- Email: [email protected]
Child-parent relationships in the care of epileptic children
Child-Parent Relationships in the Care of Epileptic Children Ikuko Kitamoto, MD, Toru Kurokawa, MD, Shigeru Tomita, MD, Yasufumi Maeda, MD, Kanji Sakamoto, MD and Kohji Ueda, MD
We investigated the attitudes of parents toward their epileptic children with the "Taken" diagnostic test for child-parent relationships. Included were 70 epileptic children, 31 boys and 39 girls, and their parents, 16 fathers and 59 mothers. Patients were divided into group A, 35 children without neurologic complications other than seizures, and group B, 35 children with complications. The results were evaluated by comparing with the normal standard revised by Akasaka et al [7J. The parents of group A and the fathers of group B showed rejection toward their children. The mothers of group B showed attitudes of dotage and anxiety, especially when their children were over 12 years of age and the seizures were not controlled. Our observations suggest that mental health care for the parents of epileptic children is necessary to decrease the psychological conflicts and to prevent untoward effects on their offspring. Key words: Epilepsy, comprehensive care, child-parent relationships, "Taken" diagnostic test. Kitamoto I, Kurokawa T, Tomita S, Maeda Y, Sakamoto K, Ueda K. Child-parent relationships in the care of epileptic children. Brain Dev 1988; 1 0: 36-40
Prognosis for seizures in patients with epilepsy is improving: sixty to eighty percent of the patients have attained a remission and approximately sixty percent are so,cially adjusted [1-3]. However, epilepsy is still considered to be an embarrassing and disgraceful disease and the related possible social rejection leads to rejection of the children by their parents [4,5] . The "Taken" diagnostic test for child-parent relationships was standardized by Shinagawa in 1956 in Japan [6], and revised by Akasaka in 1984 [7]. This test has been used to examine the relationship between children with psychosomatic diseases or other chronic disease and their parents, in Japan [8,9] . We investigated the attitudes of parents toward their epileptic children with the revised "Taken" diagnostic test and attempted to clarify factors influencing childparent relationships.
From the Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka. Received for publication: July 20, 1987. Accepted for publication: October 5, 1987. Correspondence address: Dr. Ikuko Kitamoto, MD, Department of Pediatrics, Faculty of Medicine, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812, Japan.
PATIENTS AND METHODS The patients studied were 70 children with epilepsy, the ages ranged from 6 to 15 years and there were 31 boys and 39 girls. There were 16 fathers and 59 mothers. Group A included 35 epileptic children without neurologic complications, 11 fathers and 27 mothers, and group B included 35 epileptic children with mental or motor disabilities, 5 fathers and 32 mothers. In the "Taken" diagnostic test for child-parent relationships, undesirable attitudes of parents toward children were categorized into ten items: 1) "Negative rejection" means that the parents ignored or were indifferent to their children. Here, the parents sometimes even disliked their children. 2) "Positive rejection" was the tendency of parents to scold and punish their children and neglect their responsibility. 3) "Strictness"; parents were too strict with their children. 4) Parents with excessive "expectations" who required their children to become as they themselves expected, that is beyond the ability of the child. 5) "Interference" is the behavior of parents who cared too much for their children. 6) The parents who showed "anxiety," are always anxious about their children in daily life, school achievements and their future. 7) "Blind obedience"; the parents who take excessive care and make all sorts of efforts to satisfy their children. These people are at the beck and call of their children. 8) Parents who show the attitude of "dotage";
Abnormal attitudes of parents toward children ( Number of patients)
Abnormal attitudes of parents toward children ( Number of patients ) Negative rejection
Negative rejection (
( 14 )
IS )
( 12 ) Positive rejection
( 10 ) Positive rejection ( 18 ) (
( 14 )
( 12 ) Strictness
II)
Strictness ( 22 ( 8 Expectation ( 13 ( 6 Interference
(
( II
( 12 Interference ( 12 ) (
7
-:J
16
16 ) 8)
II II
p<0.05
Blind obedience ( 14 )
( 13 ) Inconsistency ( 13 ) ( 12 ) Disagreement
Inconsistency ( (
IS ) 6)
(
IS
(
6
9
Dotage
7 Blind obedience (
II
p<0.05
7
(
II )
Anxiety
II
Dotage
P
--~
( 12 Expectation
16
Anxiety
~~~~========~~~
II
Disagreement
50
(
II
(
9
--
_J
o
100%
50
100%
Fig 1 Incidence of abnormal attitudes of mothers toward their epileptic children of group B, in relation to age of the child. c:::::J: patients under 12 years of age, ~: patients over 12.
