School readiness of children with cerebral palsy

Abstract

AIM To examine school readiness in preschool-age children with cerebral palsy (CP) on three of five domains compared with reported norms of children with typical development (CTD).METHOD A representative population of 151 preschool-age children with CP (87 males, 64 females; 131 [87%] with spasticity, 17 [11%] dyskinesia, 3 [4%] hypotonia) were assessed at 48 or 60 months corrected age. Children were functioning in the following Gross Motor Function Classification System (GMFCS) levels: I, 74 (49%); II, 17 (11%); III, 14 (9%); IV, 26 (17%); V, 20 (13%). Children's motor performance, self-care, and social function were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and communication using the Communication and Symbolic Behaviour Scales Developmental Profile (CSBS-DP).Results were compared with a reference sample of CTD (PEDI CTD n=412; CSBS-DP CTD n=790). Linear regression was used to compare these data by functional severity.RESULTS Children with CP had significantly lower PEDI scores in all domains than CTD. Selfcare scores ranged from 0.5 to more than 4SD below CTD, motor performance was 2 to >4SD below CTD, and social function between 0.5 and >4SD below CTD. Fifty-five per cent of children demonstrated significantly delayed communication skills. Non-ambulant children displayed significantly lower scores than ambulant children.INTERPRETATION Preschool-age children with CP perform significantly below their peers in three of five key readiness-to-learn skill areas including mobility, self-care, social function, and communication abilities. Broader emphasis needs to be placed on multimodal screening and intervention to prepare children with CP for school entry.Cerebral palsy (CP) is the most common physical disability in childhood (two out of 1000 live births) 1,2 and has a significant cost impact on the Australian health sector of 1.47 billion Australian dollars (AUD) per year, with an average annual cost of AUD43 431 per individual. 3 Mobility and ambulation are factors of importance in individuals with CP, influencing levels of independence, performance in activities of daily living, communication skills, participation in education, vocational involvement, and quality of life.School readiness is a framework for assessing profiles of strengths and vulnerabilities of the preschool child in the context of transition to school. 4 It considers a child's readiness to learn within five major skill areas: health and physical development; emotional well-being and social competence; approaches to learning; communication skills; and cognitive skills and general knowledge. 4,5 School readiness is an important paediatric concept as preschool-age developmental deficits are linked with later academic performance. 6 Links exist between child development, school readiness, educational attainment, and future health behaviours. 7 Identifying the breadth and severity of difficulties in school-readiness domains can maximize a child's schoolreadiness and increase the likelihood of academic success, which may...

School outcomes of adolescents with cerebral palsy in Sweden

“…It is likely that the findings of lower school achievement are due to both short‐ and long‐term factors. Preschool‐aged children with CP have been shown to have less effective communication and other ‘school readiness’ skills compared with children with typical development 22,23 . Thus, lower school outcomes of children with CP could partly be due to them having fallen behind from the start.…”

“…Preschool-aged children with CP have been shown to have less effective communication and other 'school readiness' skills compared with children with typical development. 22,23 Thus, lower school outcomes of children with CP could partly be due to them having fallen behind from the start. Early intervention might be warranted, or perhaps early intervention strategies should be re-evaluated.…”

“…As repeated measures of functional abilities are available for most individuals, the assessments conducted closest to the age of 5 years were used. Five years of age is a suitable cut‐off point to capture children's functional abilities before compulsory schooling starts, as this has been associated with ‘school readiness’, which is associated with future school achievements 22 . While the GMFCS and MACS have been included in the CPUP for many years, the CFCS is a newer instrument and consequently has a higher average age at assessment.…”

“…Five years of age is a suitable cut-off point to capture children's functional abilities before compulsory schooling starts, as this has been associated with 'school readiness', which is associated with future school achievements. 22 While the GMFCS and MACS have been included in the CPUP for many years, the CFCS is a newer instrument and consequently has a higher average age at assessment. Intellectual disability, defined herein as any diagnosis (ICD-10: F70-79) in inpatient or outpatient care registered in the national patient register between 1990 and 2015 (the outpatient register started in 2001), was also included.…”

Parenting acceptance and commitment therapy: a randomised controlled trial of an innovative online course for families of children with cerebral palsy

“… 3–5 One in five preschool children with CP show a significant delay in self-care skills. 5 In the long term, focusing on adults with CP without intellectual impairment, one in five have not completed high school, 4 in 10 are not living independently, one in two are not competitively employed and two in three are not in a long-term relationship. 6 Families want support and solutions; however, they receive little support in optimising their children's psychological, social, emotional and cognitive development or in optimising child quality of life.…”