The aim of this study was to characterize the distribution, timing, and risk factors for psychiatric comorbidity in children with recent onset epilepsy. Children aged 8 to 18 years with recent onset epilepsy (<1 year in duration) of idiopathic etiology (n=53) and a healthy comparison group (n=50) underwent a structured psychiatric diagnostic interview to characterize the spectrum of lifetime-to-date history of comorbid psychiatric disorder. There was no significant difference between the children with recent onset epilepsy and healthy comparison children in sex (31 males, 22 females vs 23 males, 27 females) or mean age 12.7y [SD 3.3] vs 12.7y [SD 3.2]). Children with recent onset epilepsy exhibited an elevated rate of lifetime-to-date Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I disorders compared with the comparison group. They showed significantly higher rates of depressive disorders (22.6 vs. 4%, p=0.01), anxiety disorders (35.8 vs 22%, p<0.05), and attention-deficit-hyperactivity disorder (26.4 vs 10%, p=0.01) with elevated but less prevalent rates of oppositional defiant and tic disorders. A subset of children with epilepsy (45%) exhibited DSM-IV Axis I disorders before the first recognized seizure, suggesting the potential influence of antecedent neurobiological factors that remain to be identified. The increased prevalence of psychiatric comorbidity antedating epilepsy onset may be consistent with the presence of underlying neurobiological influences independent of seizures, epilepsy syndrome, and medication treatment.Two population-based epidemiological investigations, conducted in the UK decades apart, demonstrate that psychiatric comorbidity is a significant complication of chronic childhood epilepsy. In the well-known Isle of Wight study, Rutter et al. 1 reported that 7% of children in the general population exhibited a mental health problem compared with 12% of children with non-neurological physical disorders. Significantly, higher rates were reported in epilepsy: 29% in children with uncomplicated and 58% in those with complicated epilepsy (i.e. structural brain abnormalities and seizures). In the recent UK epidemiological investigation conducted by Davies et al., 2 some 30 years after the Rutter et al. study, strikingly similar findings were reported. Psychiatric disorders were found in 9.3% of the general population aged 5 to 15 years, in 10.6% of those with a chronic medical disorder (diabetes), again with increased rates in epilepsy, including 26% in uncomplicated epilepsy and 56% in complicated epilepsy. These epidemiological studies confirm that children and adolescents with chronic epilepsy are at increased risk of mental health problems compared with the general population and children with other chronic non-neurological conditions. These core findings have been replicated and refined in a large number of clinical investigations using self-report and proxy-based measures of emotional-behavioral status. 3