Mental Health Disorders, Participation, and Bullying in Children with Cerebral Palsy
Open accessAbstract
Aim: To examine how social factors might mitigate the elevated risk of mental health disorders in children with cerebral palsy ( CP ). Method: This cross‐sectional study included 6‐ to 17‐year‐olds with ( n =111; 40.4% 6–11y, 59.6% 12–17y) and without ( n =29 909; 50.2% 6–11y, 49.8% 12–17y) CP from the 2016 National Survey of Children's Health. Mental health disorders included depression, anxiety, behavior/conduct problems, and attention‐deficit/hyperactivity disorder. Social factors included participation in activities, bully victimization, and difficulty with friendships. Results: After adjusting for sociodemographic factors and the presence of chronic pain, children with CP had higher odds of anxiety (odds ratio [ OR ] 4.4; 95% confidence interval [ CI ] 1.9–8.5), behavior/conduct problems ( OR 3.9; 95% CI 1.4–11.3), and multimorbidity ( OR 2.8; 95% CI 1.1–7.0), but not depression ( OR 1.4; 95% CI 0.6–3.8) or attention‐deficit/hyperactivity disorder ( OR 1.7; 95% CI 0.6–4.6), compared to controls. With adjustment for participation in activities, the odds of anxiety, behavior/conduct problems, and multimorbidity remained increased in children with CP . With adjustment for difficulty with friendships, the odds of anxiety, behavior/conduct problems, and multimorbidity were no longer increased in children with CP . With adjustment for bully victimization, the odds of behavior/conduct problems and multimorbidity were attenuated in children with CP ; however, the odds of anxiety remained increased. Interpretation: The elevated prevalence of certain mental health disorders in children with CP is partly associated with modifiable social factors. What this paper adds: Difficulty with friendships predicts an elevated prevalence of psychiatric conditions in children with cerebral palsy (CP). Bully victimization predicts an elevated prevalence of behavior/conduct problems in children with CP. Low participation does not predict mental health disorders in this population.
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Whitney et al. reported that the odds of ADHD were no longer increased after controlling for sociodemographic variables and the presence of pain.
“Whitney et al. [25] reported that the odds of ADHD were no longer increased after controlling for sociodemographic variables and the presence of pain.”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Whitney et al. reported a prevalence of ADHD of 19.5% in children with cerebral palsy.
“Whitney et al. [25] and Whitney et al. [11] reporting a prevalence of 19.5%”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Children with CP have a higher prevalence of depression (7.8%) compared to controls (2.7%).
“Compared to controls, Whitney et al. [25] found that children with CP had higher prevalence rates of depression (7.8% of children with CP vs. 2.7% of controls)”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Children with CP have a higher prevalence of anxiety (30.2%) compared to controls (6.2%).
“and anxiety (30.2% of children with CP vs. 6.2% of controls).”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Behavioral problems occurred in 27.3% of a sample of children with CP.
“Whitney et al. [25] and Whitney et al. [11] reported behavioral problems occurring in 27.3% of their sample.”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
After controlling for sociodemographic variables and pain, the odds of anxiety remained statistically significant in children with CP.
“after controlling for sociodemographic variables and the presence of pain, the odds of anxiety remained statistically significant”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
After controlling for sociodemographic variables and pain, the odds of depression were no longer significantly increased in children with CP.
“while the odds of depression were no longer significantly increased.”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
The relationship between CP and anxiety was accounted for by difficulty with friendships.
“Authors reported that the relationship between CP and anxiety was accounted for by difficulty with friendships [25].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Based on studies included in the review, the odds of anxiety were elevated in children with CP when compared to typically developing peers.
“Based on studies included in this review, the odds of ADHD [12,13,24], ASD [13,24], anxiety [12,25], depression [12], and behavioral concerns [12,25] were elevated when compared to typically developing peers.”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
The adjusted odds ratio for behavioral problems in children with CP is 3.9, controlling for sociodemographic variables and chronic pain.
“An adjusted odds ratio of 3.9 (controlling for sociodemographic variables and chronic pain) for behavioral problems in children with CP was reported by Whitney et al. [25].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Based on studies included in the review, the odds of behavioral concerns were elevated in children with CP when compared to typically developing peers.
“Based on studies included in this review, the odds of ADHD [12,13,24], ASD [13,24], anxiety [12,25], depression [12], and behavioral concerns [12,25] were elevated when compared to typically developing peers.”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
Behavioral concerns in children with CP are often associated with other factors or comorbidities, such as ID, sleep problems, and ASD symptoms, difficulties with friendships and bully victimization, and pain.
