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Psychological Problems in Children with Cerebral Palsy and Its Relationship with Health-Related Quality of Life

Year 2025, Issue: 25, 329 - 342, 29.04.2025
https://doi.org/10.38079/igusabder.1528529

Abstract

Aim: To investigate the association between psychological problems and health-related quality of life (HRQOL) parameters in children with cerebral palsy (CP).
Method: A convenience sample size of 68 children with CP (mean age: 6.82 years and standard deviation: 1.8; 31 males and 37 females) were recruited in the study. Parent-reported versions of the Strengths and Difficulties Questionnaire (SDQ) and Cerebral Palsy Quality of Life were used to detect the presence of psychological symptoms and HRQOL outcomes in children with CP. Psychological symptoms included emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and prosocial behavior.
Results: Children with hemiplegic, diplegic, and ataxic CP were mostly found to be in scoring band of close to average on SDQ-Total difficulties Scale (TDS) (SDQ-TDS<14), whereas those with quadriplegic and dyskinetic CP were in very high scoring band (SDQ-TDS >20) on the SDQ-TDS. In terms of association, there were moderate to strong associations between scores for psychological symptoms and HRQOL (r=-0.45 to 0.860).
Conclusion: The results suggest that the nature and extent of mental health problems vary among CP subtypes, with children with tetraplegic and dyskinetic CP more likely to experience mental health symptoms. Given the potential benefits of physical activity on both HRQOL outcomes and psychological mental symptoms, it is essential to encourage children with CP to participate in more physical activities.

Ethical Statement

Ethical approval to carry out to the current study was obtained from the Ethical Board for Non-Interventional Scientific Research at Bingöl University (Date: 18.07.2024 No: 24714).

Thanks

The study authors would like to thank to the participating children and their families/primary caregivers for their devotion to the data collection and assessment process, because without their help we could not have completed this study.

