Do Kids with Epilepsy Have Behavioural Problems?

By Haris Bin Tahir  ·  BrainCarePath.com

Key Takeaways

• Approximately 37% of children with newly diagnosed epilepsy meet criteria for at least one behavioural or psychiatric condition
• Behavioural difficulties in epilepsy often predate medication — they reflect the underlying neurology, not treatment side effects alone
• ADHD symptoms are four to five times more common in children with epilepsy than in the general population
• Levetiracetam (Keppra) is associated with irritability and mood changes in approximately 10–20% of children — always discuss new behaviour changes with your neurologist
• The right response is not stricter discipline — it is accurate diagnosis, appropriate school support, and targeted intervention

The paediatrician said something that caught me off guard. “Some of what looks like behaviour in these children is actually the epilepsy itself.” He was talking about a child in his clinic, not our son — but I leaned forward anyway, because I recognised something in what he was describing.

Parents of children with epilepsy consistently report that behavioural challenges are among the most difficult and least-discussed aspects of the condition. Not the seizures themselves — though those are frightening enough — but the day-to-day struggles with mood, attention, and emotional regulation that arrive alongside the diagnosis.

Do kids with epilepsy have behavioral issues? The honest answer is: yes, many do. But the reasons are more complex than most parents are ever told, and understanding those reasons changes how you respond, what support you seek, and how you talk to your child about what is happening.

Why Epilepsy Affects Behaviour

The brain regions involved in seizure activity are often the same regions that govern behaviour, attention, and emotional processing. Epilepsy is not just a condition of occasional electrical storms — it affects brain function between seizures as well.

There are several overlapping reasons why children with epilepsy show higher rates of behavioural difficulties. The underlying brain condition matters: epilepsy is frequently caused by underlying neurological differences — cortical dysplasia, structural brain abnormalities, or prior brain injury — and these same underlying differences can affect the neural circuits responsible for behaviour and emotional regulation independently of the seizures themselves. The seizures themselves also play a role: both the seizure and the postictal state (the period after a seizure) disrupt normal brain function, and frequent seizures interfere with memory consolidation, attention, and the brain’s ability to regulate emotional responses over time.

Medication side effects add another layer. Antiepileptic drugs (AEDs) affect brain chemistry broadly, not just the circuits involved in seizure activity. Levetiracetam (Keppra) is particularly notable — irritability, aggression, and mood instability are documented side effects in 10–20% of children. Finally, the psychological impact should not be underestimated. Living with unpredictable seizures is itself stressful. Children with epilepsy show significantly elevated rates of anxiety and depression — a rational response to an unpredictable condition over which they have little control.

What Behavioural Problems Are Most Common in Children with Epilepsy

Research has identified a consistent set of behavioural and emotional challenges in children with epilepsy. ADHD and attention difficulties are among the most prevalent — children with epilepsy are four to five times more likely to meet diagnostic criteria for ADHD than children without epilepsy, with attention difficulties affecting approximately 30–40% of children with epilepsy versus 5–10% of the general child population.

Anxiety disorders occur in approximately 20–30% of children with childhood epilepsy. The unpredictability of seizures, the fear of having a seizure in public, and the stigma experienced at school all contribute. Mood and emotional dysregulation are also common, with children showing elevated rates of depressive symptoms, emotional outbursts, and difficulty regulating frustration — particularly pronounced in children with frontal or temporal lobe seizure foci, as these regions directly govern emotional processing.

Oppositional behaviour develops in some children as a secondary response to the frustration and anxiety of their condition, or as a response to parenting approaches that inadvertently reinforce avoidance behaviours. Social difficulties are also common — seizure unpredictability leads many children to withdraw from social situations, and the stigma sometimes experienced at school reduces social engagement over time.

What the Research Shows

A landmark study by Hamiwka et al. published in Epilepsia in 2009 examined the prevalence of behavioural disorders in 100 children with newly diagnosed epilepsy and found that 37% met criteria for at least one psychiatric or behavioural disorder — a rate significantly higher than matched controls. Importantly, these rates were elevated at the time of first diagnosis, before any medication was started, demonstrating that the behaviour difficulties predate treatment and relate to the underlying neurology. The study is available at https://pubmed.ncbi.nlm.nih.gov/19220409/.

A follow-up study published in Epilepsia by Reilly et al. examined attention and executive function in children newly diagnosed with epilepsy and found significant difficulties in sustained attention and inhibitory control even at the point of first diagnosis. The study is available at https://pubmed.ncbi.nlm.nih.gov/25066115/. Research on levetiracetam specifically has consistently shown behavioural side effects in a significant minority of patients — a Cochrane review found that behavioural side effects occurred in approximately 15% of children taking levetiracetam and were among the most common reasons for discontinuation, though these effects often resolve when the medication is switched or the dose adjusted.

