Considerations when assessing cognition in children with cerebral palsy
Lena Elin Lorentzen1, Sandra Julsen Hollung2,3, Kristine Stadskleiv4,5
1Child and Youth Clinic, Akershus University Hospital, Lorenskog, Norway.
Insights
Cognitive assessments in children with cerebral palsy (CP) reveal significant variability. Tailoring evaluations to individual motor skills is crucial for accurate cognitive functioning assessment in CP.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Cognitive Psychology
Background:
- Cerebral palsy (CP) significantly impacts motor function, potentially influencing cognitive assessment outcomes.
- Understanding cognitive profiles in children with CP is essential for targeted interventions and educational planning.
- Standard cognitive assessments may not fully capture the abilities of children with CP due to motor limitations.
Purpose of the Study:
- To characterize cognitive assessment results in children with cerebral palsy (CP) and correlate them with clinical features.
- To compare different methods of calculating composite cognitive scores, accounting for motor impairments.
- To identify factors influencing cognitive performance in children with CP.
Main Methods:
- Analysis of data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (2002-2014).
- Utilized one-way ANOVA and multiple linear regression to examine the relationship between clinical characteristics and cognitive assessment results.
- Employed paired samples t-tests to compare composite cognitive scores, considering effect sizes (eta-squared and Cohen's d).
Main Results:
- Of 1532 children with CP, 972 (63.4%) underwent cognitive assessment; 451 (46.4%) had an Intelligence Quotient (IQ) score (mean 82.3).
- Twenty-two percent of assessed children had an intellectual disability; lowest IQ scores were observed in those with spastic quadriplegic CP, epilepsy, or severe hearing impairment.
- Composite scores were higher on measures less reliant on fine motor skills, such as the General Ability Index and Nonmotor Full Scale Score, compared to Wechsler Full Scale IQ.
Conclusions:
- Cognitive functioning in children with CP is highly variable, necessitating individualized assessment approaches.
- Assessment tools that minimize demands on fine motor skills may yield higher scores, suggesting a need to adapt evaluation methods.
- Tailoring cognitive assessment practices to the specific needs and abilities of children with CP is paramount for accurate interpretation and support.
Abstract:
Objective: To describe cognitive assessment results in relation to clinical characteristics in children with cerebral palsy (CP) and to compare methods for calculating composite scores, taking their motor impairments into account. Method: All children registered in the Norwegian Quality and Surveillance Registry for Cerebral Palsy born 2002-2014 were included. The contribution of clinical characteristics per assessment results were investigated using one-way ANOVA (eta-squared (η2) effect size) and multiple linear regression analyzes. Composite scores were compared with paired samples t-test (Cohen's d effect size). Results: Of the 1532 children with CP registered, 972 (63.4%) had a cognitive assessment. An Intelligence Quotient (IQ) score was available for 451 (46.4%) of the assessed children (range 40 - 129, mean 82.3). Twenty-two percent had an intellectual disability. Mean IQ was lowest in children with spastic quadriplegic CP, epilepsy, and/or severe hearing impairment (effect sizes were small, η2 = 0.05, 0.05 and 0.01, respectively). The Verbal Comprehension Index score was highest and Visual Spatial Index lowest, with moderate effect size, d = 0.7. Fine motor skills and speech ability contributed most towards explaining variability in Wechsler Full Scale IQ (FSIQ). General Ability Index, Fluid Reasoning Index and Nonmotor Full Scale Score were higher than FSIQ, with small to moderate effect sizes of d = 0.61, 0.46 and 0.62, respectively. Conclusions: Variability in cognitive functioning underscores the importance of individual assessments. Better scores were obtained on composite measures using subtests that did not place high demands on fine motor skills, indicating a need for tailoring assessment practice to children with CP.
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