Abstracts

Rationale: Developmental delay, cognitive deficits, autism, behavioral and psychiatric comorbidities are common in children with epilepsy. A systematic screening program looking at these comorbidities individually can be informative, but time consuming for parent and provider. We looked at the effectiveness of a parent-completed checklist to guide further screening needs versus a comprehensive screening program with specific screening forms evaluating for difficulty in development, autism, the psychosocial arena, cognition, and schooling. Methods: Parents of patients evaluated in the epilepsy monitoring unit, including established and new onset patients, and the ketogenic diet clinic of a tertiary pediatric medical center completed the Epilepsy Center Developmental and Educational History Questionnaire (ECQ) which queries concerns regarding development, cognition, and behavior. In addition, parents completed age-appropriate screening batteries as follows: ages birth to 4 years, Ages and Stages Questionnaire (ASQ) for development and the M-CHAT for autism; ages 4 - 6 years, ASQ, the Social Communication Questionnaire (SCQ) for autism, and the Strengths and Difficulties Questionnaire (SDQ) for behavior and psychiatric concerns; ages ≥6 years, SCQ, SDQ, and the Perceived Cognitive Functions Questionnaire (PCF-43) to evaluate cognitive function. Data were obtained retrospectively from 11/1/2010 until 5/15/2011 and prospectively from 5/16/2011 through 4/1/2012. Screening was conducted by the unit's advance practice nurses who scored, interpreted, and relayed results to parents. We compared positive screening results found through the comprehensive screening program to results based on the ECQ alone. Results: 194 children birth-17y were screened. The average age was 6y; 146 (75%) were established epilepsy patients and 49 (25%) were seen in the new-onset epilepsy clinic. One or more areas of concern was noted on the ECQ checklist in 148 (76%), and 120 (62%) scored positive on one or more formal screeners: ASQ:73/85 (86%); mCHAT: 31/62 (50%); SCQ:18/112 (16%); and SDQ: 41/71 (58%). A positive ECQ-checklist result was highly sensitive to positive results on these four screeners overall and individually: sensitivities were 89% for a finding on any screener, 86% -ASQ, 97%-mCHAT, 95% SCQ, and 95% SDQ. Specificity of the ECQ checklist for negative screening results was 55% overall. With the exception of the ASQ, specificity was low: 82%-ASQ, 29%-mCHAT, 29%-SCQ, 37%-SDQ. Conclusions: A structured parent checklist can be sensitive to developmental and behavioral problems requiring further evaluation, although in this study its specificity was low. In a high risk population such as seen in a tertiary center, formal screening is likely the most justifiable and efficient approach to detecting problems. In a less high-risk setting and with further development, a simple checklist may serve as a first step and guide further, formal screening. This approach could facilitate routine screening for comorbidities of epilepsy in an out-patient and non-specialty setting.