ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS

COGNITIVE, PSYCHOLOGICAL AND BEHAVIORAL

Intellectual (cognitive) impairment is estimated to exist in as many as two-thirds of cerebral palsy cases. About one-third of children with cerebral palsy are severely or moderately impaired, while another one-third has only mild cognitive impairment. Psychological and behavioral disorders are often present.

A child with a below-average IQ (70 or lower) is said to have intellectual impairment. A child with intellectual impairment has difficulty with reasoning, learning, problem solving, and adaptive functioning – the everyday skills needed for self-care and the navigation of societal norms. Below-average IQ and difficulty with adaptive functioning both have a adverse impact on a child’s ability to learn; IQ level will affect scholastic, as well as behavioral learning. A pediatric neurologist, pediatric radiologist or developmental pediatrician may assist in diagnosing cognitive impairment. A psychologist, behavioral therapist or a developmental specialist can identify learning deficiencies.

Early childhood is a crucial period in the development of emotional, social, attentive, and behavioral skills required to guide an individual into – and throughout – adult life. In childhood, children learn to recognize and label feelings in order to understand and properly express themselves. They develop sympathy and care for others once they recognize that others have feelings, too. As they grow, children learn to manage emotions, block anxiety, sadness, and frustration while learning to delay gratification, resist temptation, maintain focus, and complete tasks.

Parents, siblings, friends, teachers, and caregivers have the primary influence in a child’s social, emotional, and physical health. Opportunities to learn, interact, converse and socialize will help foster security, stability, compassion, and support. Emotionally healthy children choose positive behaviors, develop mutual friendships, find acceptance in others, and excel academically.

For optimal outcomes:

  • develop positive emotional interactions
  • show consideration for the child’s feelings, desires and needs
  • show genuine interest in the child
  • treat child with respect
  • express pride in who they are and what they do
  • seek opportunities for them to learn and interact

If a child exhibits signs of distress, depression, aggression, or anti-social behavior, parents may want to seek guidance. If a child has difficulty in play, learning, or interacting with others, he or she may benefit from screens, evaluations, problem identification, interventions, or focused instruction by professionals in the field of psychology. These professionals may include social workers, psychologists, psychiatrists, behavioral therapists, developmental specialist, or school counselor. If school age, the behaviors may be identified and corrected through the Independent Education Plan (IEP) process.

Left untreated, a child becomes isolated, has counter-productive interactions, and experiences peer rejection. These can lead to lower academic performance, social-emotional deficiencies, and attention deficits.

Forms of cognitive, psychological, attention, and behavioral associated conditions, include:

  • Abnormal neurologic control
  • Academic performance impairment
  • Anxiety
  • Attention disorders
  • Attention-deficit/hyperactivity disorder
  • Behavioral problems
  • Depression
  • Down syndrome
  • Intellectual impairment
  • Learning disabilities
  • Mental health
  • Neurosis
  • Psychological health
  • Psychosis
  • Self-esteem
  • Sleep disturbances

Every Child’s Condition Is Unique

The list of possible primary, secondary, and associative conditions, as well as co-mitigating factors, can be grouped into categories, but not all conditions will be experienced by an individual with cerebral palsy. Some may encounter conditions not listed, as well.

Cerebral palsy can take a mild, moderate, or severe form depending on a host of factors. The type, location, and extent of impairment are considered, as well as any associative conditions and co-mitigating factors, when creating a treatment plan. Over the course of the person’s life, he or she may encounter any number of associative or co-mitigating factors.

Cerebral palsy is non-progressive, meaning the brain injury or malformation will not progress in severity. However, secondary conditions resulting from the brain damage may develop and change over time. For example, brain injury can cause facial muscle impairment which doesn’t change over time. Chewing, swallowing and aspiration can occur when facial muscles are impaired. Aspiration can lead to pneumonia, and pneumonia is a health condition that can become worse or better over time.

Impairments can change with – or without – proper management. As a person ages, the muscular-skeletal structure may age prematurely depending on postural conditions, care, treatment and therapy. Other health conditions or life circumstances may also affect the individual’s condition over time. These can include access to health care, health insurance benefits, exposure to toxins, new health conditions, socialization, exercise, and traumatic accidents or events.

MyChild™ lists the possibilities in hope of providing families with a better understanding of the types of conditions – and categories of conditions – an individual with cerebral palsy may encounter over their lifespan. An overview of the different types of professionals likely to treat these conditions is also contained here. It should be noted that MyChild™ does not dispense medical advice. Any conditions your child may experience should be discussed with his or her medical team for proper diagnosis and treatment. In the case of emergencies, contact 911 immediately.

ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS Proper Terminology

Because the terminology used is so specific, yet remarkably similar, terms such as primary, secondary, associative and co-mitigating conditions are used interchangeably, yet incorrectly. It is helpful to know the difference between the terms when attempting to understand cerebral palsy.

Primary condition - These are a direct result of the brain lesion or brain malformation. Primary conditions affect motor coordination, motor control, muscle tone, posture and balance. Gross motor, fine motor, and oromotor functioning are also considered primary conditions of cerebral palsy.

Secondary condition - Primary conditions, in turn, may lead to secondary conditions such as inability to chew, inability to swallow, breathing difficulties, bladder and bowel control issues, and communication difficulties. If the brain lesion or malformation that caused cerebral palsy did not exist, these secondary conditions would not be present.

Associative conditions - Research has shown that individuals with cerebral palsy often have associative conditions not caused by the same brain injury or malformation which caused cerebral palsy, but proven to be common with individuals who have cerebral palsy. If the brain injury or malformation that caused the cerebral palsy did not occur, these conditions may still be present in the individual. Associative conditions include intellectual impairment, epileptic seizures, hearing impairment, and vision impairment.

Co-mitigating factors - An individual may also have health conditions separate from cerebral palsy. Unlike associative conditions, researchers have not concluded that these conditions have a high correlation to cerebral palsy. Co-mitigating factors exist regardless of cerebral palsy. Examples of co-mitigating conditions of cerebral palsy include autism, attention deficit hyperactivity disorder (ADHD), and asthma.

Associative Conditions and Co-Mitigating Factors

There are eight major categories of associative conditions and co-mitigating factors. To learn more about them, click one of the following: