Abstracts

Rationale: There are many factors that have been shown to influence health-related quality of life (HRQOL) in pediatric epilepsy that go beyond epilepsy-specific determinants. Recently, youth behavioral regulation, internalizing psychopathology, and parental helplessness have been shown to be key factors in youth HRQOL; however, no research to date has described the relationship between these variables in a comprehensive model. With the goal of optimizing HRQOL among youth with epilepsy, we explored the direct and indirect relationships among these variables with path analysis.  Methods: Data was obtained from 95 patients (52 female) aged 5-17 years (M = 12.25, SD = 3.62) who were seen for a neuropsychological evaluation at a tertiary pediatric epilepsy center. Seizure-related and demographic variables were collected from medical records. The Illness Cognitions Questionnaire–Parent Version (ICQ), Quality of Life Childhood Epilepsy (QOLCE), Behavior Rating Inventory of Executive Function (BRIEF), and Behavior Assessment System for Children (BASC-2), were administered to parents. Path analysis was utilized to simultaneously investigate the determinants of psychosocial variables on quality of life. Indirect effects were also evaluated using bootstrap analyses with 5,000 sample draws and bias-corrected SEs. Results: Elevated patient behavioral dysregulation (b = -0.27), internalizing psychopathology (b = -0.20), and parental helplessness (b = -0.43) uniquely predicted poorer youth HRQOL. Behavioral dysregulation (b = 0.42) significantly predicted parental helplessness, and both behavioral dysregulation (b = 0.28) and increased parental helplessness (b = 0.30) significantly predicted internalizing psychopathology in patients. Finally, indirect effects identified parental helplessness as an important intermediary variable between behavioral regulation and internalizing psychopathology (b = 0.13, 95% CI:0.04,0.26). Parental helplessness also mediated the relationship between behavioral regulation and HRQOL (b = -0.21, 95% CI:-0.36,-0.14). Conclusions: The current findings offer avenues for future intervention in pediatric epilepsy. Parental helplessness, behavioral dysregulation, and internalizing psychopathology each predicted HRQOL in unique ways. Behavioral regulation appeared to be a foundational contributor to HRQOL, as it impacted all study variables, and parental helplessness mediated many of the relationships, suggesting that it may be a key protective factor. Finally, internalizing psychopathology behaved uniquely in the model and appears to impact HRQOL in a different manner than the other variables. The implications of these findings for clinical care will be discussed, particularly the importance of family factors when tailoring interventions to maximize HRQOL in pediatric epilepsy. Funding: n/a