Northeast Regional Epilepsy Group

1. Northeast Regional Epilepsy Group Do children with epilepsy have cognitive problems? How to ensure success in school

2. Robert W. Co-Director Clinical Neuropsychology NEREG

3. Children with epilepsy obtained lower scores than controls across measures of cognition and behavior. http://pediatrics.aappublications.org/content/112/6/1338.short

4. Children with epilepsy often present with problems with cognitive functioning involving: -attention -executive functioning -memory -language.

5. Problems with cognitive functioning can cause other problems – notably social and academic difficulties

6. language troubles learning difficulties and poor academic performance behavior problems poor socio-professional prognosis Rijckevorsel (2006) http://www.seizure-journal.com/article/S1059-1311%2806%2900036-7/fulltext

7. Despite similar intelligence and educational background, significantly more patients with epilepsy (51%) than control subjects (27%) required special educational assistance. http://pediatrics.aappublications.org/content/112/6/1338.short

8. -attention -executive functioning -memory -language

9. Factors behind cognitive difficulties among children with epilepsy

10. Epilepsy is a symptom rather than the cause of brain dysfunction.

11. There are structural changes that precede seizure onset

12. Some studies show that in newly diagnosed and untreated epileptic patients, cognitive problems are already present in more than 50% of patients http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797884/

13. Epileptic seizures can cause changes within the brain which can further affect cognitive functioning

14. An ongoing epileptogenic process can irreversibly damage the brain, especially the maturing brain, even if seizures are controlled

15. and can cause persistent cognitive changes and global intellectual deficits

16. Regarding seizures factors which can impact changes in cognitive functioning include: seizure type age of onset severity and frequency

17. anatomical location and etiology psychosocial problems and side effects of antiepileptic drugs. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362729/

18. In addition to seizures, there are associated disorders which can impact functioning

19. Attention Attention Deficit Hyperactivity Disorder (ADHD)

20. ADHD subtypes ADHD – Combined Type ADHD – Predominantly Inattentive Type ADHD – Predominantly Hyperactive -Impulsive Type Other Specified ADHD Other Nonspecified ADHD

21. DSM-5 Criteria People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development: http://www.cdc.gov/ncbddd/adhd/diagnosis.html

22. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities.

23. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person's developmental level: Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games)

24. In addition, the following conditions must be met: Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities). There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

25. Prevalence in the general population 11% of US school aged children received a diagnosis of ADHD by a health care provider by 2011 as reported by parents http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html

26. 6.4 million children including 1/5 high school boys 1/11 high school girls

27. among children with epilepsy between 12 and 17% prevalence of ADHD http://www.ncbi.nlm.nih.gov/pubmed/21310586

28. higher occurrence of ADHD – inattentive type seizure/epilepsy variables do not seem to be important correlates

29. Regarding attention, there may be problems managing both internal and external stimuli.

30. Problems with attention – internal

31. Internal distractions – thought processes

32. Which can include concentrating on managing their own behavior, which can cause problems actually focusing on lessons

33. 2015 study demonstrated that children with ADHD allowed to move functioned better on working memory tasks Authors suggested that the results likely would generalize to the classroom, allowing children to likely spend less time trying to control themselves • http://link.springer.com/article/10.1007%2Fs10802-015-0011-1

34. In Classroom: opportunities to move while working standing up while working sewing pedal for tapping squeeze balls while listening/reading

35. Problems with attention – external

36. Problems managing distractibility – sights and sounds

37. managing distractions tv, radio, internet, phones

38. other people can be a distraction

39. Preferential seating in the classroom

40. Separate location for tests/quizzes

41. Quiet place to work at home

42. other work on a table/desk can be a distraction (or anxiety producing)

43. Problems with Executive Functioning

44. starting tasks - organizing/prioritizing tasks - planning/breaking down tasks - catching/correcting mistakes (self monitoring) - finishing tasks

45. Memory Problems

46. Problems with Learning Often Linked to Attention Problems

47. How to address these problems?

48. WORK HARDER

49. WORK HARDER DO BETTER

50. WORK HARDER DO BETTER DO MORE