The Prevalence of Mental Health Disorders and Symptoms in Children and Adolescents with Cerebral Palsy: A Systematic Review and Meta-Analysis
Open accessAbstract
AIM: Mental health conditions and problems are often reported in children and adolescents with cerebral palsy (CP). A systematic review was undertaken to describe their prevalence. METHOD: MEDLINE and PsycINFO databases from 1996 to 2016 were searched and reference lists of selected studies were reviewed. Studies were included if they reported point prevalence of mental health diagnoses or symptoms in a general population of children and/or adolescents with CP. Pooled prevalence for mental health symptoms was determined using a random effects meta-analysis. RESULTS: Of the 3158 studies identified, eight met the inclusion criteria. Mental health disorders were diagnosed by psychiatric interview in one study, giving a prevalence of 57% (32 out of 56 children). The remaining seven studies (n=1715 children) used parent-report mental health screening tools. The pooled prevalence for mental health symptoms using the Strengths and Difficulties Questionnaire (n=5 studies) was 35% (95% confidence interval [CI] 20-61) and using the Child Behavior Checklist (n=2 studies) was 28% (95% CI 22-36). Evidence was characterized by a moderate level of bias. INTERPRETATION: More studies are needed to ascertain the prevalence of mental health disorders. Mental health symptoms are common and mental health evaluations should be incorporated into multidisciplinary assessments for these children. WHAT THIS PAPER ADDS: Children with cerebral palsy and intellectual disability have a higher risk of mental health symptoms. The prevalence of mental health symptoms for age and severity groups is unclear.
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The presence of intellectual disability in children with cerebral palsy is associated with an increased risk of psychiatric symptoms.
“the presence of ID in this population is associated with an increased risk of psychiatric symptoms [3]”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [3]
The last review on this subject focused only on the prevalence of mental health concerns, included only eight studies, and did not focus on ADHD or ASD as mental health disorders.
“The last review on this subject that we are aware of focused only on the prevalence of mental health concerns, included only eight studies, and did not focus on ADHD or ASD as mental health disorders [3]”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [3]
A 2018 systematic review and meta-analysis found a pooled prevalence of mental health symptoms of 35% and 28% in children with cerebral palsy based on two parent-reported mental health screening tools.
“A 2018 systematic review and meta-analysis highlighted the widespread but under-recognized prevalence of mental health symptoms in this population, with a pooled prevalence of mental health symptoms being found to be 35% and 28% in children with CP based on results of two parent-reported mental health screening tools”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [3]
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BackgroundSalie, R., Eken, M. M., Donald, K. A., Fieggen, A. G., & Langerak, N. G. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1916101 · Cited by 14 · see citing works
Tremblay, S. M., Lal, S., Xiang, L., Ferro, M. A., & Anaby, D. (2023) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1085827 · Cited by 15 · see citing works
Bentum, L. S., Ohene, L. A., Agyare, V. A., Laari, L., & Ampomah, M. O. (2023) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2023.07.019 · Cited by 14 · see citing works
Self-Rated Depressive Symptoms in Children and Youth with and without Cerebral Palsy: A Pilot Study
Asano, D., Takeda, M., Nobusako, S., & Morioka, S. (2020) · Behavioral Sciences · doi:10.3390/bs10110167 · Cited by 15 · see citing works
Blaine, R. E., Bowling, A. B., Kaur, R., & Davison, K. K. (2021) · Childhood Obesity · doi:10.1089/chi.2020.0335 · Cited by 13 · see citing works
Geographic Variation in Acute Pediatric Mental Health Utilization
Winckler, B. E., Nguyen, M., Khare, M., Patel, A., Crandal, B. R., Jenkins, W., Fisher, E. S., & Rhee, K. E. (2022) · Academic Pediatrics · doi:10.1016/j.acap.2022.07.026 · Cited by 12 · see citing works
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“Many more who do not meet the full criteria for a disorder still grapple with subclinical symptoms (Downs et al., 2018).”
