Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey

Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study

Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.

Patterns of mental health problems and well-being in children with disabilities in Sweden: A cross-sectional survey and cluster analysis

BACKGROUND

Children with disabilities have an increased risk of mental health problems. Patterns of mental health problems and well-being may vary.

AIMS

To identify patterns of mental health problems and well-being in children with disabilities in Sweden, and investigate the influence of parental background (migration, education), and child cognitive level.

METHOD

In this cross-sectional study, cluster analysis was used to analyse parents' ratings of conduct problems, emotional symptoms, and prosocial behaviour on the Strengths and Difficulties Questionnaire (SDQ) in children with disabilities (n = 136). The influence of parental background (migration, education) and child cognitive level on cluster membership was explored through multinomial logistic regression.

RESULTS

Five clusters of mental health patterns emerged. Three clusters had mean ratings near or past clinical cut-off for one each of the SDQ-subscales. One cluster had difficulties on all three subscales. Greater child cognitive difficulties increased the likelihood of low prosocial behaviour (OR 2.501, p < .001) and of difficulties on all three subscales (OR 2.155, p = .006). Parental background did not influence cluster membership.

CONCLUSION

Children with disabilities display varying mental health patterns. Awareness of the complexity of mental health patterns among children with disabilities is important. Screening and support for emotional symptoms and prosocial behaviour deficits should be considered for children with conduct problems.

Mental Health Benefits of Physical Activity in Youth with Cerebral Palsy: A Scoping Review

AIMS

Children and adolescents with cerebral palsy (CP) are at heightened risk for mental health problems. Physical activity is an effective strategy to promote quality of life (QoL) and reduce mental health symptoms along with evidence-based therapies. This study described existing literature examining the mental health outcomes (e.g., QoL, well-being, anxiety, and depression) of physical activity interventions in children and adolescents with CP to help inform the implementation of physical activity interventions for this population.

METHODS

Ascoping review framework was used to map the existing quantitative literature.

RESULTS

The search returned 243 articles; after titles, abstracts, and full manuscripts were reviewed, 21 articles were included. The association between physical activity and QoL was examined in most studies (n = 17) with mixed findings. Eight studies documented at least one significant positive association between physical activity and QoL, and four found that physical activity interventions were highly enjoyable. Only one study assessed anxiety and/or depression following a PA intervention.

CONCLUSIONS

Physical activity may benefit aspects of QoL and mental health symptoms; however, this was not a consistent finding in the existing literature. Along with other therapies, physical activity interventions may be valuable in improving QoL, and in turn, the mental health symptoms of children with CP.

Psychiatric disorders in adults with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is one of the most common neurological conditions in childhood. Individuals with CP often experience various secondary conditions, including intellectual disability (ID), medical conditions, and psychiatric issues. A large number of youth with CP have psychiatric disorders; however, few studies have examined the prevalence of psychiatric issues in adults with CP at the population-level.

AIMS

To investigate the prevalence and co-occurrence of psychiatric disorders at the population-level in adults with CP only, and adults with CP and ID.

METHOD AND PROCEDURES

Using clinical information from seven Canadian data sources, we conducted a retrospective cross-sectional analysis of adults with CP, with and without ID.

OUTCOMES AND RESULTS

Adults with CP were more likely than the general population to have a psychiatric diagnosis, independent of ID status. All psychiatric disorders were more common in individuals with CP than the general population, with the exception of addiction related disorders. In most cases, having an ID substantially increased the risk of having a psychiatric disorder.

CONCLUSIONS

Adults with CP are at heightened risk for experiencing psychiatric disorders. Current findings highlight the important role health care providers play in screening for psychiatric issues in individuals with CP.

Autism and attention-deficit/hyperactivity disorder in children with cerebral palsy: high prevalence rates in a population-based study

AIM

To assess a total population of school-age children with cerebral palsy (CP) for autism and attention-deficit/hyperactivity disorder (ADHD) with a view to determining their prevalence and to relate findings to motor function, intellectual disability, and other associated impairments.

METHOD

Of 264 children, born between 1999 and 2006, from the CP register of western Sweden, 200 children (109 males, 91 females, median age at assessment 14y, range 7-18y) completed comprehensive screening and further neuropsychiatric clinical assessments.

RESULTS

Ninety children (45%) were diagnosed with autism, ADHD, or both, 59 (30%) were diagnosed with autism, and 60 (30%) were diagnosed with ADHD. Intellectual disability was present in 51%. Two-thirds had autism, ADHD, and/or intellectual disability. In regression models, autism was mainly predicted by intellectual disability (odds ratio [OR]=4.1) and ADHD (OR=3.2), and ADHD was predicted by intellectual disability (OR=2.3) and autism (OR=3.0). Autism was more common in children born preterm (OR=2.0). Gross motor function was not associated with autism. ADHD prevalence was low in children with severe motor impairment, possibly due to diagnostic limitations.

INTERPRETATION

Autism and ADHD were common in this population of children with CP and were mainlyindependent of motor severity and CP type. The strongest predictor of autism/ADHD was intellectual disability. Assessment for autism and ADHD is warranted as part of the evaluation in CP.

WHAT THIS PAPER ADDS

Forty-five percent of the children with cerebral palsy also had autism, attention-deficit/hyperactivity disorder (ADHD), or both. Autism and ADHD were predicted mainly by intellectual disability. Established diagnostic instruments worked well for all but the most disabled group of children.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder - Chinese (Mandarin) translation

目的

本国际临床指南由欧洲残疾儿童学会（the European Academy of Childhood Disability，EACD）牵头制定，旨在解决发育性协调障碍（developmental coordination disorder，DCD）的定义、诊断、评估、干预以及与社会心理方面的临床应用关键问题。

方法

本指南针对五个领域的关键问题，通过文献综述和专家团队的正式讨论达成共识。为保证指南的循证基础，以“机制”、“评估”和“干预”为检索词, 对2012年更新以来提出的最新建议以及新增的“社会心理问题”和“青少年/成人”为检索词进行检索。根据牛津大学循证医学中心证据等级 (证据水平 [level of evidence, LOE]1–4) 将结果进行分类，最终转化为指南建议。并由国际、多学科专家小组举行了两次会议，5个回合的Delphi 专家问卷调查，制定了高质量临床应用实践 (good clinical practice，GCP) 。

结果

本指南共制定35条建议。其中8条以文献综述为依据 (3 条涉及“评估”，5条涉及“干预”)； 22 条在 2012 年指南的基础上进行了更新；其他为涉及诊断、评估 (3条GCP) 及社会心理问题 (2 条 GCP) 的新建议。此外，其中有1条(LOE)新建议提出视频游戏可作为以活动和参与为导向的传统干预措施的辅助手段，并针对青少年和成人DCD提出了 2 条新建议 (1 条 GCP，1 条 LOE)。

结论

本指南是基于当前的研究证据和专家共识对DCD进行全面概述。它反映了不同学科临床和科研人员的最新科技水平。本国际指南可作为各国制定指南的基础。

Trajectories of psychiatric disorders in a cohort of children with cerebral palsy across four years

BACKGROUND

Risk of psychiatric disorders has been reported for children and adolescents with cerebral palsy (CP) at different ages, however little is known regarding the long-term trajectories of these disorders.

