Abstracts

Rationale: Behavioral and psychological co-morbidities are common in children with epilepsy. The yield and referral follow- through of systematic screening for such co-morbidities in the epilepsy clinic has not been previously assessed. We evaluated the yield of systematic screening for behavioral and psychological concerns using the Strengths and Difficulties Questionnaire (SDQ) administered by allied health professionals in a hospital-based epilepsy care program. Methods: Parents of pediatric patients evaluated in the epilepsy monitoring unit (EMU), including established and new onset patients, those and seen in Ketogenic Diet clinic were asked to complete the SDQ, a behavioral and psychological screening instrument. A retrospective chart review of patients whose parents had already completed the screening instrument as standard clinical care was performed for patients seen from November 1st, 2010 until May 15th ,2011 and prospectively from May 16th ,2011 until April 1st, 2012. The number and percent of children ages 4-17 years who screened positive were tabulated. Screening was conducted by the unit's advance practice nurses (APNs) who were also responsible for scoring and discussing results with parents, and arranging for referrals when necessary. The screening results were considered "actionable" if the SDQ identified a child with behavioral or psychological concerns who was not already receiving adequate services in those areas; "confirmatory" if they had a positive screening result but were already receiving services; and negative for children who screened negative. Results: From November 1, 2010 to April 1, 2012, a total of 71 children age 4-17 were screened using the SDQ. The average age of the children was 9 years; 41 (58%) were boys. 53 (75%%) were established epilepsy patients and 18 (25%) were patients seen in a new-onset epilepsy clinic. Behavioral or psychological concerns were identified in 41children (58%). Concerns were found in one or more areas including: overall stress (n=26), emotional distress (n=18), behavioral difficulties (n=15), difficulties getting along with others (n=21), hyperactivity and attentional difficulties (n=22), and kind and helpful behavior (n=25). Of the 41 with positive screening findings,, results were confirmatory in 29(71%) who were receiving adequate services already and actionable in 12 (29%) for whom services were either inadequate or not yet being offered. Appropriate referrals for further evaluations were made for all 12 children with actionable findings to one or more of the following services: psychiatry, social work, educational specialist, neuro psychological testing, pediatrician. The family followed through with the referral in 8 (67%) or the cases. Conclusions: The yield of routine screening of children in the EMU and ketogenic diet settings for behavioral and psychological concerns using the SDQ is sufficiently high to support its use both in new onset and in established patients and to consider whether such screening should be extended to children seen in all epilepsy care settings.