Richard, C., Kjeldsen, C. P., Findlen, U. M., Gehred, A. P., & Maitre, N. L. (2021) · Journal of Child Neurology · doi:10.1177/08830738211004519 · Cited by 11 · see citing works
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Mental Health Benefits of Physical Activity in Youth with Cerebral Palsy: A Scoping Review
Starowicz, J., Pratt, K., McMorris, C. A., & Brunton, L. K. (2022) · Physical & Occupational Therapy In Pediatrics · doi:10.1080/01942638.2022.2060058 · Cited by 12 · see citing works
Knudsen, M. J., Stadskleiv, K., O’Regan, E., Alriksson‐Schmidt, A. I., Andersen, G. L., Hollung, S. J., Korsfelt, Å., & Ödman, P. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2094477 · Cited by 10 · see citing works
“Research has also established that children with CP are at higher risk of developing mental health issues [49–51].”
BackgroundDieleman, L. M., Soenens, B., Prinzie, P., Clercq, L. D., & Pauw, S. S. W. D. (2021) · Exceptional Children · doi:10.1177/0014402920986462 · Cited by 10 · see citing works
“Given that children with CP have an increased risk to develop emotional and behavioral problems (Downs et al., 2018), it is important to investigate how these children’s problem behaviors relate to their parents’ behaviors.”
BackgroundMcCrossin, J., Lach, L., & McGrath, P. J. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2021.2017493 · Cited by 9 · see citing works
Täljedal, T., Granlund, M., Almqvist, L., Osman, F. A., Selinus, E. N., & Fängström, K. (2023) · PLoS ONE · doi:10.1371/journal.pone.0288815 · Cited by 10 · see citing works
Quality of Life and Health Services Utilization for Spanish Children With Cerebral Palsy
Ardanaz, B. P., Morales‐Asencio, J. M., León‐Campos, Á., Kaknani‐Uttumchandani, S., López‐Leiva, I., García‐Piñero, J. M., Martí‐García, C., & García‐Mayor, S. (2020) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2020.03.001 · Cited by 9 · see citing works
de Sousa, R. R., Gontijo, A. P. B., Santos, T. R. T., Wright, F. V., & Mancini, M. C. (2020) · Physical & Occupational Therapy In Pediatrics · doi:10.1080/01942638.2020.1859663 · Cited by 9 · see citing works
The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research
Rausch, R., Chahin, S., Miller, C., Dopheide, L., Bovio, N., Harris, A., & Patel, D. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124364 · Cited by 8 · see citing works
“The last review on this subject that we are aware of focused only on the prevalence of mental health concerns, included only eight studies, and did not focus on ADHD or ASD as mental health disorders [3].”
InfluentialValluri, H. G., Mohanty, M., Mongil, C. R., Fuentes, G. F., Sultan, T., & Torres, A. R. (2025) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2025.101225 · Cited by 10 · see citing works
Bjorgaas, H. M., Elgen, I. B., & Hysing, M. (2022) · Children · doi:10.3390/children9071009 · Cited by 7 · see citing works
“In a Danish population study of 446 children with CP aged 8–15 years using the Child Behavior Checklist (CBCL), almost half were categorized as high scorers for mental health problems as opposed to 15% of the general childhood population [9].”
BackgroundMethodResultInfluentialVerstraete, J., & Scott, D. (2022) · Dialogues in Health · doi:10.1016/j.dialog.2022.100032 · Cited by 7 · see citing works
Mental health problems among transition-aged youth with physical disabilities: an initial evaluation
Amalfi, A., Li, J. Y., Théberge-Lamoureux, V., Tang, C., Rinaldi, E., Khayargoli, P., & Anaby, D. (2023) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1069464 · Cited by 7 · see citing works
Health Care Usage among Children and Adults with Cerebral Palsy
Michelsen, S. I. (2020) · The Central European Journal of Paediatrics · doi:10.5457/p2005-114.256 · Cited by 8 · see citing works
Socio‐Emotional Development in Young Children With Cerebral Palsy: A Scoping Review
Hansen, J. E., Støve, L. L., Væver, M. S., & Røhder, K. (2025) · Child Care Health and Development · doi:10.1111/cch.70130 · Cited by 6 · see citing works
“A systematic review and meta-analysis from 2018 shows that approximately one out of three school-aged children with CP experience mental health difficulties, with both social and emotional domains being affected (Downs et al. 2018).”
