Original articleSelf-concept in children and adolescents with epilepsy: The role of family functioning, mothers’ emotional symptoms and ADHD
Introduction
Self-esteem and self concept, sometimes used interchangeably, are two important concepts in the psychological well-being of children. Self-esteem is defined as how children value themselves. Self-concept, one determinant of self-esteem, refers to how children view themselves [1]. A strong and stable self-concept is an important part of children’s cognitive, emotional and psycho-social development. Just like the healthy children, self-concept of children with chronic illnesses undoubtedly influences their attitudes and perceptions. In the available literature, children with epilepsy have been found to have a poorer self-concept and lower self-esteem than children with other chronic conditions [2]. The stigma of seizures, lower quality of life and a decreased sense of self-efficacy have been shown to be linked with a lower self-esteem in epilepsy [3].
Family functioning plays a critical role in the adaptation of child and family to chronic illness [4]. Deficits in family cohesion, family adaptability, communication, parent–child interactions and problem solving skills are not uncommon in families of children with epilepsy [5]. Studies have indicated that family dysfunction may lead to an exacerbation of behavioral problems in family members and a poor adjustment to epilepsy treatment [6]. In contrast, healthy family functioning is associated with a lower risk of behavioral and competence problems in children with epilepsy [6], [7]. Since mothers are most often the primary caregivers of children, they are particularly at higher risk for emotional symptoms in response to their children’s epilepsy, especially depression [8]. A number of previous studies have found a higher frequency of depression and anxiety symptoms in the mothers of children with epilepsy [9].
ADHD is a very common comorbidity in children with epilepsy, reaching a rate of 28–70% depending on the diagnostic criterion used [10]. Several factors may contribute to this comorbidity, including the underlying brain dysfunction, chronic effects of recurrent seizures, epileptiform EEG abnormalities and the effects of antiepileptic drugs (AED) [11], [12]. Regarding the ADHD symptom clusters, inattention symptoms have been shown to be more common than hyperactivity symptoms in children with epilepsy and ADHD [12], [13]. ADHD comorbidity has been linked with negative psycho-social implications. Sherman et al. [14] have found that comorbid ADHD is associated with a lower quality of life (QOL) in children with epilepsy.
The research literature on the associated factors of self-concept in children with epilepsy is limited. The findings of the available studies have suggested that factors including the severity of epilepsy, AED polytherapy, family environment, psychiatric comorbidity and neurocognitive functioning may affect how children with epilepsy perceive their self-concept [15], [16], [17], [18], [19]. In this study, we aimed to (1) compare self-concept between children and adolescents with epilepsy and healthy controls, and (2) identify which psychiatric, familial and epilepsy-related variables are associated with a poor self-concept. Regarding psychiatric variables, ADHD in the child and emotional symptoms in the mother were specifically selected. There are three main reasons for this selection. Firstly, the presence of these two conditions in pediatric epilepsy is common and highly impairing. Secondly, both ADHD and emotional symptoms of the mother have a chronic and persistent impact in the child’s life. Thirdly, both of the conditions bring a potential risk to the treatment outcomes and the psycho-social development of the child.
Section snippets
Sample and design
This study was a cross-sectional, cohort survey of children and adolescents with epilepsy who were seen at the Pediatric Neurology Clinic of Acıbadem University Hospital in Istanbul. The inclusion criteria were as follows: (1) age of 7–18 years, (2) diagnosis of epilepsy of at least a duration of 6 months, (3) normal intelligence based on either a WISC-R full scale IQ score above 80 or the average/above average academic functioning documented with the last year’s final school grades (at least
Results
The mean age of the patient and control groups were 11.78 (SD: 2.58) and 12.14 (SD: 1.16) respectively. 54.7% (n = 29) of the epilepsy and 60.7% (n = 17) of the control group were males.
Table 1 shows the comparison of Piers Harris Scale scores between the epilepsy and control groups. As seen in the table, the total score was not significantly different between the groups. Among the subscales, freedom from anxiety (p = 0.003) and popularity scores (p = 0.004) were lower in the epilepsy group.
Since older
Discussion
Children’s self-concept has a broad impact on their confidence when facing the challenges of life. This holds even more true for children struggling with chronic diseases, including epilepsy. The unpredictable nature of seizures and the social stigma of epilepsy may affect the identity satisfaction, self-esteem, self-control and adjustment capacity of the child [2]. In the present study, the total self-concept scores of our sample with uncomplicated epilepsy were not significantly different
Conclusion
Poor self-concept has been shown to be related with behavioral problems, negative attitudes toward treatment and low adjustment in chronic diseases. In case of pediatric epilepsy, low epilepsy severity may be generally considered as a protective factor for the self-concept development. However, even for those with mild epilepsy, comorbid neuro-psychiatric conditions, negative family environment and mothers’ emotional symptoms may affect self-concept. Not only the clinicians but also the
References (51)
- et al.
Psychiatric and psychosocial consequences of pediatric epilepsy
Semin Pediatr Neurol
(2007) - et al.
Family function in cognitively normal children with epilepsy: impact on competence and problem behaviors
Epilepsy Behav
(2008) - et al.
Family factors and psychopathology in children with epilepsy: a literature review
Epilepsy Behav
(2005) - et al.
Epilepsy and the family: a review of current literature
Seizure
(2000) - et al.
Maternal depression: the cost of caring for a child with intractable epilepsy
Pediatr Neurol
(2008) - et al.
Attention deficit hyperactivity disorder in children with epilepsy
Brain Dev
(2010) - et al.
Childhood epilepsy, attention problems, and ADHD: review and practical considerations
Semin Pediatr Neurol
(2005) - et al.
Impact of epilepsy in adolescence: a UK controlled study
Epilepsy Behav
(2005) - et al.
The relationship between illness severity, sociodemographic factors, general self-concept, and illness-specific attitude in Swedish adolescents with epilepsy
Seizure
(2004) - et al.
Self-concept in adolescents with epilepsy: biological and social correlates
Pediatr Neurol
(2008)
Self-esteem and behavioral adjustment in children with epilepsy and children with diabetes
J Psychosom Res
Stigma in the lives of adolescents with epilepsy: a review of the literature
Epilepsy Behav
Social anxiety and self-concept in children with epilepsy: a pilot intervention study
Seizure
Self-concept in children and adolescents with attention deficit hyperactivity disorder
J Pediatr Nurs
Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy
Epilepsy Behav
Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: review of pharmacological treatment
Epilepsy Behav
Maternal depression and parenting behavior: a meta-analytic review
Clin Psychol Rev
Self-esteem, self-concept, and quality of life in children with hemiplegic cerebral palsy
J Pediatr
Development of a self-efficacy scale for children and adolescents with epilepsy
Children’s Health Care
Family functioning in children with chronic illness compared with healthy controls: a critical review
J Pediatr
Depressive symptoms among mothers of children with epilepsy: a review of prevalence, associated factors, and impact on children
Epilepsia
Speed and complexity characterize attention problems in children with localization-related epilepsy
Epilepsia
Attention-deficit disorders and epilepsy in childhood: incidence, causative relations and treatment possibilities
J Child Neurol
ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy
Epilepsia
Effect of methylphenidate on the quality of life in children with epilepsy and attention deficit hyperactivity disorder: and open-label study using an osmotic-controlled release oral delivery system
Epileptic Disord
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