Cognition and behavior in 42 mainstream school children with newly diagnosed idiopathic or cryptogenic epilepsy ('epilepsy only') were compared with 30 healthy gender-matched classmate controls in a 3.5-year study at Wilhelmina Children's Hospital, Utrecht, The Netherlands. At 3, 12 and 42 month follow-up, children with epilepsy performed less well than controls on measures of learning, memory span for words, attention and behavior. Those with epilepsy who repeated a grade continued to have poor scores in Color Trails tests and made more writing errors (so-called “proactive interference”), whereas control children who repeated caught up with non-repeaters. Children with cryptogenic epilepsy scored more poorly. According to parent reports, children with recurring seizures had less behavioral problems than children in remission. Epilepsy patients in a group showed no deterioration in cognition and behavior over time, whereas individually, performance was impaired. Parental poor adaptation to the diagnosis of epilepsy and prediagnostic learning and behavior problems were associated with a child's impaired neuropsychological and school performance, whereas seizure-control or AED treatment was not a factor. 
COMMENT. The source of impairments in cognition and behavior in children with epilepsy may be found in parental attitudes and lack of acceptance of the diagnosis rather than antiepileptic drug toxicity or poor seizure control. Prediagnostic learning and behavior problems were also significant factors in continuing school difficulties. Time devoted to parental counseling is important in the management of childhood epilepsy.
A significant psychosocial impact of epilepsy on adolescents is also reported in a UK controlled study; low levels of epilepsy understanding are associated with higher levels of depression and anxiety, and lower self-esteem. 
A survey of behavior problems in children with epilepsy conducted in Canada found that a Child Behavior Checklist demonstrated an increased frequency of elevated behavior scores for all scales, particularly for attention and social problems. Behavior problems found in 40% of the group were unrelated to the type of epilepsy, EEG or AEDs, but they were significantly correlated with the frequency of learning difficulties, present in 57%.