Not all young people with epilepsy have behavioural issues, but they may experience varying degrees of behaioural difficulties. Here, we cover the causes and outline some strategies for anticipating and addressing them.
Causes of behavioural issues
Behavioural issues are not an automatic consequence of epilepsy.
However, young people with the condition may experience varying degrees of behavioural difficulties. Like anyone, a young person with epilepsy will experience good and bad days. It may be hard to determine whether or not their behaviour is due to an epilepsy-related factor.
Young people may experience a noticeable change in behaviour in the minutes, hours or even days before a seizure. This is known as the prodome stage, where the level of electrical activity in the brain gradually builds up.
After a seizure, a young person may be confused or have problems with their vision and speech, which can be frightening and change their behaviour..
Young people with epilepsy may experience behavioural problems for a number of reasons, including:
- Fear or stress
- Frustration with learning difficulties
- Malfunctions in the areas of the brain that monitor and control emotions and behaviour
- Abnormal electrical brain activity
- Seizures and related factors
- Side effects of anti-seizure medications
Potential behavioural difficulties
Potential behavioural difficulties associated with epilepsy include:
- Attention, concentration
- Hyperactivity, impulsiveness
- Aggression, irritability
- Poor social skills
- Mood swings
- Lethargy
- Issues with movement and co-ordination
- Inappropriate sexual behaviour
Get to know the young person
Knowing the young person well, as well as any potential triggers, can help address issues with behaviour.
Seizures themselves can sometimes be misunderstood as an issue with a young person's behaviour.
Absence seizures, for example, may be difficult to spot and are often mistaken for daydreaming. Focal seizures may present like difficult or unusual behaviour. Even some seizures where young people fall to the floor can be mistaken for clumsiness of accidental falls.
Some behaviours that are 'normal' for one young person with epilepsy, may be an extreme change in behaviour for another and would need to be addressed urgently.
Strategies for dealing with behavioural problems
It is always better to pre-empt inappropriate behaviour with proactive interventions to avoid a situation escalating.
Addressing the needs of the young person and giving them support or strategies to help compensate for any lack of skills will help. Providing lots of opportunity to boost self-esteem and rewarding appropriate behaviours will have a positive effect.
Some useful strategies might include:
- Clear, safe (risk-assessed) environments
- Routine and consistnecy
- Clear verbal instructions
- Signs and visual aids
- Checklists and timetables
- Countdowns
- Calm/time-out areas
- Pre-planning to allow risk assessment and to let the young person know what to expect
- Introduce new transitions gradually and gently, e.g. allow additional time to move around the school site or visit places beforehand
- Introduce a buddy system
Co-occurring conditions
Young people with epilepsy are also more likely than their peers to be affected by co-occurring conditions, which can further affect behaviour. These include:
- Attention deficit hyperactivity disorder (ADHD)
- Autism spectrum disorder (ASD)
- Developmental coordination disorder (DCD)
- Emotional disorders
Find out more about epilepsy and common co-occurring conditions.
