When autism is found alongside (or co-morbid with) another disorder, diagnosis and treatment may be complicated. One example is cerebral palsy and autism spectrum disorder, where severity and symptoms tend to present differently in each individual.
Autism rates among children with cerebral palsy are elevated when compared to prevalence in the general population. Even doctors admit the dual diagnosis of cerebral palsy and autism spectrum disorder presents challenges, so it’s little wonder that parents have questions when symptoms of both conditions are present in their child.
Observance of possible co-occurring conditions
Many studies (Bjorgaas et al., 2014) mention the importance of paying attention to autism symptoms in children with cerebral palsy. Timely diagnosis of autism in a child with cerebral palsy may lead to early intervention which could positively influence the child’s developmental trajectory and social functioning.
Cerebral palsy and autism are often diagnosed around the same age in young children. Unfortunately, the fact that these separate conditions share symptoms makes misdiagnosis a possibility. Some feel wide media coverage of autism may skew doctors’ diagnosis, while others feel more sinister reasons like liability in a medical malpractice claim could lead to a medical professional diagnosing autism rather than cerebral palsy.
In this article, I will examine the incidence and prevalence of cerebral palsy and autism co-occurring in children. I will also look at some of the issues complicating diagnosis and therapy, since standard testing for autism may not be appropriate for children with muscle control and motor function impairments.
Comorbidity of autism spectrum disorder and cerebral palsy in children
Findings from a study (Christensen et al., 2014) suggest 6.9% of children with cerebral palsy have co-occurring autism. The rate of prevalence of autism in the general population is therefore lower at 1.9% according to CDC’s Data and Statistics on Autism Spectrum Disorder.
A systematic review (Craig et al., 2019) investigated the prevalence of comorbidity between cerebral palsy, autism spectrum disorders and attention deficit hyperactivity disorder (ADHD). The review confirmed that ADHD and autism occur more commonly in individuals with cerebral palsy compared to the general population.
While autism and cerebral palsy are completely separate disorders with different characteristics, there are symptoms that overlap, these include:
- Delayed first word, language impairment and/or speaking difficulties
- Awkward, abnormal or repetitive movements
- Walking in an atypical manner
- Sensory symptoms (sensory processing disorders are common in autistic children and children with cerebral palsy)
When diagnosing co-occurring autism in a child with cerebral palsy, specialists may need to discern between behaviors and symptoms due to cerebral palsy and autism: for example writhing and jerking movements due to lack of muscle control or impaired motor functioning (which may be symptoms of a subtype of cerebral palsy) versus repetitive, restricted movements characteristic of autism spectrum disorder.
Similarly, communication deficits also need to be assessed with care: autism affects social communication and interaction, while cerebral palsy may affect the muscles involved in speaking. Furthermore, both conditions may be comorbid with intellectual disability and sensory difficulties which could also affect speech and language.
Difficulties with dual diagnosis of ASD and cerebral palsy
The study mentioned above (Craig et al., 2019) found the gold standard of methodologies for diagnosing autism and ADHD were not suitable for children with motor problems. The researchers concluded that future psychometric studies are needed to promote the development of measures suitable for those with cerebral palsy.
Parent-completed questionnaires are commonly used to screen for autism, but sometimes questions relating to behavior may not be appropriate for a child with motor function impairment. Play-based assessments may involve the handling of toys, which is also not a testing method appropriate for many types of cerebral palsy.
An accurate diagnosis may therefore depend on specialists who are familiar with both conditions, those who are aware of the intricacies of autism presentation when motor functioning may be compromised. When examining the main characteristics and common symptoms of cerebral palsy and autism, differences and similarities become apparent.
What is autism spectrum disorder (ASD)?
Autism is being diagnosed at an increasingly early age by doctors and pediatricians. When parents notice symptoms like repetitive/restricted behavior, social withdrawal, lack of eye contact, and late talking they may become worried about autism and request a medical consultation.
The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) is often used by doctors for the classification and diagnosis of cognitive conditions. The latest edition of the manual consolidated previous categories like asperger’s syndrome, pervasive developmental disorder and others into the umbrella term: autism spectrum disorder (ASD).
The DSM-5 criteria for an autism diagnosis are arranged in two core areas of deficits:
- Persistent difficulties with social-communication or social interaction
- Restricted, repetitive and/or sensory interests or behaviors
The DSM-5 lists all symptoms, and the number of these which need to be present for an autism diagnosis. Symptoms should cause significant difficulty in important areas of the child’s life, and such symptoms should be present from early on in the child’s life—even if manifestation only occurs at a later stage (American Psychiatric Association, 2013). For examples of these symptoms, and comprehensive diagnostic criteria, the DSM-5 should be consulted. A child will only be diagnosed with autism if symptoms are not better explained by another condition.
A child diagnosed with cerebral palsy may also lack social skills, or they may have difficulty with social interactions and communication—this may be due to symptoms associated with the disorder, particularly as children with cerebral palsy often have trouble controlling the muscles in their face and throat. Alternatively, the child may have a dual diagnosis of autism and cerebral palsy that accounts for social skills deficits or communication deficits.
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What is cerebral palsy?
Cerebral palsy is an umbrella term which includes many diverse symptoms mainly based on motor function and posture impairment that occurs in early childhood. A definition of cerebral palsy, developed by an international group of experts (Christine et al., 2007) was summarized as follows: “Cerebral palsy is a group of permanent, but not unchanging, disorders of movement and/or posture and of motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain.”
There are five main types of cerebral palsy:
- Spastic (the most common type)
A pervasive myth tells us that cerebral palsy is caused only by a lack of oxygen at birth or by a serious injury at birth. A small percentage of cases may be attributed to complications at birth, but for many other children with cerebral palsy the cause is unknown.
Risk factors have been identified and include: a serious maternal infection during pregnancy, maternal medicine used during pregnancy, maternal thyroid disorder during pregnancy, premature birth, low birthweight, congenital disorders, and other related factors.
As mentioned above, cerebral palsy presents differently in each individual, and differs according to type (of cerebral palsy) and severity. Common symptoms include:
- In babies, low muscle tone and poor muscle control could present in difficulty holding up the head, unusual posture, and the child may struggle with swallowing or feeding
- In toddlers, developmental milestones like walking and talking may not be reached due to slow or impaired motor development
Cerebral palsy is not a disease, rather the term refers to a combination of symptoms. There is a wide spectrum of severity; some children may be able to get around or stand with the assistance of a brace or walker, while others are not able to walk. Communication and learning abilities also vary in children with cerebral palsy. Determining whether communication deficits and repetitive behaviors are due to cerebral palsy or a comorbid condition like autism is a challenge that requires better, more appropriate testing.
As with autism, symptoms of cerebral palsy can vary quite significantly. An article (Shevell, 2018) makes a convincing case for replacement of the term cerebral palsy with cerebral palsy spectrum disorder. The author feels the heterogeneous nature of cerebral palsy is self-evident; mention is made of the analogous case of autism—a condition with a name that transitioned to include the word “spectrum”.
Identifying autism in a child with cerebral palsy
With overlapping symptoms and communication difficulties complicating diagnosis, how are parents supposed to know whether their child with cerebral palsy has comorbid autism? The problem with diagnosing autism in a child with cerebral palsy includes testing methodology and other factors like the heterogeneity of symptoms associated with both cerebral palsy and autism.
Clinicians often use aids like toys and play-based methods when diagnosing autism. For children with motor function impairments handling of toys may not be possible. Another example is the emphasis of atypical eye gaze as a reg flag for autism—a young child with cerebral palsy may have difficulty lifting their head, therefore, atypical eye contact may not be a symptom of autism but rather a manifestation of poor muscle control.
Some feel children with cerebral palsy are being let down by testing standards that do not take their limitations into consideration. Others speak about the long battle to get their child diagnosed with cerebral palsy, a battle which often leaves parents too weary to seek further diagnosis for possible co-occurring conditions.
No single, definitive test available
Autism and cerebral palsy are conditions that cannot be identified with a definitive test. This means parents need to insist on all available testing (MRI, blood tests, evaluations and assessments). Ideally a multidisciplinary team should assist to ensure a child is diagnosed accurately—and that they receive early, effective and appropriate treatment. This team could include developmental behavioral specialists, neurologists, pediatricians and also physical, occupational and speech therapists.
A knowledgeable team may help a child where standardized testing fails. When assessing signs and symptoms of autism in children with cerebral palsy, a knowledgeable specialist will take their motor skills impairment into consideration. They may look for signs like: insistence on sameness, lack of joint attention, restricted interests, and stimming.
Therapy for co-occurring conditions in a child with cerebral palsy may have a significant effect on their quality of life. Parents may be (understandably) hesitant about accepting another neurodevelopmental diagnosis for their child with cerebral palsy, but the benefits of appropriate therapy for a child’s unique symptoms may help them thrive.
Parents often admit to finding their child “difficult” before an autism diagnosis. Once their child’s neurodiversity is acknowledged and accepted, parents speak of coming to the understanding that it’s the world that is a difficult place for a differently wired brain.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Bjorgaas, Hanne & Elgen, Irene & Ryland, Hilde & Hysing, Mari. (2014). Autism spectrum symptoms in children with cerebral palsy: Prevalence and co-occurring conditions. Research in Autism Spectrum Disorders. 8. 581–588. 10.1016/j.rasd.2014.01.011.
