Epilepsy Research (2011) 95, 213—220

journal homepage: www.elsevier.com/locate/epilepsyres

Maternal reactions to a child with epilepsy:

Depression, anxiety, parental attitudes and family
functions
Aynur Pekcanlar Akay a,∗, Semra Hiz Kurul b, Handan Ozek a,
Sevay Cengizhan a, Neslihan Emiroglu a, Hulya Ellidokuz c

a
Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, 35340 Inciralti, Izmir, Turkey
b
Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylul University School of Medicine, Izmir, Turkey
c
Department of Preventive Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey

Received 6 December 2010; received in revised form 17 March 2011; accepted 25 March 2011
Available online 2 May 2011

KEYWORDS Summary
Epilepsy; Objective: The goal of this study was to investigate how the disease and treatment of epilepsy
Depression; affected the psychological profile (depression and anxiety) of mothers whose children had
Anxiety; epilepsy, as well as these mothers’ attitudes towards their children and their family relation-
Parental attitude; ships.
Family functioning Methods: Both the case and control groups consisted of 50 children and their mothers. All
mothers were asked to complete the Beck Depression Inventory, State-Trait Anxiety Inventory,
Parental Attitude Research Instrument and Family Assessment Device.
Results: Mothers whose children had epilepsy scored significantly higher in depression and state
anxiety compared to the mothers of the control group. The mothers of children diagnosed with
epilepsy also failed to develop supportive and friendly relationships with their children. In
addition, these mothers scored significantly higher in the Attitude of Hostility and Rejection,
Marital Discordance and Authoritarian Attitude as compared to the mothers of the control group.
Conclusion: This cross-sectional study demonstrated that, for the mothers of children who had
epilepsy, the illness might have an adverse effect on their lives and their family relationships.
© 2011 Elsevier B.V. All rights reserved.

∗
Corresponding author. Tel.: +90 2324123559; fax: +90 232776686; cellular: +90 5324683399.
E-mail addresses: aynur.akay@deu.edu.tr, pekcanlara@yahoo.com (A. Pekcanlar Akay), semra.kurul@deu.edu.tr (S. Hiz Kurul),
handan.ozek@deu.edu.tr (H. Ozek), sevay.alsen@deu.edu.tr (S. Cengizhan), neslihan.emiroglu@deu.edu.tr (N. Emiroglu),
hulya.ellidokuz@deu.edu.tr (H. Ellidokuz).

0920-1211/$ — see front matter © 2011 Elsevier B.V. All rights reserved.
doi:10.1016/j.eplepsyres.2011.03.020
214
Introduction
Epilepsy is a chronic illness that often affects the cognitive
and behavioral functions of diagnosed children. The impact
of epilepsy is not limited to the child experiencing seizures;
it affects all members of the family to a certain degree. The
unpredictable nature of the onset of seizures, the failure
in academic success as well as the social stigmatization of
children may create many problems in the family. With the
increased responsibilities of the parents, family activities
become restricted (Mu, 2005). Several studies showed signif-
icant amount of stress in families of children diagnosed with
epilepsy (Shore et al., 1998; Cushner-Weinstein et al., 2003).
Rodenburg et al. (2005) reviewed the literature about family
factors and psychopathology in children with epilepsy. They
showed that compared with the control group, families of
children with epilepsy generally fared worse on the whole
range of family factors, indicating a lower parent—child
relationship quality, more depression in mothers, and prob-
lems with family functioning. When the effect of epilepsy
on families was compared to the effect of other chronic ill-
nesses on families, the parents of children diagnosed with
epilepsy were shown to be much more affected than in the
other illnesses (Chiou and Hesieh, 2008). It has been shown
that mothers are the primary caregivers and are generally
more affected by their children’s chronic illnesses since as
a rule; it is the mother who protects and provides care for
the child’s well being and health (Kovacs et al., 1985). Ferro
and Speechley (2009) reviewed that between 12% and 49%
of mothers caring for children with epilepsy either met or
scored above the clinical cut offs for depression based on
the self-report screening measure. In a study by Iseri et al.
(2006), the rates of posttraumatic stress disorder and major
depressive disorder in the parents of children with epilepsy
were found to be statistically high. In contrast, Baki et al.
(2004) observed that the difference in proportion of moth-
ers was not significantly different between Turkish mothers
of children with epilepsy when compared to the mothers
of children without epilepsy. The depressive symptomatol-
ogy or psychopathology in mothers negatively impacts child
outcomes, including child adjustment, quality of life and
behavior (Adewuya, 2006). As for children with less con-
trollable seizures, the comorbidity of mental retardation
and learning disorders affected the mothers more negatively
(Cushner-Weinstein et al., 2003; Williams et al., 2003). The
results from a recent study by Wood et al. (2008) showed
that the only factor associated with maternal depressive
symptoms was the presence of behavior problems in the
child with epilepsy.
It has been suggested that the familial anxiety causing
activity limitations decreases the quality of life for the child
and the family. Parents who have high anxiety levels may
have a less understanding of what constitutes a higher risk
for their children and may misinterpret the condition of their
children (Williams et al., 2003).
Although the effect of childhood epilepsy on mothers’
psychological health has been increasingly addressed, the
influence on mothers’ attitudes and family functioning has
attracted less interest. It has not yet fully been understood
as to how the mothers’ anxiety, depression, attitudes and
the family functions relate to epilepsy.
A. Pekcanlar Akay et al.
The aim of this study was to investigate how epilepsy
affected the psychological profile (depression and anxiety)
of mothers whose children had epilepsy, their attitudes
towards their children and their family relationships. This
study also investigated the impact of seizure related factors
(type of seizures, intractability of seizures, and frequency
of seizures), duration of illness and comorbidity of mental
retardation on these parameters.
Subjects, materials and methods
This study was planned and conducted in The Department of Child
and Adolescent Psychiatry and The Department of Pediatric Neu-
rology, Dokuz Eylul University School of Medicine Hospital in 2010.
The study involved a series of 50 children with epilepsy and their
mothers. 60 children with epilepsy were selected from the Child
Neurology Department; 9 children and their mothers from the case
group declined to participate while 50 of them agreed to join the
study. One mother from the case group did not fill the scales prop-
erly. The control group consisted of 50 healthy children and their
mothers. A total of 60 controls were defined; 6 of them declined
to participate in the study while 4 of them did not complete the
necessary scales properly and did not return the necessary forms so
they were excluded. The entire group in the study, ranged between
the ages of 2—17 years. The control group had similar sociodemo-
graphic features (age, gender, education of children and the ages of
parents, family income, the education and professions of mothers,
number of siblings) to the epilepsy group. The control group was
recruited from a local school in the epidemiologic catchment area
of Dokuz Eylul University Hospital. All mothers gave informed con-
sent for their children to participate in the study and the children
gave assent. The study was approved by the Institutional Ethical
Committee. Mothers of children with epilepsy and those of the con-
trols were excluded if they had any known chronic disease or any
known or diagnosed psychiatric disorder.
Scales used in the study and their evaluation
Both children and mothers were interviewed by an experienced
psychiatrist. The sociodemographic data, medical history, family
history of children and mothers were recorded on a sociode-
mographic data form. This form consisted of sociodemographic
information including educational, occupational, marital and eco-
nomic status of mothers as well as information on the known chronic
illnesses and known psychiatric disorders.
All epilepsy groups consecutively recruited at the time of their
child’s visit to the outpatient Pediatric Neurology Clinic at Dokuz
Eylul University School of Medicine Hospital in 2010. The data
related to epilepsy included the age of the onset of the disease, the
duration of illness, modalities and dosages of antiepileptic treat-
ment, intractability to antiepileptic treatment, type of seizures,
frequency of seizures and the comorbidity of motor or mental retar-
dation. Patients who do not achieve seizure control after having
tried 2—3 antiepileptic drugs were defined as having intractable
epilepsy (Cross et al., 2006). The data were obtained from the
patient files at the time of the pediatric neurology department visit.
For the entire study group, mental retardation diagnoses were
determined by using psychiatric interview by an experienced child
