Children with epilepsy experience higher rates of mental health disturbances and academic problems than children with other chronic physical conditions. Until recently, one assumption has been that many of these problems result from poor psychosocial adjustment to living with seizures. However, in our current study we found high rates of behavior problems already existing at the time of the first recognized seizure, especially in children with previously unrecognized seizures. This important finding suggests that, at least in some children, epilepsy is a pervasive condition in which seizures are accompanied by behavioral disturbances. Moreover, it suggests that neurological variables should be studied in relation to behavior problems, beginning at the time of the child's first recognized seizures. The major purpose of this continuation request is to determine how neurological variables (brain structure and function, neuropsychological functions, intelligence, and seizure characteristics) interact with other child (age, gender, and temperament) and family variables (e.g., parenting and family resources) to predict child mental health disturbances and academic problems over the first year following the first recognized seizure. The sample will be 360 children (ages 6-14 years, IQ > 70) with a first recognized seizure and 240 healthy siblings (ages 6-17 years). There also will be a pilot sample of 60 children with seizures who have IQs between 55 and 70. Neurobiological data will include results from MRI, EEG, and individualized tests of academic achievement, intelligence, and neuropsychological functioning. Data on child and family variables will be obtained from the major caregiver and from children who are at least 8 years old. Data analyses will include repeated measures analysis of covariance, multiple regression, and structural equation modeling. No previous studies have investigated all of these important variables together within the context of childhood epilepsy, especially those with low IQ. Findings will greatly increase understanding of the natural history of adaptation problems in childhood epilepsy that is needed for effective interventions.
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