Christine, C., Dolk, H., Platt, M. J., Colver, A., Prasauskiene, A., Krägeloh-Mann, I., & SCPE Collaborative Group (2007). Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Developmental medicine and child neurology. Supplement, 109, 35–38. https://doi.org/10.1111/j.1469-8749.2007.tb12626.x
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., & Yeargin-Allsopp, M. (2014). Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008. Developmental medicine and child neurology, 56(1), 59–65. https://doi.org/10.1111/dmcn.12268.
Craig, F., Savino, R., & Trabacca, A. (2019). A systematic review of comorbidity between cerebral palsy, autism spectrum disorders and Attention Deficit Hyperactivity Disorder.
European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society, 23(1), 31–42. https://doi.org/10.1016/j.ejpn.2018.10.005.
Shevell M. (2018). Cerebral palsy to cerebral palsy spectrum disorder: Time for a name change?. Neurology, 10.1212/WNL.0000000000006747. Advance online publication. https://doi.org/10.1212/WNL.0000000000006747.
Smile, S., Dupuis, A., MacArthur, C., Roberts, W., & Fehlings, D. (2013). Autism spectrum disorder phenotype in children with ambulatory cerebral palsy: A descriptive cross-sectional study. Research in Autism Spectrum Disorders, 7(2), 391–397. https://doi.org/10.1016/j.rasd.2012.10.008.
Co-occurring autism spectrum disorder was more common among children with non-spastic cerebral palsy than spastic cerebral palsy. It is important to note that the identified prevalence of autism spectrum disorder among children with cerebral palsy was higher than among their peers without cerebral palsy—about 7% vs.What are the 5 disorders on the autism spectrum? ›
There are five major types of autism which include Asperger's syndrome, Rett syndrome, childhood disintegrative disorder, Kanner's syndrome, and pervasive developmental disorder – not otherwise specified.What are some challenges demonstrated by children with ASD CP? ›
Children with ASD exhibit a stressful profile of impairments in social communication and repetitive behaviors and/or interests (American Psychiatric Association, 2013) and often engage in high levels of co-occurring behavior problems such as inattention, anxiety, and disruptive behaviors (Hartley, Sikora, & McCoy, 2008 ...What is cerebral palsy spectrum? ›
There are five major types of cerebral palsy: spastic, ataxic, athetoid, hypotonic, and mixed type. The type of movement issues an individual with cerebral palsy experiences can depend on how severely their brain injury has affected their muscle tone. Muscle tone is the strength and tension of the muscles.Is cerebral palsy a type of autism? ›
Is Cerebral Palsy a Form of Autism? Cerebral palsy is not a form of autism. According to the Mayo Clinic, cerebral palsy — which develops after the brain suffers severe damage before, during, or shortly after birth — causes problems with muscle control and tone, movement, and posture.Is cerebral palsy and autism same thing? ›
Both originate in the brain, but they manifest differently. Whereas cerebral palsy primarily affects the part of the brain that corresponds with motor functioning, autism affects social interactions, language, and behavior.What are the 12 symptoms of autism? ›
- Delayed language skills.
- Delayed movement skills.
- Delayed cognitive or learning skills.
- Hyperactive, impulsive, and/or inattentive behavior.
- Epilepsy or seizure disorder.
- Unusual eating and sleeping habits.
- Gastrointestinal issues (for example, constipation)
- Unusual mood or emotional reactions.
Four social brain regions, the amygdala, OFC, TPC, and insula, are disrupted in ASD and supporting evidence is summarized; these constitute the proposed common pathogenic mechanism of ASD.What is the main cause of autism? ›
Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Some people with ASD have a known difference, such as a genetic condition. Other causes are not yet known. Scientists believe there are multiple causes of ASD that act together to change the most common ways people develop.What is the hardest part of life for a child with autism? ›
Children with ASD often have marked differences from others in the way they communicate, behave and learn. These differences can cause problems with social interactions, which in turn can lead to problems at school, stress within their families and social isolation.
Social anxiety – or extreme fear of new people, crowds and social situations – is especially common among people with autism. In addition, many people with autism have difficulty controlling anxiety once something triggers it.How does cerebral palsy affect speech and communication? ›
Cerebral palsy can affect a person's ability to coordinate the muscles around their mouth and tongue, which are needed for speech. The respiratory coordination that is needed to support speech can also be affected, e.g. some people may sound 'breathy' when they speak.
