Social-Emotional Development and Associated Risk Factors in Chinese Toddlers with Cerebral Palsy

Figures & data

Table 1 Basic Information on Children with Cerebral Palsy (n=300)

Baseline Characteristics	Classifications	Number of Participants (n)	Proportion (%)
Gender	Male	192	64.0
	Female	108	36.0
Age(months)	12~17	148	49.3
	18~23	68	22.7
	24~29	64	21.3
	30~36	20	6.7
The only child	Yes	156	52.0
	No	144	48.0
Gestational age	Full-term	204	68.0
	Premature	68	22.7
	Late-term	28	9.3
Delivery mode	Normal childbirth	216	72.0
	Caesarean section	84	28.0
Postpartum asphyxia	Yes	252	84.0
	No	48	16.0
Type of cerebral palsy	Spastic tetraplegia	136	45.3
	Spastic diplegia	8	2.7
	Spastic Hemiplegia	32	10.7
	Dyskinetic	60	20.0
	Ataxia	4	1.3
	Mixed	60	20.0
Complication	None	104	34.7
	Epilepsy	4	1.3
	Logopathy	168	56.0
	Visual disorder	20	6.7
	Audio disorder	4	1.3
Electroencephalogram	Normal	264	88.0
	Abnormal	36	12.0
Auditory evoked potential	Normal	268	89.3
	Abnormal	32	10.7
Visual evoked potential	Normal	268	89.3
	Abnormal	32	10.7

Figure 1 Comparison of the scores of each dimension of social-emotional development in children with cerebral palsy (CP) and the national normal. (A1–A4) Scores of externalizing, internalizing, dysregulation, and competence domains for boys with CP and the national normal, respectively. (B1–B4) Scores for the externalizing, internalizing, dysregulation, and competence domain for girls with CP and the national normal, respectively. All data are represented by mean ± SD values. *Indicates p < 0.05 and **p < 0.01.

Table 2 The Effect of General Clinical Features of Children with Cerebral Palsy on the Score of the Social-Emotional Development Scale

Clinical Features	Externalizing Domain	Internalizing Domain	Dysregulation Domain	Competence Domain
Gender	t=0.988, p=0.032	t=−4.072, p<0.001	t=−2.570, p=0.011	t=−0.283, p=0.777
Male	0.403±0.230	0.423±0.249,	0.520±0.237	0.786±0.386
Female	0.377±0.231	0.547±0.259	0.600±0.293	0.798±0.341
Age(months)	F=3.314, p=0.020	F=5.115, p=0.002	F=3.623, p=0.013	F=34.42, p<0.001
12~17	0.374±0.219	0.423±0.233	0.533±0.255	0.666±0.365
18~23	0.424±0.271	0.488±0.326	0.578±0.322	0.738±0.337
24~29	0.404±0.213	0.530±0.229	0.571±0.212	1.053±0.256
30~36	0.500±0.377	0.550±0.230	0.661±0.312	1.065±0.372
Type of cerebral palsy	F=5.119, p<0.001	F=6.377, p<0.001	F=5.207, p<0.001	F=8.039, p<0.001
Spastic tetraplegia	0.443±0.250	0.496±0.292	0.554±0.288	0.757±0.323
Spastic diplegia	0.222±0.000	0.519±0.356	0.625±0.490	0.386±0.456
Spastic Hemiplegia	0.355±0.149	0.389±0.147	0.552±0.203	1.014±0.384
Dyskinetic	0.337±0.257	0.338±0.190	0.422±0.188	0.893±0.376
Ataxia	0.055±0.000	0.444±0.000	0.541±0.000	0.286±0.000
Mixed	0.407±0.161	0.570±0.224	0.653±0.204	0.791±0.370
The only child	t=−0.190, p=0.854	t=0.719, p=0.473	t=−1.520, p=0.129	t=1.017, p=0.310
Yes	0.392±0.192	0.478±0.245	0.527±0.229	0.812±0.365
No	0.397±0.266	0.457±0.278	0.573±0.291	0.768±0.376
Gestational age	F=4.940, p=0.008	F=21.26, p<0.001	F=11.02, p<0.001	F=7.038, p=0.001
Full-term	0.395±0.236	0.436±0.250	0.539±0.262	0.954±0.352
Premature	0.438±0.238	0.625±0.256	0.647±0.245	0.714±0.359
Late-term	0.277±0.074	0.317±0.135	0.387±0.189	0.734±0.444
Delivery mode	t=−2.130, p=0.034	t=0.907, p=0.365	t=−2.420, p=0.016	t=−1.261, p=0.208
Normal childbirth	0.377±0.231	0.476±0.271	0.526±0.261	0.774±0.389
Caesarean section	0.439±0.223	0.446±0.227	0.607±0.253	0.834±0.314
Postpartum asphyxia	t=2.778, p=0.006	t=0.775, p=0.439	t=0.717, p=0.474	t=3.425, p=0.001
Yes	0.410±0.237	0.473±0.269	0.554±0.263	0.822±0.377
No	0.310±0.167	0.441±0.205	0.524±0.255	0.626±0.282
EEG	t=−0.497, p=0.620	t=−2.117, p=0.035	t=−5.140, p<0.001	t=−1.160, p=0.247
Normal	0.393±0.228	0.458±0.266	0.517±0.241	0.775±0.374
Abnormal	0.414±0.251	0.555±0.205	0.745±0.304	0.851±0.318

