This retrospective review of five European registries and surveillance programs aimed to look at prevalence of ASD in CP and characteristics of patients with CP and ASD. Of 1225 children with CP included in this study, 8.7% had ASD (between 4.0 to 16.7% depending on population). The average prevalence was consistent with prior studies. Children with CP and ASD were more likely to be males, have epilepsy, have intellectual disability, and have better walking abilities than peers with CP but without ASD. Other known risk factors for ASD in addition to male sex and epilepsy such as high maternal age, perinatal factors (gestational age, birthweight), and associated syndromes were assess for correlation and either were inconclusive or not associated.

By demonstrating the increased prevalence of ASD among children with CP, this article highlights the importance of screening and identifying co-morbid behavioral and psychiatric disorders in children with cerebral palsy, hopefully to help promote timely behavioral and therapeutic intervention.  The authors raise an important discussion point about screening for ASD especially for children with impaired communication and whether we miss a chance to improve functionality for this group of children. Reading this article has prompted me to investigate further different ASD screening tools for various subsets of children.

Elisabeth Pordes, MD
Special Needs Program, Children’s Hospital of Wisconsin

The authors introduce the article by stating: “perceiving the cerebral palsies as fully belonging to the vast field of developmental disabilities promotes a broader approach to their study…” with which I can not agree more. The hard part is determining in physically and intellectually disabled children if their way they interact with the world is due to their current disabilities or another diagnosis. This article, as well as previous similar studies, help point out frequent characteristics of children with CP and ASD but often in the end it will come down to a pediatrician being aware of the increased incidence in children with CP and screening for it (with whatever modified tool we can come up with!).

Kristie Malik, MD
Complex Care, Children’s Hospital at Montefiore

Delobel-Ayoub M et al. Prevalence and characteristics of autism spectrum disorders in children with cerebral palsy. Dev Med Child Neurol. 2017 Apr 25 [Epub ahead of print]. PMID 28439889