OBJECTIVE

The aim of this study was to assess the trajectories of psychiatric disorders in children with CP, and to explore their association to risk factors.

METHODS

We assessed a cohort of children with CP at age seven and again at age eleven with a child psychiatric diagnostic instrument, and parents were informants. We assessed type of CP, Gross Motor Function Classification System (GMFCS) levels, and co-occurring medical conditions in a medical examination, through the medical records, and in an interview with the parents at the onset of the study.

RESULTS

We found a significant increase in the prevalence of emotional disorders from seven to eleven years of age (p 0.01), whereas the prevalence of behavioral disorders was stable. Half of the cohort met criteria for a psychiatric disorder at both assessment points. Type of CP, spastic bilateral or unilateral, dyskinetic or ataxic, and co-occurring medical conditions were non-significant predictors of psychiatric disorders. Subthreshold psychiatric disorders at age seven were predictive of psychiatric disorders at age eleven.

CONCLUSIONS

We found a persistently elevated prevalence of psychiatric disorders in children with CP. Prevalence of behavioral disorders was stable, whereas we found a significant four-fold increase in emotional disorders. Sub-threshold psychiatric disorders predicted later psychiatric disorders. Increased focus on early mental health symptoms as well as more knowledge regarding emotional disorders in children with CP seems warranted.

Anxiety in children and adolescents with cerebral palsy

AIMS

To describe the prevalence of, and factors associated with, anxiety in 6-18-year-old children with cerebral palsy (CP) and determine how often clinicians screen for and manage anxiety in this group.

METHODS

Using a population CP register as the sampling pool, 569 families were approached by email, and 172 (mean age of children 12 years 7 months [SD 3 years 5 months]; 96 males) participated. Parents and, where able, children completed the Screen for Child Anxiety Related Emotional Disorders (SCARED). Parents also completed the Strengths and Difficulties Questionnaire. Children's medical records were searched for previous anxiety diagnoses and treatments.

RESULTS

Clinically significant anxiety was identified in 38% of children on parent reports and 46% on child reports. Girls were twice as likely to have anxiety (p = 0.02). Parent- and child-reported scores were strongly correlated (r = 0.853). Fewer parents of children with intellectual and communication impairments completed the survey. Based on the SCARED parent reports, anxiety was not identified by a clinician in 16 children (43%) with clinically significant anxiety.

CONCLUSION

Anxiety symptoms are prominent among children with CP, indicating a need for routine screening. Available screening tools are unsuitable for children with more severe limitations in cognition and communication; further research is needed to address this gap.

Identifying mechanisms of change in a magic-themed hand-arm bimanual intensive therapy programme for children with unilateral spastic cerebral palsy: a qualitative study using behaviour change theory

Background

There has been much research into how to promote upper-limb skills to achieve functional independence in children with unilateral spastic cerebral palsy (USCP). One researched intervention is the Breathe Magic programme, which follows the protocol of hand-arm bimanual intensive therapy (HABIT) whilst, incorporating magic tricks to develop children’s motor skills and bimanual skills. However, whilst research has found the programme to be effective, there has been little consideration of how the intervention leads to a positive outcome: what the psychological, social and physical mechanisms of action are.

Methods

Qualitative semi-structured interviews with 21 children with USCP who participated in the Breathe Magic HABIT intervention, and focus groups with 17 parents and/or carers were undertaken. Analysis was conducted through the lens of the COM-B behaviour change model using a combined deductive framework and inductive thematic analysis. Reliability of coding was confirmed through random extraction and double coding of a portion of responses and the calculation of inter-rater reliability.

Results

Breathe Magic brings about change and positive outcomes by increasing children’s psychological and physical capabilities, providing social opportunities, and enhancing reflective and automatic motivation. Additionally, a number of enablers to engaging in the intervention were identified, particularly under psychological capabilities, social opportunities and both reflective and automatic motivation. Very few barriers were raised; those that were raised were of relatively low frequency of reporting.

Conclusions

By conducting a theory-based qualitative process evaluation, this study demonstrated the mechanisms of change behind the Breathe Magic HABIT intervention for children with USCP. Breathe Magic was found to be a well-structured combination of intended and unintended mechanisms of change. Overall, the success of Breathe Magic was observed through not only its intended mechanisms to enhance hand skills, but also through unintended psychological improvements in children’s hand function, as well as social and motivational benefits resulting from interaction between children and parents.

Autism spectrum disorder and attention-deficit/hyperactivity disorder in children with cerebral palsy: results from screening in a population-based group

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are more common in children with cerebral palsy (CP) than in the general population, but may still be underdiagnosed. This study aimed to estimate screen-positive ASD and ADHD in a population-based group of 264 school-aged children with CP born 1999-2006 from the CP register of western Sweden. Validated parent-completed questionnaires were used at a median age of 12 years 11 months (range 8-17 years). Three different scales were used to detect signs of ASD and ADHD, respectively. Response rate was 88% (232/264). In 19 children, all in the most disabled group, the screening procedure was not feasible due to too few questionnaire items completed, leaving 213 for analyses. One third (74/213) of the children screened positive for ASD and half of the children (106/213) for ADHD, which was about twice as often as ASD/ADHD diagnoses had been clinically identified. Children with intellectual disability, epilepsy and/or impaired speech ability more often screened positive for ASD as well as ADHD. Severe motor impairment was more frequently associated with screen-positive ASD, but not ADHD. Neither sex nor CP type was associated with screen-positive ASD/ADHD. In conclusion, school-aged children with CP very often screened positive for ASD and/or ADHD. The prevalence of ASD and ADHD is most likely underestimated in children with CP. These screening findings require further investigations.

One-third of school-aged children with cerebral palsy have neuropsychiatric impairments in a population-based study

AIM

To describe motor function and associated impairments, particularly autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), in school-aged children with cerebral palsy (CP).