What is Cerebral Palsy?Causes,Signs and ...Is cerebral palsy a disability? ›
Cerebral palsy (CP) is the most common motor disability in childhood, and children with CP and their families need support. Learn more about CP and what signs to look for in young children. Cerebral palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture.What are the 3 main types of cerebral palsy? ›
- Spastic Cerebral Palsy. ...
- Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies) ...
- Ataxic Cerebral Palsy. ...
- Mixed Cerebral Palsy. ...
- In a Baby Younger Than 6 Months of Age. ...
- In a Baby Older Than 6 Months of Age. ...
- In a Baby Older Than 10 Months of Age.
Generally, children born with cerebral palsy can expect to live between 30 and 70 years on average. Those with the longest life expectancies usually have more mobility, better medical care and adaptive equipment and greater autonomy and independence. There is no cure for cerebral palsy and the condition lasts for life.What are 2 symptoms of cerebral palsy? ›
- delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months.
- seeming too stiff or too floppy (hypotonia)
- weak arms or legs.
- fidgety, jerky or clumsy movements.
- random, uncontrolled movements.
- muscle spasms.
- shaking hands (tremors)
Research suggests that ASD may develop in a child around the time of birth—before, during and immediately after. More research is needed, but these things may play a role: Having pregnancy complications.What does cerebral palsy look like in kids? ›
Symptoms of Cerebral Palsy | Gillette Children's - YouTubeHow is cerebral palsy diagnosed? ›
Specialists might suggest brain imaging tests, such as x-ray computed tomography (CT scan) or magnetic resonance imaging (MRI). An electroencephalogram (EEG), genetic testing, or metabolic testing, or a combination of these, also might be done. CP generally is diagnosed during the first or second year after birth.
Some children with cerebral palsy have sensory impairment related to their brain injury. Examples include difficulties feeling light touch, pain, pressure on the skin, temperature, and knowing where their joints and muscles are positioned4.Can autistic child go to normal school? ›
Autism has a wide spectrum and not every individual with autism can find a place in mainstream schools. However, I have had a few success stories where the right support and timely intervention helped. Several students from my schools were able to successfully complete their education from mainstream schools.What age does autism show? ›
The behavioral symptoms of autism spectrum disorder (ASD) often appear early in development. Many children show symptoms of autism by 12 months to 18 months of age or earlier.How do they test for autism? ›
Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child's developmental history and behavior to make a diagnosis. ASD can sometimes be detected at 18 months of age or younger.What is the best way to treat autism? ›
Behavioral approaches have the most evidence for treating symptoms of ASD. They have become widely accepted among educators and healthcare professionals and are used in many schools and treatment clinics. A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA).Is autism a form of brain damage? ›
Studies suggest that ASD could be a result of disruptions in normal brain growth very early in development. These disruptions may be the result of defects in genes that control brain development and regulate how brain cells communicate with each other. Autism is more common in children born prematurely.What organs are affected by autism? ›
Among the body systems involved in autism is obviously the brain. Anatomical differences in the cerebellum and amygdala have been noted in multiple studies, and other regions have been inconsistently identified as diverging from the average .Which parent is responsible for autism? ›
Due to its lower prevalence in females, autism was always thought to have a maternal inheritance component. However, research also suggests that the rarer variants associated with autism are mostly inherited from the father.How do you avoid having a child with autism? ›
- Live healthy. Have regular check-ups, eat well-balanced meals, and exercise. ...
- Don't take drugs during pregnancy. Ask your doctor before you take any medication. ...
- Avoid alcohol. ...
- Seek treatment for existing health conditions. ...
- Get vaccinated.
Just like neurotypical individuals, the future of people with ASD depends on their strengths, passions and skillsets. It is important to understand that a diagnosis of ASD does not mean that your child cannot make friends, date, go to college, get married, become a parent, and/or have a satisfying lucrative career.
Autistic people may display a range of strengths and abilities that can be directly related to their diagnosis, including: Learning to read at a very early age (known as hyperlexia). Memorising and learning information quickly. Thinking and learning in a visual way.How do parents of children with autism feel? ›
Parents of children with autism can be under tremen- dous stress. It may seem like there is never enough time to do everything that needs to be done. So much focus and attention is placed on the child with autism, that it is common for parents to have little time or energy left to focus on their other children.How do autistic parents feel? ›
Parents of children with autism sometimes describe feeling “overwhelmed, guilty, confused, angry, or depressed.” Frustration is a common emotion. They may feel frustrated when their child is clumsy, unresponsive, angry, or disregarding of others.What happens if autism is not treated? ›
Adults who have not received appropriate treatment may have trouble living independently, may be unemployed, and may struggle with relationships. Autism can also impact physical and mental health, according to the 2017 National Autism Indicators Report: Developmental Disability Services and Outcomes in Adulthood.Can you live a normal life with autism? ›
The simple answer to this question is yes, a person with autism spectrum disorder can live independently as an adult. However, not all individuals achieve the same level of independence.Does CP affect intelligence? ›
Cerebral Palsy Isn't an Intellectual Impairment, But…
People with Cerebral Palsy have limited mobility or coordination of their arms and or legs. Although permanent, CP is fortunately non-progressive, meaning it does not worsen over time. Cerebral Palsy does not on its own affect a person's intelligence.