“Behavioral concerns in children with CP are often associated with other factors or comorbidities, such as ID, sleep problems, and ASD symptoms [20], difficulties with friendships and bully victimization [25], and pain [11].”
From The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research (2025) · cites this paper as [25]
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“This variable was coded as “1” for ‘somewhat true’ or ‘definitely true’ and “0” for ‘not true,’ consistent with previous studies (Hong et al., 2021; Whitney et al., 2019).”
Hong, J. S., Song, E.-J., Peguero, A. A., Wu, C., & Schmaeman, A. C. (2020) · Families in Society The Journal of Contemporary Social Services · doi:10.1177/1044389419895853 · Cited by 7 · see citing works
“However, this measure for bullying had been used in other studies that utilized the same dataset (e.g., Lebrun-Harris et al., 2019; Whitney et al., 2019).”
MethodAlyoubi, R. A., & Abu‐Zaid, A. (2024) · Medicina · doi:10.3390/medicina60111809 · Cited by 6 · see citing works
“By fostering a holistic approach that includes mental health resources, caregivers and healthcare providers can create a supportive environment that encourages resilience and promotes better quality of life [11,12].”
Allison, K. M., & Doherty, K. M. (2024) · American Journal of Speech-Language Pathology · doi:10.1044/2023_ajslp-23-00267 · Cited by 6 · see citing works
Tremblay, 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
Zheng, H., Bornman, J., Granlund, M., Zhao, Y., & Huus, K. (2022) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038128.2022.2035815 · Cited by 5 · see citing works
“This finding is in accordance with existing research that children with long-term health conditions and/or disabilities participate less in the school context [36].”
ResultReflections on Participation at Home, As Self-Reported by Young People with Cerebral Palsy
Quartermaine, J. R., Rose, T., Auld, M. L., & Johnston, L. M. (2024) · Developmental Neurorehabilitation · doi:10.1080/17518423.2024.2347993 · Cited by 4 · see citing works
Elkholi, S. M. A., Awad, S. S., & Alotaibi, M. H. (2024) · Medicina · doi:10.3390/medicina60081216 · Cited by 4 · see citing works
“Recent evaluations of children with CP at school entry and pre-adolescence have demonstrated an increase in the occurrence of psychiatric disorders, mainly emotional disorders [49,50], with rates increasing from 57% to 79%.”
BackgroundBotha, S., & Mihai, M. A. (2024) · Journal of Education · doi:10.17159/2520-9868/i93a02 · Cited by 3 · see citing works
“Whitney et al. (2019) are of the opinion that learners with CP may experience bullying that leads to low self-esteem.”
BackgroundBingöl, H., & Karaoba, D. D. (2025) · Child Care Health and Development · doi:10.1111/cch.70114 · Cited by 3 · see citing works
Hong, J. S., Hsieh, Y., Burlaka, V., Ortega, R. M., Espelage, D. L., & Piñeros-Leaño, M. (2021) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-020-00736-7 · Cited by 2 · see citing works
Opioid prescription patterns among commercially insured children with and without cerebral palsy
Ayoubi, L., Pruente, J. R., Daunter, A. K., Erickson, S. R., Whibley, D., & Whitney, D. G. (2024) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-230009 · Cited by 2 · see citing works
Self-citationBingöl, H., & Karaoba, D. D. (2025) · İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi · doi:10.38079/igusabder.1528529 · Cited by 1 · see citing works
Dammeyer, J., Moen, S., & Bøttcher, L. (2025) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-025-10029-5 · Cited by 2 · see citing works
“Further, more than one-third of the children were scored within abnormal levels of peer problems, indicating problems with bullying and other relational problems (Whitney et al., 2019a , b ).”
