Pediatric epilepsy surgery patients show normal psychosocial development at long-term follow-up despite dissatisfying family dynamics.

Drug-resistant pediatric epilepsy involves unpredictable seizures and long-term medical management. Both factors can alter a child's psychosocial development and the dynamics of the family, to the detriment of patient and family wellbeing. While drug-resistant pediatric epilepsy can be successfully treated by neurosurgery in some cases, the outlook for psychosocial and family functioning after surgery remains unclear. A total of 163 participants across four groups took part in the current study: these were (i) individuals who had undergone surgical treatment of drug-resistant focal seizures approximately five years prior as children, and were now largely adolescents or young adults ('Patients'; n = 23), (ii) their caregivers ('Patient Caregivers'; n = 27), (iii) healthy individuals of similar age and gender to the Patients ('Controls'; n = 53), and (iv) their caregivers ('Control Caregivers'; n = 60). Based on similar software validated in adults, we built an interactive computer program, 'Living with Epilepsy', to evaluate the achievement of age-specific developmental tasks in Patients relative to their peers. The Family Adaptability and Cohesion Scale measured family dynamics. The findings showed that in the context of seizure freedom, after pediatric epilepsy surgery, Patients are similar to their healthy peers in terms of attaining developmental tasks, with no differences between the Patient and Control groups (P > .05). Family dynamics, however, seemed resistant to postsurgical adaptation, with Patients reporting lower levels of balanced family dynamics (cohesion, flexibility) and higher rates of unbalanced family dynamics (disengagement, chaos, rigidity, enmeshment) relative to Patient Caregivers (P < .001-0.041), and the Controls (P = .011-0.034). Patients also reported reduced family satisfaction compared with that of Patient Caregivers (P = .002), which was associated with polytherapy prior to surgery; that is, more drug-resistant seizures. These findings suggested that childhood-onset epilepsy has a lasting effect on family functioning, even when the child has an optimal medical and psychosocial outcome. These initial findings have significant implications for the provision of pre- to postoperative family support in pediatric epilepsy cases.

Winners and losers: Reward and punishment produce biases in temporal selection.

Studies of visual search demonstrate that the 'learned value' of stimuli (the extent to which they signal valued events, such as rewards and punishments) influences whether they will be prioritized by spatial attention. Recent work suggests that learned value also modulates attentional prioritization even when all stimuli are presented in the same location, suggesting an influence on temporal selection wherein value-related stimuli become more capable of disrupting central mechanisms of perceptual awareness. However, it remains unclear whether temporal selection is influenced specifically by learning about the relationship of stimuli with reward, or with punishment, or both. This question motivated the current experiments. Participants saw a stream of pictures in a central location, and had to identify the orientation of a rotated target picture. In Experiment 1, response accuracy was reduced if the target was preceded by a 'valued' distractor picture that signaled that a correct response to the target would be rewarded, relative to a distractor picture that did not signal reward. In Experiment 2, accuracy was reduced if the valued distractor picture signaled that an incorrect response would be punished, relative to a distractor that did not signal punishment. Experiment 3 replicated these findings, and demonstrated that the influence of rewards/punishments persisted into an extinction phase in which valued distractors were entirely task-irrelevant. These findings suggest that it is the motivational significance of the outcome, rather than its valence, that is the crucial determinant of the influence of learned value on temporal selection. (PsycINFO Database Record (c) 2019 APA, all rights reserved).