Behavioral Difficulties are Linked to Sleep Problems in Some Children With CP, Study Finds

One in four children with cerebral palsy experiences behavioral difficulties that seem to be associated with sleep problems and nighttime pain, according to a recent study.

The results, “Behavioral difficulties, sleep problems, and nighttime pain in children with cerebral palsy,” were published in Research in Developmental Disabilities.

In healthy children, behavioral difficulties such as hyperactivity, problems controlling emotions, and difficulties performing basic cognitive tasks are some of the negative consequences of poor sleep quality.

“Sleep problems are now recognized as a common comorbidity in children with CP, and yet, the potential association between sleep disturbances and the behavioral functioning of children with CP has received limited attention,” the researcher wrote.

In their study, the researchers from the McGill University Health Centre examined the prevalence of behavioral difficulties in preschool- and school-aged children with CP, and investigated its possible association with sleep problems, nighttime pain, age, type of CP, and other comorbidities (the presence of more than one disorder in the same person).

The caregivers (mainly mothers) of 113 children with CP from 4 to 12 years old were asked to complete several questionnaires about their children’s behavior (Strengths and Difficulties Questionnaire, or SDQ), sleep quality (Sleep Disturbance Scale for Children, or SDSC), and nighttime pain (a questionnaire that the researchers created to assess sleep quality in children with CP in a previous study).

The findings indicated that approximately a quarter of the children (25.6%) had behavioral difficulties. These difficulties were more frequent among school-aged children (29.1%) than among preschool-aged children (17.6%).

“The prevalence of behavioral difficulties in children with CP was just over 25%, which is markedly elevated compared to the general pediatric population, where one would expect to encounter behavioral difficulties in only one in 10 children,” the researchers wrote.

Among all the children, “peer problems were the most common behavioral difficulty (28.4%), followed by emotional symptoms (27.5%), hyperactivity (22.1%) and conduct problems (16.0%),” they added.

Statistical analyses indicated that children who had sleep problems were 9.1-times more likely to have some behavioral difficulties, while those who had nighttime pain were 4.1-times more likely to develop these difficulties.

The strong association between sleep issues and behavioral difficulties remained present even after investigators normalized the data for nighttime pain, the child’s age, and ambulatory (mobility) status. After adjustments, analyses indicated that children with CP who had sleep issues were more than seven-times more likely to have behavioral difficulties.

“One in four children with CP had behavioral difficulties based on caregiver-report on the SDQ, with the most commonly reported issues being peer problems and emotional symptoms,” the researchers wrote.

“Our findings indicate that clinicians and other members of the health care team should consider the co-occurrence of behavioral problems, pain and sleep issues in the management of children with CP,” they added.