Cerebral Palsy and Behavioral Disorders

Fact Checked

Children with cerebral palsy are at risk for behavioral problems, including hyperactivity, antisocial behaviors, anxiety, dependency, and more. They are at increased risk for behavioral conditions because of the challenges that the physical disability presents and the underlying brain damage that leads to cerebral palsy. Experts in behavior and mental health can help parents and their children cope with and learn to change problem behaviors.

What Are Behavioral Disorders?

Behavioral disorders are more common in childhood than many people realize. Still, it can be difficult to distinguish between actual conditions and responses to stress new situations or even typical developmental phases.

To be considered a behavioral disorder, a problematic behavior or set of behaviors must be exhibited in a child for six months or longer. There must be a pattern of problematic behaviors that persist despite interventions by parents or other adults.

Examples of problematic behaviors are those that are inappropriate for a child’s age or development status: harming self or others, destruction of property, hyperactivity, impulsiveness, lying, stealing, aggression, early engagement in risky behaviors like sex, smoking, or drinking, out of control tantrums, or doing poorly in school.

Behavior and Cerebral Palsy

Studies investigating behavior in children with cerebral palsy have found that they are more likely than their non-disabled peers to struggle with behavioral disorders.

The rate of diagnosed disorders in the cerebral palsy population is higher than in the general population of children. As much as 25% of children with cerebral palsy also struggle with behavior issues.[1]

Many factors contribute to increased behavior issues in children with cerebral palsy, including learning disabilities, seizure disorders, being male, comorbid conditions or disabilities, and communication difficulties.

Outside factors may also contribute, including lack of proper care, stressful environment, and caregiver strain in parents or others regularly involved in the child’s care. Difficulty with communication seems to be a significant factor in challenging behaviors.

Much like when tantrums peak at the toddler age before language develops if a child with cerebral palsy cannot communicate effectively, they may experience frustration and act out those feelings accordingly.

Signs of Behavioral Disorders

Parents and other caregivers of children with cerebral palsy must be aware of the signs of a behavioral disorder so that the child can be evaluated and treated by experts. Living with behavioral challenges is difficult for everyone, parents, and caregivers, for the child with cerebral palsy, and family members.

Recognizing and addressing the problem behaviors early is crucial for helping a child cope and learn new and more appropriate behaviors.

Several specific behavioral disorders may be diagnosed, including attention deficit hyperactivity disorder, autism spectrum disorder, and oppositional defiant disorder.

What is most important for parents and caregivers is to be able to recognize specific behaviors that are frequent,  persistent, and problematic:[2]

• Self-injury
• Harming other people or animals
• Threatening others
• Destroying property
• Lying
• Stealing
• Cheating at school
• Missing school
• Smoking, drinking, or using drugs
• Disobedience
• Hyperactivity
• Impulsivity
• Sexually inappropriate behavior

These are just some of the potentially problematic behaviors that could indicate a behavioral disorder in a child with cerebral palsy. The general rule is that any behavior inappropriate for a child’s developmental age, such as tantrums in a 10-year-old, is possibly problematic.

Parents should also note any unusual or abrupt changes in typical behaviors. Problematic behaviors that persist for six months or more may indicate a behavioral disorder.

Diagnosis and Treatment

Parents and other caregivers who believe a child with cerebral palsy struggles with problem behaviors should consult with professionals. They can evaluate the child, make a diagnosis, and help develop a treatment plan. You may want to start with your child’s school.

A school psychologist or social worker may be able to do an evaluation or direct you to an appropriate professional. A pediatrician is also a good place to start for children of any age.

A behavioral health expert can evaluate your child through observations and tests. Even if your child doesn’t meet the criteria for a diagnosis, an expert can still guide you to the appropriate resources or professionals who can help.

Any challenging behaviors, even those not labeled as a disorder, are disruptive and should be evaluated and addressed, both for the child and the child’s family.

Therapy

Various types of psychotherapy are typical types of treatment or intervention for behavioral disorders.[3] One particularly useful type of therapy is cognitive-behavioral therapy.

This type of therapy teaches skills for identifying negative thoughts and feelings and learning to reframe or correct them before they become problem behaviors.

It is an effective treatment that helps many adults and children learn to change negative responses and replace them with positive and productive ones.

Medications

Parents might hope to use medications for behavior problems as a last resort, but they can be useful for some children. Depending on the diagnosis, a child may benefit from antidepressants, stimulants, mood stabilizers, or other types of medications.[3]

How to Support a Child with Problem Behaviors

Recognizing and getting treatment for a child struggling with cerebral palsy-associated behavioral disorders is crucial.

These are the first steps toward helping a child learn to cope with negative emotions and other challenges that have led to problematic behaviors. Parents, family, friends, and caregivers of the child must also support the treatment and encourage positive changes.

• One of the most significant factors in helping curb problem behaviors is providing supportive care to help minimize or manage the day-to-day stressors of living with cerebral palsy. A child that is not receiving the care they need will continue to struggle with problematic behaviors.
• Home health aides, one-on-one assistants at school, and assistive devices for mobility and communication are all examples of supportive care that can be beneficial.
• Minimizing stress levels in the home environment is also important. Some studies have shown that a parent’s stress level can negatively impact a child’s behavior. A calm and caring environment can help support a child as he learns to make positive changes.
• Most importantly, see your pediatrician as soon as you suspect your child has behavioral challenges. The earlier you begin therapies and treatment, the better the outcome.

Behavior issues add more challenges to living with cerebral palsy, but they are manageable and treatable with the right evaluation and treatment plan.