Abstracts

Rationale: Social difficulties are common among children with epilepsy. In the developmental disability literature, there is evidence that social interaction difficulties may be an expression of an underlying cognitive impairment. It is conceivable that impairments in social cognition may contribute to the social difficulties in children with epilepsy. Social cognition involves thinking and reasoning about one’s own and other people’s thoughts and emotions. This study investigated both children’s performance on social cognition tasks and parents’ impressions of their children’s social behaviours, in children with intractable epilepsy and a control group. We also measured performance on tests of attention, memory, language, and perception, to see whether these aspects of cognition were related to social development. Methods: Participants with intractable epilepsy (n = 20, Mean age = 10.3 years, range 7-12) were recruited from the Epilepsy Monitoring Unit at the Hospital for Sick Children. Controls (n = 16) were recruited from local schools as well as from siblings of participants with epilepsy, and were matched for age, sex, and verbal intelligence. Measures included: a social stories battery (comprising first- and second-order false belief tasks, intentional lying, and sarcasm stories) and tests of language comprehension, story recall, face recognition, visual attention, working memory, and response-inhibition. Parents also completed two questionnaires that measured their children’s everyday social behavior. Performance on all tasks was converted to standard and z-scores based on age norms. Results: Epilepsy participants performed significantly worse than controls on the social stories battery, face recognition, working memory, visual attention, and comprehension of instructions. The groups did not differ on either of the social behaviour questionnaires. Scores on the social behaviour questionnaires were positively correlated but were not related to performance on the social stories battery. Correlations between accuracy on the social stories and other cognitive tasks were found for visual attention in the epilepsy group and language comprehension in the control group. Proportion of life with seizures and age of seizure onset were not related to performance on any of the tasks. Conclusions: The results demonstrate that children with intractable epilepsy have difficulty understanding situations that require them to think and reason about other people’s thoughts and emotions. These difficulties may explain or contribute to the social difficulties associated with epilepsy. The differing pattern of correlations for the two groups suggests that children with epilepsy may rely on different cognitive and/or brain systems to perceive cues and react in social situations.