METHODS

Population-based study of all children with CP born 1999-2006 from the county of Västra Götaland, Sweden; 264 children (141 males, 123 females). Information was obtained from the CP Register of western Sweden (data collected at 4-8 years of age) and all medical records at 10-17 years of age.

RESULTS

Cerebral palsy was spastic in 76%, dyskinetic in 17% and ataxic in 7% of all children. Sixty-three per cent were independent walkers. Associated impairments were present in 75%. Vision was impaired in 19%, hearing in 8% and speech in 54%. Intellectual disability (ID) was present in 53% and epilepsy in 41%. ID had increased from 42% to 53% since preschool-age. Neuropsychiatric impairments were present in 32% of the children; ASD in 18%; and ADHD in 21%. All impairments, except for ASD and ADHD, increased with more severe motor impairment.

CONCLUSION

Three in four school-aged children with CP have associated impairments, underscoring the need to broadly assess every child. The high rate of ASD and ADHD points to the importance of in-depth studies of such impairments in CP.

Mindset and perseverance of adolescents with intellectual disabilities: Associations with empowerment, mental health problems, and self-esteem

BACKGROUND

Mindset refers to the implicit assumptions about the malleability of attributes such as intelligence, behavior, and personality. Previous research has shown that people endorsing a growth mindset show better academic and mental health outcomes than those with a fixed mindset. However, little is known about the mindset of youth with intellectual disabilities (ID) and its association with mental health.

METHODS

Adolescents with (n = 247) and without (n = 96) mild to borderline ID completed questionnaires about mindset and perseverance, empowerment, mental health problems, and self-esteem.

RESULTS

Adolescents with ID endorse a more fixed mindset of emotion and behavior than adolescents without ID. No significant differences were found for mindset of intelligence and perseverance. In addition, within the group of youth with ID some differences in mindset and perseverance were found based on level of intellectual disability, gender, and comorbidities, but not for age. Finally, a growth mindset of emotion and behavior and perseverance, but not mindset of intelligence, were negatively related to mental health problems in youth with ID.

CONCLUSION AND IMPLICATIONS

Overall, findings indicate that teaching youth with ID a growth mindset of emotion and behavior and perseverance may be a potentially successful endeavour to improve mental health in adolescents with ID.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

AIM

These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice.

METHOD

Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on 'mechanisms', 'assessment', and 'intervention' were updated since the last recommendations in 2012. New searches were conducted for 'psychosocial issues' and 'adolescents/adults'. Evidence was rated according to the Oxford Centre for Evidence-Based Medicine (level of evidence [LOE] 1-4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations.

RESULTS

Thirty-five recommendations were made. Eight were based on the evidence from literature reviews (three on 'assessment', five on 'intervention'). Twenty-two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity-oriented and participation-oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD.

INTERPRETATION

The CPR-DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR-DCD may serve as a basis for national guidelines.

WHAT THIS PAPER ADDS

Updated international clinical practice guidelines on developmental coordination disorder (DCD). Refined and extended recommendations on clinical assessment and intervention for DCD. A critical synopsis of current research on mechanisms of DCD. A critical synopsis of psychosocial issues in DCD, with implications for clinical practice. The first international recommendations to consider adolescents and adults with DCD.

Altered White Matter Connectivity Associated with Intergyral Brain Disorganization in Hemiplegic Cerebral Palsy

Despite extensive literature showing damages in the sensorimotor projection fibers of children with hemiplegic cerebral palsy (HCP), little is known about how these damages affect the global brain network. In this study, we assess the relationship between the structural integrity of sensorimotor projection fibers and the integrity of intergyral association white matter connections in children with HCP. Diffusion tensor imaging was performed in 10 children with HCP and 16 typically developing children. We estimated the regional and global white-matter connectivity using a region-of-interest (ROI)-based approach and a whole-brain gyrus-based parcellation method. Using the ROI-based approach, we tracked the spinothalamic (STh), thalamocortical (ThC), corticospinal (CST), and sensorimotor U- (SMU) fibers. Using the whole-brain parcellation method, we tracked the short-, middle-, and long-range association fibers. We observed for the more affected hemisphere of children with HCP: (i) an increase in axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) for the STh and ThC fibers; (ii) a decrease in fractional anisotropy (FA) and an increase in MD and RD for the CST and SMU fibers; in (iii) a decrease in FA and an increase in AD, MD, and RD for the middle- and long-range association fibers; and (iv) an association between the integrity of sensorimotor projection and intergyral association fibers. Our findings indicate that altered structural integrity of the sensorimotor projection fibers disorganizes the intergyral association white matter connections among local and distant regions in children with HCP.

A systematic review of comorbidity between cerebral palsy, autism spectrum disorders and Attention Deficit Hyperactivity Disorder

OBJECTIVES

The aim of this systematic review was to examine the incidence and prevalence of comorbidity between Cerebral Palsy (CP), Autism spectrum disorders (ASDs) and Attention-Deficit/Hyperactivity Disorder (ADHD).

METHODS

We searched for articles indexed in PubMed, EBSCOhost, Scopus, Web of Science and other potentially relevant internet sources using a combination of expressions including "cerebral palsy" AND "autism" OR "ASD" OR "pervasive development disorder" AND "Attention Deficit Hyperactivity Disorder" OR "ADHD".

RESULTS

We identified 2542 studies on CP and ASD and 998 studies on CP and ADHD. After screening titles and abstracts and removing duplicated studies, 47 full papers (CP and ASD n = 28; CP and ADHD n = 19) were downloaded and screened for eligibility. Twenty-eight (CP and ASD n = 16; CP and ADHD n = 12) studies were identified in the peer-review literature. Based on this systematic review, ASD and ADHD seem to be more common in people with CP than in the general population, yet the gold standard methods for diagnosing ASD or ADHD are not suitable for children with motor problems.

CONCLUSIONS

Assessing the occurrence of ASD and ADHD would improve the significant cost of healthcare, therapies, and overall daily living for families with children affected by CP. However, psychometric studies are needed in the future to promote development of measures suitable for individuals with CP. In addition, this review highlights the paucity of peer-reviewed studies investigating the occurrence of ASD and ADHD in children with different CP subtypes or functional abilities, and there are still some open questions about pathogenic mechanisms common to CP, ASD and ADHD.

The prevalence of mental health disorders and symptoms in children and adolescents with cerebral palsy: a systematic review and meta-analysis

AIM

Mental health conditions and problems are often reported in children and adolescents with cerebral palsy (CP). A systematic review was undertaken to describe their prevalence.