and adolescent psychiatrist. An intelligence scale was not applied
to the children.
All mothers were asked to complete the Beck Depression Inven-
tory, State-Trait Anxiety Inventory, Parental Attitude Research
Instrument and Family Assessment Device in separate rooms in
the clinic (Beck et al., 1961; Spielberger et al., 1970; Schaefer
and Bell, 1958; Epstein et al., 1983) For depressive symptoms, we
used Beck Depression Inventory which was developed by Beck (Beck
Maternal reactions to a child with epilepsy
et al., 1961) and commonly used to assess depressive symptoms
in clinical settings (Ireys et al., 2001; Mulhern et al., 1992). For
anxiety symptoms, we used State-Trait Anxiety Inventory. State-
Trait Anxiety Inventory has been used in studies assessing the
impact of chronic medical conditions on psychological well being of
patients and their families (Vandvik and Eckblad, 1991). Mothers’
attitudes were evaluated with Parental Attitude Research Inven-
tory. The Attitude of Over-parenting refers to an over controlling,
anxious and over-demanding parental attitude. A Democratic Atti-
tude describes an encouraging supportive and sharing relationship.
Attitude of Hostility and Rejection refers to nervous, distressed
and angry mothers in relationship with her children. Marital Discor-
dance describes marital discordance on the child rearing activities
of the parents. Authoritarian Attitude reflects over-punishing and
a rigid parental attitude (Schaefer and Bell, 1958). Parental Atti-
tude Research Inventory has been used as a parental adjustment
measure in families of disabled children (Pal and Chaudhury, 1998).
Family functioning was assessed with Family Assessment Device.
Family Assessment Device has been used in several studies to assess
the functioning among mothers and fathers of children with chronic
conditions like juvenile rheumatic disease and juvenile diabetes
(Frank et al., 1998; Timko et al., 1992). Problem Solving reflects
the family’s ability to resolve problems. Communication refers to
the effectiveness, extent, clarity and directness of information
exchange in the family (Epstein et al., 1983). Roles describe the
efficacy with which family tasks are allocated and accomplished.
Affective Responsiveness refers to the ability of family members
to respond with appropriate emotion, encompassing feelings of
welfare (joy, love, concern, affection) and emergency (sadness,
depression, anger fear). Affective Involvement refers to the quality
of interest, concern, and investment that family members have for
each other. Behavior Control describes the standards and attitudes
for behavior. General Functioning describes a general problem in
all functions in the family (Epstein et al., 1983).
The reliability and validity of all these instruments have been
established in the Turkish population (Oner, 1996). The scales and
their adaptations are summarized in Table 1. All questionnaires
were self-report inventories that are commonly used in psychiatric
studies and are applicable to chronic conditions (Ireys et al., 2001;
Mulhern et al., 1992; Vandvik and Eckblad, 1991; Pal and Chaudhury,
1998; Frank et al., 1998; Timko et al., 1992).
Statistical assessment
Statistical analysis was performed using a computer package pro-
gram SPSS 15.0 (SPSS Inc., Chicago, IL). Chi-square test was used for
categorical data and T-test was used for parametric data (Portney
and Watkins, 1993a). In this study, the cases and controls were
compared regarding Beck Depression Inventory, State-Trait Anxi-
ety Inventory, Parental Attitude Research Instrument and Family
Assessment Device scales using Student’s t-test. The relations of
duration of epilepsy with scores of Beck Depression Inventory, State-
Trait Anxiety Inventory, Parental Attitude Research Instrument and
Family Assessment Device in mothers of children with epilepsy
were determined by Pearson’s correlation test. The type of seizure
and the scales applied to the mothers were analyzed with the
Mann—Whitney U-test. These tests have been commonly used in
these types of psychiatric studies (Portney and Watkins, 1993b). A
p value of <0.05 was considered significant.
Results
Mean age and gender distribution of the study and con-
trol groups are summarized in Table 2. Regarding age and
gender, there were no statistically significant differences
between the two groups (p = 0.907, p = 0.500, respectively).
215
The sociodemographic features of the children and the
mothers are summarized in Table 2.
The seizure related variables are summarized in Table 3.
Comparison of scores of Beck Depression
Inventory, State-Trait Anxiety Inventory, Parental
Attitude Research Instrument, and Family
Assessment Device
Mothers of the children with epilepsy had significantly higher
depression scores (p = 0.007) and state anxiety (p = 0.001)
compared to mothers of the control group. They demon-
strated significantly lower scores in Democratic Attitude
(p = 0.000). These mothers had significantly higher scores
Attitude of Hostility and Rejection (p = 0.000), Marital Dis-
cordance (p = 0.000) and Authoritarian Attitude (p = 0.000)
as compared to mothers of the control group. Comparison
of scores of Beck Depression Inventory, State-Trait Anxiety
Inventory, Parental Attitude Research Instrument, and Fam-
ily Assessment Device are summarized in Table 4.
The relation of duration of epilepsy with scores of
Beck Depression Inventory, State-Trait Anxiety
Inventory, Parental Attitude Research Instrument
and Family Assessment Device in mothers of
children with epilepsy
The mean duration of illness for children diagnosed with
epilepsy was 37.70 ± 34.05 (r: 2—144 months).
There was a statistically significant positive correlation
between the duration of epilepsy and the problematic family
functioning scores like Problem Solving (r = 0.355, p = 0.011),
Communication (r = 0.415, p = 0.003), Affective Involvement
(r = 0.322, p = 0.022), Behavior Control (r = 0.492, p = 0.003)
and General Functioning (r = 0.492, p = 0.000). The values up
2 points (clinical cut off) were to be accepted as abnormal
for Family Assessment Device. The longer the duration of the
illness, the worse the family functions were in the present
study.
The relation of the type and frequency of seizures
with the scale scores of the mothers of children
with epilepsy
Mothers of the group of children with more frequent
seizures (more than one seizure in a month) had significantly
higher Attitude of Over-parenting scores compared to the
group of mothers whose children had less frequent seizures
(p = 0.024).
No statistically significant relationship was found
between the types of seizures with the scale scores of the
mothers of children with epilepsy.
The relation of the intractability of drug therapy
with the scale scores of the mothers of children
with epilepsy
Patients who do not achieve seizure control after having
tried 2—3 antiepileptic drugs were defined as hav-
216 A. Pekcanlar Akay et al.

