Developing from child to adult: Risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy R.P.J. Geerlings a, ⁎, A.P. Aldenkamp a,b,c,d , L.M.C. Gottmer-Welschen a , P.H.N. de With b , S. Zinger b , A.L. van Staa e,f , A.J.A. de Louw a,b a Epilepsy Center Kempenhaeghe, Heeze, The Netherlands b Faculty of Electrical Engineering, University of Technology, Eindhoven, The Netherlands c Department of Neurology, Maastricht University Hospital, The Netherlands d Department of Neurology, Ghent University Hospital, Belgium e Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands f Research Centre Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands abstract article info Article history: Received 1 May 2015 Revised 16 July 2015 Accepted 28 July 2015 Available online 24 August 2015 Keywords: Transition to adult care Risk factors for transition Epilepsy Transition clinic Introduction: Childhood-onset epilepsy during the years of transition to adulthood may affect normal social, physical, and mental development, frequently leading to psychosocial and health-related problems in the long term. Objective: This study aimed to describe the main characteristics of patients in transition and to identify risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. Methods: Patients with epilepsy, 15–25 years of age, who visited the Kempenhaeghe Epilepsy Transition Clinic from March 2012 to December 2014 were included (n = 138). Predefined risk scores for medical, educational/oc- cupational status, and independence/separation/identity were obtained, along with individual risk profile scores for poor psychosocial outcome. Multivariate linear regression analysis and discriminant analysis were used to identify variables associated with an increased risk of poor long-term psychosocial outcome. Results: Demographic, epilepsy-related, and psychosocial variables associated with a high risk of poor long-term outcome were lower intelligence, higher seizure frequency, ongoing seizures, and an unsupportive and unstable family environment. Using the aforementioned factors in combination, we were able to correctly classify the majority (55.1%) of the patients regarding their risk of poor psychosocial outcome. Conclusion: Our analysis may allow early identification of patients at high risk of prevention, preferably at pretransition age. The combination of a chronic refractory epilepsy and an unstable family environment consti- tutes a higher risk of transition problems and poor outcome in adulthood. As a consequence, early interventions should be put into place to protect youth at risk of poor transition outcome. © 2015 Elsevier Inc. All rights reserved. 1. Introduction Transition from adolescence to adulthood is a challenging period in life, especially for youth with epilepsy and for their caregivers [1]. Epi- lepsy and comorbidities, their treatment, and persistent social stigma have a substantial impact on the child's and their relatives' lives [1,2]. Furthermore, childhood-onset epilepsy and comorbid conditions may interfere with normal brain maturation and delay age-appropriate social, physical, and cognitive development, leading to poor psychoso- cial outcome and societal integration in the long term [3]. Adolescents are vulnerable to negative psychosocial consequences [4]. Sillanpää and Cross [1] and Camfield and Camfield [5] evaluated long-term psy- chosocial outcome of childhood-onset epilepsy among patients without obvious cognitive impairment. Adults with childhood-onset epilepsy had lower educational levels, less social interaction, and more problems in self-care and daily activities compared with healthy controls. Chin et al. [6] examined psychosocial, medical, and mental health outcomes in adults with childhood-onset epilepsy. Patients with epilepsy without intellectual disabilities or other comorbid conditions showed outcomes equal to those in healthy controls regarding medical, educational, and vocational status but experienced significantly more problems with so- cial interaction and relationships. Furthermore, patients with epilepsy and concomitant cognitive impairment had worse psychosocial out- come compared with controls with cognitive impairment in absence Epilepsy & Behavior 51 (2015) 182–190 ⁎ Corresponding author at: Department of Research & Development, Epilepsy Centre Kempenhaeghe, P.O. Box: 61, NL-5590 AB Heeze, The Netherlands. Tel.: +31 40 227 9022; fax: +31 40 226 5691. E-mail addresses: GeerlingsR@Kempenhaeghe.nl (R.P.J. Geerlings), AldenkampB@Kempenhaeghe.nl (A.P. Aldenkamp), GottmerL@Kempenhaeghe.nl (L.M.C. Gottmer-Welschen), P.H.N.de.With@tue.nl (P.H.N. de With), ZingerS@Kempenhaeghe.nl (S. Zinger), a.van.staa@hr.nl (A.L. van Staa), LouwA@Kempenhaeghe.nl (A.J.A. de Louw). http://dx.doi.org/10.1016/j.yebeh.2015.07.035 1525-5050/© 2015 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh