Epilepsy and ADHD

 

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    Attention-deficit/hyperactivity disorder (ADHD) occurs more frequently in people with epilepsy than in the general population. ADHD is the most common co-occurring disorder in children with epilepsy. Studies suggest that 30 to 40 out of 100 children with epilepsy have ADHD, a rate that is 2.5 to 5.5 times higher than the general population. Amongst children with epilepsy, those with other developmental delays or intellectual disability and those with poor seizure control appear at the highest risk of ADHD.

    About ADHD

    There are three types or “presentations” of ADHD:

    1. Predominantly inattentive
    2. Predominantly hyperactive-impulsive
    3. Combined

    Children with epilepsy more commonly have the predominantly inattentive or combined type of ADHD.

    Inattentive

    People with ADHD that is mostly inattentive typically have trouble with:

    • Focusing on details
    • Making careless mistakes
    • Difficulty paying attention
    • Listening
    • Following instructions
    • Organizing
    • Doing tasks requiring sustained mental effort
    • Keeping track of belongings
    • Getting easily distracted
    • Remembering things while doing daily activities 
    Hyperactive-Impulsive

    People with ADHD hyperactive-impulsive presentation have trouble with: 

    • Constantly fidgeting with their hands or feet  
    • Squirming in their chair or not remaining seated
    • Running about or climbing excessively in children  
    • Extreme restlessness in adults
    • Difficulty quietly engaging in activities  
    • Excessively talkative
    • Blurting out answers before questions have been completed
    • Difficulty waiting or taking turns
    • Interrupting or intruding upon others 
    Combined

    Combined presentation of ADHD is a third type of this condition where people have both the symptoms of inattentive and hyperactive/impulsive symptoms.  

    Screening for ADHD

    As all children with epilepsy are at higher risk of developing ADHD, it is recommended that screening happens on an annual basis from the time they enter school. There are many different tools that your healthcare provider can use to screen for ADHD. This involves asking questions about your child’s learning and focus as well as having both parents and teachers complete standardized questionnaires.

    Some anti-seizure medications can also affect attention. Because of this, it is important to let your healthcare provider know if your child is experiencing difficulties with their focus after a new medicine is started. 

    What can mimic ADHD?

    Certain seizure types can also result in inattentive staring. These include absence seizures or focal seizures with impaired awareness. Most children who stare due to inattention will respond to calling their name or touch stimulation. Children who have a seizure that leads to staring generally cannot respond to any stimulation until the seizure ends. Trying more touch stimulation can be helpful in figuring out if the staring is due to inattention versus due to a seizure.

    Children who have difficulties in learning can also have more staring episodes particularly during school or homework. For children who are struggling at school, it is important to test for underlying learning difficulties.  

    Children who have sleep problems and are chronically overtired will also have difficulties with their focus and attention.

    Other mental health conditions such as anxiety and depression may also manifest with difficulties in attention and focus. These disorders also often coexist with ADHD. 

    Treating both ADHD and Epilepsy

    Treating someone with both epilepsy and ADHD can be challenging. Some seizure medicines can make ADHD symptoms worse. Some people are concerned that stimulant medication, often used to treat ADHD, can trigger seizures. However, the likelihood of this is very low.

    In most persons with epilepsy, medications to treat ADHD are both safe and effective. It is important to work with healthcare professionals who are knowledgeable about epilepsy and behavior.

    A treatment plan that addresses both epilepsy and ADHD should be developed.  

    Treatment options for ADHD include the following:

    • Behavioral or cognitive behavioral therapy
    • Medication
    • Skills training
    • Coaching
    • School accommodation

    Help should be unique to each person to help control symptoms, cope with both disorders, improve overall psychological well-being, and manage social relationships. Family involvement is important, too. Both ADHD and epilepsy affect the family. The family’s understanding of, and confidence in managing, the impact of both disorders should be addressed in the treatment plan.

    For children who require medication, these medications can be very effective at allowing your child to focus and learn to improve academic success and self-esteem. 

    Learn More

    Authored By:

    Ann Abramowitz PhD
    Petrina Hollingsworth MA, MBA

    on Sunday, July 29, 2018

    Reviewed By:

    Joseph I. Sirven MD / Patricia O. Shafer RN, MN

    on Sunday, July 29, 2018

    Resources

    Epilepsy Centers

    Epilepsy centers provide you with a team of specialists to help you diagnose your epilepsy and explore treatment options.

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    Epilepsy Medication

    Find in-depth information on anti-seizure medications so you know what to ask your doctor.

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    Epilepsy and Seizures 24/7 Helpline

    Call our Epilepsy and Seizures 24/7 Helpline and talk with an epilepsy information specialist or submit a question online.

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    Tools & Resources

    Get information, tips, and more to help you manage your epilepsy.

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