Table 1 Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument, Family Assessment
Device and their Turkish adaptations.

Scales Subscales Scores Evaluation of Devise and

scales adaptation

Beck Depression Sensibility 0—3 points 0—13 points: No Devised by Beck in

Inventory scores depression 1961.
Pessimism 14—24 points: Adopted by Tegin
Moderate in Turkey in 1980.
depression
Sense of failure Higher than 25
points: Severe
depression
Sense of guilt
Self-dissatisfaction
Self-accusation
Desire to commit suicide
Hysterical weeping seizures
Nervous breakdown
Social retreat indecisiveness
Conflicting self-image
Sleep disturbances tiredness
Loss of appetite
Loss of weight
Psychological complaints
Lack of sexual desire.
State-Trait Anxiety State anxiety: transient momentary 1, not at all, to Higher the score Devised by
Inventory emotional status that results from 4, very much so of the scales, the Spielbelger et al.
situational stress that fluctuates in more anxiety in 1970.
time and intensity display by the
patients.
Trait anxiety: predisposition of Adopted by Oner
people to react with anxiety when a and Le Compte in
stressful situation arises Turkey in 1985.
Parental Attitude Attitude of Over-parenting: over 1, not at all, to Higher the score Devised by
Research Instrument controlling, anxious and 4, very much so of the factor, the Schaefer and Bell
over-demanding parental attitude more the attitude in 1958.
is displayed by the
parents.
Democratic Attitude: encourages a Adopted by Küçük
supportive and a sharing relationship in Turkey in 1987.
Attitude of Hostility and Rejection:
nervous, distressed and angry
mothers in relationship with her
children
Marital Discordance: marital
discordance on the child rearing
activities of the parents
Authoritarian Attitude:
over-punishing and a rigid parental
attitude
Family Assessment Problem Solving: reflects the family’s A 4-point Liker The values up 2 Devised by Epstein
Device ability to resolve problems and the scale from points (clinical cut et al. in 1983.
steps they go through to do so. ‘‘strongly off) are to accept
disagree’’ to as abnormal.
strongly agree
Communication: refers to the Adopted by Bulut
effectiveness, extent, clarity and et al. in Turkey in
directness of information exchange in 1989.
the family.
Maternal reactions to a child with epilepsy 217

Table 2 Sociodemographic data of children and the mothers.

Epilepsy n: 50 Control n: 50
Mean ± standard deviation Mean ± standard deviation

Mean age of childerns (years) 9.76 ± 4.33 (range: 2—17) 9.86 ± 4.25 (range: 2—17)
Mean age of mothers (years) 35.76 ± 7.46 (range: 20—52) 37.55 ± 6.89 (range: 28—53)
n % n %
Gender
Female 27 54 22 44
Male 23 46 28 56
Education of children
No school 9 18 9 18
Preschooler 3 6 39 78
Elementary 34 68 2 4
High school 4 8
Education of the mother
Elementary 23 46 20 40
High school 26 52 25 50
University 1 2 5 10
Profession of the mother
Laborer 3 6 19 61.3
Government worker 10 20 2 6.5
Housewife 27 74 10 32.2
Social insurance
Yes 41 82 48 96
No 9 18 2 4

Table 3 Seizure related variables in epilepsy group.

