Speed and complexity characterize attention problems in children with localization-related epilepsy.
OBJECTIVE
Children with epilepsy (EPI) have a higher rate of attention-deficit/hyperactivity disorder (ADHD; 28-70%) than typically developing (TD) children (5-10%); however, attention is multidimensional. Thus, we aimed to characterize the profile of attention difficulties in children with epilepsy.


METHODS
Seventy-five children with localization-related epilepsy ages 6-16 years and 75 age-matched controls were evaluated using multimodal, multidimensional measures of attention including direct performance and parent ratings of attention as well as intelligence testing. We assessed group differences across attention measures, determined if parent rating predicted performance on attention measures, and examined if epilepsy characteristics were associated with attention skills.


RESULTS
The EPI group performed worse than the TD group on timed and complex attention aspects of attention (p < 0.05), whereas performance on simple visual and simple auditory attention tasks was comparable. Children with EPI were 12 times as likely as TD children to have clinically elevated symptoms of inattention as rated by parents, but ratings were a weak predictor of attention performance. Earlier age of onset was associated with slower motor speed (p < 0.01), but no other epilepsy-related clinical characteristics were associated with attention skills.


CONCLUSIONS
This study clarifies the nature of the attention problems in pediatric epilepsy, which may be under-recognized. Children with EPI had difficulty with complex attention and rapid response, not simple attention. As such, they may not exhibit difficulty until later in primary school when demands increase. Parent report with standard ADHD screening tools may under-detect these higher-order attention difficulties. Thus, monitoring through direct neuropsychological performance is recommended.
Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.|George Washington University, Washington, District of Columbia, U.S.A.
Madison M
MM
Berl
Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.
Virginia
V
Terwilliger
Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.
Alexandra
A
Scheller
Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.
Leigh
L
Sepeta
Tufts University School of Medicine, Boston, Massachusetts, U.S.A.
Jenifer
J
Walkowiak
Children's National Health System (CNHS), Washington, District of Columbia, U.S.A.|George Washington University, Washington, District of Columbia, U.S.A.
William D
WD
Gaillard
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000209:etiology*; D002648:Child; D004827:Epilepsy / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D010290:Parents / Q000523:psychology; D011569:Psychiatric Status Rating Scales
Attention-deficit/hyperactivity disorder; Cognition; Comorbidities; Pediatric