Quality of Life Research Update – Drs. Elizabeth Kerr and Nora Fayed

Adaptive functioning (AF) describes how well a person manages the day-to-day demands of independent living. It includes motor, social, communication, personal living, and community living skills. Higher AF is associated with better educational and employment outcomes, and can predict life achievement in young adulthood for people with epilepsy. Children with epilepsy who have uncontrolled seizures, and who started having seizures at a younger age, are at greater risk of AF problems. Doctors often associate intellectual disabilities with lower AF, but in children with epilepsy, even those with typical intellectual development can have problems with AF. A better measure to predict the level of AF in children without intellectual disabilities is needed.

Drs. Elizabeth Kerr and Nora Fayed wanted to know if specific elements of cognition influence AF. Since children with epilepsy often have difficulties with sustained attention and working memory, they investigated whether these components would be associated with AF. Attention span refers to how many “chunks” of information a person can process right away and is a requisite skill for both sustained attention and working memory. Sustained attention describes how well a person can stay focused on something that is mundane. Finally, working memory relates to the ability to temporarily hold and manipulate information in the mind either without interference (basic working memory), or with interference (complex working memory).

Drs. Kerr and Fayed assessed these skills in 76 children with epilepsy between the ages of 6-15 (children with severe intellectual impairments were excluded from the study). Overall AF did not capture the frequency of issues present; the majority of children experienced limitations in specific areas of functioning. Sixty children had difficulties in AF related to community living, 52 were reported to have limitations in motor AF, 50 were reported to have difficulties in social interaction and communication, and 45 experienced difficulties in personal living. They found that intellectual ability, or IQ, was the strongest predictor of AF level. This means that children with higher IQs had a higher level of AF. Results also showed that complex working memory was associated with all individual components of AF, and also overall AF. This finding suggests that for children with epilepsy who have problems with AF, therapies that target complex working memory may help to improve outcomes.

The results also showed that cognitive conditions such as attention deficit hyperactivity disorder, autism spectrum disorder, anxiety and depression can affect AF, suggesting that treatments and therapies that target these co-occurring conditions can improve overall functioning.

In conclusion, these results demonstrate that problems with AF can be seen in children with epilepsy who have broadly typical intellectual development, and that intellectual ability is strongly associated with AF. Complex working memory is a specific ability that may be able to predict levels of AF. Strategies that target complex working memory may help to improve functional outcomes.

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