Mean ± Standard deviation

The age of onset of illness (years) 6.59 ± 3.83 (range: 1—13)

Duration of illness (months) 37.70 ± 34.05 (range: 2—144)
n %
Type of seizure
Generalized
Absans 8 16
Generalized tonic-clonic 36 72
Partial
Complex partial 2 4
Simple partial 2 4
Rolandic 1 2
Other
West syndrome 1 2
Antiepileptic drugs
None 4 8
Monotherapy 38 76
Polytherapy 8 16
Seizure frequency
≤10/year 16 32
1—2/month 33 66
2—3/week 1 2
Response to drug
No response (intractability of seizures) 5 10
Positive response 45 90
Comorbid motor or mental retardation
Yes 15 30
No 35 70
218 A. Pekcanlar Akay et al.

Table 4 All scale results of mothers of children with epilepsy and control group (mean values).

Epilepsy n: 50 Control n: 50 p*
Mean ± standard Mean ± standard
deviation deviation

Beck Depression Inventory 11.66 ± 8.66 7.60 ± 5.55 0.007

State anxiety 39.04 ± 9.77 32.74 ± 9.15 0.001
Trait anxiety 41.00 ± 7.32 42.54 ± 7.52 0.302
Attitude of Over-parenting 42.44 ± 3.47 42.44 ± 8.95 1.000
Democratic Attitude 25.16 ± 2.04 28.80 ± 3.88 0.000
Attitude of Hostility and Rejection 35.86 ± 3.74 28.08 ± 8.53 0.000
Marital Discordance 18.02 ± 2.12 14.72 ± 4.45 0.000
Authoritarian Attitude 40.74 ± 4.79 33.68 ± 9.20 0.000
Problem Solving 1.91 ± 0.67 1.98 ± 0.64 0.547
Communication 1.77 ± 0.53 1.84 ± 0.55 0.567
Roles 1.95 ± 0.44 1.96 ± 0.44 0.881
Affective Responsiveness 1.78 ± 0.59 1.83 ± 0.63 0.644
Affective Involvement 1.99 ± 0.48 1.99 ± 0.47 0.988
Behavior Control 1.78 ± 0.41 1.75 ± 0.44 0.764
General Functioning 1.80 ± 0.53 1.85 ± 0.57 0.655
* t-Test was used.

