Abstracts

Rationale: It is well known that both biological and psychosocial variables influence the development of behavioral problems in epileptic children. We previously described at the 2012 American Epilepsy Society meeting that epileptic children with internalizing behavioral problems were reported by parents to have significantly poorer health-related quality of life (HRQOL), independent of any seizure variables or adaptive behavioral functional skills. Since early adverse childhood events and stress can produce later behavioral problems in childhood, we now explored whether the presence of such childhood trauma might in part mediate behavioral issues and impact HRQOL in the same cohort. Methods: We conducted an observational study of epileptic Hispanic children living in urban Los Angeles, recruiting subjects between 2 to 18 years of age clinically diagnosed with epilepsy. Sociodemographic and epilepsy information were collected, and caregivers completed developmentally-appropriate versions of the Child Behavior Checklist (CBCL), Adaptive Behavior Assessment System II (ABAS), a Childhood Adverse Events Questionnaire which we composed, Pediatric Quality of Life Inventory (PedsQL), and Impact of Childhood Neurologic Disease Scale (ICNDS). To determine if experiencing any form of past trauma affected CBCL and HRQOL scores, independent t-tests were performed for continuous outcomes and chi-squared analyses were performed for categorical outcomes; = 0.05.Results: We have enrolled 150 subjects with a mean age of 11 years, with 54% being males and 95% identifying themselves as Hispanic. We found no correlation between clinically-significant CBCL internalizing T-scores and age, gender, or seizure characteristics. However, CBCL internalizing but not externalizing T-scores negatively correlated with ABAS scores and with two HRQOL scales. We collected trauma-related data on 136 of these subjects, including exposure to community or domestic violence, physical or sexual abuse, caregiver poor mental health or substance abuse, and neglect. Thirty-five subjects (26%) reported at least one life event qualifying for traumatic stress as defined by the National Child Traumatic Stress Network. The occurrence of past childhood trauma was associated with significantly more externalizing (p<0.01) and higher rates of internalizing (p=0.054) current behavioral problems within our cohort. Moreover, we found a significant difference between the mean ICNDS (p<0.01) but not PedsQL (p=0.107) quality of life scores of subjects reporting no versus any trauma.Conclusions: Even amongst poor Hispanic children from predominantly Spanish-speaking households, internalizing behavioral problems appear to be predictive of health-related quality of life, independent of epilepsy duration, seizure control, number of anticonvulsant drugs, and underlying epilepsy etiology. Such behavioral phenotypes might in part be mediated through experiences of childhood trauma.