References

  • 1. Arakelyan S, Maciver D, Rush R, O'Hare A, Forsyth K. Community-based participation of children with and without disabilities. Dev Med Child Neurol. 2020;62(4):445-453.
  • 2. Benner JL, Hilberink SR, Veenis T, Stam HJ, Van Der Slot WM, Roebroeck ME. Long-term deterioration of perceived health and functioning in adults with cerebral palsy. Arch Phys Med Rehabil. 2017;98(11):2196-2205.e1. doi:10.1016/j.apmr.2017.03.013.
  • 3. Verschuren O, Peterson MD, Balemans AC, Hurvitz EA. Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol. 2016;58(8):798-808.
  • 4. Stadskleiv K. Cognitive functioning in children with cerebral palsy. Dev Med Child Neurol. 2020;62(3):283-289. doi:10.1111/dmcn.14463.
  • 5. Novak I. Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology. 2014;29(8):1141-1156. doi:10.1177/0883073814535503.
  • 6. Whitney DG, Peterson MD, Warschausky SA. Mental health disorders, participation, and bullying in children with cerebral palsy. Dev Med Child Neurol. 2019;61(8):937-942.
  • 7. Yamaguchi R, Nicholson Perry K, Hines M. Pain, pain anxiety and emotional and behavioural problems in children with cerebral palsy. Disabil Rehabil. 2014;36(2):125-30.
  • 8. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. The Lancet. 2013;382(9904):1575-1586. doi: 10.1016/S0140-6736(13)61611-6.
  • 9. 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;3:904586. doi:10.3389/fresc.2022.904586.
  • 10. Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. A proposed new definition of mental health. Psychiatria Hungarica. 2017;51(3):407-411. doi: 10.12740/PP/74145.
  • 11. Mesman E, Vreeker A, Hillegers M. Resilience and mental health in children and adolescents: An update of the recent literature and future directions. Curr Opin Psychiatry. 2021;34(6):586-592. doi:10.1097/yco.0000000000000741.
  • 12. Parkes J, White‐Koning M, Dickinson HO, et al. Psychological problems in children with cerebral palsy: A cross‐sectional European study. Journal of Child Psychology and Psychiatry. 2008;49(4):405-413. doi: 10.1111/j.1469-7610.2007.01845.x.
  • 13. Downs J, Blackmore AM, Epstein A, et al. The prevalence of mental health disorders and symptoms in children and adolescents with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol. 2018;60(1):30-38. doi: 10.1111/dmcn.13555.
  • 14. Sienko SE. An exploratory study investigating the multidimensional factors impacting the health and well-being of young adults with cerebral palsy. Disabil Rehabil. 2018;40(6):660-6.
  • 15. Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: A cross-sectional study. Dev Med Child Neurol. 2019;61(5):579-585. doi: 10.1111/dmcn.14083.
  • 16. Barreto TM, Bento MN, Barreto TM, et al. Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: A systematic review. Dev Med Child Neurol. 2020;62(2):163-168. doi: 10.1111/dmcn.15600.
  • 17. El O, Baydar M, Berk H, Peker O, Koşay C, Demiral Y. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2012;34(12):1030-3. doi: 10.3109/09638288.2011.632466.
  • 18. Hidecker MJ, Paneth N, Rosenbaum PL, et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):704-10. doi: 10.1111/j.1469-8749.2011.03996.x
  • 19. Mutlu A, Kaya Kara O, Kerem Günel M, Livenlioğlu A. Turkish Communication Function Classification System. http://cfcs.us/wp-content/uploads/2014/02/Turkish_ CFCS_2012_06_26.pdf. Published date 2018. Accessed date 15.06.2024.
  • 20. Goodman R. The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry. 1997;38(5):581-6. doi: 10.1111/j.1469-7610.1997.tb01545.x
  • 21. Güvenir T, Özbek A, Baykara B, Arkar H, Şentürk B, İncekaş S. Psychometric properties of the Turkish version of the Strengths and Difficulties Questionnaire (SDQ). Turk J Child Adolesc Ment Health. 2008;15(2):65-74.
  • 22. Waters E, Davis E, Boyd R, Reddihough D, Mackinnon A, Graham H. Cerebral Palsy Quality of Life Questionnaire for Children (CP QoL-Child) Manual. Melbourne: University of Melbourne. 2013.
  • 23. Atasavun Uysal S, Düger T, Elbasan B, Karabulut E, Toylan İ. Reliability and validity of the cerebral palsy quality of life questionnaire in the Turkish population. Perceptual and Motor Skills. 2016;122(1):150-164. doi: 10.1177/0031512515625388.
  • 24. Goodman R, Graham P. Psychiatric problems in children with hemiplegia: Cross sectional epidemiological survey. BMJ. 1996;312(7038):1065-9. doi: 10.1136/bmj.312.7038.1065.
  • 25. Bourdon KH, Goodman R, Rae DS, Simpson G, Koretz DS. The Strengths and Difficulties Questionnaire: US normative data and psychometric properties. Journal of the American Academy of Child & Adolescent Psychiatry. 2005;44(6):557-564.
  • 26. Ryan JM, Cassidy EE, Noorduyn SG, O'Connell NE. Exercise interventions for cerebral palsy. Cochrane Database Syst Rev. 2017;6(6):Cd011660.
  • 27. Novak I, Morgan C, Fahey M, et al. State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(2):3. doi: 10.1007/s11910-020-1022-z.
  • 28. Paul S, Nahar A, Bhagawati M, Kunwar AJ. A Review on recent advances of cerebral palsy. Oxid Med Cell Longev. 2022;2022:2622310. doi: 10.1155/2022/2622310.
  • 29. Rosenbaum P, Gorter JW, Palisano R, Morris C. The relationship of cerebral palsy subtype and functional motor impairment: A population-based study. Dev Med Child Neurol. 2010;52(7):682-3;683-4. doi: 10.1111/j.1469-8749.2010.03652.x.
  • 30. Ostojic K, Paget S, Kyriagis M, Morrow A. Acute and chronic pain in children and adolescents with cerebral palsy: Prevalence, interference, and management. Archives of Physical Medicine and Rehabilitation. 2020;101(2):213-219. doi: 10.1016/j.apmr.2019.08.475.
  • 31. Eriksson E, Hägglund G, Alriksson-Schmidt AI. Pain in children and adolescents with cerebral palsy - a cross-sectional register study of 3545 individuals. BMC Neurol. 2020;20(1):15.
  • 32. Majnemer A, Shevell M, Rosenbaum P, Law M, Poulin C. Determinants of life quality in school-age children with cerebral palsy. The Journal of Pediatrics. 2007;151(5):470-475.e3.
  • 33. Mensch S, Echteld M, Lemmens R, Oppewal A, Evenhuis H, Rameckers EA. The relationship between motor abilities and quality of life in children with severe multiple disabilities. Journal of Intellectual Disability Research. 2019;63(2):100-112.
  • 34. Wong V, Chung B, Hui S, et al. Cerebral palsy: Correlation of risk factors and functional performance using the Functional Independence Measure for Children (WeeFIM). J Child Neurol. 2004;19(11):887-93. doi: 10.1177/08830738040190110701.
  • 35. Shevell MI, Dagenais L, Hall N, Consortium R. The relationship of cerebral palsy subtype and functional motor impairment: A population‐based study. Developmental Medicine & Child Neurology. 2009;51(11):872-877. doi: 10.1111/j.1469-8749.2010.03652.x.
  • 36. Chen KL, Tseng MH, Shieh JY, Lu L, Huang CY. Determinants of quality of life in children with cerebral palsy: A comprehensive biopsychosocial approach. Res Dev Disabil. 2014;35(2):520-8. doi: 10.1016/j.ridd.2013.12.002.
  • 37. Bingol H, Fidan H, Asena Sel S, Burc E, Gunel MK. Causal pathways of potential factors affecting participation level of individuals with unilateral cerebral palsy. British Journal of Occupational Therapy. 2024;87(9):546-555. doi: 2024:03080226241265254.
  • 38. Starowicz J, Pratt K, McMorris C, Brunton L. Mental health benefits of physical activity in youth with cerebral palsy: A scoping review. Physical & Occupational Therapy in Pediatrics. 2022;42(4):434-450. doi: 10.1080/01942638.2022.2060058.
  • 39. Yorke I, White P, Weston A, Rafla M, Charman T, Simonoff E. The Association between emotional and behavioral problems in children with autism spectrum disorder and psychological distress in their parents: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders. 2018;48(10):3393-3415.

