Interaction patterns in the families of children with idiopathic epilepsy

Behaviour disturbances in epileptic children are currently recognised to be a function of a complex interaction of physiological and environmental factors. In cases of idiopathic epilepsy, family attitudes and behaviour have been consistently demonstrated to be the most significant causal antecedents of deviant behaviour. However, this conclusion has been based almost entirely on techniques designed to demonstrate psychological abnormalities in the parents of epileptic children. Consequently, theories derived from this research are inadequate due to their reliance on the outmoded conceptualisation of behaviour as a function of immutable personality traits, and also due to their failure to indicate therapeutic guide-lines. The present study proposed an alternative model of the effects of family behaviour on the adjustment of epileptic children, based on family interaction and social learning theories. The behaviour of epileptic member families was conceptualised as the adaptive reaction of an interdependent group to a crisis situation, leading to alterations in the behaviour of the epileptic child in the direction of conformity with the group. The study employed a semi-structured interview and videotaped observations of family interaction, initiated by means of the Revealed Differences Technique. Thirty family tetrads were studied, consisting of the parents, and two children aged between 8 and 16 years. Of these, fifteen contained an epileptic elder child and the other fifteen served as a control group matched for socio-economic status, religion, nationality, occupational status of the mother, and the age, sex and birth order of the siblings. Analysis of the family interaction sequences demonstrated that epileptic-member families formed rigid hierarchical units with increased efficiency in problem-solving. The mother emerged as a strong family leader. The epileptic child was observed to take a position of reduced involvement in family interaction and to actively withdraw from family decision making. The results support crisis theories of family behaviour which maintain that in situations where family integrity is threatened, a more stable and secure system of family organisation is adopted. The cross-sectional design of the study did not permit the demonstration of a causal relationship between family behaviour and the onset of behaviour disturbance in the epileptic child. However, it demonstrated in functional, behavioural terms, important differences between epileptic-member and normal families which strongly support such a casual relationsh1p and stressed, therefore, the need for further research in this area. The clinical value of the present study is discussed in terms of the guide-lines these results offer for clinical intervention techniques based on social learning theory.