Abstracts

RATIONALE: Families of children with intractable epilepsy who are surgical candidates perceive surgery as an opportunity to improve their child[ssquote]s overall health. One of the areas comprising child health is that of social experience. The objective of this study is to ascertain what changes children experience in their social adjustment one year after epilepsy surgery using a unique blend of quantitative and qualitative findings. Another objective is to examine pre surgical predictors of social adjustment one year after surgery.
METHODS: The participants included 23 children who received surgery (mean age 13.3) and a matched cohort of 18 children with intractable epilepsy but who did not undergo this procedure (mean age 13.0). Data were collected prospectively, at baseline and one year after surgery. Three subscales from the parent rated Child Behaviour Checklist that address social adjustment were chosen for this analysis. Repeated measures analysis, controlling for age and sex was conducted to examine change by group over time. Given the exploratory nature of this study, bivariate analysis of epilepsy, child and family correlates of social adjustment at time 2 was also conducted. These were submitted to stepwise regression to ascertain time 1 predictors of functioning at time 2. In addition, ethnographic interviews were conducted with parents at both times during which they were asked to reflect on their child[scquote]s social experience. These interviews were coded and analyzed using NVIVO.
RESULTS: There is no difference in the change in social functioning experienced by children in the surgical group when compared to the comparison group. Significant epilepsy correlates (p[lt]0.05) of social adjustment at time 2 included proportion of life with seizures (r=-0.322), frequency of seizures at time 1 (r=-0.447), and seizure outcome at time 2 (r=-0.33). Performance IQ was associated with social problems (r=-0.285). Family variables included state and trait anxiety (r=-0.391; r=0.304), family active orientation (r=0.4). The strongest predictor of two of the indicators of social adjustment is the same indicator at time 1. Family Active Orientation predicted the Activities scores on the CBCL. Seizure frequency at time 1 and seizure outcome predicted an additional 13.7% and 8.5% variance respectively. It is important to note that in the surgical group, being seizure free was associated with more social problems.
CONCLUSIONS: Children undergoing epilepsy surgery do not experience any major improvement in their social functioning. With the exception of family active orientation, the strongest predictor of how well children will do socially after surgery is how well they are doing before surgery. In addition, those who have more frequent seizures at time 1 and those who experience better seizure control have more difficulty in this area of health. The qualitative findings illuminate some of the processes involved in this finding and suggest that children return to the same peer context after surgery and so assume the same social position. Furthermore, their improved attunement to their social world may cause them to connect with and experience some of the harsh realities they are faced with such as isolation, bullying and teasing.
At the end of this presentation participants will gain a better understanding of the social functioning of children and adolescents after epilepsy surgery.
[Supported by: Ontario Mental Health Foundation]