Day dreaming and childhood preoccupation

Abstract

All doctors caring for children with paroxysmal disorders know that an important differential diagnosis for absence seizures (both typical in the ‘normal’ child and atypical in the child with neurodevelopmental problems) and to a lesser extent complex focal seizures is daydreaming and childhood preoccupation. Indeed when, in preparation for writing this report, I audited over a four month period those children referred for ‘blank episodes’ and similar concerns to my rapid access epilepsy clinic where I see patients with suspected new-onset seizures, I made a diagnosis of epilepsy in 5 cases and of probable day dreaming / childhood preoccupation in another 5. However, with the exception of brief references to daydreaming/preoccupation in textbooks, usually in the context of considering the differential diagnosis of typical absence seizures, there is virtually nothing published on this subject. A Medline search of ‘day dreams’, ‘day dreaming’ and ‘preoccupation’ yields very few hits and none are relevant to the consideration of the differential diagnosis of paroxysmal events in children. What follows, therefore, is personal opinion, albeit from a clinician who has a special interest in absence seizures in children.