Elsevier

Brain and Development

Volume 38, Issue 8, September 2016, Pages 714-722
Brain and Development

Original article
Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers’ emotional symptoms and ADHD

https://doi.org/10.1016/j.braindev.2016.02.015Get rights and content

Abstract

Purpose

This study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy.

Methods

Fifty-three patients with uncomplicated epilepsy (aged 7–18 years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners’ Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State–Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables.

Results

While the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers’ Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores.

Conclusion

Poor self-concept in children with epilepsy is associated with negative family functioning, mothers’ emotional symptoms and ADHD, especially the symptoms of inattentiveness.

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)

  • P. Hoare et al.

    Self-esteem and behavioral adjustment in children with epilepsy and children with diabetes

    J Psychosom Res

    (1994)
  • J.S. MacLeod et al.

    Stigma in the lives of adolescents with epilepsy: a review of the literature

    Epilepsy Behav

    (2003)
  • J.E. Jones et al.

    Social anxiety and self-concept in children with epilepsy: a pilot intervention study

    Seizure

    (2014)
  • G. Houck et al.

    Self-concept in children and adolescents with attention deficit hyperactivity disorder

    J Pediatr Nurs

    (2011)
  • J.A. Salpekar et al.

    Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy

    Epilepsy Behav

    (2014)
  • A.R. Torres et al.

    Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: review of pharmacological treatment

    Epilepsy Behav

    (2008)
  • M.C. Lovejoy et al.

    Maternal depression and parenting behavior: a meta-analytic review

    Clin Psychol Rev

    (2000)
  • R.N. Russo et al.

    Self-esteem, self-concept, and quality of life in children with hemiplegic cerebral palsy

    J Pediatr

    (2008)
  • D. Caplin et al.

    Development of a self-efficacy scale for children and adolescents with epilepsy

    Children’s Health Care

    (2002)
  • C.B. McClellan et al.

    Family functioning in children with chronic illness compared with healthy controls: a critical review

    J Pediatr

    (2007)
  • M.A. Ferro et al.

    Depressive symptoms among mothers of children with epilepsy: a review of prevalence, associated factors, and impact on children

    Epilepsia

    (2009)
  • M.M. Berl et al.

    Speed and complexity characterize attention problems in children with localization-related epilepsy

    Epilepsia

    (2015)
  • R. Kaufmann et al.

    Attention-deficit disorders and epilepsy in childhood: incidence, causative relations and treatment possibilities

    J Child Neurol

    (2009)
  • E.M. Sherman et al.

    ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy

    Epilepsia

    (2007)
  • H.K. Yoo et al.

    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

    (2009)
  • Cited by (7)

    • Behavioral and electrophysiological analyses of self-referential neural processing in major depressive disorder

      2023, Asian Journal of Psychiatry
      Citation Excerpt :

      As primary caregivers, especially in China, mothers play a major role in a person’s growth process, and some studies have found that mothers’ behavior has significant consequences for their children and families (Otani et al., 2016; Smarius et al., 2020). Previous studies have found that depressed patients’ self-concept is influenced by their mothers’ behaviors and emotional symptoms (Brand-Gothelf et al., 2015; Ekinci et al., 2016). However, few studies on the self-referential processing of depression have examined other-referential processes, especially how they process intimate information, such as that of mothers.

    • Illness identity in young adults with refractory epilepsy

      2018, Epilepsy and Behavior
      Citation Excerpt :

      In general, however, the daily impact of CHD may be less pronounced when compared with refractory epilepsy, as the majority of patients with less severe heart lesions are asymptomatic with no lifestyle limitations [45]. We hypothesized that patients with refractory epilepsy would score lower on acceptance and higher on rejection and especially engulfment when compared with CHD [46]. Further, meta-analysis has indicated that finding benefits in confrontation with a stressor was positively related to stressor severity [41].

    • Self-concept in primary school student with dyslexia: The relationship to parental rearing styles

      2021, International Journal of Environmental Research and Public Health
    View all citing articles on Scopus
    View full text