Fig 2 Incidence of abnormal attitudes of mothers toward the epileptic children in group A, in relation to duration of the disease. c=J: patients under 5 years after the onset, ~: patients over 5 years after the onset.
Abnormal attitudes of parents toward children ( Number of subjects )
Abnormal attitudes of parents toward children ( Number of subjects )
Negative rejection ( 399 ) ( 23 ) Positive rejection ( 398 ) ( 22 ) Strictness ( 40 I ( 22 Expectation ( 395 ( 18 Interference ( 399 ( 19 Anxiety 391 19 Dotage ( 409 ( 18 Blind obedience ( 398 ) ( 23 ) Inconsistency ( 399 ( 21 Disagreement ( 394 ( 17
Negative rejection ( 399 ) ( 17 ) Positive rejection ( 398 ) ( 19 ) Strictness ( 40 I ( 20 Expectation ( 395 ( II Interference ( 399 ( IS Anxiety 391 II Dotage 409 14 Blind obedience ( 398 ) ( 14 ) Inconsistency ( 399 ( II Disagreement ( 394 ( II
~ p<0.05
I
50
I 100%
Fig 3a Incidence of abnormal attitudes of parents toward healthy children in the control group and patients of group A with controlled seizures. ISS:S): healthy children in the control group, c=J: patients of group A with controlled seizures.
I
p<0.05
I
p
=::J
p
=:J
p<0.05
50
100Z
Fig 3b Incidence of abnormal attitudes of parents toward healthy children in the control group and patients of group B with intractable seizures. JS:SSJ: healthy children in the control group, § l : patients of group B with intractable seizures.
Kitamoto et al: Parents of epileptic children 37
are overprotective and never punish their children. 9) Parents who are "inconsistent," show different attitudes toward the same action. 10) Parents who "disagree" over the management of the child; the fathers shows an attitude different from that of the mother, and vice versa. Each of the attitudes is tested with ten questions. When the parents have a score of less than 20% of the best score, which means the most desirable attitude, the relationship with their children is defined as "abnormal." We investigated the incidence of each abnormal attitude of parents toward their epileptic children and factors influencing the attitude. The results of the test were excluded from our study when the questions were not fully answered by the parents. Statistical analysis was determined using the X2 test and Fisher's method to calculate the probability.
relationships in children under 12 years of age, with. that in those over 12. Mothers of group B showed abnormal attitudes in terms of anxiety (p<0.05) and dotage (p<0.05) toward their children over the age of 12 years, compared to those under 12 (Fig 1). All of the children of mothers who showed anxiety and/or dotage had intractable seizures. There was no correlation between the incidence of abnormal attitudes and the ages of patients in group A. b) Duration of epilepsy and the attitude of parents The patients with epilepsy of less than 5 years duration were compared with those with a duration of 5 years or longer. The mothers of group A showed a positive rejection (p
RESULTS a) The ages of the patients and the attitude of parents
We compared the incidence of abnormal child-parent
Abnormal attitudes of parents toward children ( Number of subjects )
Fathers
Mothers
Negative rejection ( 300) (399) ( II) (26) ( 4) (25) positive rejection
p
(( 30II I) ) ( 4)
p<0.1
(398) (26) (29)
Fig 4 Incidence of abnormal attitudes ofparents toward healthy children in the control group, and epileptic children of groups A and B.
~llj
Strictness ( 298) (40 I ) ( iO) (26) (
L
p
2)
(32)
Expectation ( 298) (395) ( 9) (22) ( 3) (19) Interference ( 300) (399) ( 9) (23) ( 4) (23) Anxiety ( 391 ) ( 298 ) ( 20 ) ( 8 ) ( ( 18 ) 3 ) Dotage ( 409 ) ( 299 ) ( 22 ) ( 9 ) ( 23 ) ( 4 )
p<0.1
1Ii••••---:JJ
Blind obedience ( 296) (398) ( II) (27) ( 4) (24) Inconsistency p
100%
[
(( 297) 9) ( 4)
p<0.1
~ii=.
