Autism and attention‐deficit/hyperactivity disorder in children with cerebral palsy: high prevalence rates in a population‐based study

Abstract

Aim To assess a total population of school‐age children with cerebral palsy (CP) for autism and attention‐deficit/hyperactivity disorder (ADHD) with a view to determining their prevalence and to relate findings to motor function, intellectual disability, and other associated impairments. Method Of 264 children, born between 1999 and 2006, from the CP register of western Sweden, 200 children (109 males, 91 females, median age at assessment 14y, range 7–18y) completed comprehensive screening and further neuropsychiatric clinical assessments. Results Ninety children (45%) were diagnosed with autism, ADHD, or both, 59 (30%) were diagnosed with autism, and 60 (30%) were diagnosed with ADHD. Intellectual disability was present in 51%. Two‐thirds had autism, ADHD, and/or intellectual disability. In regression models, autism was mainly predicted by intellectual disability (odds ratio [OR]=4.1) and ADHD (OR=3.2), and ADHD was predicted by intellectual disability (OR=2.3) and autism (OR=3.0). Autism was more common in children born preterm (OR=2.0). Gross motor function was not associated with autism. ADHD prevalence was low in children with severe motor impairment, possibly due to diagnostic limitations. Interpretation Autism and ADHD were common in this population of children with CP and were mainlyindependent of motor severity and CP type. The strongest predictor of autism/ADHD was intellectual disability. Assessment for autism and ADHD is warranted as part of the evaluation in CP. What this paper adds Forty‐five percent of the children with cerebral palsy also had autism, attention‐deficit/hyperactivity disorder (ADHD), or both. Autism and ADHD were predicted mainly by intellectual disability. Established diagnostic instruments worked well for all but the most disabled group of children.

Cerebral palsy with autism and ADHD: time to pay attention

“…Apart from observing a moderate association with the presence of intellectual disability, Påhlman et al 2 did not go as far as to speculate on possible common pathogenesis of CP with ASD and/or ADHD. Altered neural migration and synaptogenesis are posited to be important in the aetiology of at least genetic CP 3 as they are also important in ASD 4 .…”

“…This multimodal approach systematically captured ASD and ADHD comorbidities, whereas the same authors previously underestimated these conditions in the same CP registry cohort (ASD 18%; ADHD 21%; ASD and/or ADH 32%), 2 relying as it did on a collation of information from medical and habilitation records. However, the estimate for intellectual disability (53%) was similar since intellectual disability was determined previously using developmental scales 2 .…”

“…This multimodal approach systematically captured ASD and ADHD comorbidities, whereas the same authors previously underestimated these conditions in the same CP registry cohort (ASD 18%; ADHD 21%; ASD and/or ADH 32%), 2 relying as it did on a collation of information from medical and habilitation records. However, the estimate for intellectual disability (53%) was similar since intellectual disability was determined previously using developmental scales 2 . The multimodal approach produced verified estimates, which are lower than those obtained in the same cohort using a parent‐completed questionnaire comprised of validated screening tools in which intellectual disability was not assessed (ASD 35%; ADHD 50%; ASD and/or ADHD 56%) 2 …”

“…The study by Påhlman et al 2 provides a more accurate prevalence of ASD and ADHD in children with CP, and demonstrates these conditions commonly co‐occur with each other and intellectual disability. Another important result is that one‐third of these children with CP have none of these conditions.…”

“…Hence, screening instruments should be tailored to cater to disability factors, otherwise there is a risk of misclassifying or overlooking neurodevelopmental disorders. P ahlman et al 2 screened for ASD and ADHD using standard diagnostic instruments and neuropsychiatric assessments in a small cohort of 200 children aged 7 to 18 years (median age at assessment 14y) from the CP register of western Sweden. The strengths of their approach were: (1) children were evaluated by multidisciplinary team consensus with special consideration given to the intellectual level and the other impairments from the developmental and medical history; and (2) the diagnostic instruments performed well for all but the most severely disabled groups.…”