InfluentialPsychiatric symptoms in adult patients with cerebral palsy: A cohort study
Pizzighello, S., Uliana, M., Michielotto, M., Pellegri, A., Vascello, M. G. F., Piccoli, S., Martinuzzi, M., & Martinuzzi, A. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.998922 · Cited by 6 · see citing works
Kiani, F. S., & Ehsan, S. (2023) · International Journal of Human Rights in Healthcare · doi:10.1108/ijhrh-12-2022-0133 · Cited by 6 · see citing works
Anaby, D., Avery, L. M., Palisano, R. J., Levin, M. F., Khayargoli, P., Hsieh, Y., Gorter, J. W., Teplicky, R., & BEYOND Consultant Team (2023) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.15822 · Cited by 6 · see citing works
Chronic Pain in Young People With Cerebral Palsy: Activity Limitations and Coping Strategies
Carozza, L., Anderson-Mackay, E., Blackmore, A. M., Kirkman, H. A., Ou, J., Smith, N. L., & Love, S. (2022) · Pediatric Physical Therapy · doi:10.1097/pep.0000000000000943 · Cited by 6 · see citing works
Self-citationTremblay, S. M., Lal, S., Ferro, M. A., & Anaby, D. R. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2344659 · Cited by 5 · see citing works
Linder, A., Jarl, J., & Tedroff, K. (2024) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2024.11.001 · Cited by 5 · see citing works
Bennett, S. D., Heyman, I., Coughtrey, A. E., Varadkar, S., Stephenson, T. J., & Shafran, R. (2021) · Archives of Disease in Childhood · doi:10.1136/archdischild-2019-318577 · Cited by 5 · see citing works
Burden, needs, and attitudes of parents of children with cerebral palsy in a middle-income country
Onwuakagba, I. U., Okoye, E. C., Simon, L. A., Okonkwo, U. P., & Nwankwo, M. J. (2023) · Journal of Public Health · doi:10.1007/s10389-023-01896-3 · Cited by 6 · see citing works
“…of CP are often accompanied by impairments in sensation, perception, and cognition abilities that result in activity limitations, communication problems, behavioural issues, participation restrictions, and decreased quality of life (Colver et al. 2015; Downs et al. 2018; Woodmansee et al. 2016).”
Data linkage and pain medication in people with cerebral palsy: a cross‐sectional study
Jalon, E. G. G., Maguire, A., Perra, O., Gavin, A., O'Reilly, D., & Thurston, A. (2021) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.14854 · Cited by 9 · see citing works
Wang, H., Du, Y., Chen, T., Mao, Z.-H., Xu, J., Ding, L., Ruan, W., & Li, H. (2025) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x251317438 · Cited by 4 · see citing works
Li, X., Einfeld, S., Stancliffe, R. J., & Hodge, M. A. (2025) · Journal of Intellectual & Developmental Disability · doi:10.3109/13668250.2024.2446215 · Cited by 4 · see citing works
“Early estimates suggest between one-fifth and just over half of this cohort have behaviour problems (Downs et al., 2018).”
Personality Traits and Depression in Infertile Couples during the COVID-19
Burgio, S., Polizzi, C., Alesi, M., Perino, A., Cucinella, G., Kotlik, Y., López, A., Vassiliadis, A., & Gullo, G. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13164827 · Cited by 4 · see citing works
“At present, depression is the most frequently diagnosed psychiatric condition worldwide [54,55].”
BackgroundEvreinov, V. V., & Жирова, Т. А. (2019) · Russian Journal of Anesthesiology and Reanimatology · doi:10.17116/anaesthesiology201905175 · Cited by 4 · see citing works
Toward a More Comprehensive Assessment of School Age Children with Hemiplegic Cerebral Palsy
Hoyt, C. R., Sherman, S. K., Brown, S., Newbold, D. J., Miller, R. L., Van, A. N., Shimony, J. S., Ortega, M., Nguyen, A. L., Schlaggar, B. L., et al. (2021) · Rehabilitation Process and Outcome · doi:10.1177/11795727211010500 · Cited by 4 · see citing works
Lai, B. W., Davis, D., Young, R., Swanson‐Kimani, E., Wozow, C., Chaviano, K., & Rimmer, J. H. (2022) · JMIR Research Protocols · doi:10.2196/42651 · Cited by 3 · see citing works
Albiol-Pérez, S., Cano, S. P., Goncalves, M., Gutierrez, E. G., Collazos, C. A., Lombano, J. L., Estellés, E., & Ruiz, M. A. (2018) · Advances in intelligent systems and computing · doi:10.1007/978-3-319-77712-2_119 · Cited by 4 · see citing works
Curtin, H., Simms, C. K., Kiernan, D., Reilly, R. B., & Spirtos, M. (2024) · Physical & Occupational Therapy In Pediatrics · doi:10.1080/01942638.2024.2400344 · Cited by 3 · see citing works
“The increased risk of mental health disorders in children with CP has been reported (Downs et al., 2017) and the positive change in social and emotional QoL domains found here, may have an impact on the child’s over-all psychological health.”
