Epilepsy Information

American Epilepsy Society Poster (Abst. 2.023)

Depression and anxiety in children with epilepsy: Differences in observed and reported levels among parents and children

Authors: Drs. R. Trobliger, L. Myers, M. Lancman

When a child is referred for a neuropsychological evaluation, a battery of cognitive tests is administered directly while questionnaires are often completed by parents. Self-reports are not always given because of the child’s lower reading level or to avoid sensitive questions. This study compares parents' and children's reports on depression and anxiety measures to determine whether focusing solely on parental ratings leads to over or underreporting of symptoms.


A total of 25 children with epilepsy confirmed through video-EEG were included. Parents completed the Achenbach Children’s Behavioral Checklist (CBCL), which includes measures of depression and anxiety. Children completed the Beck Youth Inventory – Second Edition (BYI-II), a measure of depression and anxiety as well as anger, disruptive behavior, and self-concept. Raw and standard scores were examined across three age groups: 7-10, 11-14, and 15-18 years (with male and female subgroups).

Our sample included 8 males and 17 females with a mean age of 12.56. Fourteen patients had generalized epilepsy, ten had partial epilepsy, and one was undefined. Parents’ mean reported levels of depression and anxiety symptoms (CBCL Withdrawn/Depressed scale and Anxious/Depressed scales) were both below the borderline/clinical range. In contrast, children’s mean reported level of self-concept (BSCI-Y) was consistently in the clinical range for all three age groups, for both males and females. Children’s mean reported level of anxiety symptoms (BAI-Y) was in the clinical range for two of the three age groups, for both males and females. Children’s mean reported levels of depression (BDI-Y scale), anger (BANI-Y), and destructive behavior (BDB-Y) were consistently below the clinical range score for all three age groups, for both males and females. The correlations between the BDI-Y/BAI-Y and CBCL scores were not significant. In fact, for 80% of the cases, there was a consistent disagreement between the child's and parent's reported level of depression and/or anxiety symptoms (that is, the child’s scores were at clinical levels for one or both of the BDI-Y and BAI-Y scores while the parent’s scores were not for one or both of the CBCL scores, or vice versa).

In sum, our findings show that parents’ and children’s ratings of clinical range mood and anxiety symptoms did not match. Moreover, parents seemed to under-report pathology as compared to the children. This indicates that choosing to use only one measure of reported mood and/or anxiety symptoms during a neuropsychological evaluation could result in overlooking important clinical information. It demonstrates the importance of assessing levels of mood and anxiety symptoms from both the parents’ and child’s perspectives to ensure that clinical levels of pathology are not missed. Moreover, given that clinical levels of anxiety and self-concept weaknesses were frequently observed in our sample, neuropsychological testing should routinely assess for these and for mood symptoms in children with epilepsy.