Executive Function and Emotional, Behavioral, and Social Competence Problems in Children with Epilepsy
Many researchers have reported elevated rates of emotional, behavioral, and social competence problems (EBSP) in children with epilepsy. Although executive function has been found to be associated with EBSP in children with typical development, almost no research has looked at the individual components of executive function as potential predictors of EBSP in children with epilepsy. This is surprising given the deficits in executive function in children with epilepsy. We investigated EBSP and executive function in 42 children with epilepsy, aged 6.0 to 18.1 years and found, as expected, that EBSP were associated with executive function in these children even after epilepsy-related variables, such as seizure type, were accounted for. However, different components of executive function were related to different emotional, behavioral, and social competence problems in these children. Shifting of mental sets was a significant predictor of emotional, behavioral, and social competence problems whereas inhibition was a significant predictor of behavioral problems. This suggests that different executive function profiles in children with epilepsy may place them at-risk for developing different types of emotional, behavioral, and social competence problems. These results may help researchers and clinicians develop new techniques to identify and treat emotional, behavioral, and social competence problems in children with epilepsy.
KeywordsExecutive function Epilepsy Emotional and behavioral problems Social competence
Aspects of this study were presented at the 2016 annual meeting of the Canadian Society for Brain, Behavior, and Cognitive Science in Ottawa, Ontario, Canada and at the 2016 annual meeting of the Canadian Psychological Association in Victoria, British Columbia, Canada. This paper is based on S. Healy’s Master’s thesis submitted to the Department of Psychology, Trent University.
S.H. and N.I.B. designed and executed the study, analyzed the data, and wrote the paper. J.O. collaborated with the design and editing of the paper.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical approval for this study was obtained from both the Trent and CHEO Research Ethics Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees, the American Psychological Association, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Achenbach, T. M. (1991). Manual for child behavior checklist/ 4–18 and 1991 profile. Burlington: University of Vermont Department of Psychiatry.Google Scholar
- Alduncin, N., Huffman, L. C., Feldman, H. M., & Loe, I. M. (2014). Executive function is associated with social competence in preschool-aged children born preterm or full term. Early Human Development, 90(6), 299–306. https://doi.org/10.1016/j.earlhumdev.2014.02.011.CrossRefPubMedPubMedCentralGoogle Scholar
- Alfstad, K. Å., Clench-Aas, J., Van Roy, B., Mowinckel, P., Gjerstad, L., & Lossius, M. I. (2011). Gender differences in risk-taking behavior in youth with epilepsy: A Norwegian population-based study. Acta Neurologica Scandinavica, 124, 12–17. https://doi.org/10.1111/j.1600-0404.2011.01537.x.
- Alfstad, K. Å., Torgersen, H., Van Roy, B., Hessen, E., Hansen, B. H., Henning, O., & Lossius, M. I. (2016). Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction? Epilepsy & Behavior, 56, 88–94. https://doi.org/10.1016/j.yebeh.2016.01.007.
- Alloway, T., Gathercole, S., Adams, A., Willis, C., Eaglen, R., & Lamont, E. (2005). Working memory and phonological awareness as predictors of progress towards early learning goals at school entry. British Journal of Developmental Psychology, 23, 417–426. https://doi.org/10.1348/026151005X26804.CrossRefGoogle Scholar
- Balaraman, G. R. (2003). Children’s self-regulation and peer interaction at 36 and 54 months: Concurrent and longitudinal relations. Paper presented at the Biennial Meeting of the Society for Research in Child Development, Tampa, FL.Google Scholar
- Baum, K. T., Byars, A. W., deGrauw, T. J., Dunn, D. W., Bates, J. E., Howe, S. R., & Austin, J. K. (2010). The effect of temperament and neuropsychological functioning on behavior problems in children with new-onset seizures. Epilepsy & Behavior, 17(4), 467–473. https://doi.org/10.1016/j.yebeh.2010.01.010.CrossRefGoogle Scholar
- Biederman, J., Monuteaux, M. C., Greene, R. W., Braaten, E., Doyle, A. E., & Faraone, S. V. (2001). Long-term stability of the Child Behavior Checklist in a clinical sample of youth with attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 30(4), 492–502. https://doi.org/10.1207/S15374424JCCP3004_06.CrossRefPubMedGoogle Scholar