Notes: Differences between two groups were compared using an unpaired sample t-test, while differences between multiple groups were compared using a one-way analysis of variance, followed by an LSD t-test.

Table 3 The Effect of Family Social Demographic Characteristics on the Score of Social Emotional Development for Children with Cerebral Palsy

Characteristics		Participants (n)	Externalizing Domain	Internalizing Domain	Dysregulation Domain	Competence Domain
Paternal age(years)			F=13.25, p<0.001	F=2.641, p=0.073	F=1.039, p=0.355	F=2.046, p=0.131
	20–29	75	0.483±0.286	0.522±0.268	0.583±0.267	0.735±0.410
	30–39	153	0.331±0.176	0.439±0.204	0.544±0.214	0.832±0.365
	≥40	72	0.432±0.230	0.471±0.337	0.523±0.336	0.762±0.327
Maternal age(years)			F=3.955, p=0.020	F=3.991, p=0.020	F=1.722, p=0.181	F=2.420, p=0.091
	20–29	120	0.413±0.261	0.504±0.250	0.538±0.238	0.741±0.415
	30–39	174	0.375±0.197	0.423±0.211	0.553±0.255	0.833±0.318
	≥40	6	0.267±0.111	0.415±0.401	0.441±0.307	0.869±0.374
Paternal education level			F=5.679, p<0.001	F=4.388, p=0.002	F=1.545, p=0.189	F=1.504, p=0.201
	Junior high school	60	0.434±0.229	0.477±0.254	0.558±0.273	0.739±0.374
	Senior high school/ vocational school	60	0.466±0.300	0.565±0.276	0.614±0.312	0.842±0.363
	Junior college	88	0.374±0.191	0.473±0.273	0.541±0.240	0.744±0.420
	Undergraduate	76	0.309±0.149	0.405±0.215	0.507±0.216	0.853±0.305
	Postgraduate	16	0.487±0.230	0.343±0.230	0.510±0.297	0.757±0.333
Maternal education level			F=9.191, p<0.001	F=1.803 p=0.128	F=5.969, p<0.001	F=1.787, p=0.131
	Junior high school	88	0.472±0.295	0.525±0.274	0.640±0.313	0.738±0.395
	Senior high school/ vocational school	44	0.348±0.144	0.478±0.239	0.511±0.207	0.748±0.335
	Junior college	80	0.386±0.191	0.437±0.252	0.490±0.221	0.817±0.414
	Undergraduate	80	0.313±0.173	0.430±0.255	0.509±0.239	0.821±0.312
	Postgraduate	8	0.666±0.238	0.463±0.257	0.750±0.134	1.041±0.199
Parenting style			F=7.339, p=0.001	F=4.715, p=0.010	F=0.703, p=0.496	F=9.247, p<0.001
	Authoritative	272	0.379±0.221	0.463±0.258	0.549±0.253	0.792±0.371
	Authoritarian	12	0.444±0.264	0.358±0.263	0.486±0.379	0.438±0.563
	Permissive	16	0.597±0.273	0.639±0.222	0.604±0.308	1.029±0.269
Recreational activities			F=0.163, p=0.849	F=1.541, p=0.216	F=1.800, p=0.167	F=6.032, p=0.003
	Frequently	76	0.406±0.197	0.424±0.230	0.522±0.210	0.902±0.321
	Occasionally	132	0.392±0.271	0.490±0.271	0.581±0.268	0.785±0.374
	Never	92	0.386±0.190	0.472±0.265	0.525±0.285	0.706±0.370
Primary caregiver			F=8.183, p<0.001	F=5.295, p=0.006	F=0.244, p=0.784	F=0.405, p=0.667
	Parents	220	0.368±0.209	0.444±0.259	0.550±0.277	0.795±0.387
	Grandparents	76	0.479±0.268	0.545±0.251	0.551±0.218	0.786±0.326
	Babysitter or relatives	4	0.222±0.041	0.296±0.036	0.458±0.045	0.629±0.058

