Cognitive and behavioural outcomes in preschool children with cerebral palsy

Submission note: A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Neuropsychology to the School of Psychological Science, Faculty of Science, Technology and Engineering, La Trobe University, Bundoora.

There have been few recent studies of the cognitive and behavioural outcomes of preschool children with cerebral palsy (CP) and none that have examined an entire population-based sample across cognitive domains. Three studies were designed to address this need. The sample comprised 78 preschool children with CP, recruited from a population-based register. Cognitive and behavioural outcomes were assessed using a battery of measures selected in consideration of potential suitability for the assessment of children with motor and speech impairment. The first study investigated the suitability of using the Wechsler Preschool and Primary Scale of Intelligence – Third Edition (WPPSI-III) as a measure of cognitive function for children with CP. Sixty-nine percent of the study cohort completed the VIQ, 72 percent completed the PIQ, and 62 percent completed the FSIQ from the WPPSI-III. Of the children who were able to complete subtests of the WPPSI-III, further investigation of this sample’s cognitive outcomes was considered in Study Two. The CP sample was noted to perform significantly lower than the normative sample across all the cognitive domains under investigation – language, visuoperceptual/spatial, memory, and executive functioning. Frequency of impairment (scores below 1.0 SD) ranged from 14 to 50 percent across the various cognitive measures. The presence of epilepsy was associated with deleterious effects on cognitive outcome. Degree of motor impairment was variously associated with poor performance. Behavioural outcomes were considered in Study 3 and measured using the preschool version of the Behaviour Assessment System for Children, Version 2. Over 25 percent of the sample had parental-reported elevated levels of Hyperactivity, Aggression, Depression, Somatisation, Atypicality, Withdrawal, and Attention difficulties. Thirty-two COGNITIVE AND BEHAVIOURAL OUTCOMES IN PRESCHOOL CP xiv percent of the sample had parental-reported elevated levels of Atypicality. Greater levels of executive dysfunction were associated with internalising and externalising problem behaviours. Findings of this thesis suggest that in addition to services such as physical, speech and occupational therapy, additional support and management for cognitive, academic and psychological function for preschool children with CP should be considered.