Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T05:44:50.837Z Has data issue: false hasContentIssue false
  • English
  • Français

Academic Outcomes in Individuals With Childhood-Onset Epilepsy: Mediating Effects of Working Memory

Published online by Cambridge University Press:  27 March 2017

Ashley N. Danguecan  and
Mary Lou Smith
Ashley N. Danguecan
Affiliation:
Department of Psychology, The Hospital for Sick Children, Toronto, Canada
Mary Lou Smith*
Affiliation:
Department of Psychology, The Hospital for Sick Children, Toronto, Canada Department of Psychology, University of Toronto Mississauga, Mississauga, Canada Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada
*
Correspondence and reprint requests to: Mary Lou Smith, Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road, Mississauga ON L5L 1C6 Canada. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Academic difficulties are common in children with epilepsy, although little is known about the effect of various seizure-related and cognitive variables. Given that persistent seizures may negatively impact academics, and that working memory is predictive of academic abilities, we examined the effects of recent seizures and working memory on word reading, spelling, and arithmetic in pediatric epilepsy. We hypothesized that persistent seizures would be associated with lower working memory ability, which would in turn result in poorer academic performance. Methods: Our sample consisted of 91 children with epilepsy being treated at the Hospital for Sick Children in Toronto, Canada, who underwent neuropsychological testing between 2002 and 2009 to help determine surgical candidacy. Four to 11 years later, follow-up testing was conducted on both surgical (n=61) and non-surgical (n=30) patients. Seizure status was defined by the presence or absence of seizures within the preceding 12 months. Results: 5000 bias-corrected bootstrap resamples with replacement were used to calculate the 95% confidence intervals (CIs) for the indirect effect of seizure status on academics through working memory, controlling for baseline academic functioning. Persistent seizures were associated with reduced working memory, which was in turn associated with lower reading (B=−4.64, 95% CI [−10.21, −1.30]), spelling (B=−7.09, 95% CI [−13.97, −2.56], and arithmetic scores (B=−8.04, 95% CI [−13.66, −3.58] at follow-up. Conclusions: For children with intractable epilepsy, working memory deficits present a significant barrier to the development of academic skills. Working memory interventions may be a helpful adjunct to academic remediation in this population to facilitate academic progress. (JINS, 2017, 23, 594–604)

Keywords

Pediatric epilepsyLong-term outcomesAcademic achievementReadingSpellingArithmetic
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 23 , Issue 7 , August 2017 , pp. 594 - 604
Copyright
Copyright © The International Neuropsychological Society 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, C.B.T., Beardsworth, E.D., Oxbury, S.M., & Fenwick, P.B.C. (1990). Temporal lobectomy in 44 children: Outcome and neuropsycyhological follow-up. Journal of Epilepsy, 3, 157–168.Google Scholar
Alloway, T.P., & Alloway, R.G. (2010). Investigating the predictive roles of working memory and IQ in academic attainment. Journal of Experimental Child Psychology, 106(1), 20–29. doi: 10.1016/j.jecp.2009.11.003 CrossRefGoogle ScholarPubMed
Alloway, T.P., & Elsworth, M. (2012). An investigation of cognitive skills and behavior in high ability students. Learning and Individual Differences, 22(6), 891–895. doi: 10.1016/j.lindif.2012.02.001 CrossRefGoogle Scholar