METHOD

MEDLINE and PsycINFO databases from 1996 to 2016 were searched and reference lists of selected studies were reviewed. Studies were included if they reported point prevalence of mental health diagnoses or symptoms in a general population of children and/or adolescents with CP. Pooled prevalence for mental health symptoms was determined using a random effects meta-analysis.

RESULTS

Of the 3158 studies identified, eight met the inclusion criteria. Mental health disorders were diagnosed by psychiatric interview in one study, giving a prevalence of 57% (32 out of 56 children). The remaining seven studies (n=1715 children) used parent-report mental health screening tools. The pooled prevalence for mental health symptoms using the Strengths and Difficulties Questionnaire (n=5 studies) was 35% (95% confidence interval [CI] 20-61) and using the Child Behavior Checklist (n=2 studies) was 28% (95% CI 22-36). Evidence was characterized by a moderate level of bias.

INTERPRETATION

More studies are needed to ascertain the prevalence of mental health disorders. Mental health symptoms are common and mental health evaluations should be incorporated into multidisciplinary assessments for these children.

WHAT THIS PAPER ADDS

Children with cerebral palsy and intellectual disability have a higher risk of mental health symptoms. The prevalence of mental health symptoms for age and severity groups is unclear.

Interrelationships of Functional Status and Health Conditions in Children With Cerebral Palsy: A Descriptive Study

PURPOSE

To examine the relationship among the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) in children with cerebral palsy (CP) and to determine the average number and effect of health conditions.

METHODS

Participants were 671 children with CP aged 2 to 12 years from Canada and the United States. Cross-tabulation of functional classifications and averages were computed for the number and impact of health conditions and comparisons among groups.

RESULTS

A total of 78 of the 125 possible classification combinations were recorded. Most frequent were GMFCS I, MACS I, CFCS I; GMFCS I, MACS II, CFCS I; and GMFCS II, MACS II, CFCS I. With lower levels of function, the average number and average impact of associated health conditions increased.

CONCLUSIONS

The use of functional profiles across classification systems, with data on the associated health conditions, provides a more comprehensive picture of CP than any single classification or measure.

Prevalence and characteristics of autism spectrum disorders in children with cerebral palsy

AIM

To evaluate the prevalence of co-occurring autism spectrum disorders (ASDs) among children with cerebral palsy (CP), and to describe their characteristics.

METHOD

The data of 1225 CP cases from four population-based registers (Iceland, Sweden, and two in France) and one population-based surveillance programme (North East England, UK) participating in the Surveillance of Cerebral Palsy in Europe Network (SCPE) were analysed. The ASD diagnoses were systematically recorded using category F84 of the International Classification of Diseases, 10th Revision. The registers provided data on children born between 1995 and 2006, while the cross-sectional survey in the UK concerned children aged 0 to 19 years, registered in 2010.

RESULTS

Among the children with CP, 107 had an associated diagnosis of ASD - i.e., 8.7% of the study population (95% confidence interval 7.2-10.5). This proportion varied across centres from 4.0% to 16.7% but was independent of CP prevalence. Male sex, co-occurring epilepsy, intellectual disability, and better walking ability were associated with the coexistence of ASD.

INTERPRETATION

Our findings support the need for a multidisciplinary approach to management of children with CP to adequately identify and address all facets of presentation, including ASD.

Theory of mind, emotional and social functioning, and motor severity in children and adolescents with dystonic cerebral palsy

AIMS

This cross-sectional study aimed to investigate whether children and adolescents with dystonic cerebral palsy (CP) present with emotional and social difficulties along side motor limitations.

PARTICIPANTS/MEASURES

Twenty-two verbal and nonverbal children and adolescents with dystonic CP were compared with a normative sample of twenty children and adolescents on measures of theory of mind (ToM), emotion regulation (ER), and social difficulties (SD).

RESULTS

Higher social and emotional difficulties were found in the dystonic CP group compared to the control group. Nonverbal participants with dystonic CP were found to present with greater social impairment and lower ToM ability than their verbal counterparts. Emotional regulation and hyperactivity and attentional difficulties (HAD) significantly predicted ToM ability and social difficulties. Lower Gross Motor Function Classification System (GMFCS) level and IQ also contributed to differences in ToM ability.

INTERPRETATION

Findings support the need for greater attention to the emotional health and social development of children/adolescents with dystonic CP, along with assessments of motor difficulties in the planning and implementation of interventions and individual care plans. Further research is needed to explore links between motor disorder and mental state understanding in this clinical group.

Strengths and challenges faced by school-aged children with unilateral CP described by the Five To Fifteen parental questionnaire

PURPOSE

The purpose of this study was to describe motor and non-motor (e.g. cognitive, social, and behavioral) challenges faced in daily life by children with unilateral cerebral palsy (UCP).

METHODS

In this cross-sectional study, parents completed the Five to Fifteen questionnaire and provided demographic information for 46 children aged 6-15 years (mean 11.01 ± 2.89 SD).

RESULTS

Most children were reported to have problems in both motor and non-motor domains, ranging from 20 to 92% depending on the domain. Perception and learning were the non-motor functions most commonly reported as challenging (63 and 65%, respectively). The total number of problems was significantly higher in age groups above 9 years. The correlation between all domains was high, but was consistently higher with the fine motor sub-domain, which could be used to predict executive function, perception, memory, and learning outcomes (R²=0.502, 0.642, 0.192, 0.192).

CONCLUSION

Most children with CP have everyday challenges beyond their primary motor deficiencies.

Introduction to Challenging Behaviour

This paper is an introduction to a topic that most health professionals are likely to encounter at some time in their career. It has been derived from a review of the relevant literature and from work with people with cerebral palsy who challenge services. Challenging behaviour is relatively common among people with learning disabilities, particularly when the learning disability is severe in nature. It also occurs, although less frequently, in other groups where there may be severe physical disability involving deficits in social and expressive language skills or additional sensory impairment.

There are potentially serious consequences for the person who displays challenging behaviour, not least of which are the possibilities of limited learning experiences and social isolation. Unless the behaviour of people displaying challenging behaviour is properly understood and addressed, it will be difficult to involve them in structured activities. Their quality of life will, as a consequence, be seriously impaired. For those who self-abuse causing repeated physical injury to themselves, there may be permanent physical damage and disfigurement. Understanding challenging behaviour is the first step to a recognition that all people, regardless of disability, have a right to be included in the structure of mainstream society.