Serebral Palsi’li Çocuklarda Psikolojik Problemler ve Bunun Sağlıkla İlişkili Yaşam Kalitesiyle ile İlişkisi

Year 2025, Issue: 25, 329 - 342, 29.04.2025
https://doi.org/10.38079/igusabder.1528529

Abstract

Amaç: Serebral palsili (SP) çocuklarda psikolojik sorunlar ile sağlıkla ilişkili yaşam kalitesi (HRQOL) parametreleri arasındaki ilişkiyi araştırmak.
Yöntem: 68 SP’li çocuktan oluşan uygun büyüklükte bir örneklem çalışmaya dahil edildi (ortalama yaş: 6,82 yıl ve standart sapma: 1,8; 31 erkek ve 37 kız). Aile bildirimli Güçler ve Güçlükler Anketi (GGA) ve Serebal Palsi Yaşam Kalitesi (SPYK) SP’li çocuklarda sırasıyla psikolojik semptomların varlığını ve SİYK sonuçlarını belirlemek için kullanıldı. Psikolojik semptomlar, duygusal semptomları, davranışsal problemleri, hiperaktivite/dikkatsizlik, akran sorunları ve sosyal davranışsal sorunları içermekteydi.
Bulgular: Hemiplejik, diplejik ve ataksik SP’ li çocuklar çoğunlukla GGA-Toplam Zorluklar Skala (TZS)’da ortalamaya yakın skorlama bandında yer alırken (GGA-TZS<14), kuadriplejik ve diskinetik SP’li çocuklar GGA-TZS’de çok yüksek skorlama bandında yer almışlardır (GGA-TZS>20). Karşılaştırma açısından, psikolojik semptomlar ve SİYK skorları arasında orta-güçlü ilişkiler bulunmuştur (r=-0.45 ila 0.860).
Sonuç: Sonuçlar, ruh sağlığı sorunları türlerinin ve ciddiyet düzeylerinin SP alt tipleri arasında farklılık sergilediğini ve kuadriplejik ve diskinetik SP'li çocukların ruh sağlığı semptomları yaşama olasılığının daha yüksek olduğunu göstermektedir. Fiziksel aktivitenin hem SİYK sonuçları hem de ruh sağlığı semptomları üzerindeki potansiyel faydaları göz önüne alındığında, SP’li çocukları daha fazla fiziksel aktiviteye katılmaya teşvik etmek önemlidir.

