Cognitive functioning in children and adolescents with cerebral palsy living in Sweden

Cognition in children with cerebral palsy (CP) is often affected. How cognition differs by functional level and subtype is not clear, and the effects of adapted response modes need investigation. In this study, the aims were to investigate how many psychologists reported that interpreters and/or augmentative and alternative communication (AAC) were used, how many assessments were adapted, if there were clinical characteristics associated with whom had been assessed, and to delineate scores from the Wechsler scales with CP by sex, subtype, gross motor function (GMFCS), manual abilities (MACS), and communication level (CFCS). This was a Swedish register study that included two cohorts of children with CP. Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III/IV) and Wechsler Intelligence Scale for Children (WISC-IV/V) served as dependent variables. Descriptive statistics, logistic regression, and multiple regressions were performed. Interpreters and AAC were used in 5% and 13% of the assessments, respectively. Adapted assessments were associated with lower verbal intelligence (VIQ), performance intelligence (PIQ), and full-scale intelligence (FSIQ) mean scores. Assessment practices were associated with GMFCS, MACS, and subtype. Age was negatively associated with PIQ and FSIQ. Children with spastic unilateral CP scored higher than children with ataxic CP on VIQ, PIQ, and FSIQ. Mean scores were significantly different across MACS levels. Children with less affected gross motor, manual, and communication functioning and those with spastic CP were more likely to be assessed. Irrespective of subtype, GMFCS, MACS, and CFCS levels, the ranges of scores were wide, highlighting the great heterogeneity of cognition in this population.