Behavioral difficulties, sleep problems, and nighttime pain in children with cerebral palsy.
Sleep problems and nighttime pain are major, treatable triggers for behavior issues in kids with cerebral palsy.
01Research in Context
What this study did
Horwood et al. (2019) sent surveys to parents of 113 children with cerebral palsy. They asked about behavior, sleep, and pain at night.
The team then used statistics to see which problems clustered together.
What they found
One in four kids with cerebral palsy showed clear behavioral difficulties.
Bad sleep multiplied the odds of behavior trouble by nine. Nighttime pain almost quadrupled the odds.
How this fits with other research
Bailey et al. (2010) saw the same link in teens with intellectual disability plus chronic disease. Sleep or pain issues again went hand-in-hand with behavior problems.
Poppes et al. (2016) found the same pattern in adults with profound ID. Sleep problems, not staff ratios, best predicted challenging behavior.
Annaz et al. (2011) and Sivertsen et al. (2012) showed sleep issues are common across Williams syndrome and autism. Linda’s team now adds cerebral palsy to the list.
Why it matters
Before you write a behavior plan, ask about sleep and pain. A simple parent checklist can flag these hidden drivers. Treating sleep hygiene or pain first may cut problem behavior faster than teaching a replacement skill alone.
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02At a glance
03Original abstract
BACKGROUND: Children with cerebral palsy (CP) may be at risk of behavioral difficulties. AIMS: 1) Determine the prevalence of behavioral difficulties in preschool- and school-aged children with CP and 2) Assess the association between behavioral difficulties and a) sleep problems, b) nighttime pain and c) child characteristics (age, CP phenotype, comorbidities). METHODS AND PROCEDURES: Caregivers of 113 children with CP aged 4-12 years [mean (SD) age = 7.4 (2.5) years; 61.9% male] completed the Strengths and Difficulties Questionnaire, Sleep Disturbance Scale for Children and a sleep quality questionnaire to assess child behavior, sleep and nighttime pain, respectively. OUTCOMES AND RESULTS: 25.6% of children (17.6% preschool-aged; 29.1% school-aged) had behavioral difficulties. Sleep problems (odds ratio [OR] 9.1, 95% confidence interval [CI] 3.4-24.4) and nighttime pain (OR 4.1, 95% CI 1.5-11.5) were associated with behavioral difficulties. Sleep problems remained significantly associated with behavioral difficulties (adjusted OR 7.5, 95% CI 2.6-21.4) when adjusted for nighttime pain, age and non-ambulatory status. CONCLUSIONS AND IMPLICATIONS: Behavioral difficulties were reported in one in four children with CP and were associated with sleep problems and nighttime pain. Identifying and treating behavioral difficulties, sleep problems or nighttime pain is important in the care of children with CP.
Research in developmental disabilities, 2019 · doi:10.1016/j.ridd.2019.103500