References

  • 1. Arakelyan S, Maciver D, Rush R, O'Hare A, Forsyth K. Community-based participation of children with and without disabilities. Dev Med Child Neurol. 2020;62(4):445-453.
  • 2. Benner JL, Hilberink SR, Veenis T, Stam HJ, Van Der Slot WM, Roebroeck ME. Long-term deterioration of perceived health and functioning in adults with cerebral palsy. Arch Phys Med Rehabil. 2017;98(11):2196-2205.e1. doi:10.1016/j.apmr.2017.03.013.
  • 3. Verschuren O, Peterson MD, Balemans AC, Hurvitz EA. Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol. 2016;58(8):798-808.
  • 4. Stadskleiv K. Cognitive functioning in children with cerebral palsy. Dev Med Child Neurol. 2020;62(3):283-289. doi:10.1111/dmcn.14463.
  • 5. Novak I. Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology. 2014;29(8):1141-1156. doi:10.1177/0883073814535503.
  • 6. Whitney DG, Peterson MD, Warschausky SA. Mental health disorders, participation, and bullying in children with cerebral palsy. Dev Med Child Neurol. 2019;61(8):937-942.
  • 7. Yamaguchi R, Nicholson Perry K, Hines M. Pain, pain anxiety and emotional and behavioural problems in children with cerebral palsy. Disabil Rehabil. 2014;36(2):125-30.
  • 8. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. The Lancet. 2013;382(9904):1575-1586. doi: 10.1016/S0140-6736(13)61611-6.
  • 9. 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;3:904586. doi:10.3389/fresc.2022.904586.
  • 10. Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. A proposed new definition of mental health. Psychiatria Hungarica. 2017;51(3):407-411. doi: 10.12740/PP/74145.
  • 11. Mesman E, Vreeker A, Hillegers M. Resilience and mental health in children and adolescents: An update of the recent literature and future directions. Curr Opin Psychiatry. 2021;34(6):586-592. doi:10.1097/yco.0000000000000741.
  • 12. Parkes J, White‐Koning M, Dickinson HO, et al. Psychological problems in children with cerebral palsy: A cross‐sectional European study. Journal of Child Psychology and Psychiatry. 2008;49(4):405-413. doi: 10.1111/j.1469-7610.2007.01845.x.
  • 13. Downs J, Blackmore AM, Epstein A, et al. The prevalence of mental health disorders and symptoms in children and adolescents with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol. 2018;60(1):30-38. doi: 10.1111/dmcn.13555.
  • 14. Sienko SE. An exploratory study investigating the multidimensional factors impacting the health and well-being of young adults with cerebral palsy. Disabil Rehabil. 2018;40(6):660-6.
  • 15. Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: A cross-sectional study. Dev Med Child Neurol. 2019;61(5):579-585. doi: 10.1111/dmcn.14083.
  • 16. Barreto TM, Bento MN, Barreto TM, et al. Prevalence of depression, anxiety, and substance-related disorders in parents of children with cerebral palsy: A systematic review. Dev Med Child Neurol. 2020;62(2):163-168. doi: 10.1111/dmcn.15600.
  • 17. El O, Baydar M, Berk H, Peker O, Koşay C, Demiral Y. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil. 2012;34(12):1030-3. doi: 10.3109/09638288.2011.632466.
  • 18. Hidecker MJ, Paneth N, Rosenbaum PL, et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):704-10. doi: 10.1111/j.1469-8749.2011.03996.x
  • 19. Mutlu A, Kaya Kara O, Kerem Günel M, Livenlioğlu A. Turkish Communication Function Classification System. http://cfcs.us/wp-content/uploads/2014/02/Turkish_ CFCS_2012_06_26.pdf. Published date 2018. Accessed date 15.06.2024.
  • 20. Goodman R. The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry. 1997;38(5):581-6. doi: 10.1111/j.1469-7610.1997.tb01545.x
  • 21. Güvenir T, Özbek A, Baykara B, Arkar H, Şentürk B, İncekaş S. Psychometric properties of the Turkish version of the Strengths and Difficulties Questionnaire (SDQ). Turk J Child Adolesc Ment Health. 2008;15(2):65-74.
  • 22. Waters E, Davis E, Boyd R, Reddihough D, Mackinnon A, Graham H. Cerebral Palsy Quality of Life Questionnaire for Children (CP QoL-Child) Manual. Melbourne: University of Melbourne. 2013.
  • 23. Atasavun Uysal S, Düger T, Elbasan B, Karabulut E, Toylan İ. Reliability and validity of the cerebral palsy quality of life questionnaire in the Turkish population. Perceptual and Motor Skills. 2016;122(1):150-164. doi: 10.1177/0031512515625388.
