We examined theory of mind (ToM; mental state understanding) and language in children with epilepsy (EP; n = 10; mean age = 9.92, SD = 2.34) and with typical development (TD; n = 20; mean age = 10.05, SD = 2.08). The EP group demonstrated worse ToM compared to the TD group (t(28) = −1.11, p = .28, d = .44) but differences did not persist when controlling for language. Syntactic language was correlated with ToM in the EP group (rho (10) = .79, p < .01). This study confirms language is important for ToM in a group of children with a neurological disorder and indicates that children with epilepsy are at risk for difficulties in understanding the mental states of others due to their language deficits. This may help to explain the social difficulties these children have with their peers.

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Epilepsy is the number one neurological disorder in children in western society. Childhood epilepsy is highly comorbid with psychopathology. Although neurological and biological factors may partially explain the increased risk of psychopathology in children with epilepsy, social contextual factors are also important to understanding development of psychopathology in children with epilepsy. The current paper examines the development of children with epilepsy utilizing Bronfenbrenner's micro-, meso-, exo-, and macrosystem social contexts. Negative interpersonal interactions within the microsystems and the ripple effect of social context at the other levels may contribute to increased risk for psychopathology.