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

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.

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

“…There is a need to adjust the cut‐offs to be more accurate regarding ADHD. Screening tools with fewer items than in our original questionnaire are also needed 7,13 …”

“…Some studies have reported attention deficits but not diagnoses, while some have used a screening procedure for ADHD symptoms rather than diagnoses. 7,13 By interviewing parents, Bjorgaas et al 4 identified symptoms of ADHD in 50% of children in GMFCS levels I to IV. Studies based on records and registers most likely underestimate the prevalence of autism and ADHD and screening usually includes more children than those actually meeting the diagnostic criteria.…”

“…The diagnoses of autism and ADHD in the 200 children were compared with the screening results for the same children 13 . Screening sensitivity and specificity were then calculated.…”

“…The population of the present study originated from the 213 children who had participated in the screening study. 13 Their screening results were compared with the diagnoses of autism and ADHD already identified and reported in the first published paper of this project 12 (Fig. S1).…”

“…12 In the second study, the same 264 children were screened for autism and ADHD through comprehensive parent-completed questionnaires. 13 Of the 232 responses obtained, 213 were possible to evaluate and showed high screen positivity for both autism (35%) and ADHD (50%), strongly indicating the need to assess all children with CP ( Fig. S1, online supporting information).…”