(399) ( 25) (21) Disagreement ( 307) (394) I===r ( 7) (20) ( 3) (21) 50
c=J
a
-
a
Healthy children in the control group
~ Patients of group A Patients of group B'
38 Brain & Deve[opment, VoIIO,No 1, 1988
p
p<0.1
50
100%
c) Seizure control and the attitude of mothers As compared with the mothers of control group, the mothers of group A children showed a tendency toward a positive rejection (p < 0 .05) when the seizures were controlled, and not when the seizures persisted. Less than 5 years passed since the beginning of the disease in 78% of the children whose mothers showed a positive rejection. The mothers of group B frequently showed anxiety (p < 0.1) and dotage (p < 0.05), but neither strictness (p < 0.05) nor interference (p < 0.1) when seizures were not controlled (Fig 3a, 3b). There was no difference in the attitudes of mothers among group A whose seizures were not controlled, among group B whose seizures were controlled for 6 months or more, and in the control group. These patients were older or had epilepsy for a longer duration. d) Gross neurologic complication and the attitudes of parents The attitudes of parents of the patients group were compared with that of parents of the control group. The fathers of group A showed a significantly high incidence of negative rejection (p < 0.01), positive rejection (p<0.005), expectation (p<0.05), interference (p
the disease was less than 5 years, even if seizures were controlled. This suggests that parents tend to reject their children with epilepsy, especially soon after hearing the diagnosis. On the other hand, mothers showed anxiety and dotage toward children with motor or mental disabilities, but fathers had a tendency to ignore their handicapped children. Recent studies reported that mothers of severely mentally retarded children had to carry the burden of child care and housework, with little support [16]. Care of a handicapped child has a greater impact on the mental health of mothers, but a less deleterious effect on that of fathers [17]. Our study also showed such different attitudes between fathers and mothers. Psychiatric morbidity increased among the mothers of chronical epileptic children [18]. In our study, the mothers of epileptic children over the age of 12 and with intractable seizures, in addition to neurologic complications, showed anxiety and dotage. Such mothers complained that they were too old to care for their children and they were anxious about the future of their children following their own death. The treatment of epilepsy is mostly drug-related, however, comprehensive care, including care of the mental health of the parents is most important. Children are greatly influenced by parents, and psychiatric disturbances were significantly more common among the epileptic children, possibly because of overprotection by the parents [19]. Therefore, it is essential to impress on the parents of children with epilepsy that great efforts should be made to prevent the occurrence of psychiatric problems. The parents of epileptic children should be encouraged to raise their epileptic children in a "normal" mover.
DISCUSSION There are reports on the child-parent relationships in epileptic children [10-13]. The parents are usually embarrassed when their children are diagnosed as having epilepsy and they become anxious about the poor prospects, their future and social prejudice. The feelings of embarrassment or shame and the fear of social rejection cause emotional difficulties and untoward attitudes to their children [14] . The present study, using the "Taken" diagnostic test for child-parent relationships, showed that the attitudes of parents of epileptic children, especially viewed by parents themselves, were affected and influenced by the age of patients, duration of the disease, seizure control and gross neurologic domplications. The parents of the children with a normal development showed a positive and/or negative rejection. This differed from data in another study, in which, rejection was a less common response by parents of epileptic children [15]. Mothers of children without complications had a tendency to show a positive rejection when the duration of
ACKNOWLEDGMENTS We thank Dr. M. Ohara (Kyushu University) commented on the manuscript. REFERENCES 1. Annegers JF, Hauser WA, Elveback LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia 1979; 20:729-37. 2. Ohtahara S, Yamatogi Y, Ohtsuka Y, Oka E, Kanda S. Prognosis in childhood epilepsy: a prospective follow-up study. Folia Psychiatr Neural Jpn (Tokyo) 1977;31: 301-13. 3. Okuma T, Kumashiro H. Natural history and prognoses of epilepsy: report of a multi-institutional study in Japan. Epi· lepsia 1981;22:35-53. 4. Caveness WF, Gallup GHJr. A survey of public attitudes toward epilepsy in 1979 with an indication of trends over the past thirty years. Epilepsia 1980;21:509-18. 5. Jan lE, Ziegler RG, Erba G. Does your child have epilepsy? Baltimore: University Park Press, 1983: 3. 6. Shinagawa F, Shinagawa T. A guide of "Taken" diagnostic test for child-parents relationship (in Japanese). Tokyo: Nihonbunkakagaku-sha,1958. 7. Akasaka T, Maruki K, Suzuki I, Nezu S. Evaluation of
Kitamoto et af: Parents of epileptic children 39
8.
