Mental Health Considerations With Cerebral Palsy: Difference between revisions
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=== Cerebral Palsy === | === Cerebral Palsy === | ||
There is no universally accepted definition of cerebral palsy, and there is no a single method to classify the impairment. The following definition was accepted in 2005 by the international multidisciplinary group. It is a modified definition first published by Bax in 1964:<blockquote>"Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, by epilepsy and by secondary musculoskeletal problems"<ref>[https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2007.00001.x The Definition and Classification of Cerebral Palsy]. Dev Med Child Neurol. 2007 Feb;49(s109):1-44. </ref></blockquote> | There is no universally accepted definition of cerebral palsy, and there is no a single method to classify the impairment. The following definition was accepted in 2005 by the international multidisciplinary group. It is a modified definition first published by Bax in 1964:<blockquote>"[[Cerebral Palsy Introduction|Cerebral palsy]] describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, by epilepsy and by secondary musculoskeletal problems"<ref>[https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2007.00001.x The Definition and Classification of Cerebral Palsy]. Dev Med Child Neurol. 2007 Feb;49(s109):1-44. </ref></blockquote> | ||
=== Mental Health Disorders === | === Mental Health Disorders === | ||
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== Assessment == | == Assessment == | ||
* Screening tools, such as the Strengths and Difficulties Questionnaire (SDQ) . SDQ is a brief screening questionnaire for mental health problems, including versions for self-report, parent-report and teacher-report.consisting of 25 items. Four of the items record problem domains, each including five items, and one pro-social domain, including five items.<ref>Bjorgaas HM, Elgen IB, Hysing M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318898/pdf/children-09-01009.pdf Mental Health in Pre-Adolescents with Cerebral Palsy: Exploring the Strengths and Difficulties Questionnaire as a Screening Tool in a Follow-Up Study including Multi-Informants.] Children (Basel). 2022 Jul 6;9(7):1009. </ref> Some researchers questioned this tool lack of sensitivity in delineating between psychiatric disorders. Goodman et al. found that the questionnaire identi- fied less than 50% of individuals with specific phobias, separation anxiety and eating disorders.<ref>Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry. 2000 Jun;9(2):129-34.</ref> | * Screening tools, such as the [https://www.sdqinfo.org/a0.html Strengths and Difficulties Questionnaire] (SDQ) . SDQ is a brief screening questionnaire for mental health problems, including versions for self-report, parent-report and teacher-report.consisting of 25 items. Four of the items record problem domains, each including five items, and one pro-social domain, including five items.<ref>Bjorgaas HM, Elgen IB, Hysing M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9318898/pdf/children-09-01009.pdf Mental Health in Pre-Adolescents with Cerebral Palsy: Exploring the Strengths and Difficulties Questionnaire as a Screening Tool in a Follow-Up Study including Multi-Informants.] Children (Basel). 2022 Jul 6;9(7):1009. </ref> Some researchers questioned this tool lack of sensitivity in delineating between psychiatric disorders. Goodman et al. found that the questionnaire identi- fied less than 50% of individuals with specific phobias, separation anxiety and eating disorders.<ref>Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry. 2000 Jun;9(2):129-34.</ref> | ||
* [http://www.shared-care.ca/files/SCARED_Child_Updated_June_2015.pdf Screen for Child Anxiety Related Disorders] (SCARED) The 41-item SCARED questionnaire8 – parent version was used to screen for anxiety disorders. The SCARED is a questionnaire constructed to measure symptoms of DSM IV-linked anxiety disorders in children.8 | * [http://www.shared-care.ca/files/SCARED_Child_Updated_June_2015.pdf Screen for Child Anxiety Related Disorders] (SCARED) The 41-item SCARED questionnaire8 – parent version was used to screen for anxiety disorders. The SCARED is a questionnaire constructed to measure symptoms of DSM IV-linked anxiety disorders in children.8 | ||
Revision as of 23:28, 22 December 2023
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Introduction[edit | edit source]
Cerebral palsy (CP) is a lifelong condition that affects motor function, communication, and daily living activities. Progression of musculoskeletal deformities associated with this condition and changes in psychosocial development are factors leading to mental health challenges.[1] Clinical symptoms of anxiety are a common occurrence in children with cerebral palsy. [2] Other mental health issues diagnosed in individuals with cerebral palsy include depression, autism, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Contributing factors to mental health issues in cerebral palsy can include biological and environmental factors. When untreated, mental health issues can lead to negative consequences such as decreased participation in social activities and lower academic or work performance. Screening for both cognitive dysfunction and other mental disorders should become an integral part of the assessment of children with CP.[3] Evidence-based treatments and rehabilitation programmes with a life-span perspective for mental health issues in individuals with cerebral palsy requires multidisciplinary approach.[1]
This article discusses the impact of cerebral palsy on mental health issue and introduces evidence-based interventions for addressing mental health issues in individuals with cerebral palsy.