What This Means for Your Family

The most important thing I can tell you about behavioral issues in kids with epilepsy is this: they are not proof that your parenting has failed. They are not a sign that your child is choosing to be difficult. They are, in the majority of cases, a neurological, pharmacological, or psychological response to the epilepsy itself.

That means the solutions are not purely behavioural. Some of them are medical — reviewing medication, adjusting dose, adding treatment for comorbid ADHD or anxiety. Some are educational — school accommodations, IEP, teacher training. Some are therapeutic — cognitive-behavioural therapy for anxiety, family therapy for parent-child dynamics that have shifted around the diagnosis. And some are social — peer support, age-appropriate explanation of the condition to the child.

Practical steps for families: talk to the neurologist specifically about behaviour, because behaviour changes may signal a seizure-related issue or medication side effect. Request a neuropsychological assessment — this identifies whether ADHD or anxiety exists as a co-occurring condition. Inform the school clearly and create a seizure action plan, since teachers who understand epilepsy respond differently to behaviour incidents. Connect with other parents, because the behavioural challenges of childhood epilepsy are consistently underrepresented in the formal medical conversation.

Questions to Ask Your Child’s Neurologist and School

• Ask: Could any of my child’s behaviour changes be related to their seizures or postictal state?
• Ask: Could the behaviour changes be a side effect of the current medication?
• Ask: Should we assess my child for ADHD or anxiety as co-occurring conditions?
• Ask: What school accommodations are appropriate for a child with epilepsy and attention difficulties?
• Ask: Is cognitive-behavioural therapy or social skills training recommended for my child?
• Ask: At what point would you recommend a referral to a paediatric psychiatrist or psychologist?
• Ask: How do we tell the school what to watch for — including subtle behaviour changes that may be seizure-related?

Frequently Asked Questions About Kids with Epilepsy and Behavioural Problems

Do kids with epilepsy have behavioral issues more than other children?

Yes. Research consistently shows that children with epilepsy have significantly higher rates of ADHD, anxiety, and emotional difficulties than children without epilepsy. Approximately 30–40% of children with epilepsy meet criteria for at least one behavioural or psychiatric diagnosis. The reasons include the underlying neurology of the epilepsy itself, medication side effects, and the psychological impact of living with an unpredictable condition.

Can seizure medications cause behaviour problems in children?

Yes. Certain antiepileptic drugs (AEDs) are associated with specific behavioural side effects. Levetiracetam (Keppra) is the most commonly cited — irritability, aggression, and mood instability occur in approximately 10–20% of children who take it. Phenobarbital is associated with hyperactivity. If behaviour changes began or worsened after starting a new medication, discuss this with your neurologist. Side effects often resolve when the medication is switched or the dose adjusted.

What is the link between epilepsy and ADHD in children?

The link is neurological. The brain circuits affected in epilepsy overlap significantly with those involved in attention regulation. Additionally, frequent subclinical seizures — small electrical discharges that do not cause obvious physical symptoms — can disrupt attention continuously throughout the day without being detected. ADHD diagnosis in a child with epilepsy requires careful assessment to distinguish medication side effects, subclinical seizures, and true comorbid ADHD.

How can I tell if my child’s behaviour is epilepsy-related or just typical development?

A neuropsychological assessment is the most reliable way to understand this. Key questions to consider: Did the behaviour changes begin or worsen with the epilepsy diagnosis or medication start? Are the behaviours episodic — worse at certain times of day or around seizures? Do teachers describe the same patterns at school, or are they home-specific? These questions help narrow the cause and guide the most appropriate support.

The paediatrician’s words stayed with me because they shifted something. Not the diagnosis — that was already there. But the way I understood what I was seeing. When the behaviour is the epilepsy, the response to the behaviour changes. Your child is not choosing to struggle. They are navigating a condition that makes certain things genuinely harder. Your job is not to fix the behaviour. It is to understand what is driving it — and then find the right people to help address it at its actual source. That is not a small thing. It is, in fact, everything.

This article is written for informational purposes only and does not constitute medical advice. Always consult your neurologist, paediatrician, or qualified healthcare provider for diagnosis and treatment decisions specific to your child’s situation. Read our full medical disclaimer at braincarepath.com/disclaimer/

References: 1. Hamiwka LD, Wirrell EC. Comorbidities in pediatric epilepsy. J Child Neurol. 2009. PMID 19220409 · 2. Reilly C et al. Neurobehavioral comorbidities in children with active epilepsy. Pediatrics. 2014. PMID 25066115