Abstracts

Rationale: Attention Deficit Hyperactivity Disorder (ADHD) and Anxiety Disorder may be especially common in pediatric epilepsy. Furthermore, anxiety and ADHD often co-occur in children without epilepsy. The aim of this study is to specifically characterize anxiety and ADHD symptoms in pediatric epilepsy and determine if there are overlapping effects with all three conditions.Methods: A retrospective review was performed in a tertiary care outpatient program specializing in epilepsy and psychiatric complications. Most have well established diagnoses of epilepsy usually with MRI and EEG findings. All patients received a clinical evaluation from a pediatric neuropsychiatrist specializing in epilepsy. Evaluation also included parent completion of rating scales including the Behavioral Assessment System for Children (BASC-2), Behavior Rating Inventory of Executive Function (BRIEF), and the Swanson, Nolan and Pelham Scale (SNAP), an ADHD rating scale. Clinically significant ratings included t-scores of 60+ on broadband categories and 65+ on narrow band categories.Results: Of the 48 patients sampled (average age 10.5, range 3-17; 18 female), 24 had a diagnosis of ADHD, 18 had Anxiety, and 5 had both ADHD and Anxiety diagnoses. Full records were available for most patients, though incomplete measures were eliminated. The most commonly elevated BASC-2 category was adaptive skills, and the most commonly elevated BRIEF categories were working memory and behavioral regulation index. A majority (18/21) with ADHD had elevated BASC-2 t-scores in the broadband category of adaptive skills, and 16/21 on behavioral symptoms. On the BRIEF, 20/23 with ADHD had elevated t-scores in working memory and metacognition index, and 16/23 for behavioral regulation index. More than half of patients with Anxiety (12/17) had elevated BASC-2 t-scores in the broadband category of adaptive skills and 10/17 in behavioral symptoms. On the BRIEF, 9/16 with Anxiety had elevated t-scores in working memory, global executive composite, and behavioral regulation index, and 10/16 in emotional control. Most patients with comorbid ADHD and Anxiety had elevated BASC-2 t-scores on the broadband category of adaptive skills (4/5), and on the narrowband categories of leadership and functional communication. Regarding the SNAP, among patients with ADHD, 15/19 had clinically significant scores, and among patients with anxiety, 8/12 had clinically significant scores. The two groups did not differ (Chi-square 0.5793. p= 0.446576).Conclusions: Based on our sample, children and adolescents with pediatric epilepsy commonly have anxiety and ADHD symptoms. Both groups had problems with adaptive skills, behavioral symptoms, working memory, and behavioral regulation index. Intriguing in our findings is that SNAP scores, geared primarily for ADHD symptoms, were elevated in both anxiety and ADHD. The anxiety group had prominent symptoms of ADHD even though clinical ADHD diagnoses had not been made. Further studies will help clarify whether epilepsy characteristics or anxiety symptoms lead to ADHD symptom presentation in pediatric epilepsy.