Psychiatric disorders in children with cerebral palsy. Is there a need for mental health screening?

Abstract

Cerebral palsy (CP) is one of the most prevalent neuro-motor disorders in childhood. Previous studies using mental health questionnaires, had found mental health problems in up to every second child with CP. Peer problems were among the most common, often co-existing with other mental health problems. Whether a high prevalence of mental health problems found when using screening questionnaires reflected a high prevalence of psychiatric disorders when using stringent diagnostic criteria, was unknown. Neither was the impact of co-existing medical conditions on the prevalence of psychiatric disorders known, nor the feasibility of using screening questionnaires to identify psychiatric disorders in children with CP. The aims of the present thesis were to ascertain the prevalence of psychiatric disorders in children with CP, and to assess to what extent psychiatric disorders were associated with co-existing medical conditions. Further, the aim was to assess the prevalence of autism spectrum symptoms in children with CP, using the Autism Spectrum Screening Questionnaire (ASSQ). Likewise, we aimed to compare mental health problems in children with CP to a population based sample using the Strengths and Difficulties Questionnaire (SDQ), and to evaluate the SDQ as a screeing instrument in children with CP. The thesis is based on a population including children with CP diagnosed according to ICD-10 criteria under G.80.0-G80.9, born in 2001-2003 and living in the Western Health Region of Norway. Children were assessed at school starting age, and parents of all children taking part in the study were interviewed using the child psychiatric diagnostic instrument, the Kiddie-SADS. Psychiatric disorders were diagnosed according to DSM-IV criteria. Mental health problems were assessed using the SDQ, and problems with social functioning were assessed using the ASSQ. Medical information was gathered through medical records and a medical examination. Psychiatric disorders were found in almost one in two children with CP according to Kiddie-SADS. The burden of mental health problems was even higher, with two in three children scoring above a population cut-off at 90th percentile when using the SDQ. Peer problems were most common, with nine in ten children scoring above the 90th percentile. When using the ASSQ, one in five children scored above a population cut-off at 98th percentile. There was a considerable co-occurrence of mental health problems. Using the Kiddie-SADS as a gold standard, results from SDQ total difficulties score in children with CP were compared. Sensitivity was 0.85, and specificity was 0.55. Conclusion: A high prevalence of psychiatric disorders in children with CP was found. Autism spectrum symptoms, possibly representing autism spectrum disorders, were highly prevalent. Co-existing medical conditions and co-occurring mental health problems were common, representing a challenge when diagnosing psychiatric disorders in children with CP. Mental health screening is recommended at school starting age in children with CP.