Autism spectrum disorder and attention-deficit/hyperactivity disorder in children with cerebral palsy: results from screening in a population-based group

Magnus Påhlman,Elisabet Wentz,Christopher Gillberg,Kate Himmelmann

doi:10.1007/s00787-020-01471-1

Abstract

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are more common in children with cerebral palsy (CP) than in the general population, but may still be underdiagnosed. This study aimed to estimate screen-positive ASD and ADHD in a population-based group of 264 school-aged children with CP born 1999–2006 from the CP register of western Sweden. Validated parent-completed questionnaires were used at a median age of 12 years 11 months (range 8–17 years). Three different scales were used to detect signs of ASD and ADHD, respectively. Response rate was 88% (232/264). In 19 children, all in the most disabled group, the screening procedure was not feasible due to too few questionnaire items completed, leaving 213 for analyses. One third (74/213) of the children screened positive for ASD and half of the children (106/213) for ADHD, which was about twice as often as ASD/ADHD diagnoses had been clinically identified. Children with intellectual disability, epilepsy and/or impaired speech ability more often screened positive for ASD as well as ADHD. Severe motor impairment was more frequently associated with screen-positive ASD, but not ADHD. Neither sex nor CP type was associated with screen-positive ASD/ADHD. In conclusion, school-aged children with CP very often screened positive for ASD and/or ADHD. The prevalence of ASD and ADHD is most likely underestimated in children with CP. These screening findings require further investigations.

Highlights

Cerebral palsy (CP) is the most common cause of motor disability in childhood, affecting about 2 per 1000 live births [1, 2]
We found a pattern of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) registered rates decreasing with increasing motor impairment, in contrast to the distribution of other impairments like intellectual disability (ID) and epilepsy, suggesting underestimation of ASD and ADHD in more severe cerebral palsy (CP)
The responders represented the whole group of children with CP regarding sex, gestational age, CP type, Gross Motor Function Classification System (GMFCS) level, intellectual level, visual and hearing impairment, epilepsy and speech ability

Summary

Introduction

Cerebral palsy (CP) is the most common cause of motor disability in childhood, affecting about 2 per 1000 live births [1, 2]. There is growing evidence that neuropsychiatric disorders, primarily autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), are more prevalent in children with CP than in the general population [8,9,10,11,12,13,14,15,16]. A recent systematic review does confirm this, but there are few population-based studies of children with CP [17]. A previous study by our group, where medical records of children in a population-based group with CP were scrutinised regarding identified neuropsychiatric disorders, supported these findings. ASD was diagnosed in 18% and ADHD in 21% [18]. These record-based numbers are most likely underestimations, and registered diagnosis rates

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