Assessing mental health of people with complex communication needs: A systematic review.
Pennacchia, J. M., Østvik, J., Dutia, I. M., Walsh, M., Coghill, D., Granlund, M., & Imms, C. (2025) · Journal of Communication Disorders · doi:10.1016/j.jcomdis.2025.106494 · Cited by 3 · see citing works
“…with disabilities generally experience poorer wellbeing and more mental health problems than those without disabilities (Australian Institute of Health and Welfare (AIHW), 2016; Downs et al., 2018; Eres et al., 2022; Whitney et al., 2019; Whitney, Warschausky & Peterson, 2019; Wolman et al., 1994).”
Larsen, S. M., Ramstad, K., Hollung, S. J., Andersen, G. L., & Diseth, T. H. (2025) · Acta Paediatrica · doi:10.1111/apa.70055 · Cited by 3 · see citing works
“The present study did not confirm associations between a higher risk of mental health issues in participants with CP and cognitive impairment, reported in the systematic review from 2018 [31].”
Ivarsson, M., Danielsson, H., & Imms, C. (2025) · BMC Psychology · doi:10.1186/s40359-025-02450-4 · Cited by 3 · see citing works
“For the current study, the first author (M.I.), developed a supplementary tool to assess the risk of bias in four domains addressing specific challenges related to the measurement of longitudinal trajectories of mental health problems in children with NDD. Specific assessment criteria (questions) were formulated for e…”
InfluentialBingöl, H., & Karaoba, D. D. (2025) · Child Care Health and Development · doi:10.1111/cch.70114 · Cited by 3 · see citing works
Behavioral and Mental Health Disorders (Including Attentional Disorders)
Rubin, I. L., Coles, C. D., & Barnhill, J. (2023) · Springer eBooks · doi:10.1007/978-3-031-20792-1_40 · Cited by 3 · see citing works
Bingöl, H., Fidan, H., Sel, S. A., Burç, E., & Günel, M. K. (2024) · British Journal of Occupational Therapy · doi:10.1177/03080226241265254 · Cited by 3 · see citing works
“As mental health issues are prevalent in the CP population (Downs et al., 2018), it is imperative to recognize and address mental health issues in children with unilateral CP as a means to enhance their participation outcomes.”
Amiri, A., Kalantari, M., Rezaee, M., Baghban, A. A., & Gharebashloo, F. (2019) · Iranian Rehabilitation Journal · doi:10.32598/irj.17.4.319 · Cited by 3 · see citing works
“Consequently, children and adolescents with CP experience participation restrictions [2], decreased quality of life [3], and mental health disorders [4].”
BackgroundContributing factors for participation and independence in children and youths with disabilities
Axelsson, A. K., Ivarsson, M., Danielsson, H., & Ullenhag, A. (2024) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038128.2024.2432332 · Cited by 2 · see citing works
“These challenges have long-term implications, such as poorer opportunities for participation in physical and social activities [2], and increased risk of psychopathology [3].”
Martens, B. H. M., Iskander, M., Soudant, D. L. H. M., Vles, G. F., Bonouvrié, L. A., Teernstra, O., Vles, J. S. H., & Vermeulen, R. J. (2025) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2025.04.002 · Cited by 2 · see citing works
Tian, L. H., Tinker, S. C., Russell, L., Joncas-Schronce, L., Danielson, M. L., Ivey-Stephenson, A. Z., Summers, A. D., Yeargin‐Allsopp, M., & Maenner, M. J. (2025) · Maternal and Child Health Journal · doi:10.1007/s10995-025-04177-5 · Cited by 2 · see citing works
“%) using the Child Behavior Checklist reported in a meta-analysis of studies among children and adolescents with CP (Downs et al., 2018).”
Hansen, J. E., Schuengel, C., Willemen, A. M., Stuart, A., Væver, M. S., & Røhder, K. (2025) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2025.105131 · Cited by 2 · see citing works
Kohleis, K., Storck, M., Geissler-preuss, S., Hirsch, A., Kuhn, F., Ortfeld, S., Rapp, M., & Bode, H. (2018) · Klinische Pädiatrie · doi:10.1055/a-0664-0832 · Cited by 2 · see citing works
“[8] Downs J, Blackmore AM, Epstein A et al.”
