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FULL-LENGTH ORIGINAL RESEARCH
Academic achievement in school-aged children with active epilepsy: A population-based study *†Colin Reilly, ‡Patricia Atkinson, *§¶Krishna B. Das, #Richard F. C. Chin, §¶Sarah E. Aylett, *Victoria Burch, †§Christopher Gillberg, §¶**Rod C. Scott, and *§Brian G. R. Neville Epilepsia, 55(12):1910–1917, 2014 doi: 10.1111/epi.12826
SUMMARY
Colin Reilly is a research educational psychologist at Young Epilepsy, United Kingdom.
Objective: To provide population-based data on the performance of school-aged children with epilepsy on measures of academic achievement and factors associated with this performance after controlling for IQ. Methods: Eighty-five (74%) of 115 children with “active” epilepsy (experienced a seizure in the past year and/or on antiepileptic drugs [AEDs]) underwent psychological assessment including measures of IQ, aspects of working memory and processing speed. Sixty-five of the 85 were able to complete subtests on the Wide Range Achievement Test–Fourth Edition (WRAT-4). Paired sample t-tests were conducted to compare subtest scores. Factors associated with academic performance after controlling for IQ were examined using linear regression. Results: Seventy-two percent of the children, who could complete subtests on the WRAT-4, displayed “low achievement” (1 standard deviation [SD] below test mean) and 42% displayed “underachievement” (1 SD below assessed IQ) on at least one of the four WRAT-4 subtests. The mean scores on the Math Computation subtest and Sentence Comprehension subtest were significantly lower than scores on the Word Reading (p < 0.05) and Spelling (p < 0.001) subtests. Younger age at seizure onset was associated (p < 0.05) with decreased scores on three of the four WRAT-4 subtests after controlling for IQ. Difficulties with auditory working memory were associated with difficulties on reading comprehension (p < 0.05), and parent-reported difficulties with school attendance were associated with decreased scores on the Spelling and Word Reading subtests after controlling for IQ (p < 0.05). Significance: Difficulties with academic achievement are common in school-aged children with “active” epilepsy. Much of the difficulties can be attributed to lowered global cognition. However, specific cognitive deficits, younger onset of first seizure, and school attendance difficulties may contribute to difficulties independent of global cognition. There is a need to screen all children with “active” epilepsy for difficulties in school achievement, to identify contributory factors and to identify efficacious interventions for ameliorating such difficulties. KEY WORDS: Cognition, Reading, Comprehension, Math, Spelling.
Accepted September 4, 2014; Early View publication October 20, 2014. *Research Department, Young Epilepsy, Lingfield, Surrey, United Kingdom; †Gillberg Neuropsychiatry Center, University of Gothenburg, Gothenburg, Sweden; ‡Child Development Centre, Crawley Hospital, Crawley, West Sussex, United Kingdom; §Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom; ¶Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; #Muir Maxwell Epilepsy Centre, Edinburgh Neurosciences, The University of Edinburgh, Edinburgh, United Kingdom; and **College of Medicine, University of Vermont, Burlington, Vermont, U.S.A. Address correspondence to Colin Reilly, Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, U.K. E-mail: creilly@youngepilepsy. org.uk Wiley Periodicals, Inc. © 2014 International League Against Epilepsy
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1911 Academic Achievement in Epilepsy Population-based studies of long-term outcome in childhood epilepsy indicate that the condition is associated with significant adverse outcomes compared with the normal population across a range of domains including education and employment.1,2 School-related difficulties, as evidenced by receipt of special educational services, are common in children with epilepsy.3,4 Reported rates of intellectual disability (ID; IQ score 50. Four children younger than 6 years of age did not complete any items on the Sentence Comprehension subtest and thus did not achieve a score on this subtest. Twenty children were unable to complete items on the WRAT-4 due to their level of developmental functioning (all had IQ score
