significantly higher rates of anxiety, depression, and behavioral difficulties compared to their peers. Now, a large study offers fresh insights into how these young patients improve during therapy, and the findings challenge some common assumptions about the pace of recovery.
Rapid Improvements Are Common
Researchers analyzed data from 147 children and teenagers with epilepsy who received cognitive behavioral therapy as part of a clinical trial. They were looking for "sudden gains," moments when symptoms improved dramatically between one therapy session and the next, rather than gradually over time.
The results were striking. Nearly half of the participants experienced at least one sudden gain during treatment, with 39% having between two and four of these rapid improvements across different measures. These weren't small changes but substantial leaps forward that remained stable in subsequent sessions.
Personal Goals Tell a Different Story
One of the most interesting findings involved how progress was measured. The study tracked both standardized questionnaires that psychologists typically use and personalized goals that each child and their family set with their therapist. These individual goals might include things like asking a teacher for help when stuck in class or reacting calmly when waiting for their turn.
Sudden gains occurred far more frequently when looking at these personal goals compared to standardized measures. About 45% of participants experienced sudden gains in their individual goals, while standardized symptom measures showed lower rates of sudden improvement. This suggests that conventional questionnaires might miss important progress that matters most to families.
The Therapy Itself Was Unique
The intervention studied was delivered remotely by specially trained staff who weren't mental health professionals, though they received supervision from clinical psychologists. Participants received up to 22 sessions over six months, with the treatment tailored to each child's specific needs, whether that was anxiety, depression, or behavioral issues.
Most sudden gains on personal goals and measures of parental confidence happened very early in treatment, typically within the first few sessions. However, improvements on other measures like behavior problems or anxiety tended to occur later, between sessions five and ten.
Who Experiences Sudden Gains?
The study examined whether certain characteristics made sudden gains more or less likely. The findings were mixed and somewhat surprising.
Children from non white ethnic backgrounds were significantly less likely to experience sudden gains in their personal goals, a pattern that has appeared in other therapy studies as well. Children whose primary caregiver was not employed were less likely to have sudden gains in anxiety measures.
On the other hand, children with intellectual disabilities were more likely to experience sudden gains in behavioral measures. And predictably, children who attended more therapy sessions had more opportunities for sudden gains to occur.
Interestingly, many factors that clinicians might expect to matter, such as age or the type of mental health problem, didn't consistently predict whether a child would experience these rapid improvements.
What This Means for Outcomes
Children who experienced sudden gains had better scores at the end of therapy on the specific measures where they improved. However, when researchers looked six months later at overall mental health symptoms, sudden gains didn't predict better outcomes.
This finding is actually encouraging in an unexpected way. It suggests that steady, gradual progress is just as valuable as dramatic breakthroughs. Parents and therapists shouldn't be discouraged if improvement comes slowly rather than in leaps.
A Few Setbacks Along the Way
The researchers also tracked "sudden losses," when symptoms temporarily worsened between sessions. These were less common than sudden gains and, reassuringly, most reversed during the course of treatment. Sudden losses tended to happen later in therapy and were most common for anxiety, behavioral problems, and the impact of seizures on daily life.
Implications for Treatment
The study raises important questions about how therapy progress should be monitored. Currently, most sudden gains research happens retrospectively, after treatment ends. But what if therapists received real time feedback about sudden changes during treatment? Could they capitalize on sudden gains or address sudden losses more effectively?
The research also highlights the value of tracking progress using measures that matter most to individual families, not just standardized symptom checklists. Each approach captures different aspects of improvement.
For families with children who have epilepsy and mental health difficulties, this research offers hope. Effective therapy is available, progress can happen in various ways, and meaningful improvement doesn't always require dramatic breakthroughs. Whether change comes suddenly or gradually, what matters is that it comes.
The study included children across a wide age range, from preschoolers to teenagers, as well as those with autism and intellectual disabilities, reflecting the diversity of real world clinical practice. This breadth makes the findings particularly relevant for families navigating these challenges.
Richards‐Belle, A., Linton, D., Cross, J. H., Heyman, I., Dalrymple, E., Chorpita, B., ... & Bennett, S. (2025). Sudden gains in modular CBT for mental health disorders in children and young people with epilepsy. Journal of Child Psychology and Psychiatry.
