RISK AND RESILIANCE FACTORS IN ADJUSTMENT OF CHILDREN WITH EPILEPSY

Uvod: Brojna su istraživanja potvrdila da su djeca s idiopatskom epilepsijom (IE) u pojačanom riziku za probleme prilagodbe koji se iskazuju internaliziranim poremećajima, sniženim samopoimanjem i slabijim obrazovnim napredovanjem u usporedbi sa zdravom kao i djecom s drugim kroničnim bolestima. No, korelati prilagodbe u djece s IE još su nedovoljno upoznati što se očituje nekonzistentnim nalazima istraživanja posebice glede obilježja epilepsije/napadaja i psihološke prilagodbe. Cilj: Ispitati prediktore prilagodbe djece s IE unutar Walander-Varnijevog modela rizičnih i zaštitnih faktora prilagodbe na bolest te ispitati razlikuju li se djeca s IE prema osnovnoj podjeli s obzirom na tip napadaja (žarišni i generalizirani) u rizičnim i zaštitnim faktorima te prilagodbi. Ispitanici i metode: U ispitivanje je uključeno ukupno 128 djece (9 do 16,10 godina) liječene s dijagnozom IE, od čega 71 sa žarišnim i 57 s generaliziranim tipom napadaja. Postupak istraživanja temelji se na demografskim podacima, obilježjima bolesti i liječenja, školskom uspjehu, rezultatima testiranja intelektualnih sposobnosti te primjeni upitnika za samoprocjenu djeteta (skale stresa, stigme, strategija suočavanja, kvalitete obiteljskih odnosa, socijalne podrške te anksioznosti, depresivnosti, ljutnje, ometajućeg ponašanja i samopoimanja). Rezultati: I rizični i zaštitni faktori značajno doprinose prilagodbi. Značajni prediktori slabije prilagodbe su: žarišni tip napadaja, veća razina stigme, stresa i osjetljivosti na stres kao i dulje trajanje bolesti. Ujednačen profil intelektualnog funkcioniranja, kvaliteta obitelji, odnosa s majkom i s ocem prediktori su bolje prilagodbe u aspektu emocionalnog funkcioniranja, a viša razina inteligencije boljeg školskog uspjeha. Utvrđene razlike među skupinama po tipu epilepsije pokazuju da su djeca sa žarišnim napadajima osjetljivija na stres, imaju slabije radno pamćenje i češću neujednačenost kognitivnog funkcioniranja kao i slabiju prilagodbu iskazanu višim razinama simptoma emocionalnih poremećaja. Zaključak: Prvi puta provedenom provjerom Walander-Varnijevog modela rizičnih i zaštitinih faktora u prilagodbi na kroničnu bolest na djeci s epilepsijom utvrđeni prediktori prilagodbe doprinose objašnjenju individualnih razlika i varijabiliteta psihološke prilagodbe u djece s IE i pružaju temelj za razvoj ciljanih programa prevencije i intervencije.Introduction: Numerous studies have confirmed that children with idiopathic epilepsy (IE) are at increased risk for adjustment problems such as internalized disorders, reduced self-concept and lower academic achievement compared to healthy children as well as children with other chronic diseases. However, correlates of children’s adjustment are still vague especially regarding to epilepsy/seizures and psychological adaptation. Objectives: the aim of this study was to examine the predictors of adaptation of children with IE within the Wallander-Varni model of risk and resilience factors for adaptation to the disease and assessing whether children with IE differ according to the basic division due to the type of seizures (focal and generalized) in risk, resiliance factors and adaptations. Subjects and Methods: A total of 128 children (9 to 16.10 years) diagnosed with IE, including 71 with focal and 57 with generalized seizures, were included in the study. The research process was based on demographic data, characteristics of illness and treatment, school success, intellectual ability, and application of a child self-assessment questionnaires (stress scale, stigma, coping strategy, family relationship quality, social support and anxiety, depression, anger, disruptive behavior and self-concept. Results: Both risk and resilience factors contribute significantly to the adjustment. Significant predictors of weaker adaptations were focal type of seizures, higher levels of stigma, stress and stress sensitivity as well as longer duration of illness. A consistent profile of intellectual functioning, family quality, relationship with mother and father were predictors of better adjustment in the aspect of emotional functioning, and the higher level of intelligence the better school achievement. According to the type of epilepsy, the established differences between groups indicate that children with focal seizures are more sensitive to stress, have a lower working memory, and more frequent uneven intellectual profile, as well as a poorer adjustment to higher levels of emotional disturbance symptoms. Conclusion: It is confirmed for the first time that Walander-Varni model is useful to establish predictors of adaptation and contribute to the explanation of individual differences and variability of psychological adaptation in children with IE. That provide scientifically proof basis for the development of aimed prevention and intervention programs