9.
10. 11. 12.
"Taken" diagnostic test for child-parents relationship: 1. Restandardization of the test by healthy children and their parents (in Japanese). Shinshin-Igaku (Tokyo) 1984;24: 479-86. Akasaka T, Nezu S, Maruki K, Suzuki 1. Evaluation of "Taken" diagnostic test for child-parents relationship: II. Comparative studies on asthmatic children who joined asthma summer school and institutionalized asthmatic children and their parents with healthy control by the re-standardized "Taken" diagnostic test (in Japanese). Shinshin-Igaku (Tokyo) 1985;25:269-75. Nishima S. Influences of child-parents relationship on bronchial asthma in children (in Japanese). Shinshin-Igaku (Tokyo) 1980;20:417-22. Levy OM. Maternal overprotection. New York: Columbia University Press, 1943. Hartlage LC, Green JB, Offutt L. Dependency in epileptic children. Epilepsia 1972;13:27-30. Ward F, Bower BD. A study of certain social aspects of
40 Brain & Development, Vol10,No 1,1988
13. 14.
15. 16. 17.
18. 19.
epilepsy in childhood. Dev Med Child Neurol 1978;20 (suppl1): 1-50. Long CG. Moore JR. Parental expectations for their epileptic children. J Child Psychol Psychiatry 1979;20:299-312. Livingston S. Comprehensive management of epilepsy in infancy, childhood and adolescence. Springfield (Illinois): Charles C Thomas, 1972:464-74. Lindsay 1. Emotional problems in childhood and adolescence. Br Med J 1972;3:283-5. Dupont A. Socio-psychiatric aspects of the young severely retarded and their family. Br J Psychiatry 1986; 148: 227 -34. Clarkson SER, Clarkson lE, Ditter 10, et al. Impact of a handicapped child on mental health of parents. Br Med J 1986;293: 1395-7. Hoare P. Psychiatric disturbance in the families of epileptic children. Dev Med Child Neurol 1984;26: 14-9. Hoare P. Does illess foster dependency? A study of epileptic and diabetic children. Dev Med Child Neurol 1984; 26: 204.
We investigated the attitudes of parents toward their epileptic children with the "Taken" diagnostic test for child-parent relationships. Included were 70 epileptic children, 31 boys and 39 girls, and their parents, 16 fathers and 59 mothers. Patients were divided into group A, 35 children without neurologic complications other than seizures, and group B, 35 children with complications. The results were evaluated by comparing with the normal standard revised by Akasaka et al [7J. The parents of group A and the fathers of group B showed rejection toward their children. The mothers of group B showed attitudes of dotage and anxiety, especially when their children were over 12 years of age and the seizures were not controlled. Our observations suggest that mental health care for the parents of epileptic children is necessary to decrease the psychological conflicts and to prevent untoward effects on their offspring. Key words: Epilepsy, comprehensive care, child-parent relationships, "Taken" diagnostic test. Kitamoto I, Kurokawa T, Tomita S, Maeda Y, Sakamoto K, Ueda K. Child-parent relationships in the care of epileptic children. Brain Dev 1988; 1 0: 36-40
Prognosis for seizures in patients with epilepsy is improving: sixty to eighty percent of the patients have attained a remission and approximately sixty percent are so,cially adjusted [1-3]. However, epilepsy is still considered to be an embarrassing and disgraceful disease and the related possible social rejection leads to rejection of the children by their parents [4,5] . The "Taken" diagnostic test for child-parent relationships was standardized by Shinagawa in 1956 in Japan [6], and revised by Akasaka in 1984 [7]. This test has been used to examine the relationship between children with psychosomatic diseases or other chronic disease and their parents, in Japan [8,9] . We investigated the attitudes of parents toward their epileptic children with the revised "Taken" diagnostic test and attempted to clarify factors influencing childparent relationships.
From the Department of Pediatrics, Faculty of Medicine, Kyushu University, Fukuoka. Received for publication: July 20, 1987. Accepted for publication: October 5, 1987. Correspondence address: Dr. Ikuko Kitamoto, MD, Department of Pediatrics, Faculty of Medicine, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812, Japan.
