epilepsy (those who have not only neuropsychological deficits but also disorganized/unsupportive home environments) are particularly at risk for adverse academic outcomes. Implications for intervention are discussed. Key Words: Epilepsy-ChildrenFamily-Cognition-Academic achievement.Children with epilepsy are at great risk for academic difficulties (1-7) and for underemployment as adults (6,8). Fastenau et al. (9) described a model to explain how various risk factors might contribute to academic problems. In that model, neuropsychological functioning appears to play an integral role, possibly mediating the effects of structural and electrophysiologic abnormalities (10-14). Other risk factors in the model include seizure, demographic, and psychosocial variables (9).Studies to date have not been consistent in identifying seizure variables (e.g., seizure type, age at onset, seizure

Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis

“…Findings from limited empirical evidence document associations between family functioning and a range of psychosocial and health outcomes. For instance, poorer levels of family functioning predicted higher levels of behavior problems, lower self-esteem, social competencies, academic achievement, and treatment adherence [13][14][15][16].…”

Psychometric properties of the Family Resilience Assessment Scale: A Singaporean perspective

“…Associations between family functioning and a range of psychosocial and health outcomes in young people with epilepsy has also been demonstrated. Poorer levels of family functioning have been shown to predict higher levels of behavioral problems [9,10], lower self-esteem [11], social competencies [10,12], academic achievement [13,14], and treatment adherence [15,16].…”

Children With Epilepsy: Specific Learning Difficulties

“…Among the main factors there are: 1) the pre-disease condition (e.g., the child's skills and abilities), 2) factors connected with the disease (e.g., the etiology and type of the epilepsy syndrome) (Aldenkamp et al, 2005), 3) the moment when the disease occurred in the context of the child's developmental processes, 4) the duration of the disease, 5) the immediate effect of epileptic activity (e.g., partial seizures vs. generalized, the occur- Table 3. Illustration of the problem on the case of a 12-year-old boy rence of status epilepticus or transient cognitive impairment) (Aldenkamp, 2004), 6) factors associated with the treatment: surgical and/or pharmacological (Ijff andAldenkamp, 2013; Sherman et al, 2003), 7) the absence from school connected with the occurrence of seizures (Aguiar et al, 2007), 8) the profile of cognitive deficits that appear in the course of the disease (Aldenkamp et al, 2005), 9) factors associated with the patient's socio-economical conditions (Fastenau et al, 2004). Of significant meaning for the appearance of school difficulties can also be psychiatric disorders that co-occur with epilepsy (depression, anxiety, or intensified symptoms of attention deficit hyperactivity disorder, commonly known as ADHD) (Reilly, Agnew and Neville, 2011).…”