Austin, J.K., & Huberty, T.J. (1993). Development of the Child Attitude Toward Illness Scale. Journal of Pediatric Psychology, 18(4), 467–480. doi: 10.1093/jpepsy/18.4.467 CrossRefGoogle ScholarPubMed
Baddeley, A. (2012). Working memory: Theories, models, and controversies. Annual Review of Psychology, 63(1), 1–29. doi: 10.1146/annurev-psych-120710-100422 CrossRefGoogle ScholarPubMed
Battaglia, D., Chieffo, D., Lettori, D., Perrino, F., Di Rocco, C., & Guzzetta, F. (2006). Cognitive assessment in epilepsy surgery of children. Child’s Nervous System, 22(8), 744–759. doi: 10.1007/s00381-006-0151-2 CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, New Jersey: Erlbaum.Google Scholar
De Weerdt, F., Desoete, A., & Roeyers, H. (2013). Working memory in children with reading disabilities and/or mathematical disabilities. Journal of Learning Disabilities, 46(5), 461–472. doi: 10.1177/0022219412455238 CrossRefGoogle ScholarPubMed
Dodrill, C.B. (2004). Neuropsychological effects of seizures. Epilepsy & Behavior, 5, 21–24. doi: 10.1016/j.yebeh.2003.11.004 CrossRefGoogle ScholarPubMed
Drewel, E.H., Bell, D.J., & Austin, J.K. (2009). Peer difficulties in children with epilepsy: Association with seizure, neuropsychological, academic, and behavioral variables. Child Neuropsychology, 15(4), 305–320. doi: 10.1080/09297040802537646 CrossRefGoogle ScholarPubMed
Dunn, D.W., Johnson, C.S., Perkins, S.M., Fastenau, P.S., Byars, A.W., deGrauw, T.J., & Austin, J.K. (2010). Academic problems in children with seizures: Relationships with neuropsychological functioning and family variables during the 3years after onset. Epilepsy & Behavior, 19(3), 455–461. doi: 10.1016/j.yebeh.2010.08.023 CrossRefGoogle Scholar
Elger, C.E., Helmstaedter, C., & Kurthen, M. (2004). Chronic epilepsy and cognition. The Lancet Neurology, 3(11), 663–672. doi: 10.1016/S1474-4422(04)00906-8 CrossRefGoogle ScholarPubMed
Elliott, I.M., Lach, L., & Smith, M.L. (2005). I just want to be normal: A qualitative study exploring how children and adolescents view the impact of intractable epilepsy on their quality of life. Epilepsy and Behavior, 7(4), 664–678. doi: 10.1016/j.yebeh.2005.07.004 CrossRefGoogle Scholar
Fastenau, P.S., Jianzhao, Shen, Dunn, D.W., & Austin, J.K. (2008). Academic underachievement among children with epilepsy: Proportion exceeding psychometric criteria for learning disability and associated risk factors. Journal of Learning Disabilities, 41(3), 195–207. doi: 10.1177/0022219408317548 CrossRefGoogle ScholarPubMed
Fastenau, P.S., Shen, J., Dunn, D.W., Perkins, S.M., Hermann, B.P., & Austin, J.K. (2004). Neuropsychological predictors of academic underachievement in pediatric epilepsy: Moderating roles of demographic, seizure, and psychosocial variables. Epilepsia, 45(10), 1261–1272. doi: 10.1111/j.0013-9580.2004.15204.x CrossRefGoogle ScholarPubMed
Gathercole, S.E., Alloway, T.P., Willis, C., & Adams, A.M. (2006). Working memory in children with reading disabilities. Journal of Experimental Child Psychology, 93(3), 265–281. doi: 10.1016/j.jecp.2005.08.003 CrossRefGoogle ScholarPubMed
Hallböök, T., Tideman, P., Rosén, I., Lundgren, J., & Tideman, E. (2013). Epilepsy surgery in children with drug-resistant epilepsy, a long-term follow-up. Acta Neurologica Scandinavica, 128(6), 414–421. doi: 10.1111/ane.12154 CrossRefGoogle ScholarPubMed
Hamiwka, L.D., & Wirrell, E.C. (2009). Comorbidities in pediatric epilepsy: Beyond “just” treating the seizures. Journal of Child Neurology, 24(April), 734–742. doi: 10.1177/0883073808329527 CrossRefGoogle Scholar
Harris, P.A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J.G. (2009). Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. doi: 10.1016/j.jbi.2008.08.010 CrossRefGoogle ScholarPubMed
