The effect of depression on academic achievement in children with epilepsy Ays ße Tosun a, * , Sezen Gokcen b , Burcu Ozbaran b , Gul Serdaroglu a , Muzaffer Polat a , Hasan Tekgul a , Sarenur Gokben a a Division of Pediatric Neurology, Department of Pediatrics, Ege University Hospitial, Bornova, Izmir 35100, Turkey b Department of Child Psychiatry, Ege University Medical School, Izmir, Turkey article info Article history: Received 7 November 2007 Revised 25 April 2008 Accepted 21 May 2008 Available online 2 July 2008 Keywords: Epilepsy Depression Child School achievement abstract In this cross-sectional study our aim was to evaluate the effect of depression on academic achievement in children with epilepsy and low school performance. Fifty-one children with epilepsy and low school per- formance were evaluated with the Children’s Depression Inventory (CDI) to measure depressive symp- toms. School performance was evaluated with Achenbach’s Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Children diagnosed with depressive spectrum disorders received medical therapy. All tests were administered in the first interview and repeated at the end of 6 months of therapy. Forty-three children completed the study. The patients were evaluated with DSM-IV diagnostic criteria. Accordingly, 9 (20.9%) children had Major Depressive Disorder (MDD) and 4 (9.3%) had Depressive Dis- order, Not Otherwise Specified (DD-NOS). All children with MDD and DD-NOS received antidepressant medication, but only seven of them completed treatment. Posttreatment CDI scores were significantly lower, and TRF scores also improved. Pediatric neurologists should be aware of the possibility of depres- sive disorders in children with epilepsy, especially in those with low school performance. Ó 2008 Elsevier Inc. All rights reserved. 1. Introduction Epilepsy is a chronic disease that can affect the behavioral and cognitive functions of children. In addition to being vulnerable to the same etiological risk factors for psychiatric disorders as the general population, children and adolescents with epilepsy and their families are also under additional stress because of this chronic disorder. These children have more behavioral, emotional, internalizing, attention, and somatic problems compared with the general population. The underlying pathology of the disorder involving the hippocampus, amygdala and subcortical nuclei may also play a role. A relationship between epilepsy and depression has been recog- nized for a long time. There is a general consensus that patients with epilepsy have a four- to fivefold higher incidence of depres- sion and suicide than the general population [1]. In the general population, the prevalence of depression in children and adoles- cents ranges from 2 to 9%, but the prevalence of depression is in- creased in adults with epilepsy, ranging from 34 to 78% [2]. The prevalence is also increased in children and adolescents with epi- lepsy, and has been reported to be 23–26% on the basis of measure- ments derived from self-report instruments [3]. The depression is often not recognized in children with epilepsy. In fact, the preva- lence might be higher if we carefully asked about symptoms. Cognitive deficits and academic achievement problems are also commonly seen in children and adolescents with epilepsy. These problems may be related to psychiatric disorders, especially depression [2–5]. Fröjd et al. [6] studied 2516 children (13–17 years old). They completed a questionnaire anonymously in the classroom. Among the girls, 18.4% and, among the boys, 11.1% were classified as being depressed. They found that depression was asso- ciated with difficulties in concentration, social relationships, self- reliant school performance, and reading and writing. Their study also suggested that children reporting difficulties in academic per- formance should be screened for depression. The Child Behavior Checklist (CBCL) can be used to obtain a behavioral profile for chil- dren with chronic epilepsy. Fang et al. [7] used the CBCL in 56 chil- dren with epilepsy and 45 age-matched healthy controls and concluded that the CBCL can be used as a screening test for depres- sive symptoms with these children. In the study described here, we aimed to evaluate the effect of depression and antidepressant treatment on academic achieve- ment in children with epilepsy and low school performance. 2. Methods Fifty-one children with epilepsy (between the ages of 9 and 16) followed at Ege University Department of Pediatric Neurology were included in this cross-sectional study. Written consent for participation in the study was obtained from the parents of all children. Epilepsy and epileptic syndromes were evaluated according to Inter- national League Against Epilepsy criteria [8]. Seizure-related data were collected. Children with a normal neurological examination and who had not had seizures 1525-5050/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2008.05.016 * Corresponding author. Fax: +90 2323889900. E-mail address: aysetosun2000@yahoo.com (A. Tosun). Epilepsy & Behavior 13 (2008) 494–498 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh