Beyond the Seizure: Evidence for Assessment and Treatment of Psychosocial Well-Being in Children with Epilepsy

Virtual Special Editions are collections of targeted papers curated by a Guest Editor. Here Ms K. Bailey Queen's University, Department of Psychology, Canada talks about Paediatric Psychosocial Well-Being.

Research and medical care of individuals with epilepsy tend to focus on treatment and management of seizures. In this virtual special edition we present a collection of papers that examine psychosocial aspects that should also be considered in the development of a comprehensive care plan for children with epilepsy.

In the first paper, Bailey and Im-Bolter propose that there are environmental factors that impact development of children and adolescents diagnosed with epilepsy [1]. These authors utilize Bonfenbrenner’s ecological systems model to explain how social contextual factors may contribute to the development of psychopathology in children with epilepsy. In their review, they discuss a variety of proximal and distal social structures that have a negative impact on interpersonal interactions (e.g., parent – child relationships) and increase the risk of psychopathology.

Other studies examine the negative impact that epilepsy has on the quality of life for children with epilepsy [2-4]. Using qualitative methods, McEwan et al. provide evidence that adolescents with epilepsy struggle with peer relationships and development of autonomy and independence [2]. Quantitative research suggests that reduced quality of life may be less about the severity of the disease and more about parental concerns and support [3-4]. Cianchetti et al. report that parents worry about the future of their children and adolescents regardless of the severity of the disease and this apprehension is negatively associated with quality of life for children and parents [3]. Research by Murugupillai et al. also indicates that parental concerns about their children extend beyond the physical ramifications of seizures. Parents tend to have concerns about their child’s school and employment success, behavioural problems, and psychological and emotional functioning [4]. Parental concerns about psychological and emotional functioning are not unfounded. Approximately 12-14% of children and adolescents with epilepsy also have depression (Reilly et al. 2011). In 2011, Reilly et al. conducted a systematic review of the literature that examines depression and anxiety in children with epilepsy. The review provides an overview of the literature describing the prevalence, symptoms, assessment, diagnosis and treatment of anxiety and depression in children with epilepsy. A recent review by Kanner (2017) emphasizes the need to include assessment of psychiatric comorbidities in the evaluation of new cases of patients presenting with seizures.

Lastly, treatment of psychopathology is considered by Jones et al. [7]. These authors argue that there are a number of negative social factors associated with epilepsy that require intervention. They examined the efficacy of cognitive behaviour therapy initially developed for children with anxiety disorders to reduce social anxiety in a group of 15 children with epilepsy who met criteria for an anxiety disorder. During the 12-week program children were taught social skills and given opportunities to practice these skills. Participation in the program resulted in a decline in social anxiety and improved self concept by the 12th week and persisted at the 3-month follow up.

Taken together, this collection of articles highlights the need to consider psychosocial well-being in assessment and treatment of children with epilepsy.