Psychiatric disorders in children and adolescents with mental retardation and active epilepsy

Objective: To assess the prevalence and types of psychiatric disorders in a representative sample of schoolage children with the combination of mental retardation (MR) and active epilepsy. Subjects and Methods: Ninety-eight children were identified with MR and active epilepsy in a population-based study from Goteborg, Sweden, which has a general population at risk of 48 873 children. They were born between 1975 and 1986 and were 8 to 16 years old at the time of psychiatric examination, Five children had died, 3 had parents who declined participation, and 90 were clinically examined. Results: Fifty-three children (59%) had at least 1 psychiatric diagnosis, and the conditions in 30 (33%) could not be classified because of profound severe MR. Twenty-four children (27%) had autistic disorder, and another 10 (11%) had an autisticlike condition. The combination of MR, active epilepsy, and autism or an autisticlike condition occurred at a rate of 0.07% in the general population. The most common seizure types in the group with autism or an autisticlike condition were complex partial, atypical absence, myoclonic, and tonic-clonic. Conclusions: Children with MR and active epilepsy suffered from a psychiatric disorder in a majority of those cases in which the children had enough skills and mobility to exhibit behavioral and emotional problems. Many such problems had been undiagnosed despite parental concern and the conviction that the psychiatric problems were the most burdensome in many cases. Neurologists and psychiatrists need to develop better programs for the adequate management of psychiatric disorders in this population.