  • 24. Goodman R, Graham P. Psychiatric problems in children with hemiplegia: Cross sectional epidemiological survey. BMJ. 1996;312(7038):1065-9. doi: 10.1136/bmj.312.7038.1065.
  • 25. Bourdon KH, Goodman R, Rae DS, Simpson G, Koretz DS. The Strengths and Difficulties Questionnaire: US normative data and psychometric properties. Journal of the American Academy of Child & Adolescent Psychiatry. 2005;44(6):557-564.
  • 26. Ryan JM, Cassidy EE, Noorduyn SG, O'Connell NE. Exercise interventions for cerebral palsy. Cochrane Database Syst Rev. 2017;6(6):Cd011660.
  • 27. Novak I, Morgan C, Fahey M, et al. State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(2):3. doi: 10.1007/s11910-020-1022-z.
  • 28. Paul S, Nahar A, Bhagawati M, Kunwar AJ. A Review on recent advances of cerebral palsy. Oxid Med Cell Longev. 2022;2022:2622310. doi: 10.1155/2022/2622310.
  • 29. Rosenbaum P, Gorter JW, Palisano R, Morris C. The relationship of cerebral palsy subtype and functional motor impairment: A population-based study. Dev Med Child Neurol. 2010;52(7):682-3;683-4. doi: 10.1111/j.1469-8749.2010.03652.x.
  • 30. Ostojic K, Paget S, Kyriagis M, Morrow A. Acute and chronic pain in children and adolescents with cerebral palsy: Prevalence, interference, and management. Archives of Physical Medicine and Rehabilitation. 2020;101(2):213-219. doi: 10.1016/j.apmr.2019.08.475.
  • 31. Eriksson E, Hägglund G, Alriksson-Schmidt AI. Pain in children and adolescents with cerebral palsy - a cross-sectional register study of 3545 individuals. BMC Neurol. 2020;20(1):15.
  • 32. Majnemer A, Shevell M, Rosenbaum P, Law M, Poulin C. Determinants of life quality in school-age children with cerebral palsy. The Journal of Pediatrics. 2007;151(5):470-475.e3.
  • 33. Mensch S, Echteld M, Lemmens R, Oppewal A, Evenhuis H, Rameckers EA. The relationship between motor abilities and quality of life in children with severe multiple disabilities. Journal of Intellectual Disability Research. 2019;63(2):100-112.
  • 34. Wong V, Chung B, Hui S, et al. Cerebral palsy: Correlation of risk factors and functional performance using the Functional Independence Measure for Children (WeeFIM). J Child Neurol. 2004;19(11):887-93. doi: 10.1177/08830738040190110701.
  • 35. Shevell MI, Dagenais L, Hall N, Consortium R. The relationship of cerebral palsy subtype and functional motor impairment: A population‐based study. Developmental Medicine & Child Neurology. 2009;51(11):872-877. doi: 10.1111/j.1469-8749.2010.03652.x.
  • 36. Chen KL, Tseng MH, Shieh JY, Lu L, Huang CY. Determinants of quality of life in children with cerebral palsy: A comprehensive biopsychosocial approach. Res Dev Disabil. 2014;35(2):520-8. doi: 10.1016/j.ridd.2013.12.002.
  • 37. Bingol H, Fidan H, Asena Sel S, Burc E, Gunel MK. Causal pathways of potential factors affecting participation level of individuals with unilateral cerebral palsy. British Journal of Occupational Therapy. 2024;87(9):546-555. doi: 2024:03080226241265254.
  • 38. Starowicz J, Pratt K, McMorris C, Brunton L. Mental health benefits of physical activity in youth with cerebral palsy: A scoping review. Physical & Occupational Therapy in Pediatrics. 2022;42(4):434-450. doi: 10.1080/01942638.2022.2060058.
  • 39. Yorke I, White P, Weston A, Rafla M, Charman T, Simonoff E. The Association between emotional and behavioral problems in children with autism spectrum disorder and psychological distress in their parents: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders. 2018;48(10):3393-3415.
There are 39 citations in total.

Details

Primary Language English
Subjects Physiotherapy
Journal Section Articles
Authors

Hasan Bingöl 0000-0003-3185-866X

Dilan Demirtaş Karaoba 0000-0002-6754-9335

Early Pub Date April 29, 2025
Publication Date April 29, 2025
Submission Date August 5, 2024
Acceptance Date April 10, 2025
Published in Issue Year 2025 Issue: 25

Cite

JAMA Bingöl H, Demirtaş Karaoba D. Psychological Problems in Children with Cerebral Palsy and Its Relationship with Health-Related Quality of Life. IGUSABDER. 2025;:329–342.

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