Parenting stress evaluation and behavioral syndromes in a group of pediatric patients with epilepsy Davide Farrace a , Marco Tommasi b, ⁎, Claudia Casadio a , Alberto Verrotti c a Department of Sciences in Quantitative Economics, Philosophy and Education, Gabriele D'Annunzio University, Chieti-Pescara, Italy b Department of Psychological, Humanistic and Territorial Sciences, Gabriele D'Annunzio University, Chieti-Pescara, Italy c Department of Pediatrics, University of Perugia, Italy abstract article info Article history: Received 28 March 2013 Revised 16 July 2013 Accepted 22 July 2013 Keywords: Epilepsy Pediatric patients Parenting stress Behavioral syndrome The aim of the present work was to measure the amount of stress in parents of children with epilepsy and to de- termine whether and how parenting stress is linked to behavioral symptoms of the children. Parenting stress was measured with the Parenting Stress Index (PSI) and behavioral symptoms with the Child Behavior Checklist (CBCL). Data obtained from 26 parents of children with epilepsy were compared with those obtained from 31 par- ents of healthy children. Children with epilepsy obtained higher scores in all the subscales of PSI and in almost all the subscales of CBCL compared with healthy children. Epilepsy caused a high level of parenting stress and of prob- lematic behaviors since the behavioral symptoms predicting the degree of parenting stress significantly differed between healthy children and children with epilepsy. Therefore, parents of children with epilepsy should be of- fered psychological support to cope with parenting stress and to improve the relationship with their children. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Children's chronic diseases and disabilities may cause critical effects on the entire family [1]. These effects depend on a number of character- istics of the child, the parents, and their environment [2]. Being aware of the effects produced by children's disease on their parents is important because it allows one to encourage coping strategies and to offer the support needed to reduce the emotional burden related to the situation. It also helps to promote an improvement in the relationship between parents and children, including those children without medical prob- lems, resulting in a greater ability to combine medical care with work and relationships with friends and with the partner [1,3]. On the other hand, stress, in general, decreases the ability to withstand adversity and predisposes people to develop mood disorders [4]. Research has already shown a sensible measure of parenting stress [5] in connection with the effects of externalizing and internalizing be- havioral problems of healthy children [6]. While behavioral problems occurring in children with epilepsy have been established in the litera- ture [7,8], parenting stress has been investigated only recently [9,10]. Moreover, an increased level of stress is detected in parents of autis- tic children in proportion to the severity of the condition [11], of chil- dren with diabetes [12], or of children with asthma [13]. Given that having children with diseases such as those mentioned above can gen- erate parenting stress, we may assume that also having children with epilepsy, characterized by unpredictable crisis onset, can cause stress related to treatment concerns in their parents. Parenting stress is an important theoretical concept since in the literature it has shown its rel- evance for explaining disorders and resilience of families in influencing the behaviors adapted by parents [5,9]. Abidin introduces his PSI stating that an early identification of “child–parent” stressing systems and in- terventions focused at reducing this stress might reduce the frequency and intensity of emotional and behavioral disorders in the children. For this purpose, the PSI measures the stress perceived in the parent– child interaction. Parenting stress is a specific form of stress uniquely perceived by parents that results from the demands of being a parent. It is a multidimensional concept composed of the factors that can produce dysfunctional parental behaviors, which are divided in two major domains: child characteristics and parent characteristics [5]. The short form of the PSI, used in this study, is described in detail in the Measures section. To our knowledge, only one study has examined parenting stress and behavior of children with drug-resistant epilepsy [10]. Children with epileptic syndromes can have a high incidence of behavioral disor- ders [14]. Epilepsy is a condition that predisposes children to develop behavioral problems, which increase with seizure recurrence [15] and which create in turn stress in the parents. In addition, clinical variables (time of onset, type of seizure, seizure rates) and personal expectations (feelings and emotions about the current health status and future of the child) also explain the increase of parenting fears while lowering children's quality of life [16,17]. In adults, instead, the quality of life is influenced more by mood disorders and antiepileptic drug (AED) side effects than by sociodemographic and clinical variables [18,19]. The main goal of our work was to identify the possible presence of a greater stress in parents of children with epilepsy, determining whether and how parenting stress is linked to behavioral disorders of children Epilepsy & Behavior 29 (2013) 222–227 ⁎ Corresponding author. E-mail address: marco.tommasi@unich.it (M. Tommasi). 1525-5050/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.yebeh.2013.07.020 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh