Comparison of Behavioral Problems in Children and Adults with Cerebral Palsy

Background: Cerebral palsy (CP) is the most common cause of motor impairment in children frequently causing a lifelong disability. Behavioral problems are a common observed comorbidity, however, only few data exist on this comorbidity in adults with CP.

Aim This article aims to compare the frequency of behavioral problems in patients with CP between children and adults and to determine the relevance of the developmental level.

Methods: In a cross-sectional study, 40 children (mean age, 9.6 years; range, 2.8-16.6 years) and 43 adults with CP (mean age, 29.7 years; range, 18.1-58.0 years) were recruited. Both the groups were assessed by the Strengths and Difficulties Questionnaire (SDQ), the Parents/Caregiver Report Form of the Vineland Adaptive Behavior Scales II (VABS), and the Child Behavior Checklist (CBCL). All questionnaires were filled in by parents or caregivers. The type of CP was defined in accordance with guidelines as spastic bilateral, spastic unilateral, atactic, or dyskinetic. In the adults group, 58% fulfilled criteria for GMFCS level 4/5, whereas in the children group only 16% shows this severe level of impairment.

Results: Children with CP have a significantly higher level of behavioral problems in SDQ total compared with adults (mean, 19.4 vs. 13.9; p = 0.003), although in the subgroups of SDQ no significant difference exists. In contrast, adults show a lower level of prosocial behavior in SDQ prosocial (mean, 5.5 vs. 6.9, p = 0.029). In CBCL, the most frequently reported pathological results (T value > 70) in the children group are attention problems (29.7%), social interaction problems (29.7%), and thought problems (21.6%). In the adult group, the most frequently reported problems are attention problems (28.0%), social interaction problems (23.3%), and anxiety/depression (14.1%). In none of the CBCL scales, a significant difference exists between the adults and the children. In VABS in all groups, a significant difference with a functional higher level in the group of children was reported: communication scale (mean, 64.6 vs. 37.4; p < 0.001); daily living skills (mean, 60.6 vs. 37.8, p < 0.001); socialization (mean, 65.0 vs. 43.2; p < 0.001).

Conclusion: In children as well as in adults, behavioral problem are frequent. Children seem to show a higher functional behavioral level as measured by VABS. However, as a limitation of our study in the group of adults more patients show a higher level of impaired motor function, which could influence this observation.