Abstracts

Rationale: Recent evidence suggests that children and adolescents with temporal lobe epilepsy (TLE) are at greater risk for depression; however, less is known regarding the specific neurocognitive predictors of depression in this population. Therefore, the current work examined the unique contribution of executive function (EF) variables in predicting depression to aid in early screening of risk factors and more targeted therapeutic intervention. Methods: The study included 62 patients with TLE (64% male) aged 8 to 16 years (M = 12.62, SD = 2.26) at a tertiary pediatric epilepsy center. Seizure-related and demographic variables were collected from medical records. Executive functioning was assessed with subtests from the Delis-Kaplan Executive Function System (D-KEFS; Letter Fluency, Category Fluency), WISC-IV (Digit Span: Forward, Backwards), the Wisconsin Card Sorting Test (Total Perseverative Errors), and from the Behavior Rating Inventory of Executive Function (BRIEF: Metacognitive Index [MI], Behavioral Regulation Index [BRI]). Finally, patient depression was assessed using the Behavior Assessment System for Children ?" 2: Parent Rating Scale (BASC-2: PRS). Correlation analyses were carried out between EF variables and patient depression. A two-block hierarchical regression was then implemented to test whether EF variables predicted patient depression above and beyond control variables. Results: Correlation analyses revealed significant associations between patient depression and the following variables: WCST Total Perseverations (p < 0.001), the BRIEF BRI (p < 0.0001), and family stress (p < 0.01). Moreover, the first stage of the hierarchical regression model was significant (p = 0.042) with family stress found to be the sole unique and moderate predictor (partial r = 0.328, p = 0.011) of depression in youths with TLE. Stage two tested whether neuropsychological variables (i.e., BRI and WCST) contributed to unique variance of patient depression above and beyond control variables. After introducing these neuropsychological variables, the regression model was significant (adj R2 = 0.284, p < 0.001) and explained an additional 19.7% of the variation in depression ratings (?R2=0.197, p =0.001). When common variance among the six predictors was controlled, the following variables emerged as uniquely and moderately related to patient depression: WCST (partial r = -0.267, p = 0.045) and BRI (partial r = 0.305, p = 0.021). While a significant predictor in block 1, family stress did not contribute any unique variance to the prediction of Depression (p = 0.079) following the inclusion of EF variables. Conclusions: The current findings offer support for the relationship between EF and depression in pediatric TLE. The presence of poor behavioral regulation as well as impaired cognitive flexibility and problem solving may be important in the development and maintenance of depression in this population. These findings bring to light the significant relationship between executive dysfunction and depression in pediatric epilepsy, suggesting a possible role for cognitive screening early in the condition to initiate intervention and/or minimize the potential for internalizing psychopathology. The type of executive dysfunction exhibited may provide insights into how cognitive-based interventions may improve coping and ultimately HRQOL in youth with TLE. Funding: n/a