Quality of life in mothers of children with cerebral palsy: The role of children's gross motor function

Four hundred and twenty-four Iranian mothers of children with cerebral palsy (CP) were recruited using the convenience sampling approach in a cross-sectional study. The researchers assessed the quality of life (QOL) in mothers according to the gross motor function levels and types of CP. The evaluation was done using a well-validated Persian version of the 36-item Short Form Health Survey (SF-36) questionnaire. In 2012, demographic data and clinical relevant information were also collected in rehabilitation clinics affiliated to Tehran University of Medical Sciences. The results indicated that the mean score for the study sample on physical component summary (PCS) and mental component summary (MCS) was 39.21 and 41.23, respectively. This suggests that participants considered themselves to have a low QOL (p < .05). The mean PCS scores for SF-36 were significantly different between mothers having CP children of different age, levels of motor function, and CP types (p < .05 and p < .01, respectively). The results indicate that mothers of children with CP suffer from poor physical and mental health. Therefore, particular attention should be paid to the QOL in mothers of children with CP, and rehabilitation professionals should offer supportive strategies to promote aspects of their QOL.

Screening for psychopathology in a national cohort of 8- to 15-year-old children with cerebral palsy

Cerebral palsy (CP) is often accompanied by psychopathology and learning disability.

AIMS

(1) to evaluate the prevalence of psychopathology as estimated by the Child Behavior Checklist (CBCL) parental questionnaire in 8- to 15-year-old Danish children with CP and to analyze its association with cognitive ability and families' social characteristics; (2) to examine to what extent children with CP had been evaluated by a child psychiatrist and/or psychologist.

METHOD

The parents of 462 children with CP answered a questionnaire about their child's treatment and the family's characteristics and 446 the CBCL. The cutoff for psychopathology was the Total CBCL score or DSM-oriented scores above the 93rd percentile in an age- and gender-stratified population.

RESULTS

The psychopathology screening was positive in 46.2% (CI 41.6-50.8%) against 15.1% in general population. Cognitive disability was associated with an increased prevalence of psychopathology (odds ratio (OR) 2.6, CI 1.4-4.6, for Developmental Quotient of cognitive function (DQ) 50-85 and OR 3.0, CI 1.3-7.0, for DQ<50). Children with CP and a single parent showed increased odds for a positive CBCL screening compared to children living with two parents (OR 2.1, 95% CI 1.1-4.0). Children with DQ 50-85 more often had a psychological evaluation. A positive CBCL screening was strongly associated with a psychiatric assessment (21% vs. 7%, p<0.01).

CONCLUSION

The high prevalence of emotional and behavioral problems indicates that screening for psychopathology should be a part of multidisciplinary follow-up of CP. The CBCL can be used as a screening instrument in children with CP without severe motor and cognitive disability.

Sleep concerns in children and young people with cerebral palsy in their home setting

AIMS

The aims were to identify in-home concerns about sleep in children and young people with cerebral palsy (CP) across age and Gross Motor Function Classification Scale (GMFCS) levels.

METHODS

This was a retrospective review of clinical notes of 154 children and young people with CP, aged 1-18 years (M = 7.8; standard deviation = 5.4) who received a home-based sleep service. Reported concerns were synthesised, for analysis according to age groups (1-5, 6-13, 14-18) and GMFCS levels.

RESULTS

Sixteen factors of concern were derived from the home-based assessment reports. Most children and young people had multiple factors of concern. These varied across age groups and GMFCS levels. Body position was of concern across all age groups, for over 90% at GMFCS levels IV and V, and for 10% at GMFCS level I. Settling routines were of concern for more than 90% at GMFCS levels I and II, but for less than 50% at GMFCS levels IV and V. Settling routines were of concern to over 65% of those under 6 years but less than 25% of those over 14 years. Conversely, pain and pressure care concerned less than 10% of children under 6, and more than 35% of those over 14 years.

CONCLUSIONS

Concerns about sleep vary across ages and GMFCS levels of children and young people with CP. Concerns relate to impairment of body structure and function, activity, environment, and personal supports. Multi-disciplinary, home-based assessment and interventions are recommended to address these concerns.

Brain Plasticity following Intensive Bimanual Therapy in Children with Hemiparesis: Preliminary Evidence

Neuroplasticity studies examining children with hemiparesis (CH) have focused predominantly on unilateral interventions. CH also have bimanual coordination impairments with bimanual interventions showing benefits. We explored neuroplasticity following hand-arm bimanual intensive therapy (HABIT) of 60 hours in twelve CH (6 females, mean age 11 ± 3.6 y). Serial behavioral evaluations and MR imaging including diffusion tensor (DTI) and functional (fMRI) imaging were performed before, immediately after, and at 6-week follow-up. Manual skills were assessed repeatedly with the Assisting Hand Assessment, Children's Hand Experience Questionnaire, and Jebsen-Taylor Test of Hand Function. Beta values, indicating the level of activation, and lateralization index (LI), indicating the pattern of brain activation, were computed from fMRI. White matter integrity of major fibers was assessed using DTI. 11/12 children showed improvement after intervention in at least one measure, with 8/12 improving on two or more tests. Changes were retained in 6/8 children at follow-up. Beta activation in the affected hemisphere increased at follow-up, and LI increased both after intervention and at follow-up. Correlations between LI and motor function emerged after intervention. Increased white matter integrity was detected in the corpus callosum and corticospinal tract after intervention in about half of the participants. Results provide first evidence for neuroplasticity changes following bimanual intervention in CH.

Predictors of participation of adolescents with cerebral palsy: A European multi-centre longitudinal study

We investigated whether childhood factors that are amenable to intervention (parenting stress, child psychological problems and pain) predicted participation in daily activities and social roles of adolescents with cerebral palsy (CP). We randomly selected 1174 children aged 8-12 years from eight population-based registers of children with CP in six European countries; 743 (63%) agreed to participate. One further region recruited 75 children from multiple sources. These 818 children were visited at home at age 8-12 years, 594 (73%) agreed to follow-up at age 13-17 years. We used the following measures: parent reported stress (Parenting Stress Index Short Form), their child's psychological difficulties (Strength and Difficulties Questionnaire) and frequency and severity of pain; either child or parent reported the child's participation (LIFE Habits questionnaire). We fitted a structural equation model to each of the participation domains, regressing participation in childhood and adolescence on parenting stress, child psychological problems and pain, and regressing adolescent factors on the corresponding childhood factors; models were adjusted for impairment, region, age and gender. Pain in childhood predicted restricted adolescent participation in all domains except Mealtimes and Communication (standardized total indirect effects β -0.05 to -0.18, 0.01 Collapse

