Abstracts

Rationale: Children with epilepsy have higher rates of autism spectrum disorders (ASD) when compared to the general pediatric population and children with ASD have higher rates of epilepsy. The link between epilepsy and ASD is thought to be related to Intellectual Disability (ID); however, there is a subset of the pediatric epilepsy population that has ASD without ID that is understudied. The goal of this project is to complete the first matched study to determine if there are differences in social communication (SC) and executive functioning (EF) as these domains are critical for children to succeed academically, socially, and vocationally. We hypothesized that children with epilepsy and ASD would have greater difficulties with SC and EF when compared to children with epilepsy-only and ASD-only. Methods: Children with epilepsy and ASD without ID (EPI+ASD) were compared to age-, gender-, and IQ-matched children with epilepsy-only (EPI) and ASD-only (ASD). Retrospective data was gathered from clinical research databases at Children's National. Measures used include the Social Responsiveness Scale (and 2nd Edition; SRS) to examine SC, and Behavior Rating Inventory of Executive Function (and 2nd Edition; BRIEF) to examine EF. All participants completed a standardized IQ measure to assess overall cognitive functioning (FSIQ). Group differences were assessed using one-way Analysis of Variance (ANOVA) and chi-square analyses. Results: Participants included 60 children (20 per group; 73% male) with a mean age of 10.8 (range 4-18) and FSIQ of 90 (range 70-120). A main effect of group was found (p<.05) on the SRS such that EPI had no elevated concerns for SC when compared to ASD, which had elevated concerns (T>65) across all SC scales (Table1). EPI+ASD was not significantly different from either group but had elevated concerns across most SC scales. No main effect of group was found for EF; however, there was a trend towards significance for inhibitory control (medium effect size; η2=.10); small sample size and heterogeneity likely contributed to nonsignificant results. All groups had clinically significant working memory difficulties (Figure 1). Both the EPI+ASD and ASD groups had clinically significant difficulties with shifting abilities (small effect size; η2=.05). While no group differences, the means score for the EPI+ASD group were elevated on 4 of 7 subscales compared to 1 for EPI and 2 for ASD. Conclusions: This is the first rigorously matched study of children with epilepsy and ASD without ID. Differences in parent ratings of SC suggest that the social impairments in EPI+ASD are present but not as severe as ASD alone. It will be important to confirm this finding through direct measures of social skills as parents may underrecognize the social problems of their child due to also having to contend with their child's seizure disorder. However, if SC is confirmed to be less impaired compared to ASD alone, that is an area to be explored (e.g., medications). Cognitive regulation aspects of EF are comparable across groups indicating that they struggle in similar areas, but groups with ASD had more problems with shifting/flexibility consistent with prior EF profiling in ASD populations. EPI+ASD may have greater EF problems, particularly with inhibitory control than the other groups; however, those findings are at a trend level and require further study. These results highlight that children with EPI+ASD without ID have important differences in their needs. Future studies will examine epilepsy characteristics and other functional domains in a larger sample. Funding: 1U54HD090257, District of Columbia Intellectual and Developmental Disabilities Research Center Award