Mental Health in Pre-Adolescents with Cerebral Palsy: Exploring the Strengths and Difficulties Questionnaire as a Screening Tool in a Follow-Up Study including Multi-Informants

There is a high prevalence of mental health problems in children with Cerebral Palsy (CP). Still, knowledge regarding the trajectory of mental health problems throughout childhood and differences according to informants is lacking. There is also a need for more knowledge regarding the validity of mental health screening tools. In the present study, we assessed changes in parent-rated mental health problems in a cohort of 36 children with CP from school-starting age to pre-adolescence and differences in mental health problems according to informants. Further, we assessed the validity of the Strengths and Difficulties Questionnaire (SDQ) for psychiatric disorders. The study cohort was assessed using the SDQ and a child psychiatric diagnostic instrument at school-starting age and at pre-adolescence. Mean parental SDQ scores increased significantly for emotional, hyperactivity and total problems. Self-reported impact of mental health problems was significantly lower than parent-reported impact, and parents and pre-adolescents reported significantly higher mean scores than teachers for emotional problems, conduct problems and total problem scores. Validated against psychiatric disorders, the SDQ was satisfactory for screening children with CP for risk of psychiatric disorders at pre-adolescence. We recommend that mental health screening be integrated into the regular follow-up for children with CP.

Illness perception in children with cerebral palsy, a longitudinal cohort study

Background

The perception of a disorder could be of importance both in problem solving behaviors, and in the emotional approach towards a disorder.

Aims

In this paper, we wanted to assess changes in illness perception in children with Cerebral Palsy (CP) over a four-year interval, to compare parental and self-ratings, and to assess illness perceptions according to co-occurring medical and psychiatric disorders.

Methods

Parents in a cohort of children with CP (N = 36), filled in the Illness Perception Questionnaire at age seven and again at age eleven, and self-reports were gathered at age eleven. Stability across time, informant differences and scores according to motor function, intellectual disability and the prevalence of psychiatric disorders were assessed.

Results

We found stable parental perceptions across a four –year interval. Parents reported significantly higher impact of CP on the child, than that reported by the child itself. In children with a more severe motor disability and/or co-occurring psychiatric disorders, parents reported significantly higher median scores for perceived impact of the CP condition on symptoms, duration of the condition, and impact on leisure activities, compared to those who had less severe motor disability and/or intellectual abilities within the normal range.

Conclusions

We propose that illness perception should be included in the follow-up of children with CP, as it may provide a mutual understanding between the child/family and professionals involved in follow-up services, with possible impact on treatment adherence and outcome of the condition.

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Parents reported significantly more negative impact of CP than their children.

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Parents reported stable perception of their child's CP across a four-year period.

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Parents and children reported significant impact of CP on leisure activities.

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Impact of CP was significant in children with co-occurring psychiatric disorders.

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.

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.