Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey

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Abstract
Objective : To examine the prevalence and predictors of psychiatric problems in children with hemiplegia. Design : Cross sectional questionnaire survey of an epidemiological sample with individual assessments of a representative subgroup. The questionnaire survey was repeated on school age subjects four years later. Subjects : 428 hemiplegic children aged 2 1/2-16 years, of whom 149 (aged 6-10 years) were individually assessed. Main outcome measures : Psychiatric symptom scores and the occurrence of psychiatric disorder. Results : Psychiatric disorders affected 61% (95% confidence interval 53% to 69%) of subjects as judged by individual assessments and 54% (49% to 59%) and 42% (37% to 47%) as judged from parent and teacher questionnaires, respectively. Few affected children had been in contact with child mental health services. The strongest consistent predictor of psychiatric problems was intelligence quotient (IQ), which was highly correlated with an index of neurological severity; age, sex, and laterality of lesion had little or no predictive power. Conclusion : Though most hemiplegic children have considerable emotional or behavioural difficulties, these psychological complications commonly go unrecognised or untreated. Comprehensive health provision for children with chronic neurodevelopmental disorders such as hemiplegia should be psychologically as well as physically oriented. Key messages: They are almost equally common accompani- ments of left and right hemiplegias They are best predicted by IQ, possibly as a marker for underlying neurobiological abnormalities These difficulties often go untreated, com- pounding the child's other difficulties

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