Disadvantage and Neurocognitive Comorbidities in Childhood Idiopathic Epilepsies

OBJECTIVE

To characterize the relationship between neighborhood disadvantage on cognitive function as well as clinical, sociodemographic, and family factors in children with new onset idiopathic epilepsy and healthy controls.

METHODS

Research participants were 288 children aged 8-18 years with recent onset epilepsy (CWE, n = 182; mean age = 12.2 ± 3.2 years), healthy first-degree cousin controls (HC, n = 106; mean age = 12.5 ± 3.0), and one biological or adopted parent per child (n=279). All participants were administered a comprehensive neuropsychological battery (reasoning, language, memory, executive function, motor function, and academic achievement). Family residential addresses were entered into the Neighborhood Atlas to determine each family's Area Deprivation Index (ADI), a metric used to quantify income, education, employment, and housing quality. A combination of parametric (ANOVA) and non-parametric (χ² ) tests examined the effect of ADI by group (epilepsy and controls) across cognitive, academic, clinical, and family factors.

RESULTS

Disadvantage (ADI) was equally distributed between groups (p = .63). For CWE, high disadvantage was associated with lower overall intellectual quotient (p =.04), visual naming/expressive language (p = .03), phonemic (letter) fluency (p <.01), passive inattention (omission errors) (p = .03), delayed verbal recall (p = .04) and dominant fine motor dexterity and speed (p < .01). Cognitive status of the HC group did not differ by level of disadvantage (p = .40). CWE exhibited greater academic difficulties in comparison to HC (p < .001), which were exacerbated by disadvantage in CWE (p = .02), but not HC (p < .05). High disadvantage was associated with a threefold risk for academic challenges prior to epilepsy onset (odds ratio = 3.31, p = .024).

SIGNIFICANCE

Socioeconomic hardship (increased neighborhood disadvantage) exerts a significant adverse impact on the cognitive and academic status of youth with new and recent onset epilepsies, an impact that needs to be incorporated into etiological models of the neurobehavioral comorbidities of epilepsy.

In Search of Cognitive Promotive and Protective Factors for Word Reading

This study examined whether strong cognitive skills (i.e. vocabulary, rapid naming, verbal working memory [VWM], and processing speed [PS]) contributed to resilience in single-word reading skills in children at risk for reading difficulties because of low phonological awareness scores (PA). Promotive factors were identified by main effects and protective factors through PA x cognition interactions. This study included 1,807 children ages 8-16. As predicted, all cognitive skills were significantly related to reading, consistent with promotive effects. A significant, but small effect PA x vocabulary interaction (R2 change=.002, p=.00038) was detected but its form was not consistent with a classic protective effect. Rather, the PA x vocabulary interaction was consistent with a "skill-enhancement" pattern, such that children with strong PA and vocabulary skills had better than expected reading. This study provides a framework for reading resilience research and directs attention to promotive mechanisms underlying reading success.