Table 4 The Relationship Between Parental Coping Styles and Positive Detection Rates

Coping Styles Dimensions	Mature (n=76)	Immature (n=168)	Mixed (n=56)	χ^2	p-value
Dysregulation domain
Negative	73 (96.0%)	152 (90.5%)	43 (76.8%)	12.50	0.001
Positive	3 (4.0%)	16 (9.5%)	13 (23.2%)
Competence domain
Negative	63 (82.9%)	149 (88.7%)	48 (85.7%)	1.39	0.455
Positive	13 (17.1%)	19 (11.3%)	8 (14.3%)
Internalizing domain
Negative	71 (93.4%)	157 (93.4%)	48 (85.7%)	3.65	0.158
Positive	5 (6.6%)	11 (6.6%)	8 (14.3%)
Externalizing domain
Negative	63 (82.9%)	137 (81.6%)	52 (92.9%)	3.86	0.129
Positive	13 (17.1%)	31 (18.4%)	4 (7.1%)

Notes: Mature (problem solving - seeking help); immature (self-blame - fantasy - retreat); mixed (rationalization).

Figure 2 The effect of parental anxiety and depression on the positive detection rate of social emotional development in children with cerebral palsy (CP). (A) Correlations between paternal psychological state (anxiety and depression) and the positive detection rate of each domain for social emotional development in children with CP. (B) Correlations between the maternal psychological state (anxiety and depression) and the positive detection rate of each domain for social emotional development in children with CP.

Table 5 Multivariate Logistic Regression Analysis of Independent Risk Factors for the Positive Domains of Children with Cerebral Palsy

Variables	Positive Externalizing Domain	Positive Internalizing Domain	Positive Dysregulation Domain	Positive Competence Domain
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Birth weight	0.43 (0.22–0.83)	–	–	–
Delivery mode	2.50 (1.23–5.11)	–	–	–
Time of final diagnosis	1.63 (0.98–2.71)	0.27 (0.10–0.77)	–	–
Clinical classification of cerebral palsy	0.76 (0.61–0.94)	–	0.45 (0.30–0.67)	1.31 (1.07–1.60)
Postpartum asphyxia	–	–	–	2.66 (1.04–6.76)
Caregiver	1.89 (0.98–3.67)	–	–	–
Gestational age	0.37 (0.17–0.84)	–	–	–
Age of children	–	–	0.41 (0.21–0.77)	–
Paternal age	–	–	0.26 (0.08–0.81)	–
Maternal age	–	–	4.43 (1.37–14.35)	–
Parental coping styles	–	–	2.86 (1.42–5.74)	1.94 (1.06–3.55)
Paternal depression	–	1.36 (1.14–1.90)	3.70 (0.95–14.39)	–
Maternal depression	–	–	–	1.08 (0.03–0.19)
Paternal anxiety	–	–	1.04 (1.01–1.08)	–
Maternal anxiety	–	–	–	–
Paternal education level	–	–	–	–
Maternal education level	0.68 (0.51–0.92)	2.08 (1.31–3.30)	–	0.74 (0.54–1.72)
Daily recreational activities	–	–	2.88 (1.55–5.37)	2.42 (1.25–4.67)

Notes: Dash indicates that these variables were excluded from regression models during the selection process of variables; only the remaining variables were included in the final logistic models.

Abbreviations: CI, confidence interval; OR, odds ratio.