Key Words

• Adolescence
• Cerebral palsy
• Longitudinal predictors
• Participation

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MESH Headings Collapse

Grants

• 086315 Wellcome Trust

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Affiliation(s)

Van Mô Dang UJF Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525/Themas, Grenoble F-38041, France.
Allan Colver Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
Heather O Dickinson Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
Marco Marcelli AUSL Viterbo, Via Enrico Fermi 15, 01100 Viterbo, Italy.
Susan I Michelsen National Institute of Public Health, Oster Farimagsgade 5, 1353 Copenhagen, Denmark.
Jackie Parkes School of Nursing & Midwifery, Queen's University Belfast, 21 Stranmillis Road, Belfast BT9 5AF, UK.
Kathryn Parkinson Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
Marion Rapp Klinik für Kinder und Jugendmedizin, Universität Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Catherine Arnaud INSERM, UMR 1027, Paul Sabatier University, Toulouse, France; Purpan, Clinical Epidemiology Unit, Toulouse, France.
Malin Nystrand Göteborg University, The Queen Silvia Children's Hospital, S-41685 Göteborg, Sweden.
Jérôme Fauconnier UJF Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525/Themas, Grenoble F-38041, France.

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Self-reported mental health in youth with cerebral palsy and associations to recurrent musculoskeletal pain

PURPOSE

To explore self-reports on emotional, conduct, hyperactivity and peer problems and on prosocial behaviour in youth with cerebral palsy (CP), compare the reports to normative data and to mothers' reports and to analyse if recurrent CP-related musculoskeletal pain (RMP) influence the self-reports.

METHODS

Eighty-one youth with CP (mean age 14.2 years, 40 boys) were assessed by clinical examination, interview and the questionnaire Strengths and Difficulties Questionnaire (SDQ) filled in by the youths and their mothers. Gross motor function (GMFCS) was: level I 43%, level II 41%, level III 12% and level IV-V 4%.

RESULTS

Compared to normative data, youth with CP reported similar levels of peer problems, less conduct problems (p < 0.01), less hyperactivity problems (p < 0.01) and more prosocial behaviour (p < 0.01). Compared to the mothers' reports, youth with CP reported lower levels of peer problems (p < 0.01). Twenty-six boys (65%) and 28 girls (68%) had RMP. Girls, but not boys with RMP reported a higher level of peer problems (p = 0.02) than youth without RMP.

CONCLUSION

Self-report on mental health in addition to parental proxy-report is important because it yields additional information. Peer acceptance and the impact of pain on peer problems and participation are candidate topics for further research.

Disability as a risk factor? Development of psychopathology in children with disabilities

Empirical research has established that children with disabilities are more likely to develop psychopathology than children without disabilities. But too little is known about the association between disability and psychopathology. The aim of this article is to discuss developmental psychopathological models that conceptualise the connection between childhood disability and psychopathology. Empirical studies of psychopathology among children with a congenital hearing impairment and children with cerebral palsy will be reviewed, representing in-depth examples of association between disability and psychopathology. Both a congenital hearing impairment and cerebral palsy were found to be dominating risk factors for all types of psychopathology, but no relationship was identified between degree of disability and risk of psychopathology. The higher risk cannot be explained by biological impairments alone. To explain the contradictory findings, developmental models of disability and psychopathology are applied. Within a multi-factorial developmental psychopathological perspective and a dialectical model of disability (Vygotsky, 1993), it is suggested that disability can be understood as an incongruence between the individual development of the child and demands and expectations in the specific relations and institutions in which the child participates. This incongruence creates and strengthens negative factors for the child with disability and results in a higher risk of psychopathology.

Online child and adolescent mental health surveys can be good enough

PURPOSE

To assess the value and practicability of online child mental health surveys.

METHODS

Study 1 followed up an existing low-risk sample from the general population. Study 2 recruited a new high-risk sample via a parents' organization for children with a neurological condition. Both studies invited parents of 2-17 year olds to complete the online development and well-being assessment. Pre-existing data on the Study 1 sample made it possible to examine selective participation.

RESULTS

Response rates were low (20 % for Study 1, 8 % for Study 2). Participation in Study 1 was lower for parents who rented rather than owned their home, for non-traditional families, for parents living in more deprived areas, and for Asian families. Nevertheless, studies 1 and 2 generally replicated the findings of previous interviewer-based surveys with higher response rates.

CONCLUSIONS

Online surveys can be quick and easy to carry out and can potentially generate good enough data for service planning and other purposes despite low response rates, selective participation and missing data. Web-based assessments are a useful addition to the researcher's toolbox, but they do not render the other tools redundant.

DTI correlates of cognition in term children with spastic diplegic cerebral palsy

BACKGROUND AND AIMS

Presently, there is no published study that shows association between cognition and white matter injury in spastic cerebral palsy. We aimed to correlate cognitive functions with diffusion tensor imaging derived metrics in spastic diplegic children.

METHODS

Twenty-two term children with spastic diplegia and 22 healthy controls were recruited. All patients were graded on the basis of gross motor function. The Indian children intelligence Test was used to quantify cognition and diffusion tensor imaging was used to quantify microstructural changes in various white matter regions. Diffusion tensor imaging metrics were quantified by placing regions of interests in different white matter regions like corona radiata, anterior limb of internal capsule, posterior limb of internal capsule, mid brain, pons, medulla, genu, splenium, temporal white matter, parietal white matter, frontal white matter and occipital white matter.

RESULTS

Spastic diplegic children showed significantly lower neuropsychological test scores as compared to controls. A significantly decreased fractional anisotropy values were observed in corona radiata, anterior limb of internal capsule, posterior limb of internal capsule, mid brain, pons, medulla, genu, splenium and occipital white matter; however significantly increased mean diffusivity values were observed in corona radiata, anterior limb of internal capsule, posterior limb of internal capsule, mid brain, pons and genu in spastic diplegic as compared to controls. A significant positive correlation in fractional anisotropy and negative correlation in mean diffusivity was observed with neuropsychological test scores.

CONCLUSION

These results suggest that these imaging metrics may be used as a biomarker of cognitive functions in term children with spastic diplegia.

