Cognitive Impairment

The ability to perceive and understand what happens in one’s life informs a person’s decisions and goals. If an individual with Cerebral Palsy has a cognitive impairment, his or her intellectual ability is usually affected to the extent of requiring additional interventions and supports.

What is cognitive functioning?

Cognition – or the ability to use one’s intellectual capacity to reason, accurately perceive, and learn – informs many aspects of our lives. It’s the cornerstone of our ability to use what we know to achieve goals, communicate with others, and build relationships.

If a child has Cerebral Palsy, it doesn’t mean that he or she has impaired cognitive functioning. Sometimes, a child’s Cerebral Palsy will only affect his or her physical functioning. However, about 30 to 50 percent of children with Cerebral Palsy have some level of cognitive impairment. Children with severe Cerebral Palsy have a greater likelihood of having cognitive impairments.

Like many other aspects of having a child with Cerebral Palsy, cognitive impairment requires management. Not doing so can have undesirable consequences; studies show that individuals with Cerebral Palsy who are struggling with cognitive impairment have more general health concerns, and a higher mortality rate.

Once parents learn that their child is cognitively-impaired, they may become worried that their child’s full potential may not be realized. However, children with cognitive impairments lead enjoyable and meaningful lives.

Cognition is the ability of a person to think matters out by using information from the brain. Because Cerebral Palsy is essentially caused by damage to the brain, the centers that transmit accurate information from several sources may be impaired. This means a person with a brain injury may experience difficulty in understanding or processing the information he or she receives. When this occurs, it’s referred to as cognitive or intellectual impairment.

Some of the brain’s functions that fall under cognition include:

• Attention span
• Comprehension
• Decision-making
• Difficulty processing emotions and feelings
• Language skills
• Learning
• Memory
• Problem-solving
• Recognition
• Speech proficiency

Currently, the benchmark that determines whether a child has an intellectual impairment is if they have an IQ of 70, or less. But in a practical sense, an intellectual impairment can be specific to certain functions; it’s possible that a child that has difficulty in one specific area may have an IQ above 70. That child may still benefit from interventions.

There are a number of associated conditions that often, but not always, accompany cognitive impairments, including:

• Anxiety
• Attention deficit/hyperactivity disorder
• Behavioral challenges
• Depression or moodiness
• Fatigue
• Inability to connect emotionally
• Psychological disorders
• Sleep disturbances

What causes cognitive impairments?

Generally, there is no single cause for cognitive impairments in children. In the case of children with Cerebral Palsy, however, the brain injury that caused Cerebral Palsy is likely the cause of cognitive impairment. The extent and the nature of the impairment are dependent on where the brain injury occurred, and its severity.

More specifically, cognitive impairment can be attributed to conditions that occur in the fetal stages of development, or at birth. Sometimes, the causal factors are unknown.

Some of the conditions or circumstances that cause cognitive impairments include:

• Brain hemorrhage
• Chromosomal abnormalities
• Congenital hypothyroidism
• Genetic abnormalities
• Lack of oxygen during labor
• Prenatal infections
• Preterm complications
• Stroke

Although cognitive impairments can occur at different times and under different circumstances over a lifetime (Alzheimer’s disease would be an example of this), children with Cerebral Palsy who have a cognitive impairment are likely born with the condition. However, the body of a person with Cerebral Palsy is like any other in that certain associated and secondary conditions can exacerbate the impairment.

What are some of the signs that a child may be struggling with a cognitive impairment?

A child’s cognitive impairment might be something that is difficult to detect. Typically, parents realize that something is different about their child as a child fails to meet established developmental benchmarks. Still, the signs that a child has a cognitive impairment might be written off to other factors. It goes without saying that if a parent suspects that something is wrong, he or she could consult a physician even if the issue at hand seems minimal.

Child development experts know that young children, even from a young age, respond to their environment, sometimes positively and other times negatively. The key to determining if a child has a cognitive impairment is to observe him or her in the home environment. Is a child off in his own world and unresponsive? Does he or she seem uninterested in the people or activities within the home?

Even when children are babies, they should respond to external stimulations such as noises, the sound of a mother or father’s voice, or a touch. If a child is not responsive under those conditions, he or she should be seen by a physician immediately.

Some of the signs that a child has a cognitive impairment include:

• Aversion to physical interaction
• Delayed language development
• Depression or anxiety
• Difficulty focusing, prone to distraction
• Difficulty learning, literacy challenges
• Inability to express thoughts quickly, process information
• Inability to recognize noises
• Outbursts of temper
• Shortened memory span
• Social ambivalence, trouble interacting with others
• Trouble interpreting sensory demands
• Trouble responding to others (reduced brain plasticity)
• Trouble speaking

Additionally, there are some associated conditions that seem to be present in many children with cognitive impairment, including:

• Blindness or significant vision loss
• Deafness or hearing loss

It’s vital for parents to find out as soon as possible if a child has a cognitive impairment so they can start working with physicians and therapists on early intervention therapies, and so parents can begin to work with a child in a way that will help them connect with the child.

What therapies are available to help children with cognitive impairments?

A cognitive impairment is a condition that has no cure, but with the right set of therapies and interventions, a child can learn to work within his or her limits, which in turn extends his or her ability to function. Additionally, it’s impossible to determine what an infant’s future capabilities will by the time he or she grows up.

Early interventions – the specifics of which will depend on the nature and severity of a child’s condition – will help a child learn to expand his or abilities. When medical professionals and educators begin to devise a specific plan for a child, there are many factors that will need to be addressed.

A child’s cognitive challenges will be addressed as part of his or her overall medical plan. The following professionals will be involved in a child’s efforts to work within in his or her impairment:

• Occupational therapists
• Physical therapists
• Physicians
• Psychologists
• Special education teachers
• Speech and language pathologists

The goal of all interventions is to help a child compensate for physical or cognitive impairments. Some of the barriers that children with cognitive impairment will address in a school or therapeutic setting include:

Behavior

Children with cognitive impairments are under stress because they are not learning or developing at the same rate as their peers. They may feel out of place and misunderstood; all of these feelings can lead to acting out. Educators and therapists will likely take several steps to mitigate behavioral difficulties by encouraging interaction between students, offering recognition to children, fostering interests in educational and recreational activities, providing assistance in the classroom, and helping children to focus on their successes. These measures help a child build self-esteem, which will likely improve his or her disposition.

Communication

Professionals will use a myriad of different methods to communicate depending on the nature of a child’s strengths. Often, they will use photos as visual instructions along with words so children can begin to associate images and words. This improves a child’s ability to interpret concepts. Also, educators will use simple, short statements that are easy to understand. If needed, augmentative communication may be implemented.

Functionality

If a child does not understand how his or her body works, or has difficulties with spasticity or other physical impairments, therapists may break down tasks into simple, step-by-step components. Often, a child will be able to process how to handle simple tasks in succession, which can lead to the completion of a more complex task. Broken down, concepts are easier for children to perform.

Learning

Educators use may use many strategies to help a child learn. Visual cues along with speech will help a student understand instructions and commands. Also, cultivating decision-making skills by offering students choices and alternatives will help a child sort out and understand concepts. Children should also be afforded the opportunity to participate in instruction – if a child is asked to provide feedback about concepts, educators can be sure they understand what’s being taught.

Literacy

When it comes to literacy, children with cognitive impairments may not read like other children, but it doesn’t mean they are incapable of understanding what words mean. Often, educators and therapists will get around this by reading questions to children and engaging in conversation with the child and his or her classmates. In cases where a child cannot understand words, visual cards with images on them will be used, along with demonstrations of how the object in the picture is used. Technology might also be employed under these circumstances. Computer screens with images that correspond to words, voice-activated word processing and two dimensional displays are common tools for educators and therapists.

Memory

A child’s memory span can be a challenging issue for teachers and therapists to rectify. Some of the methods they use to help children remember lessons include audio playbacks, prompt cards that features objects and keywords, and notes to remind children of what they have learned. The theory behind these methods is that the more children are exposed to concepts, the greater the likelihood that they will retain what they’ve learned.

Sensory

A child’s brain injury that led to cognitive impairments may cause sensory misfires; it’s possible that a child may not understand what he or she is hears and sees. This is a vexing situation for professionals and family members, but there are some methods that can improve a child’s ability to interpret his or her surroundings. These include making sure that acoustics are clear and not to loud or soft, providing aids for children with low vision, making sure objects have textures that children can identify, and using abundant lighting.

Helping a child overcome cognitive challenges is about setting achievable goals. With the correct set of supports, children will gradually increase their abilities. However, a child may not establish those abilities in the way other children do; how he or she learns, interacts with others, engages with peers, expresses thoughts and feelings or processes information may look vastly different than what a parent expects.

Does a child’s cognitive impairment affect his or her lifespan?

Unfortunately, there is a correlation between lifespan and cognitive impairment. There is no one reason that a child with a cognitive impairment may have a shorter life. Researchers suspect that stress combined with the general condition of the body affected by cognitive impairments may be a contributing factor.

The fact that there are links between cognitive impairments and reduced lifespan does not mean that a child will have a reduced lifespan, however. Many individuals with Cerebral Palsy that have cognitive impairments live a normal lifespan providing that the right kinds of medical attention and support are in place.

Clearly, a child’s life span is a major concern for a parent. The best way a parent can help extend a child’s longevity is vigilantly monitor his or her health – if an issue seems minor, don’t hesitate to have it checked out by a doctor who can inform a parent about what’s happening, even when a child cannot.

How can a parent help a child cope with a cognitive impairment?

Children with cognitive impairments face tremendous levels of uncertainty and frustration, thus in need of additional support. At first, it might be difficult for parents to learn how to communicate with their child, but learning the best ways to interact with a child will be immensely beneficial as a child grows up.

Of course, what constitutes the best way to help a child cope with his or her impairment is as individual as a child’s condition. There is no one way to help a child cope, but there are some strategies parent can use to enhance communication with a child, and offer the sort of support that will help a child cope.

Some ways a parent can help a child cope with his or her condition include:

• Ask a child to express his or her feelings or frustrations
• Avoid circumstances that would lead to a child’s isolation
• Express pride in a child’s achievements
• Make sure a child has adequate opportunities for social interaction
• Provide a positive feedback about achievements, show interest
• Seek out new learning opportunities
• Show consideration for a child’s struggles

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.