Peter Hoare

THE DEVELOPMENT OF PSYCHIATRIC DISORDER AMONG SCHOOLCHILDREN WITH EPILEPSY

Two groups of epileptic children, one newly diagnosed and one with chronic epilepsy, were compared with two comparable groups of diabetic children and with children in the general population in order to investigate the development of psychiatric disorder. The results confirm previous findings that children with chronic epilepsy are significantly more disturbed than children with chronic physical illness not involving the central nervous system, and than children in the general population. Children with newly diagnosed epilepsy were also significantly more disturbed than those with newly diagnosed diabetes, and than children in the general population. The rate of psychiatric disturbance was similar in the two groups of epileptic children. In both groups of epileptic children, those with focal EEG abnormalities and/or complex partial seizures were particularly vulnerable to psychiatric disturbance.

The quality of life of children with chronic epilepsy and their families : preliminary findings with a new assessment measure

The aim of this study was to develop and validate a new schedule to measure the impact of epilepsy on children and thier families. 30 questions assess four aspects of the childs and familys lifestyle: epilepsy and its treatment, impact on the child, impact on the parent and impact on the family. For each question, two dimensions are considered: the frequency of the problem, and its importance or degree of concern that it causes. The questionnaire was piloted on the parents of 21 children with chronic epilepsy attending a seizure clinic. Epilepsy was well controlled in half of the children and poorly controlled in the remainder. The questionnaire discriminated well between the two groups of children. Further research will be undertaken to assess the usefulness of the questionnaire on a larger and more representative group of children with epilepsy.

Psychometric properties of the quality of life questionnaire for children with CP

This paper describes the development and psychometric properties of a condition‐specific quality of life instrument for children with cerebral palsy (CP QOL‐Child). A sample of 205 primary caregivers of children with CP aged 4 to 12 years (mean 8y 5mo) and 53 children aged 9 to 12 years completed the CP QOL‐Child. The children (112 males, 93 females) were sampled across Gross Motor Function Classification System (GMFCS) levels (Level I=18%, II=28%, III=14%, IV=11%, V=27%). Primary caregivers also completed other measures of child health (Child Health Questionnaire; CHQ), QOL (KIDSCREEN), and functioning (GMFCS). Internal consistency ranged from 0.74 to 0.92 for primary caregivers and from 0.80 to 0.90 for child self‐report. For primary caregivers, 2‐week test‐retest reliability ranged from 0.76 to 0.89. The validity of the CP QOL is supported by the pattern of correlations between CP QOL‐Child scales with the CHQ, KIDSCREEN, and GMFCS. Preliminary statistics suggest that the child self‐report questionnaire has acceptable psychometric properties. The questionnaire can be freely accessed at http://www.deakin.edu.ac/hmnbs/chase/cerebralpalsy/cp_qol_home.php

Self-esteem and behavioural adjustment in children with epilepsy and children with diabetes

This paper describes a study to investigate the relationship between self-esteem and behavioural adjustment in two groups of children with chronic illness, one with epilepsy and the other diabetes. A total of 62 children with epilepsy and 91 children with diabetes were recruited from the total population of children aged 8-15 attending the epilepsy and diabetic clinics at a childrens hospital over a 12 month period. Self-esteem and behavioural adjustment were assessed with the Harter and Achenbach Questionnaires respectively. The results showed the children with epilepsy were consistently more behaviourally disturbed and had lower self-esteem than children with diabetes. The independent completion of the questionnaires, (the Harter by the child and the Achenbach by the parents) increases the validity of the findings. Long duration of illness was the most consistent illness variable associated with poor behavioural adjustment in the two groups. The cross-sectional design of the study did not make it possible to draw any definite conclusions about the causal or temporal relationship between low self-esteem and behavioural disturbance. Once again, the potential value of prospective studies into the psychosocial adjustment of children with chronic illness is highlighted.

PSYCHIATRIC DISTURBANCE IN THE FAMILIES OF EPILEPTIC CHILDREN

The rates of psychiatric disturbance among the parents and school‐age siblings of two groups of epileptic children, one newly diagnosed and one with chronic epilepsy, were compared with those of adults and children in the general population. Siblings of children in the newly diagnosed group were no more disturbed than children in the general population, whereas those of children with chronic epilepsy were. The parents of both groups were no more disturbed than adults in the general population, but there was an association between disturbance in the chronically epileptic children and increased psychiatric morbidity among their mothers. Professionals involved in the care of epileptic children should be aware of the effects on the psychological health of other members of the family, and of ways of helping the child and the family to cope with the illness.

