Abstracts

Rationale: To (1) assess family function and determine the effects of epilepsy variables on family function in cognitively normal children with epilepsy (CWE), and (2) to compare the effect of family function on CBCL Total Competence, Internalizing and Externalizing Behavior in CWE and their non-epileptic siblings (SIBS).Methods: This was a cross-sectional, cohort survey of CWE, aged 6-17 years, with an estimated developmental quotient >70 identified through the Neurology database at the Alberta Children’s Hospital. Parents were asked to complete the Family Assessment Measure III (FAM III) and a Child Behavior Checklist (CBCL) for their child with epilepsy and for his/her nearest-aged sibling without seizures. Epilepsy variables including syndrome, etiology, seizure frequency, age at onset, total AEDs used and family history of epilepsy were assessed by chart review. Family function was divided into three categories: Strong (overall FAM III rating T score <40), Average (T score >40 - <60) and Weak (T score >60).Results: 82/101 (81%) families approached for study participated. Overall, families were functioning well (mean overall rating scores on the FAM III of 49.6 - no significant difference from normative mean). Only 11% of families had T scores >60 indicating poorer family function. Families scored significantly better than the normative mean on the Involvement subscale (p<0.03) and significantly worse than the mean on Role Performance subscale (p<0.04) - a scale which measures agreement regarding role definitions and ability to adapt to new roles. No significant correlations were found between any epilepsy variable and overall rating score on the FAM III. However, very significant correlations were noted for both CWE and SIBS between the overall FAM III rating score and CBCL Total Competence (CWE - p<0.004), SIBS - p<0.03), Internalizing (CWE - p<0.001, SIBS - p<0.001) and Externalizing Behaviors (CWE - p<0.001, SIBS p<0.002). While CWE scored significantly lower than SIBS on Total Competence (p<0.002), and significantly higher on Internalizing Behaviors (p<0.001), this difference was very dependent on family function category. The proportion of CWE and SIBS in the borderline/clinical range on Total Competence and Internalizing and Externalizing Behavior was not significantly different in families functioning in the Strong or Weak categories. However, in families functioning in the Average category, significantly more CWE than SIBS were functioning in the borderline/clinical range for Internalizing (p<0.004) and Externalizing Behavior (p<0.05). Conclusions: Families of cognitively normal CWE function well overall. While they score significantly higher on the Involvement subscale, they do poorly in Role Performance. Stronger family function protects against behavior and competence problems in CWE. Specific strategies aimed at improving Role Performance may strengthen family function and reduce the risk of behavioral co-morbidities.