An estimated 300,000 young people under the age of 14 have epilepsy in the United States, and while many do not experience any adverse effects on their scholastic performance, others may experience learning problems related to their seizures. Several major factors may contribute to these learning difficulties: seizure-related effects, medication-related effects, psychosocial factors, and developmental disorders.
No single factor relating to a child’s seizures accurately predicts what, if any, impact her epilepsy will have on her learning abilities. Aspects of her seizure disorder that may come into play when talking about academic potential include what the cause of her epilepsy might be, at what age she began having seizures, the seizure type/s she experiences, what part of her brain is affected by her seizure activity, and how frequently the seizures happen.
Different seizure types can have different impacts on a child’s school performance. For example, a child’s memory may be adversely affected by a generalized tonic-clonic (grand mal) seizure or a complex partial seizure. Absence seizures, which are characterized by a brief loss of consciousness, may prevent a student from hearing and seeing what is happening in his class while he is having seizures. This loss of contact with his surroundings can therefore impede his learning. Children may also fall behind from missing school for doctor’s appointments, tests, or while recovering from a major seizure.
Learning can be affected by the type of medication, the number of medications, and the dosage level of medication a child may be taking. Some commonly prescribed medications have side effects which may include drowsiness, inattention or restlessness, all of which can have an adverse impact on a student’s learning potential. If a child is taking multiple medications to control her seizures, or taking medication at a very high dosage level, she may experience more learning difficulties than children taking only one drug or taking a lower dose of a medicine.
Drug side effects on a student’s learning can be difficult to detect, and are often not apparent in a standardized IQ or academic achievement test. Special tests of attention, ability to process information and memory may be able to help determine if a child’s anti-seizure medication is affecting her learning.
Family coping strategies, school and parent expectations, and behavioral or emotional problems can all impact the learning of a student who has epilepsy. These factors can be both a cause and a consequence of academic difficulties. The stigma that still surrounds epilepsy in some communities can lead to stress in a student’s life, resulting in poor school performance. A student’s self-esteem and confidence can also suffer due to the effects of epilepsy in her life. A continuing downward spiral of decreased school performance and diminished self-esteem can prove to be very problematic for some students living with epilepsy.
For more information about helping a student cope with the impact of epilepsy in his life, click here.
Children with epilepsy may also have developmental disorders that can impact their school performance. These disorders may include learning disabilities, attention deficit/hyperactivity disorder (ADHD), developmental delay, mental retardation, and autism.
Learning disabilities are diagnosed when a child shows normal learning in some scholastic areas and significant deficits in others. Subjects commonly affected by learning disabilities include reading, writing and mathematics, while other areas that can be affected include motor coordination skills, visual processing abilities, and social skills. Some students may have one type of learning disability, while others have multiple difficulties. Approximately 10% of all school-age children have some form of learning disability; however, not all learning problems are caused by a specific learning disability.
ADHD is a diagnosis given to children (and adults) who exhibit a series of behaviors over a period of time. These behaviors typically include inattention, hyperactivity, and impulsivity.
Examples of inattention include: being easily distracted; forgetfulness; making careless mistakes; difficulty following directions; and being disorganized.
Examples of hyperactivity and impulsivity include: fidgeting; restlessness; running in excess; excessive talking; and impatience with waiting one’s turn.
Because every child exhibits these behaviors at some time or another, ADHD is usually considered only if the behaviors began at an early age; if the behaviors last more than six months; if the behaviors occur in many different settings; and if the behaviors are more frequent and severe than is typical in children of the same age. The behaviors must also be an obstacle to success in the child’s life, both at school and in social and family settings.
The diagnosis of ADHD in children with epilepsy can be complicated and controversial. Some types of seizures (like absence) are typified by brief lapses in consciousness, while one of the hallmarks of ADHD is repeated inattention. Different seizure medications may also produce side effects that are similar to typical ADHD symptoms. Some ADHD medications may lower a child’s seizure threshold (the point at which a person is likely to experience a seizure). If parents and school officials suspect the student with epilepsy may also have ADHD, careful monitoring and documentation of the child’s behavior, examining the results of testing to determine the child’s ability to pay attention, and reviewing a thorough medical history, including the types of the medication the child is taking, should all be completed by the child’s physician.
Children whose academic, physical and social skills are not as developed as other children their age are said to have developmental delay. This term often includes children who are slow learners (those children whose IQ scores fall in the 70 to 85 range) and those who have some degree of mental retardation.
Mental retardation is diagnosed if a child’s IQ test scores fall below 70. Having mental retardation is different from having a learning disability. Most, if not all, of a child’s learning abilities are affected if he has mental retardation, whereas a child with a learning disability usually experiences difficulties in very specific scholastic or social skills areas.
Autism, or Pervasive Developmental Disorder (PDD), is the term used when a child has significant, ongoing difficulties communicating with others and lacks imaginative playing skills. Children with autism often exhibit persistent, repetitive interests and behaviors. Approximately 25% of children with autism will experience at least one seizure by the time they reach adulthood.
The sooner a child’s learning disabilities are identified, the sooner school personnel and parents can develop effective strategies that will help the child succeed academically. Open, honest communication between the family and the school about the challenges the student is facing is critical in this development process. Tutoring and counseling may be effective in helping the student succeed with her schoolwork, in addition to modifications and accommodations made by her teachers within the classroom setting.
If the initial management plan does not result in a significant improvement in the child’s scholastic achievement, a comprehensive evaluation may be requested. This evaluation will include thorough psychological and educational testing of the student to determine the areas in which he could benefit from various programs and services, and what those programs and services might entail. Students whose academic achievement is substantially lower than their peers are eligible for special education services, and the team who will develop the student’s special education plan will rely on the results of the evaluations in order to put together the most effective plan for that individual.
Comprehensive evaluations are often conducted by a team of experts, which may include psychologists, speech and language therapists, physical therapists, and social workers. All of these individuals bring their own personal areas of expertise to the evaluation process, and when all of the results of the various tests are compiled, the team will have an accurate and thorough picture of what the child’s strengths and needs are.
Children with disabilities are entitled to a free, appropriate public education in the least restrictive environment. Federal and state laws are in place to ensure that students with disabilities receive the types of supports they need to achieve their full academic potential. Click here for further information on special education laws, organizations that assist families who are going through the special education process with their children’s schools, and how the Epilepsy Foundation can help with this issue.