- Carlson, S., & White, R. (2013). Executive function, pretend play, and imagination. In T. Marjorie (Ed.), The Oxford handbook of the development of imagination (pp. 161–174). New York, NY: Oxford University Press.Google Scholar
- Demeyer, I., De Lissnyder, E., Koster, E. H. W., & De Raedt, R. (2012). Rumination mediates the relationship between impaired cognitive control for emotional information and depressive symptoms: A prospective study in remitted depressed adults. Behavior Research and Therapy, 50, 292–297. https://doi.org/10.1016/j.brat.2012.02.012..CrossRefGoogle Scholar
- Epir, S., Renda, Y., & Baser, N. (1984). Cognitive and behavioral characteristics of children with idiopathic epilepsy in a low-income area of Ankara, Turkey. Developmental Medicine & Child Neurology, 26(2), 200–207. https://doi.org/10.1111/j.1469-8749.1984.tb04432.x.CrossRefGoogle Scholar
- Gewirtz, S., Stanton-Chapman, T., & Reeve, R. E. (2009). Can inhibition at preschool age predict attention-deficit/hyperactivity disorder symptoms and social difficulties in third grade? Early Child Development and Care, 179(3), 353–368. https://doi.org/10.1080/03004430601119885.CrossRefGoogle Scholar
- Ghassabian, A., Székely, E., Herba, C. M., Jaddoe, V. W., Hofman, A., Oldehinkel, A. J., & Tiemeier, H. (2014). From positive emotionality to internalizing problems: The role of executive functioning in preschoolers. European Child & Adolescent Psychiatry, 23(9), 729–741. https://doi.org/10.1007/s00787-014-0542-y.CrossRefGoogle Scholar
- Giancola, P. R., Roth, R. M., & Parrott, D. J. (2006). The mediating role of executive functioning in the relation between difficult temperament and physical aggression. Journal of Psychopathology and Behavioral Assessment, 28(4), 211–221. https://doi.org/10.1007/s10862-005-9015-4.CrossRefGoogle Scholar
- Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior rating inventory of executive function: Professional manual. Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
- Guralnick, M., & Neville, B. (1997). Designing early intervention programs to promote children’s social competence. In M. Guralnick (Ed.), The effectiveness of early intervention (pp. 579–610). Baltimore, MD: Paul H. Brookes.Google Scholar
- Hill, B. D., Ploetz, D. M., O’Jile, J. R., Bodzy, M., Holler, K. A., & Rohling, M. L. (2013). Self-reported depressive symptoms have minimal effect on executive functioning performance in children and adolescents. Journal of Child and Family Studies, 22(3), 398–404. https://doi.org/10.1007/s10826-012-9592-2.CrossRefGoogle Scholar
- Hughes, C. (1998). Executive function in preschoolers: Links with theory of mind and verbal ability. British Journal of Developmental Psychology, 16(2), 233–253. https://doi.org/10.1111/j.2044-835X.1998.tb00921.x.CrossRefGoogle Scholar
- Huizinga, M., Dolan, C., & van der Molen, M. (2006). Age-related change in executive function: Developmental trends and a latent variable analysis. Neuropsychologia, 44, 2017–2036. https://doi.org/10.1016/j.neuropsychologia.2006.01.010.CrossRefPubMedGoogle Scholar
- Jacola, L. M. (2013). The relationship between executive function and maladaptive behavior in adolescents with down’s syndrome (Order No. AAI3539912). Available from PsycINFO. (1440032260; 2013-99160-350). http://web2.trentu.ca:2048/login?url=http://search.proquest.com/docview/1440032260?accountid=14391.
- Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early social-emotional functioning and public health: The relationship between kindergarten social competence and future wellness. American Journal of Public Health, 105(11), 2283–2290. https://doi.org/10.2105/AJPH.2015.302630.CrossRefPubMedPubMedCentralGoogle Scholar
- Juhász, C., Behen, M. E., Muzik, O., Chugani, D. C., & Chugani, H. T. (2001). Bilateral medial prefrontal and temporal neocortical hypometabolism in children with epilepsy and aggression. Epilepsia, 42(8), 991–1001. https://doi.org/10.1046/j.1528-1157.2001.042008991.x.CrossRefPubMedGoogle Scholar
- Kertz, S. J., Belden, A. C., Tillman, R., & Luby, J. (2015). Cognitive control deficits in shifting and inhibition in preschool age children are associated with increased depression and anxiety over 7.5 years of development. Journal of Abnormal Child Psychology, 44(6), 1185–1196. https://doi.org/10.1007/s10802-015-0101-0.CrossRefGoogle Scholar
- Lee, G. (2010). Neuropsychology of epilepsy and epilepsy surgery. New York, NY: Oxford University Press.Google Scholar
