Language Characteristics of Children and Youth with Cerebral Palsy

Cerebral palsy affects one in 500 babies and one in three extremely low birth weight babies in Canada and results in non-progressive motor disabilities and accompanying sensory and cognitive deficits (Ontario Federation for Cerebral Palsy, 1999). Children with cerebral palsy are at increased risk for language disorders. It is estimated that 20% of children diagnosed with cerebral palsy have severe communication impairments (Pennington, Goldbart, & Marshall, 2005). The language skills of children with cerebral palsy have not been studied extensively and studies reveal mixed results due to the heterogeneity of this group and to variation in exposure to opportunities to communicate (Bishop, Brown, & Robson, 1990; Falkman & Hjelmquist, 2002; Redmond & Johnson, 2001). It is important to learn about the language skills of those with cerebral palsy in order to help parents and service providers understand how children process information, express themselves, learn to read and write and to plan appropriate intervention programs so children may participate fully (Sandberg & Hjelmquist, 1996; Schenker, Coster, & Parish, 2005). Our goal was to find out how the children's language developed over a few years.

What did we do?

Children and youth participated in an assessment of their language abilities as part of a larger battery of tests and interviews carried out by CanChild during a 3 year study about children's participation (Law, et al., 2005). 

The following information was gathered once a year for 3 consecutive years:

• Children and youth completed the Peabody Picture Vocabulary Test III, a measure of listening vocabulary. Participants identified the word they had heard by selecting the correct picture from four choices.
  
• A family member, usually the child's mother, completed a phone interview in which she provided information about how well her son or daughter performed various language skills on a regular basis. Parents were asked to tell if their child understood language, spoke in words and sentences, read words, books and newspapers, and wrote messages or reports at school. Parents reported on their child's everyday use of language for speaking, listening, reading and writing, using the questions on communication from the Vineland Adaptive Behaviour Scales.
  

Who participated in the study?

• Two hundred and seventeen children and youth (118 boys and 99 girls) with cerebral palsy participated.
  
• They ranged in age from 6-14 years in the first year of the study.
  
• They were diagnosed with cerebral palsy at one of Ontario 's children's treatment centres and their families listed cerebral palsy as a primary health concern.
  
• The children were able to complete various child assessment measures and the parents were able to answer the interviewer's questions.
  
• Forty four percent of the participants ranged in age from 9-11 years, while over twenty percent ranged in age from 6-8 years (26%) or were 12 years and older (30%).
  
• Most children (86.6%) came from two parent families.
  
• Most children (81.5%) were Caucasian, however, eight other ethnic groups were represented.
  

What did we find?

How did children with cerebral palsy perform on vocabulary and overall language abilities in the first year of the study?

• As a group, children had receptive vocabulary skills that were within the normal range compared to the general population.
  
• The group performed in the low end of the normal range for overall language abilities on the Communication Domain of the Vineland Adaptive Behaviour Scales.
  

Is the percentage of children with cerebral palsy who have language difficulties greater than for children without cerebral palsy at the start of the study?

• On both of the child assessment and parent report measures, we would expect approximately 68% of participants to score within +/-1 standard deviation of the mean if the scores were normally distributed. We would expect about 9% to have scores greater than -1.5 standard deviations below the mean or what is considered language disordered.
  
• Fifty eight percent of the children fell within the normal range while 22.5% scored greater than -1.5 SD below the mean for vocabulary.
  
• Forty two percent of the children fell within the normal range for understanding language, producing language, and reading and writing skills combined. Forty two percent also scored greater than -1.5 SD below the mean for overall language skills.
  
• In summary, the participants in this study had slightly more difficulties with vocabulary than children who were developing language normally in the first year of the study.
  
• At the start of the study, participants had far more difficulties with overall language abilities than children who were developing language normally.
  

Did the language skills of the children and youth change over a three year period?

• The receptive vocabulary skills of the participants remained relatively stable over the three year period with 56% of children performing within the normal range.
  
• The overall language skills (including oral and written skills and understanding language) of the children and youth decreased over a three year period with the percentage of children functioning in the normal range falling from 42% to 34%.
  

How is this information useful?

To Parents

• Because children with cerebral palsy are at greater risk for language disorders, it is important to have your child's language skills assessed at an early age (preferably by age 2).
  
• Language stimulation should be part of your child's overall early intervention program. Early language intervention and the establishment of a consistent way for your child to communicate (speech, alternate communication system, i.e. manual sign, photographs, picture communication symbols or PCS, low tech voice output communication aids or VOCA's) will provide a good foundation for learning to read and write and for participating in classroom discussions.
  

To Service Providers

• Because of the relative strength of vocabulary skills, building these skills can help facilitate the use of augmentative communication devices and the onset of reading skills.
  
• Children with cerebral palsy may experience multiple sensory, physical, visual, and cognitive deficits. The relative strengths and weaknesses in these areas are different for each child. Assessment and intervention procedures should reflect these individual differences
  
• Careful assessment in each of the language, motor, cognitive, and sensory areas is needed to create individual profiles of performance for children with cerebral palsy (Redmond & Johnson, 2001).
  
• In depth assessment in multiple developmental (language, cognition, and motor) will aid in planning the best academic programs possible for children with cerebral palsy.
  
• Language intervention programs should provide opportunities for children to communicate through alternate means, and numerous opportunities to express concepts. Providing these opportunities as early as possible facilitates both language learning and advancement in academic subjects (Olswang & Pinder, 1995; Pinder & Olswang, 1995).
  

To Researchers

• Researchers are encouraged to gather information on language development along with motor or cognitive functioning in order to better understand the interrelationships between the development of motor, cognitive, and language skills in children with cerebral palsy.