Abstracts

Rationale: Research has highlighted that the language abilities of young children exposed in utero to valproate or carbamazepine may be compromised. However, the level of impairment and the language systems affected remain unclear and require investigation to allow for a comprehensive understanding. Methods: Following the administration of neuropsychological assessment at six years of age, conducted by the Liverpool and Manchester Neurodevelopment Group, mothers of children exposed to either valproate or carbamazepine were approached to enrol their child for further, more in depth, assessment of their child s language abilities. Children whose mothers consented were assessed using the Clinical Evaluation of Language Fundamentals (4th Edition). Control children matched for age, gender and non-verbal IQ were recruited for each child with a history of exposure to either valproate or carbamazepine monotherapy throughout gestation. Results: Thirty children exposed to valproate and 30 children exposed to carbamazepine aged between six and seven years were assessed along with matched control children. The children exposed to valproate in utero in comparison to control children had significantly poorer mean language scores across the domains of core language (p<0.001), receptive language (p<0.001), expressive language (p<0.001), language content (p<0.001) and language structure (p<0.001). Children exposed to carbamazepine in utero also differed significantly from control children on their overall core language ability (p=0.042), their expressive language (p=0.023) and in terms of language structure (p=0.018). A significant increase in the rate of below average performance (<84) was found for the group exposed to valproate (44%) in comparison to 11% of matched control children (p=0.005). Twenty four percent of children exposed to carbamazepine in utero fell below average in comparison to 7% of their matched sample (p=0.070). Rates of speech and language therapy were substantially higher in the valproate exposed group (38%) in comparison to the matched control group (18%) and the children exposed to carbamazepine (23%). Conclusions: Children exposed to valproate or carbamazepine in utero are at an increased risk of poor language ability. For children exposed to valproate the impairment appears to be global. Further investigation of language abilities within these exposure groups is required in larger cohorts where the effects of dose can be considered.