Assessment of motor imagery in cerebral palsy via mental chronometry: The case of walking

Recent studies show varying results on whether motor imagery capacity is compromised in individuals with cerebral palsy (CP). Motor imagery studies in children predominantly used the implicit hand laterality task. In this task participants judge the laterality of displayed hand stimuli. A more explicit way of studying motor imagery is mental chronometry. This paradigm is based on the comparison between the movement durations of actually performing a task and imagining the same task. The current study explored motor imagery capacity in CP by means of mental chronometry of a whole body task. Movement durations of 20 individuals with CP (mean age = 13 years, SD = 3.6) were recorded in two conditions: actual walking and imagined walking. Six unique trajectories were used that varied in difficulty via manipulation of walking distance and path width. We found no main effect of condition (actual walking versus imagining) on movement durations. Difficulty of the walking trajectory did affect movement durations. In general, this was expressed by an increase in movement durations with increasing difficulty of the task. No interaction between task difficulty and movement condition was found. Our results show that task difficulty has similar effects on movement durations for both actual walking and imagined walking. These results exemplify that the tested individuals were able to use motor imagery in an explicit task involving walking. Previous studies using the implicit hand laterality task showed varying results on motor imagery capacity in CP. We therefore conclude that motor imagery capacity is task dependent and that an explicit paradigm as the one used in this study may reveal the true motor imagery capacity. The implications of these findings for the use of motor imagery training are discussed.     

Walking-induced muscle fatigue impairs postural control in adolescents with unilateral spastic cerebral palsy

BackgroundFatigue is likely to be an important limiting factor in adolescents with spastic cerebral palsy (CP).AimsTo determine the effects of walking-induced fatigue on postural control adjustments in adolescents with unilateral CP and their typically developing (TD) peers.MethodsTen adolescents with CP (14.2 ± 1.7 yr) and 10 age-, weight- and height-matched TD adolescents (14.1 ± 1.9 yr) walked for 15 min on a treadmill at their preferred walking speed. Before and after this task, voluntary strength capacity of knee extensors (MVC) and postural control were evaluated in 3 conditions: eyes open (EO), eyes closed (EC) and with dual cognitive task (EODT).ResultsAfter walking, MVC decreased significantly in CP (−11%, P < 0.05) but not in TD. The CoP area was only significantly increased in CP (90%, 34% and 60% for EO, EC and EODT conditions, respectively). The CoP length was significantly increased in the EO condition in CP and TD (20% and 21%) and was significantly increased in the EODT condition by 18% in CP only.ConclusionsUnlike TD adolescents, treadmill walking for 15 min at their preferred speed lead to significant knee extensor strength losses and impairments in postural control in adolescents with unilateral spastic CP.     

Évaluation du recours au programme de soins prévu par la loi du 5 juillet 2011

ObjectivesThe law of 5 July 2011 introduced the possibility of outpatient care without consent in the context of care programs (CP). Despite major ethical and legal issues and frequent recourse in France, few studies are available on the use of this mechanism. An in-depth review of practices involving a large sample of CP was essential. The main objective of this study was to look at their content, the clinical profile of the patients involved, and the progress of these CP.MethodsWe carried out a retrospective, observational study, including all the CP set up between January 1st, 2016 and December 31st, 2018 in the Sarthe department. Data strictly related to the CP (content, justification, duration, patient compliance, re-hospitalizations, etc.), and patient-related variables (socio-demographic characteristics, diagnosis, antecedents, etc.) were studied.ResultsWe studied 559 CP, 70 % of which (n = 391) in the context of “care by decision of the hospital director”, with a wide disparity of recourse by psychiatric sector. One third of the hospitalizations without consent ended with a CP. They involved men (68.5 %, n = 383), with a psychotic disorder (77.8 %, n = 435), with a history of hospitalization (90 %, n = 503), and with poor adherence to care (83.2 %, n = 465). Cannabis use accounted for 41.3 % (n = 231) of cases. Certificates initiating CP did not have a clear justification (34.6 %, n = 251) or state a goal of adherence to treatment (16.5 %, n = 120). The content of the different CP was homogeneous: 65.6% of medical consultations and 47.6 % with a nurse, 100 % mentioned treatment used. Their average duration was 3.4 months. Even though the CP were followed (69.9 %, n = 391), 52.8% (n = 295) ended with reintegration, mainly justified by symptomatic relapse (34.8 %, n = 147), and new CP were put in place almost systematically (90.6 %, n = 260). However, reintegrations were shorter than first-time admissions (26 vs. 95 days). When a decision was lifted (n = 174), it was based on the criteria of clinical stability (35.7 %, n = 120) and compliance with the CP (27.6 %, n = 93). Half of hospitalizations in “care at the decision of the State representative” ended with a CP. These CP were longer (4.5 months) and with a higher rate of reintegration (62.2 %) than for those in “care at the decision of the hospital director”. There was no significant difference of CP compliance according to the mode of psychiatric care.ConclusionsOur study allows a precise vision of patients concerned by CP: men with risk factors for psychiatric dangerousness, with a severe clinical profile. It also found a high rate of re-hospitalization despite good adherence with the CP which is in line with a device allowing the work of an alliance to care and interventions at the beginning of relapse. CP have poorly personalized content and are poorly justified by psychiatrists although it is a freedom-restricting measure, highlighting the need for increased awareness amongst psychiatrists of the legal framework of their practice regarding care without consent.     

