Abstracts

Rationale: : Despite recent evidence for prevalent anxiety disorders (ANX) in pediatric epilepsy, studies to date have not examined the clinical implications of ANX in these children. This study examined the functional impairment (psychopathology, cognition, language, academic performance, and social competence) associated with ANX by comparing children with epilepsy with ANX to those with no psychiatric diagnosis (NoDg). It also determined if the number and type of ANX diagnoses was associated with functional impairment.Methods: Structured psychiatric interviews, IQ, language, and achievement tests were administered to 139 children with epilepsy, aged 5-15 years. Child self-report anxiety and depression questionnaires and parent Child Behavior Checklist (CBCL) were obtained on all subjects. ANOVAs were used to compare groups on continuous measures and chi-square tests were used to compare groups on categorical measures.Results: The 55 ANX subjects had significantly higher CBCL total (p<.0009), externalizing (p<.03), internalizing (p<.002), and social problem scores (p<.01), and more subjects with suicidal ideation (p<.003) than the 94 NoDg subjects. They also had significantly lower Verbal IQ (p<.05) and language scores (p < .02), more subjects with deficits in mean reading (p < .04) and math achievement scores (p < .05), as well as poor social skill scores (p < .05) than the NoDg group. The ANX subjects had more than one ANX diagnosis in 70%, comorbid attention deficit hyperactivity disorder (ADHD) in 34%, depression in 5%, and ADHD+depression in 17%. Children with multiple vs. single ANX had significantly greater impairment on psychopathology (p<.005), suicidal ideation (p<.0005), cognitive (p<.002), language (p<.02), achievement (p<.02), and social functioning measures (p<.004). Whereas the multiple ANX+ADHD subjects had significantly more severe impairment in all areas of functioning than the single ANX subjects (p<.02-.002), those with multiple ANX-ADHD group had significantly lower Verbal IQ (p<.02) and higher CBCL externalizing scores (p < .04) than the single ANX subgroup. Generalized anxiety disorder (N=35) and social or specific phobia (N=12) were associated with higher CBCL externalizing (p < .03) and lower social skill scores (p<.008), respectively. Conclusions: ANX are associated with a wide range of impairment involving behavior, emotions, suicidal ideation, cognition, language, academic performance, and social skills. These findings highlight the importance of early identification and treatment of these children, particularly those with multiple ANX, generalized anxiety disorder, social or specific phobia, and comorbid ADHD.