Development of social functioning in children with cerebral palsy: A longitudinal study
Andrea Burgess1, Leanne Sakzewski1, Koa Whittingham1
1The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, Brisbane, Australia.
Insights
Social functioning in children with cerebral palsy (CP) is strongly linked to their communication abilities, as measured by the Communication Function Classification System (CFCS). Most children in CFCS Level I met age expectations, while most in higher levels did not.
Area of Science:
- Pediatric neurology
- Developmental psychology
- Rehabilitation medicine
Background:
- Social functioning is crucial for children with cerebral palsy (CP).
- The Communication Function Classification System (CFCS) categorizes communication abilities in children with CP.
- Understanding the relationship between communication and social development in CP is essential.
Purpose of the Study:
- To describe the development of social function in children with cerebral palsy (CP).
- To analyze social function across all levels of the Communication Function Classification System (CFCS).
Main Methods:
- Prospective, longitudinal, population-based cohort study of children with CP in Queensland, Australia.
- Social functioning assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and PEDI Computer Adaptive Test (PEDI-CAT) at various ages (2 to 12 years).
- Children classified by CFCS levels.
Main Results:
- Social function at 8-12 years strongly correlated with CFCS level.
- 35/45 children (78%) in CFCS Level I met age expectations for social function.
- 25/29 children (86%) in CFCS Levels II-V had social functioning below age expectations.
- Intellectual impairment was associated with lower social/cognitive scores.
Conclusions:
- A strong relationship exists between social functioning and CFCS levels in children with CP.
- CFCS level and age were stronger predictors of social functioning development than motor function classifications.
- Interventions targeting communication may positively impact social development in children with CP.
Aim:
To describe the development of social function in children with cerebral palsy (CP) classified in all levels of the Communication Function Classification System (CFCS).
Method:
This prospective, longitudinal population-based cohort study recruited children with CP born in Queensland, Australia. Social functioning was measured using the Pediatric Evaluation of Disability Inventory (PEDI) social function domain at 2 years, 2 years 6 months, 3 years, 4 years, and 5 years, and the PEDI Computer Adaptive Test (PEDI-CAT) social/cognitive domain at 8 to 12 years.
Results:
Seventy-four children provided 356 observations. PEDI-CAT social/cognitive scaled scores at 8 to 12 years were (mean [SD] n) CFCS level I, 68.6 (2.7) 45; CFCS level II, 64.0 (3.4) 10; CFCS level III, 63.5 (3.7) 4; CFCS level IV, 56.8 (5.0) 9; CFCS level V, 47.2 (5.8) 6. Scores within expected range for age (not less than 2 SD below mean) at 8 to 12 years were achieved by 35 (78%) children in CFCS level I and four (14%) in CFCS levels II to V. Forty-nine per cent of children scored at least two standard deviations below the population mean on a proxy measure of fluid intelligence. Intellectual impairment was associated with lower PEDI-CAT social/cognitive scaled scores in univariable analysis (β = -8.3, 95% confidence interval - 10.91 to -5.63; p < 0.001) but had a smaller effect when modelled together with CFCS.
Interpretation:
Social function attained by 8 to 12 years of age was strongly related to level of communication function (CFCS). The small number of children classified in CFCS levels II to V necessitates caution when viewing these individual CFCS level trajectories.
What This Paper Adds:
There is a strong relation between social functioning and Communication Function Classification System (CFCS) levels. At 8 to 12 years, 35 out of 45 children in CFCS level I met social functioning age expectations. Twenty-five out of 29 in CFCS levels II to V had social functioning below that expected for age. CFCS and age were more strongly associated with development of social functioning than Gross Motor Function Classification System or Manual Ability Classification System and age.
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