Helmstaedter, C., Kurthen, M., Lux, S., Reuber, M., & Elger, C.E. (2003). Chronic epilepsy and cognition: A longitudinal study in temporal lobe epilepsy. Annals of Neurology, 54(4), 425–432. doi: 10.1002/ana.10692 CrossRefGoogle ScholarPubMed
Kearns, D.M., & Fuchs, D. (2013). Does cognitively focused instruction improve the academic performance of low-achieving students? Exceptional Children, 79(3), 263–290.CrossRefGoogle Scholar
Kerr, E.N., & Blackwell, M.C. (2015). Near-transfer effects following working memory intervention (Cogmed) in children with symptomatic epilepsy: An open randomized clinical trial. Epilepsia, 56(11), 1784–1792. doi: 10.1111/epi.13195 CrossRefGoogle ScholarPubMed
Maehler, C., & Schuchardt, K. (2009). Working memory functioning in children with learning disabilities: Does intelligence make a difference? Journal of Intellectual Disability Research, 53(1), 3–10. doi: 10.1111/j.1365-2788.2008.01105.x CrossRefGoogle Scholar
Melby-Lervåg, M., & Hulme, C. (2013). Is working memory training effective? A meta-analytic review. Developmental Psychology, 49(2), 270–291. doi: 10.1037/a0028228 CrossRefGoogle ScholarPubMed
Mitchell, W.G., Chavez, J.M., Lee, H., & Guzman, B.L. (1991). Academic underachievement in children with epilepsy. Journal of Child Neurology, 6(1), 65–72. doi: 10.1177/088307389100600114 CrossRefGoogle ScholarPubMed
Oostrom, K., Smeets-Schouten, A., Kruitwagen, C., Boudewyn Peters, A., & Jennekens-Schinkel, A. (2003). Not only a matter of epilepsy: Early problems of cognition and behavior controlled study starting at diagnosis, 112(6), 1338–1344. doi: 10.1542/peds.112.6.1338 CrossRefGoogle Scholar
Ottman, R., Lipton, R.B., Ettinger, A.B., Cramer, J.A., Reed, M.L., Morrison, A., & Wan, G.J. (2011). Comorbidities of epilepsy: Results from the Epilepsy Comorbidities and Health (EPIC) survey. Epilepsia, 52(2), 308–315. doi: 10.1111/j.1528-1167.2010.02927.x CrossRefGoogle ScholarPubMed
Poloczek, S., & Hasselhorn, M. (2012). Sebastian Poloczek Gerhard Büttner, 11(1), 20–38. doi: 10.1891/1945-8959.11.1.20 Google Scholar
Puka, K., & Smith, M.L. (2016a). Academic achievement in the long-term after epilepsy surgery in childhood. Epilepsy and Behavior, 62, 97–103. doi: 10.1016/j.yebeh.2016.06.003 CrossRefGoogle ScholarPubMed
Puka, K., & Smith, M.L. (2016b). Long-term outcomes of behavior problems after epilepsy surgery in childhood. Journal of Neurology, 263(5), 991–1000. doi: 10.1007/s00415-016-8089-0 CrossRefGoogle ScholarPubMed
Puka, K., & Smith, M.L. (2015). Predictors of long-term quality of life after pediatric epilepsy surgery. Epilepsia, 56(6), 873–881. doi: 10.1111/epi.13004 CrossRefGoogle ScholarPubMed
Puka, K., Tavares, T.P., & Smith, M.L. (2015). Development of intelligence 4 to 11 years after paediatric epilepsy surgery. Journal of Neuropsychology, doi: 10.1111/jnp.12081 CrossRefGoogle Scholar
Rabren, K., Eaves, R.C., Dunn, C., & Darch, C. (2013). Students with learning disabilities’ satisfaction, employment, and postsecondary education outcomes. Journal of Education and Learning, 2(2), 14–22. doi: 10.5539/jel.v2n2p14 CrossRefGoogle Scholar
Rapport, M.D., Orban, S.A., Kofler, M.J., Friedman, L.M., Ko, M.J., & Friedman, L.M. (2013). Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clinical Psychology Review, 33(8), 1237–1252. doi: 10.1016/j.cpr.2013.08.005 CrossRefGoogle ScholarPubMed
Redick, T.S., Shipstead, Z., Wiemers, E.A., Melby-Lervåg, M., & Hulme, C. (2015). What’s working in working memory training? An educational perspective. Educational Psychology Review, 27(4), 617–633. doi: 10.1007/s10648-015-9314-6 CrossRefGoogle ScholarPubMed
Reid, A.Y., Metcalfe, A., Patten, S.B., Wiebe, S., MacRodimitris, S., & Jetté, N. (2012). Epilepsy is associated with unmet health care needs compared to the general population despite higher health resource utilization- A Canadian population-based study. Epilepsia, 53(2), 291–300. doi: 10.1111/j.1528-1167.2011.03353.x CrossRefGoogle Scholar