Role of ESSENCE for preschool children with neurodevelopmental disorders

Early Symptomatic Syndromes Eliciting Neurodevelopmental Examinations (ESSENCE) has been proposed as a guide to the neurodevelopmental needs of the under 5s. The problems are their multiplicity, the presence of partial features of specific conditions e.g. autism spectrum disorder and attention deficit/hyperactivity disorder and the young age of the children. For these reasons, child development teams often leave families to cope with very difficult situations. This paper includes epilepsy and the cerebral palsies to see if providing precise diagnostic categories and therapeutic targets can be achieved. It includes a discussion of causal sequences which have yet to be applied comprehensively to the neurodevelopment disorders.

Psychiatric disorders among children with cerebral palsy at school starting age

The aim of the present population study was to estimate the prevalence of psychiatric disorders in children with cerebral palsy (CP), as well as the impact of comorbid conditions. A cohort of children with CP born 2001-2003, and living in the Western Health Region of Norway were evaluated at school starting age. Parents were interviewed with the diagnostic instrument Kiddie-SADS, to find the prevalence of psychiatric disorders. Sixty-seven children participated, 43 boys, with mean age 88 months (SD 6,8 months). Most children had spastic CP, Gross Motor Function Classification System (GMFCS) levels I and II were found in 2/3 of the group. We found the diagnostic instrument appropriate for GMFCS levels I-IV. Child psychiatric disorders were found in 57% of the children, including 28 children meeting criteria for an attention deficit disorder, which was the most common. Communication problem was significantly associated with having a psychiatric disorder, whereas intellectual disability, type of CP and functional level did not account for significant differences. Subthreshold symptoms were found in 33 children, and 42 children (75%) met criteria for either psychiatric disorder, or mental health symptoms. One in four (14 children) were considered well-functioning from a mental health point of view. We conclude with a recommendation for early psychiatric evaluation of all children with CP.

Perinatal risk factors and later social, thought, and attention problems after perinatal stroke

Objective. Survivors of perinatal stroke may be at risk for behavioral problems. Perinatal risk factors that might increase the likelihood of later behavior problems have not been identified. The goal of this study was to explore whether perinatal factors might contribute to behavior problems after perinatal stroke. Methods. 79 children with unilateral perinatal stroke were studied. Perinatal factors included gender, gestational age, neonatal seizures, instrumented delivery, fetal distress, acute birth problems, birth weight, and time of diagnosis. Subjects with evidence of hypoxic ischemic encephalopathy were excluded. Parents completed the Achenbach Child Behavior Checklist (CBCL) (Achenbach 1985). The CBCL yields T-scores in several symptom scales. We focused on Social, Thought, and Attention Problems scates. Results. Gestational age and the presence of uteroplacental insufficiency were associated with significant differences on the Thought Problems scale; Attention Problems scores approached significance for these variables. Fetal distress, neonatal seizures, or neonatal diagnosis was associated with 25–30% incidence of clinically significant T-scores on Social, Thought, and Attention Problems scales. Conclusions. Several perinatal factors were associated with a high incidence of social, thought, and behavior problems in children with perinatal stroke. These findings may be useful in anticipatory guidance to parents and physicians caring for these children.

Unmet health care needs in children with cerebral palsy: a cross-sectional study

Children with potentially severe health conditions such as cerebral palsy (CP) are at risk for unmet health care needs. We sought to determine whether children with CP had significantly greater unmet health care needs than children with other special health care needs (SHCN), and whether conditions associated with CP increased the odds of unmet health care needs. We analyzed data from the National Survey of Children with Special Health Care Needs, 2005-2006, using multivariate logistic regression to calculate the adjusted odds of children with CP having one or more unmet health care needs compared to children with other SHCN. We also determined the association of CP-related conditions with unmet health care needs in children with CP. After weighting to national averages, our sample represented 178,536 children with CP (1.9%), and 9,236,794 with children with other SHCN (98.1%). Although having CP increased the odds that children had unmet health care needs (OR = 1.46, 95% CI [1.07-1.99]), the presence of a "severe" health condition weakened the association. Gastrointestinal problems and emotional problems increased the odds that children with CP would have unmet health care needs above that of children without the associated conditions (p ≤ .01). Children with CP are similar to children with other SHCN and may benefit from collaborative programs targeting severe chronic conditions. However, children with CP and associated conditions have increased odds of unmet health care needs in comparison to children without those problems.

Psychosocial health in children and adolescents surviving cancer

AIM

To explore psychosocial health in children and adolescents surviving cancer three years after diagnosis compared with healthy controls, as assessed by adolescents themselves, their parents and teacher.

MATERIAL AND METHODS

Case-control study included 50 children and adolescents diagnosed with cancer between 1 January 1993 and 1 January 2003 and treated at the Paediatric Department St. Olav's University Hospital, Trondheim, Norway. Data were collected using the Strengths and Difficulties Questionnaire (self-report, parent report and teacher report), as well as the Achenbach System of Empirically Based Assessment questionnaire (teacher report).

RESULTS

Children surviving cancer had more emotional symptoms, higher total problem scores and poorer academic performance than their peers. Emotional problems were consistently reported by parents, teachers and adolescents themselves, in particular in children with brain tumours and among survivors with late effects.

CONCLUSION

Our study shows that children surviving cancer are at higher risk for emotional problems when compared with their friends, even after several years following diagnosis and treatment. We conclude that when planning long-term follow-up care, rehabilitation of children and adolescents with cancer, especially for survivors with brain tumours and late effects, should particularly take into account their psychological problems and psychosocial functioning.

The health of children and young people with cerebral palsy: a longitudinal, population-based study

BACKGROUND

Cerebral palsy (CP) is a chronic condition about which little is known in relation to the long term stability of and factors influencing health.

OBJECTIVES

To describe the health status of 4-17 year olds with ambulant CP, compare with the general population and identify factors predicting change in health over time.

DESIGN

A longitudinal, clinical survey.

SETTING

A regional hospital-based Gait Analysis Laboratory.

PARTICIPANTS

Those aged 4-17 years and able to walk at least 10m independently were identified from a case register of people with CP. A total of 184 subjects took part (38% of all eligibles in the region); 154 (84%) returned for a second assessment on average 2.5 years later.

METHODS

The Child Health Questionnaire (Parent-form-50) was completed by 184 parents at time 1, and 156 at time 2.

RESULTS

Children and young people with CP have significantly poorer health across a number of domains when compared to children in the general child population. Over time improvements occurred in behaviour (p=0.01), family activities (p<0.001) and physical functioning (p=0.05). Linear regression showed that gross motor function (p<0.001) and cerebral palsy subtype (p<0.05) were associated with changes in physical functioning; age was associated with changes in behaviour (p=0.007) and family activities (p=0.01); and communication ability was significantly associated with changes in family activities (p=0.005).

