Autism and attention-deficit/hyperactivity disorder in children with cerebral palsy: high prevalence rates in a
Magnus Påhlman1,2, Christopher Gillberg1, Kate Himmelmann2,3
1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Autism and ADHD are common in children with cerebral palsy (CP), with intellectual disability being a key predictor. Early assessment for these conditions is recommended for children with CP.
Area of Science:
- Neurodevelopmental disorders
- Pediatric neurology
- Child psychiatry
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder in children.
- Co-occurring neurodevelopmental conditions like autism and ADHD can significantly impact management and outcomes.
- Prevalence and predictors of autism and ADHD in children with CP require further investigation.
Purpose of the Study:
- To determine the prevalence of autism and attention-deficit/hyperactivity disorder (ADHD) in a population of school-aged children with cerebral palsy (CP).
- To examine the relationship between autism/ADHD diagnoses and motor function, intellectual disability, and other impairments in children with CP.
Main Methods:
- A cohort of 264 children (born 1999-2006) from the CP register of western Sweden was identified.
- 200 children underwent comprehensive screening and neuropsychiatric clinical assessments.
- Prevalence rates and associations were analyzed using regression models.
Main Results:
- 45% of children with CP were diagnosed with autism, ADHD, or both.
- Intellectual disability was a significant predictor for both autism (OR=4.1) and ADHD (OR=2.3).
- Autism was more common in preterm-born children (OR=2.0), and ADHD prevalence was lower in those with severe motor impairment.
Conclusions:
- Autism and ADHD are highly prevalent in children with CP, largely independent of motor severity.
- Intellectual disability is the strongest predictor for autism and ADHD in this population.
- Screening for autism and ADHD should be an integral part of the clinical evaluation for children with CP.
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.
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