Using categorical measures may improve diagnosis and treatment.


Article Content

Research suggests that children with epilepsy have a higher than average risk of comorbid mental illness. However, few studies have used measures that would provide definitive psychological or psychiatric diagnoses in these children. Most studies have used dimensional measures such as the Child Behavior Checklist (CBCL), which reveals broad rather than specific areas of psychopathology.


Researchers from the schools of medicine and nursing at Indiana University explored the prevalence of psychopathology in children with epilepsy by pairing the CBCL with either the Child Symptom Inventory (CSI) or the Adolescent Symptom Inventory (ASI), both categorical measures, and then conducting a computerized diagnostic interview. They evaluated 173 children (88 boys and 85 girls; mean age, 11.7 years) who had a definitive diagnosis of epilepsy for at least six months. The primary caregiver of each participant completed the CBCL as well as either the CSI or ASI, depending on the age of the child. An analysis of the responses determined the prevalence of psychopathology in each child, and correlated the CBCL scores and CSI or ASI symptom scores with specific diagnoses.


Findings indicated that all children scored higher on the CSI or ASI than a comparison group for attention deficit-hyperactivity disorder, oppositional defiant disorder, and dysthymic disorder. Younger children (between ages nine and 12) had high CBCL scores in internalizing and attention problems, and were at high risk according to the CSI for conduct disorder and Asperger syndrome. Older children (ages 13 and 14) had higher scores on the ASI for specific phobias, obsessions, posttraumatic stress disorder, motor tics, antisocial personality, panic attack, somatization disorder, and enuresis. There were significant correlations between the CBCL and the CSI or ASI for attention problems, aggressive behavior, and oppositional defiant and conduct disorders.


Study results support prior research suggesting higher than average risk of comorbid mental illness in pediatric epilepsy, and this is the first study to report outcomes from the CSI and ASI in this population. As the CSI and ASI provide information that can be referenced to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, screening children using these categorical measures may improve the mental health aspects of treatment plans in children with epilepsy.


Dunn DW, et al. Dev Med Child Neurol 2009;51(5):364-72.