DOES ILLNESS FOSTER DEPENDENCY? A STUDY OF EPILEPTIC AND DIABETIC CHILDREN

The development of inappropriate dependency was investigated among two comparable groups of children, one with newly diagnosed epilepsy or diabetes, the other with chronic epilepsy or diabetes. The two groups of epileptic children were significantly more dependent than the two diabetic groups, and than children in the general population. Psychiatric disturbance was significantly more common among the epileptic children, and possibly is a factor in their inappropriate dependency. Specific advice and counselling for the parents is likely to help promote the childrens sense of self‐esteem and independence.

12-month efficacy and safety of OROS MPH in children and adolescents with attention-deficit/hyperactivity disorder switched from MPH.

PurposeThe aim of this study was to evaluate long-term clinical treatment with OROS® methylphenidate (MPH) (Concerta®) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who had been previously treated with immediate release (IR) MPH.MethodsSubjects aged 6–16 years (n=105) who were stable on IR MPH (10–60 mg/day) were switched to 18, 36 or 54mg OROS® MPH once daily for 21 days, depending on prestudy MPH dose. Subjects who benefited from OROS® MPH could continue in a 12-month extension period. ADHD symptoms and treatment response were assessed by parents/caregivers and investigators.ResultsOut of 105 enrolled children, 101 completed the 21-day treatment phase. In all, 89 parents/caregivers (88.1%) wanted their child to continue with the study treatment into the extension phase, and 56 children (63 %) completed the 1-year trial. The parent/caregiver global assessment of satisfaction ranged from 49 to 69% during the extension phase, and 49 to 71% of investigators rated the treatment as adequate. Efficacy and satisfaction were found more commonly in patients in the older age group (10–16 years), those on a higher dose (36 mg or 54 mg) and with the predominantly inattentive ADHD subtype. OROS® MPH was well tolerated.ConclusionsChildren and adolescents can effectively and safely be switched from IR MPH to OROS® MPH with improved symptom control and compliance.

Eating habits, body-esteem and self-esteem in scottish children and adolescents

Two hundred ninety-nine girls, from primary school grade 6 to senior school grade 4 classes in a Scottish, independent, single-gender school completed three questionnaires assessing body-esteem, self-esteem, and eating behavior. The aim of the study was threefold: to see whether there was a significant increase in more abnormal eating habits during adolescence; to see whether there was a significant decline in body-esteem during adolescence; and to see whether there was any association between eating habits, body-esteem, and self-esteem. The results provided some evidence in support of the first two hypotheses and also indicated a strong association between a low level of self-esteem and dislike of body shape, and an abnormal pattern of eating. The risks and implications of dieting in this age group are also discussed.

Symptom control in children and adolescents with attention-deficit/hyperactivity disorder on switching from immediate-release MPH to OROS MPH Results of a 3-week open-label study.

AimThe aim of this study was to assess the impact of switching from immediate-release (IR) methylphenidate (MPH) to OROS® MPH (CONCERTA®), a once-daily long-acting MPH formulation, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).MethodsSubjects with ADHD aged 6–16 (n=105),who were stably maintained on their current IR MPH regimen (10–60 mg/day), were switched to 18, 36 or 54mg OROS® MPH once daily for 21 days, depending on pre-study daily MPH dose.ADHD symptoms were assessed by parents, teachers and investigators.ResultsBy Day 21, parent/caregiver IOWA Conners ratings had decreased from baseline by 2.7 points to 5.2 (I/O), and by 1.8 points to 5.0 (O/D). Teacher IOWA Conners ratings were maintained. Decreases in IOWA Conners ratings are indicative of ADHD symptom improvement. Approximately 75% of parents and investigators rated therapy as good or excellent. OROS® MPH therapy was well tolerated.ConclusionsSwitching from IR MPH to OROS® MPH maintained and may have improved symptom control in children and adolescents with ADHD, during the course of this study. The changes in parent/caregiver IOWA Conners ratings suggest that OROS® MPH improves symptom control in the after-school period. This is consistent with the 12-h duration of action previously demonstrated for OROS® MPH.

Helping parents and children with epilepsy cope successfully: The outcome of a group programme for parents

This paper describes a study to determine the effectiveness of a group programme for parents designed to reduce the psychosocial morbidity among children with epilepsy and their families. The participants were the parents of 108 children attending the seizure clinic at a childrens hospital. The first part of the project had shown that half of the children and their families had considerable morbidity. Despite the high rate of psychosocial morbidity among these children and their families, only 35% of the parents expressed an interest in participation in the intervention programme, with only 12% attending any meetings. The latter were mainly the small number of parents whose children had severe intractable epilepsy as well as educational and family problems. Many parents did, however, request more information about epilepsy and for the provision of a counselling service. The latter is likely to be most beneficial in the months following diagnosis.