Researchers reflect on challenges & implications of dual diagnosis of cerebral palsy and autism

October 16, 2013

Children with CP are more likely to be diagnosed with autism than children in the general population, according to a new study by researchers at the US Centers for Disease Control. 

The publication, released during the first week of October in the journal Developmental Medicine and Child Neurology (DMCN), confirms earlier findings drawn from the same US surveillance system that identified prevalence rates of autism spectrum disorder (ASD) at 6.9 percent in children with cerebral palsy. Rates of ASD in the general population are at 2 percent, and thought to be rising.

Genetic and other risk factors that predispose to both conditions merit further investigation, according to NeuroDevNet’s ASD research group co-lead Dr. Lonnie Zwaigenbaum, “but for me,” he said, “the findings are a good reminder that kids with CP also experience other developmental and emotional challenges, including a heightened risk of ASD.” Zwaigenbaum authored a commentary on the CDC findings in the same edition of Developmental Medicine, and emphasized that the elevated rate of ASD “is pretty consistent with other conditions seen in children with CP, including learning disabilities, anxiety, and ADHD.

“This is a higher-risk group of children, who often have a lot of strengths along with their disabilities - but their developmental challenges go beyond the motor system,” Zwaigenbaum adds. “We should not just be looking for signs of ASD, but for more general challenges that require more holistic approach to follow-up.”

Dr. Darcy Fehlings, co-lead of NeuroDevNet’s CP research group and her colleague Dr. Sharon Smile, a developmental pediatrician at Bloorview, concur. Smile and Fehlings co-authored a recent study in Research in Autism Spectrum Disorders looking at ASD in children with CP who are capable of walking. They found that intellectual disability is common among children with both CP and ASD. ASD in this population is typically diagnosed later than among children whose primary diagnosis is autism.

“It’s important for clinicians to be aware of this heightened prevalence, and the possibility of dual diagnoses,” said Fehlings. “Our research has showed delays in making the autism diagnosis in children with CP, which led to delays in getting appropriate, ASD-focused intervention.”

In addition to helping identify the risk of ASD, and opening the door supports that can optimize social communication skills in children with dual CP/ASD diagnoses, developmental surveillance has additional benefits, notes Zwaigenbaum. “It offers opportunities to enhance function and participation that can benefit all children with neurodevelopmental disorders.”

Sources: Christensen, D., Van Naarden Braun, K., Doernberg, N. S., Maenner, M. J., Arneson, C. L., Durkin, M. S., Benedict, R. E., Kirby, R. S., Wingate, M. S., Fitzgerald, R. and Yeargin-Allsopp, M. (2013), Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008.

Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.12268 Smile S, Dupuis A, Macarthur C, Roberts W, Fehlings D: Autism spectrum disorder phenotype in children with ambulatory cerebral palsy: A descriptive cross-sectional study. Research in Autism Spectrum Disorders 2013: RASD660: pp 391-97.

Zwaigenbaum, L (2013) The intriguing relationship between cerebral palsy and autism – Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.12268