In the eye of the beholder: Using a multiple-informant approach to examine the mediating effect of cognitive functioning on emotional and behavioral problems in children with an active epilepsy

Tamar Silberg; Jaana Ahoniska-Assa; Ayelet Bord; Miram Levav; Orli Polack; Michal Tzadok; Gali Heimer; Omer Bar-Yosef; Ronny Geva; Bruria Ben-Zeev

doi:10.1016/j.seizure.2020.09.002

In the eye of the beholder: Using a multiple-informant approach to examine the mediating effect of cognitive functioning on emotional and behavioral problems in children with an active epilepsy

Seizure. 2020 Nov:82:31-38. doi: 10.1016/j.seizure.2020.09.002. Epub 2020 Sep 14.

Authors

Affiliations

¹ Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel. Electronic address: Tamar.Silberg@biu.ac.il.
² Pediatric Rehabilitation Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel-Aviv, Israel.
³ Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.
⁴ Child Development Center, Kupat Holim Leumit, Jerusalem, Israel.
⁵ Pediatric Neurology Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
⁶ Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.

PMID: 32979603
DOI: 10.1016/j.seizure.2020.09.002

Abstract

Purpose: Childhood epilepsy is often associated with cognitive impairments and psychosocial problems. However, it is not clear which factors mediate symptom severity and child's resilience. Emotional and behavioral problems have been associated with various home and school environments, suggesting that information collected may vary depending on both context and informant. In this study we examined the mediating effect of child's cognitive functions on the association between child and epilepsy-related factors and psychosocial problems. Additionally, the differences in psychosocial problems reported by various informants (parents, teachers) in different school settings were explored.

Methods: Participants were 155 children with epilepsy (50 % girls), age range 5-18 years who completed a brief neuropsychological battery. Parents completed the Child Behavior Checklist (CBCL) and teachers completed the corresponding Teacher's Rating Form (TRF), to assess a child's emotional and behavior problems.

Results: The cognitive profile of the sample was within average to low-average range. Parents and teachers both reported high levels of emotional and behavioral problems, and teachers reported relatively higher levels of symptoms. A mediation effect of cognition on the association between child and epilepsy-related factors (i.e., number of antiseizure medications and illness duration) and child's emotional and behavioral problems was evident only for teachers' reports.

Conclusions: The results emphasize that the complex interactions between epilepsy, cognition and psychosocial outcomes are perceived differently in diverse contexts by different informants. The incongruities in informants' perceptions regarding the role of cognition in child's psychological state should be acknowledged and incorporated when planning effective educational and rehabilitation interventions for children with epilepsy.

Keywords: Emotional and behavioral problems; Multiple informants: CBCL; Neuropsychology; Pediatric neurology; TRF.

MeSH terms

Adolescent
Child
Child Behavior Disorders* / epidemiology
Child Behavior Disorders* / etiology
Child, Preschool
Cognition
Emotions
Epilepsy* / complications
Female
Humans
Parents
Problem Behavior*