Routine developmental, autism, behavioral, and psychological screening in epilepsy care settings

AimScreening for cognitive impairment, developmental delay, and neuropsychiatric problems is not always performed in children with epilepsy. The aim of this study was to assess the value of this screening and its validity for determining previously unidentified (actionable') problems in children with epilepsy. MethodNew and existing patients with epilepsy were recruited from a hospital-based epilepsy center. The parent of the child completed screening evaluations for development (Ages and Stages Questionnaire [ASQ], 0-66mo), autism (Modified Checklist for Autism in Toddlers [mCHAT], 16-30mo), social communication (Social Communication Questionnaire [SCQ], 4y), and psychiatric concerns (Strengths and Difficulties Questionnaire [SDQ], 4-17y). ResultsWe screened 236 children overall (136 males [58%], 100 females [42%]; mean age [SD] 6y 7mo [4y 6mo]). Of these, 176 children (75%) had established epilepsy diagnoses and 60 (25%) were patients with new-onset epilepsy. Of those with new-onset disease, 22 (37%) were determined not to have epilepsy. Positive findings by test were 82% (ASQ), 54% (mCHAT), 15%, (SCQ), and 58% (SDQ). Findings were actionable in 46 children (20%): 18% of findings in children with established epilepsy and 23% of findings in patients with new-onset epilepsy. Of the 46 children for whom further referrals were made, the parents of 28 (61%) have pursued further evaluations. InterpretationIn this study, children with existing and new-onset diagnoses of epilepsy had actionable screening findings. These findings support the development of systematic screening of comorbidities for children with epilepsy. What this paper adds Actionable results were found in 20% of children with epilepsy who were screened.Routine screening should be offered to all children with established or new-onset epilepsy.Screening should be done in conjunction with a capacity for referral, in order to interpret and act on the results. This article is commented on by Fodstad and Dunn on pages 1038-1039 of this issue.