Reilly, C., Atkinson, P., Das, K.B., Chin, R.F.C., Aylett, S.E., Burch, V., & Neville, B.G.R. (2014). Academic achievement in school-aged children with active epilepsy: A population-based study. Epilepsia, 55(12), 1910–1917. doi: 10.1111/epi.12826 CrossRefGoogle ScholarPubMed
Reilly, C., & Neville, B.G.R. (2011). Academic achievement in children with epilepsy: A review. Epilepsy Research, 97(1-2), 112–123. doi: 10.1016/j.eplepsyres.2011.07.017 CrossRefGoogle ScholarPubMed
Roberts, G., Quach, J., Spencer-smith, M., Anderson, P.J., Gathercole, S., Gold, L., & Wake, M. (2016). Academic outcomes 2 years after working memory training for children with low working memory: A randomized clinical trial. JAMA Pediatrics, 170, e154568. doi: 10.1001/jamapediatrics.2015.4568 CrossRefGoogle ScholarPubMed
Seidenberg, M., Beck, N., Geisser, M., O’Leary, D.S., Giordani, B., Berent, S., & Boll, T.J. (1988). Neuropsychological correlates of academic achievement of children with epilepsy. Journal of Epilepsy, 1(1), 23–29. doi: 10.1016/S0896-6974(88)80029-X CrossRefGoogle Scholar
Skirrow, C., Cross, J.H., Cormack, F., Harkness, W., Vargha-Khadem, F., & Baldeweg, T. (2011). Long-term intellectual outcome after temporal lobe surgery in childhood. Neurology, 76(15), 1330–1337. doi: 10.1212/WNL.0b013e31821527f0 CrossRefGoogle ScholarPubMed
Smith, M.L., Lah, S., & Elliott, I.M. (2011). Outcomes of pediatric epilepsy surgery. In C. Helmstaedter, B. Hermann, M. Lassonde, P. Kahane, & A. Arzimanoglou (Eds.), Neuropsychology in the care of people with epilepsy (pp. 239–247). Montrouge, France: John Libbey Eurotext.Google Scholar
Sturniolo, M.G., & Galletti, F. (1994). Idiopathic epilepsy and school achievement. Archives of Disease in Childhood, 70(5), 424–428. doi: 10.1136/adc.70.5.424 CrossRefGoogle ScholarPubMed
Tavares, T.P., Puka, K., & Smith, M.L. (2015). Emotional functioning: Long-term outcomes after pediatric epilepsy surgery. Epilepsia, 56(5), 745–753. doi: 10.1111/epi.12956 CrossRefGoogle ScholarPubMed
van Iterson, L., de Jong, P.F., & Zijlstra, B.J.H. (2015). Pediatric epilepsy and comorbid reading disorders, math disorders, or autism spectrum disorders: Impact of epilepsy on cognitive patterns. Epilepsy & Behavior, 44, 159–168. doi: 10.1016/j.yebeh.2015.02.007 CrossRefGoogle ScholarPubMed
Viggedal, G., Kristjansdottir, R., Olsson, I., Rydenhag, B., & Uvebrant, P. (2012). Cognitive development from two to ten years after pediatric epilepsy surgery. Epilepsy & BehaviorB, 25(1), 2–8. doi: 10.1016/j.yebeh.2012.06.010 CrossRefGoogle ScholarPubMed
Wechsler, D. (1992). Wechsler Individual Achievement Test. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale, Third Edition, San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (2001). Wechsler Individual Achievement Test, Second Edition, San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (2003). Wechsler Intelligence Scale for Children, Fourth Edition, San Antonio, TX: Psychological Corporation.Google Scholar
Wechsler, D. (2008). Wechsler Fundamental Academic Skills, Canadian edition. Toronto, ON: Pearson.Google Scholar
Wilkinson, G. (1993). Wide Range Achievement Test, Third Edition, Wilmington, DE: Wide Range Inc.Google Scholar
Williams, J., Phillips, T., Griebel, M.L., Sharp, G.B., Lange, B., Edgar, T., & Simpson, P. (2001). Factors associated with academic achievement in children with controlled epilepsy. Epilepsy & Behavior, 2(3), 217–223. doi: 10.1006/ebeh.2001.0166 CrossRefGoogle ScholarPubMed
Woodcock, R., McGrew, K., & Mather, N. (2001). Woodcock-Johnson tests of achievement, Third Edition, Rolling Meadows, IL: Riverside Publishing.Google Scholar