Neuropsychological predictors of academic underachievement in pediatric epilepsy: moderating roles of demographic, seizure, and psychosocial variables.
OBJECTIVE
Academic underachievement is common in pediatric epilepsy. Attempts to identify seizure and psychosocial risk factors for underachievement have yielded inconsistent findings, raising the possibility that seizure and psychosocial variables play a complex role in combination with other variables such as neuropsychological functioning. This study cross-validated a neuropsychological measurement model for childhood epilepsy, examined the relation between neuropsychological functioning and academic achievement, and tested the degree to which demographic, seizure, and psychosocial variables moderate that relation.


METHODS
Children with chronic epilepsy (N = 173; ages 8 to 15 years; 49% girls; 91% white/non-Hispanic; 79% one seizure type; 79% taking one medication; 69% with active seizures) completed a comprehensive neuropsychological battery. Children diagnosed with mental retardation were excluded.


RESULTS
Structural equation modeling identified a three-factor measurement model of neuropsychological function: Verbal/Memory/Executive (VME), Rapid Naming/Working Memory (RN/WM), and Psychomotor (PM). VME and RN/WM were strongly related to reading, math, and writing; PM predicted writing only. Family environment moderated the impact of neuropsychological deficits on writing (p < or = 0.01) and possibly for reading (p = 0.05); neuropsychological deficits had a smaller impact on achievement for children in supportive/organized homes compared with children in unsupportive/disorganized homes.


CONCLUSIONS
These findings lend partial support for our theoretical model showing direct effects of neuropsychological function on achievement and the moderating role of family factors. This study suggests that a subgroup of children with epilepsy (those who have not only neuropsychological deficits but also disorganized/unsupportive home environments) are particularly at risk for adverse academic outcomes. Implications for intervention are discussed.
Department of Psychology, Purdue School of Science, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA. pfastena@iupui.edu
Philip S
PS
Fastenau
Jianzhao
J
Shen
David W
DW
Dunn
Susan M
SM
Perkins
Bruce P
BP
Hermann
Joan K
JK
Austin
D000293:Adolescent; D017028:Caregivers / Q000706:statistics & numerical data; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D004522:Educational Status; D004827:Epilepsy / Q000175:diagnosis / Q000523:psychology*; D005192:Family Health; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008960:Models, Psychological; D015233:Models, Statistical; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D011859:Radiography; D012307:Risk Factors; D012737:Sex Factors; D014477:Underachievement