InfluentialWhitney, D. G. (2025) · Disability and health journal · doi:10.1016/j.dhjo.2025.101783 · Cited by 1 · see citing works
Self-citationA bio‐psycho‐social view of cerebral palsy: friendships reduce mental health disorders
Paulus, F. W. (2019) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.14200 · Cited by 1 · see citing works
“But which role do they play in the generation of friendships and the participation in activities? From a preventative perspective, how could we help children with CP to develop stable friendships as early as possible?(2) What could parents, nurseries, and schools do? What could the role of specially trained profession…”
BackgroundMilićević, M. (2020) · doi:10.47152/127442 · Cited by 1 · see citing works
Managing the Child with Cerebral Palsy Who Has Medical Complexity
Kuo, D. Z., Slovin, S. R., & Renwick, A. (2020) · Springer eBooks · doi:10.1007/978-3-319-74558-9_24 · Cited by 1 · see citing works
Odintsova, M., Lubovsky, D. V., Gusarova, E., & Ivanova, P. (2022) · Clinical Psychology and Special Education · doi:10.17759/cpse.2022110308 · Cited by 1 · see citing works
Dan, B. (2019) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.14358
“Among hot topics in the 2019 volume, mental health in cerebral palsy (CP) was addressed by several studies, highlighting bullying and the emerging influence of social media, and emphasizing the need to identify protective factors for individuals with CP and their families.(1) A clearer picture of cardiovascular risk,…”
BackgroundFunctional Performance in School Going Cerebral Palsy Children
Asif, M. F., Javaid, A., Waqas, S., & Asim, H. M. (2021) · Journal of Riphah College of Rehabilitation Sciences · doi:10.53389/jrcrs.2021090105
Ishtiaq, M. (2022) · Journal of Research in Psychology · doi:10.31580/jrp.v3i2.2335
Managing the Child with Cerebral Palsy Who Has Medical Complexity
Kuo, D. Z., Slovin, S. R., & Renwick, A. (2019) · Springer eBooks · doi:10.1007/978-3-319-50592-3_24-1
Qu, L., Ringer, D., Wang, J., & Yim, A. (2023) · The Child Health Interdisciplinary Literature and Discovery Journal · doi:10.15173/child.v2i1.3522
การพฒนาและตรวจสอบแบบประเมนความใสใจแบบแบงแยกในเดกทมภาวะสมองพการแบบแขงเกรงครงทอน
เกษมสวัสดิ์, ณ., & ลวดลาย, ส. (2022) · doi:10.58837/chula.the.2022.545
THE ROLE OF DHAKA'S COMMUNITY-BASED PARKS IN IMPROVING CHILDREN’S MENTAL AND PHYSICAL HEALTH
Mim, A. T., & Saika, U. (2024) · Journal of Event Tourism and Hospitality Studies · doi:10.32890/jeth2024.4.5
Epilepsy in Children with Cerebral Palsy
Kaźmierkiewicz, K., Chojnacka, M., Spychalska, W., & Piotrowicz, E. (2025) · Quality in Sport · doi:10.12775/qs.2025.41.59991
“[29], [30]”
Göktaş, A., & Özkan, E. (2025) · Developmental Neurorehabilitation · doi:10.1080/17518423.2025.2526358
Emotional, Behavioral, and Social Disorders in Children and Adolescents with Cerebral Palsy
Masi, G., Falcone, F., & Brovedani, P. (2025) · Springer eBooks · doi:10.1007/978-3-032-09211-3_10
Twists and Turmoil: Comanaging Mood and Movement in a Child with Cerebral Palsy
Riordan, H. (2026) · Springer eBooks · doi:10.1007/978-3-032-10099-3_18
Psychological and Emotional Well-Being of Individuals with Cerebral Palsy
Same, K., & Motamed, M. (2026) · Springer eBooks · doi:10.1007/978-3-032-20967-2_13
- Authors
- Whitney, D. G., Peterson, M. D., & Warschausky, S. A.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Whitney, Daniel G
- Venue
- Developmental Medicine & Child Neurology
- Publisher
- Wiley
- Published
- 2019-02
- Volume
- 61
- Issue
- 8
- Pages
- 937-942
- ISSN
- 0012-1622 (ISSN-L)
- 1469-8749
- PMC
- PMC6609479
- OpenAlex
- W2913658035
- Cited by
- 59
- References
- 31
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 11 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 9 · 2019: 6 · 2018: 1
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Developmental Medicine & Child Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institute on Disability, Independent Living, and Rehabilitation Research (90AR5020‐0200)
- National Institutes of Health (5 UL1 TR002240‐05)
- 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, children, mental illness, anxiety, depression, conduct problems, attention deficit hyperactivity disorder, multimorbidity, bullying victimization, friendship difficulties, participation in activities, social factors, modifiable risk factors
- MeSH terms
- Adolescent, Anxiety, Mental Disorders, Cerebral Palsy, Child, Cross-Sectional Studies, Depression, Female, Humans, Male, Mental Health, Friends, Bullying, Social Participation
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