Abstract

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 (SDQ) 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 to a normative sample (p<0.001). 48% and 57% of children respectively had borderline-abnormal TDS and impact scores. Significant, independent associations were observed between intellectual impairment and an increased risk for hyperactivity (OR 8.4, 95% CI 3.4-20.8), peer problems (OR 3.1, 95% CI 1.7-5.5) psychological and social impact (OR 3.0, 95% CI1.6-5.6) when children with an IQ<50 were compared to those with IQ>70. Boys had an increased risk for conduct (OR 2.1, 95% CI 1.2-3.7) and hyperactivity disorders (OR 2.5, 95% CI 1.4-4.6). Poor self esteem was associated with an increased risk for peer problems (OR 5.8, 2.5-13.4) and poor prosocial skills (OR 7.5, 95% CI 2.4-23.2) compared to 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.