Parenting stress does not normalize after child's epilepsy surgery Olga Braams a,b,c,d, ⁎, Joost Meekes a,b,d , Kees Braun b,e , Renske Schappin c , Peter C. van Rijen b,f , Marc P.H. Hendriks g,h , Aag Jennekens-Schinkel a,b,d , Onno van Nieuwenhuizen b,d a Sector of Neuropsychology for Children and Adolescents, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands b Brain Center Rudolf Magnus, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands c Department of Pediatric Psychology and Social Work, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands d Bio Research Center for Children, Wekeromseweg 8, 6816 VS Arnhem, The Netherlands e Department of Child Neurology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands f Department of Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands g Academic Centre for Epileptology, Kempenhaeghe, Sterkselseweg 65, 5591 VE Heeze, The Netherlands h Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands abstract article info Article history: Received 23 June 2014 Revised 27 October 2014 Accepted 29 October 2014 Available online xxxx Keywords: Parenting Stress Child Epilepsy Surgery Purpose: This study aimed to investigate parenting stress expressed by parents before and two years after their children's epilepsy surgery. Methods: Subjects: Parents of 31 consecutively included surgery patients with epilepsy and parents of 31 healthy sex- and age-matched control children were the subjects of this study. Materials and procedure: The question- naire ‘Parenting Stress Index’, which distinguishes a Parent domain (stress leading parents to feel themselves inadequate) from a Child domain (child features felt by parent to cause stress) was completed before surgery of the patients and two years thereafter. At both time points, intelligence examination of the child was part of a comprehensive neuropsychological assessment, as were evaluations of recent stress-enhancing life events and epilepsy severity. Results: Prior to surgery, total parenting stress was significantly higher in parents of patients than in parents of con- trols. Two years after surgery, total parenting stress had decreased significantly in parents of patients. The scores on parent-related subscales Role Restriction and Spouse and on the child-related subscale Distractibility/Hyperactivity, all relatively high before surgery, decreased significantly. Still, parents of patients experienced significantly more stress compared with parents of controls mainly because of persistently higher stress scores in par- ents of patients on the subscale Role Restriction (Parent domain) and on five of six subscales in the Child domain. Intelligence of the child was associated with parenting stress: the lower the child's intelligence, the higher the stress score on the subscale Distractibility/Hyperactivity and the lower the stress score on the subscale Mood. Stress decreased more in parents of patients who became seizure-free after surgery than in parents of patients with recurrent seizures. Conclusions: Parenting stress decreases but does not normalize in the first two years after epilepsy surgery. Parents should be offered counseling on epilepsy-related intricacies contributing to parenting stress, immediately after diagnosis as well as after epilepsy surgery, notwithstanding the resulting seizure status of the child. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Parenting-related stress is since long acknowledged as an important determinant of dysfunctional parenting [1,2]. Dysfunctional parenting affects the child's behavior, the latter affects parenting stress, and the in- creased parenting stress increases dysfunctional parenting [3]. Current models of parenting stress, i.e., of ‘the aversive psychological reaction to the demands of being a parent’, agree that complex processes under- lie parenting stress [1–3]. Testing and cross-validating their multidi- mensional model of parenting stress, Östberg and Hagekull demonstrated a pattern of direct and indirect effects on parenting stress in mothers of infants and preschool children. Everyday problems with, e.g., feeding and sleeping, excessive crying, and illness were among the direct contributors to mothers' parenting stress [2]. Irregularity of the child's rhythmicity in biologically determined needs contributed indirectly to mothers' parenting stress, i.e., through her perceiving the child as fussy or difficult [2]. Epilepsy & Behavior xxx (2014) xxx–xxx ⁎ Corresponding author at: University Medical Center Utrecht, Department of Neuropsychology for Children and Adolescents, PO Box 85090, Home Room Number KG.01.327.1, 3508 AB Utrecht, The Netherlands. Tel.: +31 88 755 8272. E-mail addresses: Obraams@umcutrecht.nl (O. Braams), meekes.joost@gmail.com (J. Meekes), K.Braun@umcutrecht.nl (K. Braun), R.Schappin@umcutrecht.nl (R. Schappin), P.v.Rijen@umcutrecht.nl (P.C. van Rijen), HendriksM@kempenhaeghe.nl (M.P.H. Hendriks), A.Jennekens@umcutrecht.nl (A. Jennekens-Schinkel), OnnovanNieuwenhuizen@umcutrecht.nl (O. van Nieuwenhuizen). YEBEH-04099; No of Pages 6 http://dx.doi.org/10.1016/j.yebeh.2014.10.034 1525-5050/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Please cite this article as: Braams O, et al, Parenting stress does not normalize after child's epilepsy surgery, Epilepsy Behav (2014), http:// dx.doi.org/10.1016/j.yebeh.2014.10.034