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Original research
Risk factors for intellectual disability in children with spastic cerebral palsy
  1. David Cummins1,
  2. Claire Kerr2,
  3. Karen McConnell2,
  4. Oliver Perra2
  1. 1 Royal Jubilee Maternity Service, Belfast, UK
  2. 2 School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
  1. Correspondence to Dr Claire Kerr, School of Nursing and Midwifery, Queen's University Belfast, Belfast BT9 7BL, UK; c.kerr{at}qub.ac.uk

Abstract

Background Cerebral palsy (CP) is a non-progressive disorder of posture and movement caused by prenatal or perinatal lesions of the brain. Children with CP are also at increased risk of other disabilities, for example, intellectual disability. Previous studies suggest the risk of intellectual disability varies in complex ways according to the type of motor impairment and perinatal factors such as gestational age.

Objective To determine the patterns of risk of intellectual disability in children with spastic CP.

Design Cross-sectional, population-based study using the Northern Ireland Cerebral Palsy Register.

Participants Persons born in 1981–2008 with congenital bilateral or unilateral spastic CP (N=1452).

Outcome measure The outcome measure was severe intellectual disability (IQ <50), as reported by clinicians known to the child. Data pertaining to CP subtype, sex, gestational age, birth weight and functional level were included in analyses.

Results Severe intellectual disability was significantly more prevalent in children with bilateral spastic CP (BSCP) compared with children with unilateral spastic CP (χ² (2)=162.60, p<0.001). Compared with very preterm infants with BSCP, the risk of intellectual disability increased in moderately preterm (OR=3.97, 95% CI 1.04 to 15.23) and at-term (OR=2.51, 95% CI 1.16 to 5.44) children with BSCP.

Conclusions Children with BSCP are at increased risk of intellectual disability, with those born at term at the highest risk. The findings highlight the importance of early screening, particularly for children with BSCP born at term.

  • epidemiology
  • neurology

Data availability statement

Data may be obtained from a third party and are not publicly available. Owing to conditions of ethical approval and data access agreements with Health and Social Care Trusts, data are not open access. Specific requests in relation to accessing data or collaborating with the Northern Ireland Cerebral Palsy Register can be sent to the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2020-320441

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Owing to conditions of ethical approval and data access agreements with Health and Social Care Trusts, data are not open access. Specific requests in relation to accessing data or collaborating with the Northern Ireland Cerebral Palsy Register can be sent to the corresponding author.

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    Footnotes

    • Twitter @dcumminsno9, @CKerrPhysio, @oliver_perra

    • Contributors DC contributed to interpretation of findings and wrote the manuscript. OP co-manages the Northern Ireland Cerebral Palsy Register, developed the paper proposal, carried out data analysis, contributed to interpretation of findings and made edits to the manuscript. CK co-manages the Northern Ireland Cerebral Palsy Register, assisted with development of the paper proposal, and contributed to interpretation of findings and writing of the manuscript. KM assisted with development of the paper proposal and made edits to the manuscript. All authors approved the final version of the manuscript.

    • Funding The Northern Ireland Cerebral Palsy Register is funded by the Public Health Agency, Northern Ireland.

    • Disclaimer The funder had no role in the study design, execution, analyses, interpretation of data or decision to submit the results.

    • Competing interests CK and KM have received research funding from the Medical Research Council Proximity to Discovery Scheme supporting academic–industry collaboration.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.