Behavioral problems continue into adolescence for patients with cerebral palsy

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Key study points:

1. 36.9% of adolescents with cerebral palsy (CP) had co-existing behavioral problems, the most common being peer problems. There was evidence that behavioral problems diminished slightly with age.

2. Greater prosocial behaviors were associated with higher IQ, greater motor abilities (both gross and fine), and attendance at an integrated school.

3. Only 16.1% of the adolescents sampled had received psychological services.

Primer: CP is an umbrella term that refers to motor impairment resulting from a discrete brain insult occurring in utero, during delivery, or in the neonatal period. Behavioral problems are known to commonly co-exist in children with CP who are below 12 years of age, present in about 35% to 40%. These include hyperactivity, inattention, aggressiveness, antisocial behavior, emotional lability, and difficulties with peer relationships. However, there has been no formal evaluation of whether these behavioral concerns continue into adolescence. This study is the first to consider behavioral difficulties in adolescents with CP;

Background reading:

1. Brossard-Racine M, Hall N, Majnemer A, et al. Behavioural problems in school age children with cerebral palsy. Eur J Paediatr Neurol. 2012;16:35–41.

2. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.

This [cross-sectional ] study surveyed 160 adolescents (mean age 15.4 ± 2.17 years; range 12-19 years) with CP and their parents; information about patients’ motor and cognitive abilities (including IQ), functional status, parental stress levels, and behavioral problems was collected. Overall, 36.9% of the adolescents had behavioral problems, with peer problems being most common (61.9%). Other problems included emotional symptoms (34.4%), conduct problems (21.3%), hyperactivity (20.0%), and lack of prosocial behaviors (15.6%). Adolescents displaying hyperactive symptoms had greater functional limitations. Younger adolescents showed a greater risk for behavioral difficulties than older adolescents, particularly for emotional symptoms, conduct problems, and hyperactivity. Having a higher IQ and attending an integrated school was associated with more prosocial behaviors and less hyperactive behavior. Higher prosocial behavior score was consistently associated with better motor performance. Only 16.1% of the adolescents sampled had received psychological services; the study raises the need for greater psychosocial interventions for this population.

In sum: Just over a third of adolescents with CP have co-existing behavioral problems, which mirrors the proportion that have difficulties in these domains as children. However, there was evidence that emotional symptoms, conduct problems, and hyperactivity diminished somewhat over the spectrum of ages sampled (12- to 19-year-olds). Greater prosocial behaviors were associated with higher IQ, greater motor abilities (both gross and fine), and attendance at an integrated school. This was a cross-sectional study that established interesting correlations, but without directionality.

Click to read the study in [Journal of Child Neurology]

 By [DB]

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