Association between behavioral problems and parental stress in children and adolescents with epilepsy

Objective: The current study evaluated the association between behavioral problems in children and adolescents with epilepsy and parental stress.

Methods: A prospective observational study of 314 consecutive parents of children and adolescents with epilepsy who attended the out-patient epilepsy clinic of a tertiary care hospital was done between June 2022 and September 2023. Self-reported Child Behaviour Check List (CBCL) was reported by parents; who also reported the parental stress scale (PSS). The data as per CBCL guidelines was evaluated in three groups of children and adolescents with epilepsy aged 1.5 to 5 years; 6 to 10 years and 11 to 18 years. The associations between score on CBCL with reported score on PSS was evaluated.

Results: Among the 314 children and adolescents with epilepsy, 37(11.8 %) were aged between 1.5 to 5 years; while 108(34.4 %) aged between six to 10 years, the remaining 169(53.8 %) aged between 11 to 18 years. In children below 5 years of age, internalizing factors like anxiety/depression, somatic symptoms were significantly higher. Importantly, the reported scores on PSS were lower in parents of adolescents than children with epilepsy. When evaluated for correlation of CBCL with PSS, internalizing characteristics like withdrawal were strongly associated with parental stress in children below the age of 5 years. On the contrary, in children aged above five years, and in adolescents externalizing characteristics showed strong correlations with parental stress. Child's higher school performance had a negative correlation with PSS(R-Square: -0.499; p < 0.001) and requirement for special school or child not attending school had positive correlation with PSS(R-square: 0.433;p < 0.001).

Conclusion: Behavioral problems in children and adolescents with epilepsy differ with age. Parental stress is associated with internalizing behavior in pre-school children whereas externalizing behavior dominated in children and adolescents. Poor performance of children at school and requirement for special school is associated with high parental stress.