Predictors of participation of adolescents with cerebral palsy: A European multi-centre longitudinal study.
Childhood pain, behavior troubles, and parent stress each forecast poorer teen participation in CP—tackle all three early.
01Research in Context
What this study did
Dang et al. (2015) tracked European teens with cerebral palsy for years. They asked what early childhood signs predict poor teen participation in school, play, and community life.
The team measured childhood pain, behavior problems, and parenting stress. Years later they checked how active the same teens were in daily life.
What they found
Kids who hurt often, acted out, or had stressed parents became less active teens. Each risk factor alone lowered later participation across most life areas.
The link stayed strong even after they ruled out other medical differences.
How this fits with other research
Cohrs et al. (2017) later showed that one in seven youth with severe CP already feel severe pain. Their work extends the 2015 warning: pain starts early and keeps hurting participation.
Peters et al. (2013) found the same stress path in mothers of teens with other delays. When moms used active coping, their own mood and parenting confidence stayed higher. The CP study mirrors this: parent stress shapes teen outcomes across diagnoses.
Golubović et al. (2013) add a caution: teens and parents often disagree on quality-of-life ratings. The 2015 study used parent reports to predict teen participation; their data may miss the teen’s own view.
Why it matters
You can act early. Screen every young CP client for pain, behavior issues, and parent stress. Treat pain aggressively and teach parents coping skills. These steps may protect the teen’s future school, play, and community life.
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02At a glance
03Original abstract
We investigated whether childhood factors that are amenable to intervention (parenting stress, child psychological problems and pain) predicted participation in daily activities and social roles of adolescents with cerebral palsy (CP). We randomly selected 1174 children aged 8-12 years from eight population-based registers of children with CP in six European countries; 743 (63%) agreed to participate. One further region recruited 75 children from multiple sources. These 818 children were visited at home at age 8-12 years, 594 (73%) agreed to follow-up at age 13-17 years. We used the following measures: parent reported stress (Parenting Stress Index Short Form), their child's psychological difficulties (Strength and Difficulties Questionnaire) and frequency and severity of pain; either child or parent reported the child's participation (LIFE Habits questionnaire). We fitted a structural equation model to each of the participation domains, regressing participation in childhood and adolescence on parenting stress, child psychological problems and pain, and regressing adolescent factors on the corresponding childhood factors; models were adjusted for impairment, region, age and gender. Pain in childhood predicted restricted adolescent participation in all domains except Mealtimes and Communication (standardized total indirect effects β -0.05 to -0.18, 0.01<p<0.05 to p<0.001, depending on domain). Psychological problems in childhood predicted restricted adolescent participation in all domains of social roles, and in Personal Care and Communication (β -0.07 to -0.17, 0.001<p<0.01 to p<0.001). Parenting stress in childhood predicted restricted adolescent participation in Health Hygiene, Mobility and Relationships (β -0.07 to -0.18, 0.001<p<0.01 to p<0.001). These childhood factors predicted adolescent participation largely via their effects on childhood participation; though in some domains early psychological problems and parenting stress in childhood predicted adolescent participation largely through their persistence into adolescence. We conclude that participation of adolescents with CP was predicted by early modifiable factors related to the child and family. Interventions for reduction of pain, psychological difficulties and parenting stress in childhood are justified not only for their intrinsic value, but also for probable benefits to childhood and adolescent participation.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2014.10.043