Mental health disorders, participation, and bullying in children with cerebral palsy.
Daniel G Whitney, Mark D Peterson, Seth A Warschausky
PMID 30710352WHAT IT FOUND
Only some mental health disorders were more common in children with cerebral palsy after accounting for other factors: anxiety, conduct problems, and multiple disorders.
Difficulty with friendships and bullying were associated with these; activity participation alone was not.
Key findings
01After adjustment for age, sex, ethnic group, household poverty, and chronic pain, children with cerebral palsy had significantly higher odds of anxiety, behavior or conduct problems, and two or more mental health disorders.
02Children with cerebral palsy had lower participation in activities and higher difficulty with friendships and bully victimization than controls.
03When difficulty with friendships was added to the adjusted model, the higher odds of anxiety, behavior or conduct problems, and two or more mental health disorders were no longer significantly increased; when bully victimization was added, behavior or conduct problems and two or more mental health disorders were no longer significantly increased, but anxiety remained significantly increased.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study is cross-sectional, so it cannot show that friendship difficulty or bullying caused mental health disorders, or that mental health disorders caused social problems. Parents or guardians reported the children’s conditions, activities, friendships, and bullying, and the researchers could not verify diagnoses with medical records. Cerebral palsy severity and motor classification were not available; only a parent’s subjective report of mild versus moderate or severe was used, and it was not used in adjusted analyses. Important comorbidities such as intellectual disability, communication impairment, and epilepsy were not adjusted for, although they are common in cerebral palsy and may relate to mental health. Participation was measured as participation in one or more organized activities in the past 12 months, which does not capture inclusion, quality, or amount of participation. The cerebral palsy and comparison groups had very different sample sizes.
The easy way to misread this
Do not conclude that improving friendships or reducing bullying will reduce mental health disorders. This was a cross-sectional parent-report survey, so it shows associations, not cause and effect, and lower activity participation was not associated with the mental health outcomes.