CONCLUSIONS

Children and young people with CP have poorer health than their able bodied peers but relatively stable health over 2.5 years. Where change occurred, it was for the better.

Speech, expressive language, and verbal cognition of preschool children with cerebral palsy in Iceland

AIM

The aim of this study was to describe speech, expressive language, and verbal cognition of children with cerebral palsy (CP).

METHOD

A population study included 152 Icelandic children with congenital CP (74 males, 78 females; mean age 5y 5mo, range 4y-6y 6mo). Children who spoke in sentences, phrases, or one-word utterances were categorized as verbal. Speech was classified as normal, mild dysarthria, or severe dysarthria. Cognition was reported as IQ (Wechsler Preschool and Primary Scale of Intelligence - Revised) or developmental quotient (DQ).

RESULTS

Most children (81%) had spastic CP and bilateral symptoms (76%); 74 (49%) were at Gross Motor Function Classification System (GMFCS) level I, 27% at levels II and III, and 24% at levels IV and V (p<0.001). One hundred and twenty-eight children (84%) communicated verbally whereas 24 were nonverbal. Nonverbal status and severe dysarthria were associated with greater motor impairment (GMFCS; p<0.001). Twenty-five children (16%) had severe dysarthria. Most (88%) of the nonverbal children had multiple disabilities compared with 18% of the verbal group (p<0.001). Median (interquartile range) verbal IQ was 93 (73-104) and performance IQ 77 (61-94; p<0.001). Sixty-eight children (45%) had normal verbal cognition and almost a quarter of the children with severe dysarthria had a full-scale IQ/DQ of 70.

INTERPRETATION

Most children with CP express sentences and almost half of them have normal verbal IQ. Nonverbal status frequently indicates multiple impairments whereas severe dysarthria may be associated with normal cognition.

Behavioural and emotional symptoms of preschool children with cerebral palsy: a population-based study

AIM

To describe behavioural and emotional symptoms among Icelandic preschool children with cerebral palsy (CP).

METHOD

Children with congenital CP, assessed with the Child Behavior Checklist/1½-5 (CBCL/1½-5) and Caregiver-Teacher Report Form (C-TRF), were enrolled in the study. A comparison group was recruited from the general population. Thirty-six children (53% males) with CP were assessed at a mean age of 4 years 11 months (SD 5 mo, range 4-6 y); 26 (72%) had bilateral distribution of symptoms and 32 (89%) had spastic CP. Thirty (83%) were at Gross Motor Function Classification System levels I or II and six at levels III or IV. For comparison, 110 (43% males) and 120 (48% males) children were assessed with the CBCL/1½-5 and the C-TRF respectively, at a mean age of 4 years 6 months (SD 6 mo, range 4-6 y).

RESULTS

Sixteen children (48%) with CP had high scores on total problems scale of the CBCL/1½-5 and 20 (65%) on the C-TRF compared with 18% of the comparison group, both on the CBCL/1½-5 and the C-TRF (p<0.001). Children with CP had higher scores on all subscales of the CBCL/1½-5 and the C-TRF, except somatic complaints. Attention difficulties, withdrawn, aggressive behaviour, and anxious/depressed symptoms were most pronounced among children with CP.

INTERPRETATION

A large proportion of preschool children with CP have substantial behavioural and emotional difficulties, which need to be addressed in their treatment.

Do Unilateral Lesions of the Developing Brain Have Side-specific Psychiatric Consequences in Childhood?

This study used a large epidemiological sample of children with lateralised brain lesions to establish whether damage to the developing human brain has side-specific psychiatric consequences. Parents and teachers completed behaviour questionnaires on 429 hemiplegic children and teenagers, with a subsample of 149 hemiplegic children also being assessed by parent and child interviews. Although childhood hemiplegia was accompanied by a high rate of psychopathology, children with right- and left-sided hemiplegias did not differ significantly on any dimensional or categorical measure of psychopathology. This absence of laterality effects, perhaps reflecting the developing brain's neuroplasticity, casts doubt on theories linking particular types of child or adult psychopathology to side-specific damage to the developing brain.

[Psychiatric disorders and neurological comorbidity in children with intellectual disability]

INTRODUCTION

This article gives an overview of the consultant child and adolescent psychiatric services in the region of Upper Bavaria (Germany).

METHOD

The data of 257 children and adolescents with intellectual disability and psychiatric disorders were evaluated.

RESULTS

About 14% of the children with ID in special schools or day care centers, and 40% of the children with ID in residential care showed a definite psychiatric disorder. The most frequently diagnosed disorders were adjustment disorders, hyperkinetic disorders and conduct disorders, as well as emotional problems and pervasive developmental disorders. Children with severe intellectual disability had more additional somatic disorders and were more impaired in their psychosocial functions.

CONCLUSIONS

The results show the need for psychiatric services for children and adolescents with intellectual disability and psychiatric disorders. The development and implementation of integrative and interdisciplinary models is necessary to allow for adequate medical care for these patients.

Is there a protective effect of normal to high intellectual function on mental health in children with chronic illness?

BACKGROUND

High intellectual function is considered as a protective factor for children's mental health. Few studies have investigated the effect of intellectual function on mental health in children with chronic illness (CI). The aim of the present study was twofold: First, we asked if normal to high intellectual function (IQ) has a protective effect on mental health in children with CI, and secondly, if this effect is more substantial than in their peers (NCI).

METHODS

The participants were selected among children who participated in the Bergen Child Study (BCS): 96 children with CI (the CI-group) and 96 children without CI (the NCI-group). The groups were matched on intellectual function as measured by the WISC-III by selecting the same number of children from three levels of the Full Scale IQ Score (FSIQ): "very low" (<70),"low" (70 to 84), or "normal to high" (>84). CI was reported by parents as part of a diagnostic interview (Kiddie-SADS-PL) that also generated the mental health measures used in the present study: the presence of a DSM-IV psychiatric diagnosis and the score on the Children's Global Assessment Scale.

RESULTS

The risk of a psychiatric diagnosis was significantly lower for children with a normal to high FSIQ-level than for children with a very low and low FSIQ-level in the CI-group as well as in the NCI-group. The group differences were statistically non-significant for all three FSIQ-levels, and the effect of the interaction between the group-variable (CI/NCI) and the FSIQ-level was non-significant on both measures of mental health.

CONCLUSION

The present study showed a protective effect of normal to high intellectual function on children's mental health. This protective effect was not more substantial in children with CI than in children without CI.