Abstracts

Rationale: Learning challenges have been inconsistently reported in retrospective studies of pediatric non-epileptic seizures (NES). This multisite study examined if children with NES have significantly more learning challenges involving cognitive, academic and language skill than their siblings. It also determined if within the NES and sibling groups subjects met diagnostic criteria for a learning disorder (LD) based on self-report rather than on parent report and whether LD was associated with other psychiatric diagnoses, epilepsy and coping. Methods: NES participants aged 8-18 years had confirmed typical NES episodes on video EEG. 48 NES (33 female, 15 male) and 33 siblings (18 female, 15 male) underwent standardized cognitive, language, and achievement testing and structured psychiatric interviews. 15 NES subjects were singletons. Parents and medical charts provided information on confirmed epilepsy and psychotropic drug treatment. T-tests and chi-square analyses (Fisher's exact tests for measures with cell frequencies <5) examined between group differences in the distribution of continuous (including IQ, language and achievement scores) and categorical (including LD, presence of other psychiatric diagnoses, epilepsy) variables, respectively. Results: Standardized cognitive, language, and achievement tests revealed average mean scores among both NES and sibling groups. However, the percentage of subjects experiencing deficits in math (NES 31.9%, siblings 12.9%, p=.05) and spelling achievement scores (NES 17%, siblings 3.1%, p=.06) was significantly different. Structured psychiatric interviews identified a similar rate of LD NOS in 30 (62.5%) NES and in 17(51.5%) siblings. But parents reported LD in only 7 NES and 2 siblings. Though not significantly different, both siblings (48.5%) and NES (38.3%) subjects reported school problems as their most bothersome stressor. Within both groups, the presence of LD was associated with multiple psychiatric diagnoses but not with a specific diagnosis. In the NES group, 83% of those with LD also had epilepsy, compared to 56% of those without LD. Among the NES group, those with LD did not differ from those with no LD on a measure of coping styles. In contrast siblings with LD use significantly more monitoring (i.e., attending to or focusing on a stressor; p=.02), including cognitive decision-making (p=.02), direct problem solving (p=.0006), and support seeking (p=.003). Conclusions: These findings highlight the importance of asking children with NES about LD even when parents and standardized testing do not confirm this diagnosis. They also demonstrate that despite multiple psychiatric diagnoses and LD in the NES and sibling groups, NES children with and without LD do not differ in the coping strategies they identify. Finally, this is the first prospective study that assessed LD in pediatric NES controlling for family variables.