Executive function in children and adolescents with unilateral cerebral palsy

AIM The aim of this study was to compare executive function in children with left- and right-sided unilateral cerebral palsy (CP) and typically developing children. METHOD There was a cross-sectional cohort of 46 children with unilateral CP (24 right-side, 22 left-side; 25 males, 21 females; mean age 11y 1mo, SD 2y 5mo) and 20 typically developing children (nine males, 11 females; mean age 10y 10mo, SD 2y 4mo). Four cognitive domains of executive function were assessed: attentional control, cognitive flexibility, goal setting, and information processing. Subtests from the Delis-Kaplan Executive Function System, the Test of Everyday Attention for Children, the Rey-Osterrieth Complex figure, and the Wechsler Intelligence Scale for Children - Fourth Edition were utilized. Between-group differences (right unilateral CP, left unilateral CP, and typically developing children) were examined using analyses of covariance. RESULTS Children with CP performed significantly more poorly than typically developing children on all executive function measures (aggregate executive function: F(1,63)=31.16; p<0.001; eta(2)=0.33). There were no significant differences between children with left and right unilateral CP, except in the case of inhibition/switching total errors, with children with left unilateral CP making fewer errors than children with right unilateral CP(F(1,39)=4.14; p=0.049; eta(2)=0.1). INTERPRETATION Children and adolescents with unilateral CP experience difficulties across multiple executive function domains compared with typically developing children, irrespective of the side of hemiplegia. This finding supports an early vulnerability model of early brain injury and has implications for intervention for children with CP.