Rationale: Screenings are recommended for co-occurring conditions in pediatric epilepsy. However, there is limited information about whether any screening measure outperforms another. This study aimed to compare different screening measures for common co-occurring conditions (ADHD and emotional concerns) in a pediatric epilepsy population during a routine neurology clinic visit.
Methods: Fifty of 226 contacted (22%) parents of children with epilepsy ages five to 17 years old agreed to complete screening measures; 12 children completed self-report measures. Parent measures included the Strengths and Difficulties Questionnaire (SDQ; Hyperactivity/Inattention (ADHD), Emotional Problems (E)), the Pediatric Quality of Life Inventory Epilepsy Module (PedsQL-EM; Executive Functioning (EF), Mood/Behavior (M/B)), and the ADHD Rating Scale (ADHD-RS; Total (Total), Inattention (IA), Hyperactivity/Impulsivity (H/I)). Self-report measures included the Neurological Disorders Depression Inventory for Epilepsy-for Youth (NDDI-E-Y) and the SDQ-E. Comparisons among measures were conducted using Chi Square, correlational, and agreement statistics.
Results: Positive screening rates were similar with 56% (28/50) for the ADHD-RS-Total, 40% (20/50) for the SDQ-ADHD, and 50% (24/48) for the PedsQL-EM-EF (
X2=2.61,
p=0.27). Overall agreement between the measures ranged from 77% to 85%, while Cohen's kappa agreements were moderate or substantial. All measures had significantly correlated raw scores. A difference in positive screen rates (
X2=10.8,
p=0.005) was observed among the ADHD-RS-IA (72%; 36/50), SDQ-ADHD (40%; 20/50), and PedsQL-EM-EF (50%; 24/48). The ADHD-RS-IA positive rate was higher compared to the SDQ-ADHD (
X2=810.4,
p= 0.001) and the PedsQL-EM-EF (
X2=5,
p= 0.03), while the SDQ-ADHD and PedsQL-EM-EF positive rates were comparable. For the parent reported emotional screening measures, positive rates were comparable (
X2=0.62,
p=0.43) between the SDQ-E (38%; 19/50) and the PedsQL-EM-M/B (46%;22/48). Overall agreement was 85%, with substantial Cohen’s Kappa agreement and significantly correlated raw scores. Overall agreement between the self-report SDQ-E and parent report measures ranged from 50%-59%, with 1 child positive on the self-report, but not on the parent report. Overall agreement between the NDDI-E-Y and parent report measures ranged from 77%-89%, with no child solely identified on self-report.
Conclusions:
The screening measures selected detected youth at risk for ADHD and emotional concerns in pediatric epilepsy. The ADHD-RS-IA identified the most youth for attention concerns, while the SDQ-E and PedsQL-EM-M/B were comparable for screening for emotional concerns. While consideration of each individual clinic’s needs is essential, this study is also a step towards providing specific guidance regarding a suggested screening protocol that is important to complement the general AAN guidelines that recommend screening for co-occurring conditions in youth with pediatric epilepsy.
Funding: This study was supported by the Hess Foundation, District of Columbia Intellectual and Developmental Disabilities Research Center (DC-IDDRC) Award P50HD105328 by NICHD (PI: V. Gallo), and T32 NINDS T32NS115656 (PI Haydar).