Researchers at the Epilepsy Center, Ann & Robert H Lurie Children’s Hospital of Chicago assessed the yield of routine screening for neurodevelopmental delay and autism in all patients, 5 years of age and younger, seen in the monitoring unit or ketogenic diet clinic. The Ages and Stages Questionnaire, a parent completed form selected for development screening, addresses communication, gross and fine motor, problem solving, and personal-social. The Modified Checklist for Autism in Toddlers (mCHAT) was used for children up to age 4 years; and the Social Communication Questionnaire (SCQ) in children 4 years and older. Of 65 who participated, 49 (75%) were established epilepsy patients, and 16 (25%) were screened in a new-onset epilepsy clinic. Mean age at screening was 2.5 years (range 2 months to 5 years), and 38 (58%) were boys. Seizure frequency at time of screening was seizure free (N=14), <1/month (N=2), monthly (N=4), weekly (N=5), and daily (N=30).

Developmental screening was positive/delayed in 47 (72%), negative in 10 (15%), and borderline in 8 (12%). Established epilepsy patients were more likely to be developmentally delayed and to test positive than new-onset patients (p=0.0001). Among 49 screened for autism, 24 (49%) scored positive. Of 12 with normal or borderline developmental screening, none screened positive for autism, whereas 24 of 37 (65%) of those with developmental delay also scored positive for autism (p<0.0001). The prevalence of positive autism screening correlated with the degree and type of developmental delay. Delays in the social-personal domain were more likely than those in gross and fine motor to discriminate between positive and negative autism screening. Positive autism screening in 20 children were better explained by the underlying developmental delays. New concerns identified through screening prompted referrals for further evaluations in 16 patients; these included physical therapy, speech therapy, early intervention mental health and school services, and psychiatry. The yield of routine screening was sufficiently high to support developmental and autism screening in all children attending an epilepsy center. [1]

COMMENT. The authors conclude that comorbid developmental and behavioral problems in children with epilepsy are sufficiently prevalent to warrant routine screening. The screening program in the Epilepsy Center at the Lurie Children’s Hospital of Chicago has been expanded to include patients up to 18 years of age. The American Academy of Pediatrics recommends routine developmental and autism screening for all infants and toddlers. [2, 3]