BackgroundThe role of neuropsychiatry in the care of children and adults with cerebral palsy
Hauptman, A. J., & Barkoudah, E. (2022) · BJPsych Open · doi:10.1192/bjo.2022.62 · Cited by 2 · see citing works
Azeez, H. M., Piroozi, B., Zarezadeh, Y., & Shokri, A. (2023) · Health & Social Care in the Community · doi:10.1155/2023/6639932 · Cited by 2 · see citing works
Michalski, S. C., Huang, Y., Srasuebkul, P., Cvejic, R. C., Arnold, S. R. C., & Trollor, J. N. (2025) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674251374483 · Cited by 2 · see citing works
“However, there is considerable evidence suggesting the prevalence of mental illness among people with cerebral palsy is high, with Downs et al. (2018) finding that people with cerebral palsy disability and provides insights into the complexity and associations of mental illness within this…”
Psychiatric Disorders in Children with Cerebral Palsy
Walter, R. S., & Kingsley, R. S. (2020) · Springer eBooks · doi:10.1007/978-3-319-74558-9_38 · Cited by 2 · see citing works
Epidemiology of Epilepsy among Pediatric Patients in Tabuk City
Alblewi, S. M., Abuhamad, R. N., Abufara, F., Bedaiwi, L. A., Alotaibi, J. T. A., Alyami, M. A. M., Alshammari, Y. S., Althobaiti, A. A. H., & Alzahrani, A. M. M. (2022) · World Journal of Environmental Biosciences · doi:10.51847/llgwvxzpym · Cited by 2 · see citing works
An Examination of the Mental Health Status of Canadian Children and Youth with Disabilities
O’Rourke, R. H., Brown, D. M. Y., Ginis, K. A. M., & Arbour‐Nicitopoulos, K. P. (2022) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2022-033 · Cited by 1 · see citing works
Relationship Between Change in Participation and Later Mental Health Problems in Children
Lo, O. Y. H., Wong, Y. M., Kwok, N. T., Ma, P.-S., & Chien, C. (2024) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492231216663 · Cited by 1 · see citing works
“Consistent with previous studies (Basu & Banerjee, 2020; Downs et al., 2018; Emerson, 2003; Scharte & Bolte, 2013), the findings of this study indicate that the presence of disabilities and the levels of environmental support are significant predictors of later mental health problems.”
Bingöl, H., Taşar, N., Bümen, Ş., & Günel, M. K. (2023) · Medical Science and Discovery · doi:10.36472/msd.v10i6.958 · Cited by 1 · see citing works
Asano, D., Takeda, M., Abe, H., Nobusako, S., & Gima, H. (2025) · Behavioral Medicine · doi:10.1080/08964289.2025.2494535 · Cited by 2 · see citing works
- Authors
- Downs, J., Blackmore, A. M., Epstein, A., Skoss, R., Langdon, K., Jacoby, P., Whitehouse, A. J. O., Leonard, H., Rowe, P. W., Glasson, E. J., & The Cerebral Palsy Mental Health Group
- Affiliations
- The Kids Research Institute Australia (AU)
- Therapy and Health Services, Ability Centre Mount Lawley WA Australia
- Princess Margaret Hospital for Children (AU)
- Corresponding author
- Downs, Jenny
- ORCID
- Venue
- Developmental Medicine & Child Neurology
- Publisher
- Wiley
- Published
- 2017-09-15
- Volume
- 60
- Issue
- 1
- Pages
- 30-38
- ISSN
- 0012-1622 (ISSN-L)
- 1469-8749
- OpenAlex
- W2756091964
- Cited by
- 148
- References
- 39
- Citations by year
- 2026: 15 · 2025: 26 · 2024: 17 · 2023: 20 · 2022: 19 · 2021: 14 · 2020: 14 · 2019: 11 · 2018: 12
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Developmental Medicine & Child Neurology (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- cerebral palsy, mental illness, psychiatric symptoms, children, adolescents, prevalence, Strengths and Difficulties Questionnaire, Child Behavior Checklist, intellectual disability, mental health screening
- MeSH terms
- Adolescent, Mental Disorders, Cerebral Palsy, Child, Humans, Intellectual Disability, Comorbidity
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