Definitions[edit | edit source]
Cerebral Palsy[edit | edit source]
There is no universally accepted definition of cerebral palsy, and there is no a single method to classify the impairment. The following definition was accepted in 2005 by the international multidisciplinary group. It is a modified definition first published by Bax in 1964:
"Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, by epilepsy and by secondary musculoskeletal problems"[4]
Mental Health Disorders[edit | edit source]
Prevalence of Mental Disorders in CP[edit | edit source]
"The motor function does not predict the risk of other mental disorders then intellectual disability in children and adolescents with CP".[3]
- When compared to control group, children with cerebral palsy are affected by mental disorders more frequently:[3]
- 3.5 times more frequently for mental disorders
- 2.5 times more prevalent for autism spectrum disorders
- 2.7 times more common for affective or anxiety disorders
- Twice as often for ADHD
- A five-fold increase in psychiatric disorders [5]
- Significant increase in emotional disorders from seven to eleven years of age[5]
- Girls are twice as likely to have anxiety.[2]
- Long term disability in adolescents highly correlates with depressive and anxiety symptoms.[6]
- Adolescents with disability have lower scores for self-worth, appearance satisfaction, scholastic competence and social acceptance when compared with adolescents without disability.[6]
- The prevalence of the mental health problems remains high throughout childhood and even into adulthood.
Factors Leading to Mental Health Challenges in CP[edit | edit source]
Physical Limitations[edit | edit source]
hospitalizations and surgery
Physical disabilities in young people have been associated with subclinical mental health problems, including depressive and anxious symptoms. [7]
Pain[edit | edit source]
pain could add to an elevated level of anxiety and depressive disorders
- Children with cerebral palsy experience musculoskeletal pain that is associated with more self-reported mental health problems and lower HRQL.[8]
- Assessment of HRQL has the potential to capture both pain and mental health problems, and should be an integrated part of the systematic clinical follow-up.[8]
Communication[edit | edit source]
Communication problems can be defined as having no speech, difficulties with pronunciation, or slow speech.[5]
Societal Stigma and Discrimination[edit | edit source]
Sexual Development[edit | edit source]
Assessment[edit | edit source]
- Screening tools, such as the Strengths and Difficulties Questionnaire (SDQ) . SDQ is a brief screening questionnaire for mental health problems, including versions for self-report, parent-report and teacher-report.consisting of 25 items. Four of the items record problem domains, each including five items, and one pro-social domain, including five items.[9] Some researchers questioned this tool lack of sensitivity in delineating between psychiatric disorders. Goodman et al. found that the questionnaire identi- fied less than 50% of individuals with specific phobias, separation anxiety and eating disorders.[10]
- Screen for Child Anxiety Related Disorders (SCARED) The 41-item SCARED questionnaire8 – parent version was used to screen for anxiety disorders. The SCARED is a questionnaire constructed to measure symptoms of DSM IV-linked anxiety disorders in children.8
Evidence-Based Intervention[edit | edit source]
holistic approach to care that includes preventative strategies to address both mental and physical health outcomes should begin well in advance to their transition into young adulthood in order to mitigate the impact these factors have on health and well-being during this critical developmental time. [1]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 Sienko SE. An exploratory study investigating the multidimensional factors impacting the health and well-being of young adults with cerebral palsy. Disabil Rehabil. 2018 Mar;40(6):660-666.
- ↑ 2.0 2.1 McMahon J, Harvey A, Reid SM, May T, Antolovich G. Anxiety in children and adolescents with cerebral palsy. J Paediatr Child Health. 2020 Aug;56(8):1194-1200.
- ↑ 3.0 3.1 3.2 Rackauskaite G, Bilenberg N, Uldall P, Bech BH, Østergaard J. Prevalence of mental disorders in children and adolescents with cerebral palsy: Danish nationwide follow-up study. Eur J Paediatr Neurol. 2020 Jul;27:98-103.
- ↑ The Definition and Classification of Cerebral Palsy. Dev Med Child Neurol. 2007 Feb;49(s109):1-44.
- ↑ 5.0 5.1 5.2 Bjorgaas HM, Elgen IB, Hysing M. Trajectories of psychiatric disorders in a cohort of children with cerebral palsy across four years. Disabil Health J. 2021 Jan;14(1):100992.
- ↑ 6.0 6.1 Helseth S, Abebe DS, Andenæs R. Mental health problems among individuals with persistent health challenges from adolescence to young adulthood: a population-based longitudinal study in Norway. BMC Public Health. 2016 Sep 15;16:983.
- ↑ Lal S, Tremblay S, Starcevic D, Mauger-Lavigne M, Anaby D. Mental health problems among adolescents and young adults with childhood-onset physical disabilities: A scoping review. Front Rehabil Sci. 2022 Sep 6;3:904586.
- ↑ 8.0 8.1 Ramstad K, Jahnsen R, Skjeldal OH, Diseth TH. Mental health, health related quality of life and recurrent musculoskeletal pain in children with cerebral palsy 8-18 years old. Disabil Rehabil. 2012;34(19):1589-95.
- ↑ Bjorgaas HM, Elgen IB, Hysing M. Mental Health in Pre-Adolescents with Cerebral Palsy: Exploring the Strengths and Difficulties Questionnaire as a Screening Tool in a Follow-Up Study including Multi-Informants. Children (Basel). 2022 Jul 6;9(7):1009.
- ↑ Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry. 2000 Jun;9(2):129-34.
