The psychopathology of childhood epilepsy was examined by comparing symptoms in 48 children with complex partial seizures (CPS), 39 with primary generalized epilepsy with absence (PGE), and 59 nonepileptic children, aged 5 to 16 years, referred by pediatric neurologists to the UCLA Department of Psychiatry and Neuropsychiatric Institute, Los Angeles, CA. Responses on a Child Behavior Checklist (CBCL) completed by parents and the Schedule for Affective Disorders and Schizophrenia (K-SADS) administered to parent and child were compared. The CBLC (Achenbach, 1991) cutoff point for clinically significant pathology was 65 of a possible 113 behavioral problem items (eg Externalizing, Internalizing; aggression, depression, hyperactivity). K-SADS diagnoses were grouped as Affective/anxiety, Disruptive, Comorbid, and symptomatic (delusions, hallucinations, social withdrawal, suicidal, irritability).
Psychopathology was identified by the CBLC and K-SADS in 26% and 51%, respectively, of the CPS and PGE patients. Compared to the nonepileptic group, children with epilepsy had significantly higher mean CBCL scores, and more diagnoses and symptoms of psychopathology. The scores and rates of pathology did not differ in the CPS and PGE groups. IQ scores were correlated with mean CBCL scores and K-SADS diagnosis in both CPS and GPE groups, and the negative association was statistically significant in CPS patients for mean total and Externalizing CBCL scores and for irritability on the K-SADS. Poor seizure control was significantly correlated with mean total and Internalizing CBCL scores but not with K-SADS diagnoses or symptoms. The K-SADS is a more sensitive test of psychopathology than the CBCL in children with CPS and PGE. 
COMMENT. Children with either complex partial or primary generalized epilepsies are at increased risk of having behavioral and affective disorders. Poor seizure control may not be associated with an increased risk of psychiatric diagnoses and symptoms, but the high rate of refractory epilepsy and effect of antiepileptic drugs on behavior limit the significance of this finding. A structured diagnostic interview (K-SADS) in addition to the child behavior checklist (CBCL) may be necessary to uncover psychopathology in children with epilepsy. Children with CPS like those with GPE have high rates of both externalizing (disruptive) and internalizing (affective/anxiety) disorders. The high rates of irritability, social withdrawal, suicidal ideation, and interictal hallucinations emphasize the need for psychological counseling and psychiatric intervention in children with epilepsy.