Abstracts

Behavioral problems are known to be significantly overrepresented among pediatric epilepsy patients. For many, the mental illness is more debilitating than the epilepsy. This study investigates what sorts of behavior problems among pediatric epilepsy patients readily receive psychiatric referral or on the other hand escape such clinical attention.
49 chronic pediatric epilepsy outpatients (ages 4-18, average 11.1; 26 male, 23 female) were consecutively recruited to participate. None had received psychiatric treatment in the past. A parent completed the Child Behavior Checklist (CBCL), which consists of 113 behavioral problem items and generates standardized scores for broad-band (Total, Externalizing and Internalizing) and narrow-band categories (Withdrawn, Somatic, Anxiety/Depression, Social, Thought, Attention, Delinquency, Aggression). The cutoff point for clinical significance was a[italic] t[/italic]-score of 65. The sample was compared to a retrospective sample of 40 pediatric epilepsy patients (ages 6-18, average 10.6; 26 male, 14 female) who were previously referred for psychiatric evaluation. CBCL scores for the two groups were compared and Chi-square analyses were done for the groups as a whole as well as by gender.
In the psychiatrically referred group, clinically significant CBCL scores were found in 82% (33/40). Common subcategories included 82% (33/40) for attention, 67% (27/40) for thought problems, and 62% (25/40) for social problems. 50% (20/40) had aggression, 37% (15/40) had delinquent behavior, 30% (12/40) had somatic complaints, 45% (18/40) were withdrawn, and 30% (12/40) had anxiety/depression. In the group not referred to psychiatry, significant CBCL scores were found in 41% (20/49). Common subcategories included 27% (13/49) for somatic complaints, 24% (12/49) for attention and 18% (9/49) for thought problems. 12% (6/49) had aggression, 16% (8/49) had social problems, and 10% (5/49) were withdrawn. Only one had anxiety/depression, and two had delinquent behavior. More behavior problems were present in the referred group for all categories (p[lt]0.001) with one exception. Somatic complaints were not significantly different between groups in the total sample and among boys. However, among girls, the referred group had more somatic problems than the non-referred group (p[lt]0.01).
Aggression, delinquency, anxiety, and depression are prominent in referred patients and nearly absent in non-referred patients, thus seemed to lead consistently to psychiatric referral. The girls in the non-referred group have fewer somatic complaints and possibly were referred more often than boys with somatic complaints. The non-referred patients still have significant overall behavior problems (41%), especially attention and thought problems. More study is needed to better recognize behavior problems warranting psychiatric referral.
[Supported by: Children[apos]s Reasearch Institute, Children[apos]s National Medical Center, Washington, DC 20010]