ing intractable epilepsy. Mothers of the children with
intractable seizures had significantly higher trait anxiety
scores compared to the group of mothers whose children
achieved seizure control (p = 0.027).
The relation of the antiepileptic drug use with the
scale scores of the mothers of children with
epilepsy
Mothers of the group of children with epilepsy that had no
medication had significantly higher Behavior Control scores
compared to the group of mothers whose children had one
or more antiepileptic drugs (p = 0.019).
The relation of comorbid motor and mental
retardation with the scale scores of the mothers of
children with epilepsy
Mothers of the children with epilepsy, in the presence of
motor or mental retardation had significantly higher Prob-
lem Solving scores compared to the group of mothers whose
children without motor or mental retardation (p = 0.036).
The values up to 2 points (clinical cut off) were to be
accepted as abnormal for Problem Solving scores. Higher
Problem Solving scores as family function refer to a higher
problem solving deficit.
Discussion
The mothers of children diagnosed with epilepsy reported
a higher level of depression and state anxiety compared to
the mothers of the control group in the present study, which
was similar to previous studies (Ferro and Speechley, 2009;
Williams et al., 2003). These results may have been caused
by the unpredictable course of the illness when the child may
have been at risk of death during seizures and social stigma-
tization. The families have to deal with stressors regarding
the illness like frequent health checkups and treatment pro-
cedures (Lv et al., 2009). The high level of anxiety and
depression among these mothers might affect their attitudes
towards their children and family functioning.
In the present study, mothers of the children with
epilepsy obtained lower scores in the areas of Democratic
Attitude compared to the mothers of the control group. This
result means that mothers of the children with epilepsy,
as compared to the mothers of the control group, failed
to be a supportive parent and to develop a sharing rela-
tionship with their children. In this study, mothers whose
children had epilepsy had increased attitudes of hostility
and rejection, Marital Discordance on the child rearing activ-
ities and over-punishing, and a rigid parental attitude as
compared to mothers of the control group. This might indi-
cate that mothers of children with epilepsy are unhappier
and more unsatisfied with respect to their maternal role
than the mothers of the control group. Mothers of the chil-
dren with epilepsy were nervous, distressed and angry in
their relationships with their children. The chronic illness
of children could change family roles causing anger or guilt
in the parents. Parents could become isolated from family
and friends, which may limit the parents’ ability to pursue
their own interests (Cole and Reiss, 1993). Epilepsy could
create a significant negative social stigmatization or having
a child with chronic disorder may cause trouble undertaking
the motherhood role (Wirrel et al., 2008).
It was shown that the longer the duration of the illness,
the worse were the family functions like ‘Problem Solving’,
‘Communication’, ‘Affective Involvement’, ‘Behavioral Con-
trol’ and ‘General Functioning’ in the present study.
As the duration of the illness increases, the impairment
in family functions might reflect a poor adaptation to the
illness. Chronic conditions could upset existing structures
within the family system and may provoke changes to restore
equilibrium and reestablish or recreate roles, rituals, and
daily routines. Families may deal with illness-related stres-
Maternal reactions to a child with epilepsy
sors such as the need for frequent medical visits, the
demands of a multicomponent treatment regimen, and
an unpredictable illness course. Parents of children with
epilepsy might display controlled behavior in expressing
their feelings, especially negative feelings such as sad-
ness, depression, anger and fear towards their children
with epilepsy. They might also display more nervous and
angry feelings towards their children with the intention
of protecting the child or with the seizure-related fears.
The increased duration of illness in epilepsy was associ-
ated with an increased authoritarian; over-punishing and
rigid parental attitude in the mothers of the children with
epilepsy in the present study. In another study, it was shown
that as the duration of illness increases in chronic diseases,
the controlling type of behavior and anxiety levels rises in
the families (Cole and Reiss, 1993). Regarding the results of
the present study, when the functional areas are taken into
consideration, it might be suggested that the long duration
of illness may cause many problems in mothers and families.
As in previous studies, both conditions, severity involving
the presence of other disabilities, and poor seizure control
were associated with the mother’s anxiety and poor fam-
ily functioning (Williams et al., 2003; Lv et al., 2009). In
the results of the present study, poor seizure control and
intractable seizures were associated with increased trait
of anxiety of the mothers. There were problems of atti-
tude in over-parenting, implying an over controlling, anxious
and over-demanding parental attitude. Thus, mothers of the
children with epilepsy might hold over supportive and caring
roles which rendered their children to become more depen-
dent and less able to function independently. Findings from
the present study suggest that if their children had men-
tal retardation, mothers of children with epilepsy had more
difficulty in problem solving which reflects the families’ abil-
ity to resolve problems. Parents of children with epilepsy
might develop a sense of loss and helplessness associated
with their role as parents. When parents cannot control the
seizures, a feeling of helplessness may often result in the
reduction of parental confidence and role certainty.
Behavior problems and attention deficit problems are
common in children with epilepsy. Rodenburg et al. (2006)
demonstrated that parental psychopathology was signifi-
cantly correlated with both internalizing and externalizing
behavior problems in children with epilepsy. However, since
we did not hand out a scale that scans the children’s psy-
chiatric symptoms we were not able to relate them to the
mothers’ psychopathologies. This may also be considered
as a limitation for the study. Other possible limitations of
this study include the small sample size and the exclusion
of fathers and siblings of children with epilepsy. With these
limitations in mind, we demonstrated the efficacy of psy-
chological instruments such as Parental Attitude Research
Instrument and Family Assessment Device in studying the
psychosocial effects of a chronic medical condition like
epilepsy on the patients and families.
In conclusion, this study proves the hypothesis that moth-
ers of children with epilepsy may experience difficulties
regarding their children’s chronic illnesses. The mothers
of children with epilepsy and their attitudes and family
functioning are affected negatively during the process. The
recognition of the possibility that the mother could be
directly affected by her child’s chronic condition should
219
be kept in mind by pediatricians. The psychosocial aspects
of epilepsy have to be managed while working with these
patients and their families to explain the importance of
preventive approaches and treatment interventions.
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