ORIGINAL ARTICLES

Psychological problems in children with hemiplegia: a European multicentre survey

J Parkes¹, M White-Koning², N McCullough¹, A Colver³

¹ School of Nursing & Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
² Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Faculté de Médecine, Toulouse, France
³ Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK

Jackie Parkes, School of Nursing & Midwifery, Queen’s University Belfast, 10 Malone Road, Belfast BT9 5BN, Northern Ireland; j.parkes{at}qub.ac.uk

Objective: To describe the prevalence and determinants of psychological problems in European children with hemiplegia.

Design: Cross-sectional survey.

Setting: Home visits in nine European regions by research associates who administered standard questionnaires to parents.

Patients: 279 children with hemiplegia aged 8–12 years were recruited from population-based case registers.

Outcome measure: Strengths and Difficulties Questionnaire comprising emotion, conduct, hyperactivity, peer problems and prosocial domains. An "impact score" (IS) measures the social and psychological impact of the child’s difficulties.

Results: Children with hemiplegia had higher mean scores on the total difficulties score (TDS) compared with a normative sample (p<0.001). 48% and 57% of children, respectively, had borderline–abnormal TDS and IS. Significant, independent associations were observed between intellectual impairment and an increased risk for hyperactivity (odds ratio; OR 8.4, 95% CI 3.4 to 20.8), peer problems (OR 3.1, 95% CI 1.7 to 5.5), psychological and social impact (OR 3.0, 95% CI 1.6 to 5.6) when children with an intellectual quotient (IQ) <50 were compared with those with an IQ >70. Boys had an increased risk for conduct (OR 2.1, 95% CI 1.2 to 3.7) and hyperactivity disorders (OR 2.5, 95% CI 1.4 to 4.6). Poor self-esteem was associated with an increased risk for peer problems (OR 5.8, 95% CI 2.5 to 13.4) and poor prosocial skills (OR 7.5, 95% CI 2.4 to 23.2) compared with those with high self-esteem. Other determinants of psychological adjustment were impaired communication, severe pain and living with a single parent.

Conclusions: Many of the psychological problems identified are amenable to treatment. Special attention should be given to those at highest risk of developing psychological difficulties.

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