Some examples of common exercises for speech therapy include: Articulation therapy - Using language cards to help focus on specific sounds; encouraging children to make sounds while looking in the mirror to help them understand how their mouth moves.Can children with cerebral palsy learn to talk? ›
About 75% of children with cerebral palsy have speech defects. Luckily, it's estimated that 50% to 70% of these children can benefit from speech training and enjoy a higher quality of life. Speech therapy can help children control key muscles involved in forming words, making sounds and controlling their breath.What's the life expectancy for cerebral palsy? ›
How Long Can Someone Live with Cerebral Palsy? Generally, children born with cerebral palsy can expect to live between 30 and 70 years on average. Those with the longest life expectancies usually have more mobility, better medical care and adaptive equipment and greater autonomy and independence.What are 2 symptoms of cerebral palsy? ›
- delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months.
- seeming too stiff or too floppy (hypotonia)
- weak arms or legs.
- fidgety, jerky or clumsy movements.
- random, uncontrolled movements.
- muscle spasms.
- shaking hands (tremors)
Children with cerebral palsy have an increased risk for an array of co-existing conditions, such as autism and epilepsy. However, ADHD is reported to be more common in children with CP than in the general population. Recent estimates suggest that 19% of children with cerebral palsy also have ADHD.What is severe autism called? ›
Severe autism is sometimes called “level 3” on the spectrum. People with severe autism require help with day-to-day functioning. Caregiving, or a high level of support, may be needed across the lifespan.Who is the oldest person with cerebral palsy? ›
When Bernadette Rivard was born with severe physical disabilities in the 1930s, some might have thought her life would be a burden. It proved to be far from it.Does CP get worse with age? ›
CP does not get worse over time, though the exact symptoms can change over a person's lifetime. All people with CP have problems with movement and posture.Does cerebral palsy affect intelligence? ›
Cerebral Palsy does not on its own affect a person's intelligence. However, as many as 30-50% of children with CP have some form of cognitive impairment caused by a coexisting condition.What is the main cause of cerebral palsy? ›
What is Cerebral Palsy?Causes,Signs and ...Who is most at risk for cerebral palsy? ›
Low birthweight―Children who weigh less than 5 1/2 pounds (2,500 grams) at birth, and especially those who weigh less than 3 pounds, 5 ounces (1,500 grams) have a greater chance of having CP.What part of the brain is affected by cerebral palsy? ›
Cerebral palsy affects the motor area of the brain's outer layer (called the cerebral cortex), the part of the brain that directs muscle movement. In some cases, the cerebral motor cortex hasn't developed normally during fetal growth.Are people with cerebral palsy hyperactive? ›
Attention-Deficit / Hyperactivity Disorder (ADHD) is reported to be more common in children with CP than in the general population, with reported prevalence rates varying by study.Is CP a neurodevelopmental disorder? ›
Cerebral palsy (CP) is considered a neurodevelopmental disorder because it affects the brain's development and function, causing varying degrees of lifelong disability.
Disorders of early brain development are often called neurodevelopmental disorders and include autism spectrum disorder (ASD), intellectual disability, motor disability (eg cerebral palsy), seizures, learning disabilities (eg dyslexia), and attention deficit hyperactivity disorder (ADHD).How long do people with autism live? ›
One of the most important investigations of recent years revealed that average life expectancy of a person with severe autism is 39.5 years, rising to only 58 years for those with high-functioning autism, or Asperger syndrome.What is the lowest level of autism? ›
Level 1 ASD is the least severe. This could be viewed as mild autism. People who qualify as having Level 1 ASD may struggle in social situations and have some concerns with restrictive or repetitive behaviors but they only require minimal support to help them function in their day to day activities.What happens if autism is not treated? ›
Adults who have not received appropriate treatment may have trouble living independently, may be unemployed, and may struggle with relationships. Autism can also impact physical and mental health, according to the 2017 National Autism Indicators Report: Developmental Disability Services and Outcomes in Adulthood.