PATIENTS AND METHODS The patients studied were 70 children with epilepsy, the ages ranged from 6 to 15 years and there were 31 boys and 39 girls. There were 16 fathers and 59 mothers. Group A included 35 epileptic children without neurologic complications, 11 fathers and 27 mothers, and group B included 35 epileptic children with mental or motor disabilities, 5 fathers and 32 mothers. In the "Taken" diagnostic test for child-parent relationships, undesirable attitudes of parents toward children were categorized into ten items: 1) "Negative rejection" means that the parents ignored or were indifferent to their children. Here, the parents sometimes even disliked their children. 2) "Positive rejection" was the tendency of parents to scold and punish their children and neglect their responsibility. 3) "Strictness"; parents were too strict with their children. 4) Parents with excessive "expectations" who required their children to become as they themselves expected, that is beyond the ability of the child. 5) "Interference" is the behavior of parents who cared too much for their children. 6) The parents who showed "anxiety," are always anxious about their children in daily life, school achievements and their future. 7) "Blind obedience"; the parents who take excessive care and make all sorts of efforts to satisfy their children. These people are at the beck and call of their children. 8) Parents who show the attitude of "dotage";
Abnormal attitudes of parents toward children ( Number of patients)
Abnormal attitudes of parents toward children ( Number of patients ) Negative rejection
Negative rejection (
( 14 )
IS )
( 12 ) Positive rejection
( 10 ) Positive rejection ( 18 ) (
( 14 )
( 12 ) Strictness
II)
Strictness ( 22 ( 8 Expectation ( 13 ( 6 Interference
(
( II
( 12 Interference ( 12 ) (
7
-:J
16
16 ) 8)
II II
p<0.05
Blind obedience ( 14 )
( 13 ) Inconsistency ( 13 ) ( 12 ) Disagreement
Inconsistency ( (
IS ) 6)
(
IS
(
6
9
Dotage
7 Blind obedience (
II
p<0.05
7
(
II )
Anxiety
II
Dotage
P
--~
( 12 Expectation
16
Anxiety
~~~~========~~~
II
Disagreement
50
(
II
(
9
--
_J
o
100%
50
100%
Fig 1 Incidence of abnormal attitudes of mothers toward their epileptic children of group B, in relation to age of the child. c:::::J: patients under 12 years of age, ~: patients over 12.
Fig 2 Incidence of abnormal attitudes of mothers toward the epileptic children in group A, in relation to duration of the disease. c=J: patients under 5 years after the onset, ~: patients over 5 years after the onset.
Abnormal attitudes of parents toward children ( Number of subjects )
Abnormal attitudes of parents toward children ( Number of subjects )
Negative rejection ( 399 ) ( 23 ) Positive rejection ( 398 ) ( 22 ) Strictness ( 40 I ( 22 Expectation ( 395 ( 18 Interference ( 399 ( 19 Anxiety 391 19 Dotage ( 409 ( 18 Blind obedience ( 398 ) ( 23 ) Inconsistency ( 399 ( 21 Disagreement ( 394 ( 17
Negative rejection ( 399 ) ( 17 ) Positive rejection ( 398 ) ( 19 ) Strictness ( 40 I ( 20 Expectation ( 395 ( II Interference ( 399 ( IS Anxiety 391 II Dotage 409 14 Blind obedience ( 398 ) ( 14 ) Inconsistency ( 399 ( II Disagreement ( 394 ( II
~ p<0.05
I
50
I 100%
Fig 3a Incidence of abnormal attitudes of parents toward healthy children in the control group and patients of group A with controlled seizures. ISS:S): healthy children in the control group, c=J: patients of group A with controlled seizures.
I
p<0.05
I
p
=::J
p
=:J
p<0.05
50
100Z
Fig 3b Incidence of abnormal attitudes of parents toward healthy children in the control group and patients of group B with intractable seizures. JS:SSJ: healthy children in the control group, § l : patients of group B with intractable seizures.