- McDonald, C. R., Delis, D. C., Norman, M. A., Wetter, S. R., Tecoma, E. S., & Iragui, V. J. (2005). Response inhibition and set shifting in patients with frontal lobe epilepsy or temporal lobe epilepsy. Epilepsy and Behavior, 7(3), 438–446. https://doi.org/10.1016/j.yebeh.2005.05.005.CrossRefPubMedGoogle Scholar
- Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., & Howerter, A. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobes” tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100. https://doi.org/10.1006/cogp.1999.0734.CrossRefPubMedGoogle Scholar
- Neuenschwander, R., Cimeli, P., Ro¨thlisberger, M., & Roebers, C. M. (2013). Personality factors in elementary school children: Contributions to academic performance over and above executive functions? Learning and Individual Differences, 25, 118–125. https://doi.org/10.1016/j.lindif.2012.12.006.CrossRefGoogle Scholar
- Nigg, J. T., Wong, M. M., Martel, M. M., Jester, J. M., Puttler, L. I., Glass, J. M., & Zucker, R. A. (2006). Poor response inhibition as a predictor of problem drinking and illicit drug use in adolescents at risk for alcoholism and other substance use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 468–475. https://doi.org/10.1097/01.chi.0000199028.76452.a9.CrossRefPubMedGoogle Scholar
- Nguyen, T. T., Glass, L., Coles, C. D., Kable, J. A., May, P. A., Kalberg, W. O., & Mattson, S. N. (2014). The clinical utility and specificity of parent report of executive function among children with prenatal alcohol exposure. Journal of the International Neuropsychological Society, 20(7), 704–716. https://doi.org/10.1017/S1355617714000599.CrossRefPubMedPubMedCentralGoogle Scholar
- Raaijmakers, M. A. J., Smidts, D. P., Sergeant, J. A., Maassen, G. H., Posthumus, J. A., van Engeland, H., & Matthys, W. (2008). Executive functions in preschool children with aggressive behavior: Impairments in inhibitory control. Journal of Abnormal Child Psychology, 36(7), 1097–1107. https://doi.org/10.1007/s10802-008-9235-7.CrossRefPubMedGoogle Scholar
- Rose, S. A., Feldman, J. F., & Jankowski, J. J. (2011). Modeling a cascade of effects: The role of speed and executive functioning in preterm/full-term differences in academic achievement. Developmental Science, 14(5), 1161–1175. https://doi.org/10.1111/j.1467-7687.2011.01068.x.CrossRefPubMedGoogle Scholar
- Schouten, A., Oostrom, K. J., Peters, A. C. B., Verloop, D., & Jennekens-Schinkel, A. (2000). Set-shifting in healthy children and in children with idiopathic or cryptogenic epilepsy. Developmental Medicine & Child Neurology, 42(6), 392–397. https://doi.org/10.1111/j.1469-8749.2000.tb00117.x.CrossRefGoogle Scholar
- Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioral therapies in the 21st century: Summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy and Research, 31(2), 235–262. https://doi.org/10.1007/s10608-006-9118-6.CrossRefGoogle Scholar
- Visser, E. M., Berger, H. J. C., Van, S. L., Prins, J. B., & Teunisse, J. P. (2015). Cognitive shifting and externalising problem behavior in intellectual disability and autism spectrum disorder. Journal of Intellectual Disability Research, 59(8), 755–766. https://doi.org/10.1111/jir.12182.CrossRefPubMedGoogle Scholar
- von Stumm, S., Deary, I. J., Kivimäki, M., Jokela, M., Clark, H., & Batty, G. D. (2011). Childhood behavior problems and health at midlife: 35-year follow-up of a Scottish birth cohort. Journal of Child Psychology and Psychiatry, 52(9), 992–1001. https://doi.org/10.1111/j.1469-7610.2011.02373.x.CrossRefGoogle Scholar
- Wechsler, D. (2004). The Wechsler intelligence scale for children—fourth edition. London: Pearson Assessment.Google Scholar
- White, L. K., McDermott, J. M., Degnan, K. A., Henderson, H. A., & Fox, N. A. (2011). Behavioral inhibition and anxiety: The moderating roles of inhibitory control and attention shifting. Journal of Abnormal Child Psychology, 39(5), 735–747. https://doi.org/10.1007/s10802-011-9490-x.CrossRefPubMedPubMedCentralGoogle Scholar
- Young, S. E., Friedman, N. P., Miyake, A., Willcutt, E. G., Corley, R. P., Haberstick, B. C., & Hewitt, J. K. (2009). Behavioral disinhibition: Liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence. Journal of Abnormal Psychology, 118(1), 117–130. https://doi.org/10.1037/a0014657.CrossRefPubMedPubMedCentralGoogle Scholar
- Zhao, Q., Rathouz, P. J., Jones, J. E., Jackson, D. C., Hsu, D. A., Stafstrom, C. E., & Hermann, B. P. (2015). Longitudinal trajectories of behavior problems and social competence in children with new onset epilepsy. Developmental Medicine & Child Neurology, 57(1), 37–44. https://doi.org/10.1111/dmcn.12549.CrossRefGoogle Scholar