Kitamoto et al: Parents of epileptic children 37
are overprotective and never punish their children. 9) Parents who are "inconsistent," show different attitudes toward the same action. 10) Parents who "disagree" over the management of the child; the fathers shows an attitude different from that of the mother, and vice versa. Each of the attitudes is tested with ten questions. When the parents have a score of less than 20% of the best score, which means the most desirable attitude, the relationship with their children is defined as "abnormal." We investigated the incidence of each abnormal attitude of parents toward their epileptic children and factors influencing the attitude. The results of the test were excluded from our study when the questions were not fully answered by the parents. Statistical analysis was determined using the X2 test and Fisher's method to calculate the probability.
relationships in children under 12 years of age, with. that in those over 12. Mothers of group B showed abnormal attitudes in terms of anxiety (p<0.05) and dotage (p<0.05) toward their children over the age of 12 years, compared to those under 12 (Fig 1). All of the children of mothers who showed anxiety and/or dotage had intractable seizures. There was no correlation between the incidence of abnormal attitudes and the ages of patients in group A. b) Duration of epilepsy and the attitude of parents The patients with epilepsy of less than 5 years duration were compared with those with a duration of 5 years or longer. The mothers of group A showed a positive rejection (p
RESULTS a) The ages of the patients and the attitude of parents
We compared the incidence of abnormal child-parent
Abnormal attitudes of parents toward children ( Number of subjects )
Fathers
Mothers
Negative rejection ( 300) (399) ( II) (26) ( 4) (25) positive rejection
p
(( 30II I) ) ( 4)
p<0.1
(398) (26) (29)
Fig 4 Incidence of abnormal attitudes ofparents toward healthy children in the control group, and epileptic children of groups A and B.
~llj
Strictness ( 298) (40 I ) ( iO) (26) (
L
p
2)
(32)
Expectation ( 298) (395) ( 9) (22) ( 3) (19) Interference ( 300) (399) ( 9) (23) ( 4) (23) Anxiety ( 391 ) ( 298 ) ( 20 ) ( 8 ) ( ( 18 ) 3 ) Dotage ( 409 ) ( 299 ) ( 22 ) ( 9 ) ( 23 ) ( 4 )
p<0.1
1Ii••••---:JJ
Blind obedience ( 296) (398) ( II) (27) ( 4) (24) Inconsistency p
100%
[
(( 297) 9) ( 4)
p<0.1
~ii=.
(399) ( 25) (21) Disagreement ( 307) (394) I===r ( 7) (20) ( 3) (21) 50
c=J
a
-
a
Healthy children in the control group
~ Patients of group A Patients of group B'
38 Brain & Deve[opment, VoIIO,No 1, 1988
p
p<0.1
50
100%
c) Seizure control and the attitude of mothers As compared with the mothers of control group, the mothers of group A children showed a tendency toward a positive rejection (p < 0 .05) when the seizures were controlled, and not when the seizures persisted. Less than 5 years passed since the beginning of the disease in 78% of the children whose mothers showed a positive rejection. The mothers of group B frequently showed anxiety (p < 0.1) and dotage (p < 0.05), but neither strictness (p < 0.05) nor interference (p < 0.1) when seizures were not controlled (Fig 3a, 3b). There was no difference in the attitudes of mothers among group A whose seizures were not controlled, among group B whose seizures were controlled for 6 months or more, and in the control group. These patients were older or had epilepsy for a longer duration. d) Gross neurologic complication and the attitudes of parents The attitudes of parents of the patients group were compared with that of parents of the control group. The fathers of group A showed a significantly high incidence of negative rejection (p < 0.01), positive rejection (p<0.005), expectation (p<0.05), interference (p
the disease was less than 5 years, even if seizures were controlled. This suggests that parents tend to reject their children with epilepsy, especially soon after hearing the diagnosis. On the other hand, mothers showed anxiety and dotage toward children with motor or mental disabilities, but fathers had a tendency to ignore their handicapped children. Recent studies reported that mothers of severely mentally retarded children had to carry the burden of child care and housework, with little support [16]. Care of a handicapped child has a greater impact on the mental health of mothers, but a less deleterious effect on that of fathers [17]. Our study also showed such different attitudes between fathers and mothers. Psychiatric morbidity increased among the mothers of chronical epileptic children [18]. In our study, the mothers of epileptic children over the age of 12 and with intractable seizures, in addition to neurologic complications, showed anxiety and dotage. Such mothers complained that they were too old to care for their children and they were anxious about the future of their children following their own death. The treatment of epilepsy is mostly drug-related, however, comprehensive care, including care of the mental health of the parents is most important. Children are greatly influenced by parents, and psychiatric disturbances were significantly more common among the epileptic children, possibly because of overprotection by the parents [19]. Therefore, it is essential to impress on the parents of children with epilepsy that great efforts should be made to prevent the occurrence of psychiatric problems. The parents of epileptic children should be encouraged to raise their epileptic children in a "normal" mover.
DISCUSSION There are reports on the child-parent relationships in epileptic children [10-13]. The parents are usually embarrassed when their children are diagnosed as having epilepsy and they become anxious about the poor prospects, their future and social prejudice. The feelings of embarrassment or shame and the fear of social rejection cause emotional difficulties and untoward attitudes to their children [14] . The present study, using the "Taken" diagnostic test for child-parent relationships, showed that the attitudes of parents of epileptic children, especially viewed by parents themselves, were affected and influenced by the age of patients, duration of the disease, seizure control and gross neurologic domplications. The parents of the children with a normal development showed a positive and/or negative rejection. This differed from data in another study, in which, rejection was a less common response by parents of epileptic children [15]. Mothers of children without complications had a tendency to show a positive rejection when the duration of
ACKNOWLEDGMENTS We thank Dr. M. Ohara (Kyushu University) commented on the manuscript. REFERENCES 1. Annegers JF, Hauser WA, Elveback LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia 1979; 20:729-37. 2. Ohtahara S, Yamatogi Y, Ohtsuka Y, Oka E, Kanda S. Prognosis in childhood epilepsy: a prospective follow-up study. Folia Psychiatr Neural Jpn (Tokyo) 1977;31: 301-13. 3. Okuma T, Kumashiro H. Natural history and prognoses of epilepsy: report of a multi-institutional study in Japan. Epi· lepsia 1981;22:35-53. 4. Caveness WF, Gallup GHJr. A survey of public attitudes toward epilepsy in 1979 with an indication of trends over the past thirty years. Epilepsia 1980;21:509-18. 5. Jan lE, Ziegler RG, Erba G. Does your child have epilepsy? Baltimore: University Park Press, 1983: 3. 6. Shinagawa F, Shinagawa T. A guide of "Taken" diagnostic test for child-parents relationship (in Japanese). Tokyo: Nihonbunkakagaku-sha,1958. 7. Akasaka T, Maruki K, Suzuki I, Nezu S. Evaluation of
Kitamoto et af: Parents of epileptic children 39
8.
9.
10. 11. 12.
"Taken" diagnostic test for child-parents relationship: 1. Restandardization of the test by healthy children and their parents (in Japanese). Shinshin-Igaku (Tokyo) 1984;24: 479-86. Akasaka T, Nezu S, Maruki K, Suzuki 1. Evaluation of "Taken" diagnostic test for child-parents relationship: II. Comparative studies on asthmatic children who joined asthma summer school and institutionalized asthmatic children and their parents with healthy control by the re-standardized "Taken" diagnostic test (in Japanese). Shinshin-Igaku (Tokyo) 1985;25:269-75. Nishima S. Influences of child-parents relationship on bronchial asthma in children (in Japanese). Shinshin-Igaku (Tokyo) 1980;20:417-22. Levy OM. Maternal overprotection. New York: Columbia University Press, 1943. Hartlage LC, Green JB, Offutt L. Dependency in epileptic children. Epilepsia 1972;13:27-30. Ward F, Bower BD. A study of certain social aspects of
40 Brain & Development, Vol10,No 1,1988
13. 14.
15. 16. 17.
18. 19.
epilepsy in childhood. Dev Med Child Neurol 1978;20 (suppl1): 1-50. Long CG. Moore JR. Parental expectations for their epileptic children. J Child Psychol Psychiatry 1979;20:299-312. Livingston S. Comprehensive management of epilepsy in infancy, childhood and adolescence. Springfield (Illinois): Charles C Thomas, 1972:464-74. Lindsay 1. Emotional problems in childhood and adolescence. Br Med J 1972;3:283-5. Dupont A. Socio-psychiatric aspects of the young severely retarded and their family. Br J Psychiatry 1986; 148: 227 -34. Clarkson SER, Clarkson lE, Ditter 10, et al. Impact of a handicapped child on mental health of parents. Br Med J 1986;293: 1395-7. Hoare P. Psychiatric disturbance in the families of epileptic children. Dev Med Child Neurol 1984;26: 14-9. Hoare P. Does illess foster dependency? A study of epileptic and diabetic children. Dev Med Child Neurol 1984; 26: 204.