Patterns and predictors of participation in leisure activities outside of school in children and adolescents with Cerebral Palsy

This study analyzed the patterns and predictors of participation in leisure activities outside of school of Spanish children and adolescents with Cerebral Palsy (CP). Children and adolescents with CP (n = 199; 113 males and 86 females) participated in this cross-sectional study. Their mean age was 12.11 years (SD = 3.02; range 8–18 years), and they were evaluated using the Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE). Means, standard deviations and percentages were used to characterize the profile of participation, and linear regression analyses were employed to assess associations between the variables (child, family and environmental factors) and the diversity, intensity and enjoyment of participation. Children and adolescents with CP reported low diversity and intensity of participation and high levels of enjoyment. Participation in leisure activities outside of school was determined more by child and environmental factors than by family ones.     

Household task participation of children and adolescents with cerebral palsy,Down syndrome and typical development

This cross-sectional study compared patterns of household task participation (e.g., performance, assistance and independence) of youth with cerebral palsy (CP), Down syndrome (DS) and typical development (TD). Parents of 75 children and adolescents were interviewed to report on their youths’ active engagement in daily self-care and family-care tasks, using the children helping out: responsibilities, expectations and supports (CHORES) questionnaire. Groups were equivalent in age (mean = 9.3 years; SD = 2.2 years), sex (male = 39; female = 36), respondent education, presence of maid, and number of siblings at home, but differed on child cognitive function and family socioeconomic status, with the DS and the CP groups scoring lower than the TD group but not different from each other. ANOVA revealed group differences on CHORES performance of self-care tasks (p = 0.004), on total participation score (p = 0.04) and on assistance scores (p < 0.02). Post hoc comparisons showed that TD group scored higher than CP and DS groups on performance and assistance in self-care tasks and total assistance; TD and CP groups were similar on total performance and assistance in family-care tasks. The groups also differed on independence indices; the TD index was greater than the CP and DS, and the CP index was greater than the DS. Parents from the three groups did not differ on ratings of importance regarding their children's household participation (p = 0.416). In spite of observed differences, children and adolescents with CP and DS are actively engaged in daily self-care and family-care tasks; their participation at home is not prevented by the presence of their disabilities.     

Physical activity levels of adolescents with and without intellectual disabilities during physical education and recess

To compare physical activity levels in adolescents with and without intellectual disabilities during physical education and recess. Forty adolescents diagnosed with intellectual disabilities (inclusive classrooms, n = 20; self-contained classrooms, n = 20) and 40 age-matched typically developing peers (general classrooms) participated. All participants wore an Actigraph GT1M accelerometer for 5 consecutive weekdays during school hours. Three groups of adolescents were similarly active during physical education; however, adolescents with intellectual disabilities in self-contained classrooms were less active during recess than did the other two groups. In addition, they spent less percentage of time in moderate-to-vigorous physical activity during recess than did the typically developing adolescents. An inclusive, structured, and supportive environment promotes physical activity engagement in adolescents with intellectual disabilities.     

Habitual physical activity and cardiometabolic risk factors in adults with cerebral palsy

Adults with cerebral palsy (CP) are known to participate in reduced levels of total physical activity. There is no information available however, regarding levels of moderate-to-vigorous physical activity (MVPA) in this population. Reduced participation in MVPA is associated with several cardiometabolic risk factors. The purpose of this study was firstly to compare levels of sedentary, light, MVPA and total activity in adults with CP to adults without CP. Secondly, the objective was to investigate the association between physical activity components, sedentary behavior and cardiometabolic risk factors in adults with CP. Adults with CP (n = 41) age 18–62 yr (mean ± SD = 36.5 ± 12.5 yr), classified in Gross Motor Function Classification System level I (n = 13), II (n = 18) and III (n = 10) participated in this study. Physical activity was measured by accelerometry in adults with CP and in age- and sex-matched adults without CP over 7 days. Anthropometric indicators of obesity, blood pressure and several biomarkers of cardiometabolic disease were also measured in adults with CP. Adults with CP spent less time in light, moderate, vigorous and total activity, and more time in sedentary activity than adults without CP (p < 0.01 for all). Moderate physical activity was associated with waist-height ratio when adjusted for age and sex (β = −0.314, p < 0.05). When further adjustment was made for total activity, moderate activity was associated with waist-height ratio (β = −0.538, p < 0.05), waist circumference (β = −0.518, p < 0.05), systolic blood pressure (β = −0.592, p < 0.05) and diastolic blood pressure (β = −0.636, p < 0.05). Sedentary activity was not associated with any risk factor. The findings provide evidence that relatively young adults with CP participate in reduced levels of MVPA and spend increased time in sedentary behavior, potentially increasing their risk of developing cardiometabolic disease.     

Foot pressure distribution in children with cerebral palsy while standing

Foot deformity is a major component of impaired functioning in cerebral palsy (CP). While gait and balance issues related to CP have been studied extensively, there is little information to date on foot–ground interaction (i.e. contact area and plantar pressure distribution).This study aimed to characterize quantitatively the foot–ground contact parameters during static upright standing in hemiplegia and diplegia.We studied 64 children with hemiplegia (mean age 8.2 years; SD 2.8 years) and 43 with diplegia (mean age 8.8 years; SD 2.3 years) while standing on both legs statically on a pressure sensitive mat. We calculated pressure data for the whole foot and sub-regions (i.e. rearfoot, midfoot and forefoot) and average contact pressure. The Arch Index (AI) served for classifying the feet as flat, normal or cavus feet. The data were compared with those from a sample of age- and gender-matched participants (control group, 68 children). Most of the feet showed very high AI values, thus indicating a flat foot. This deformity was more common in diplegia (74.4%) than in hemiplegia (54.7%). In both diplegic and hemiplegic children, average plantar pressure was significantly increased in the forefoot and midfoot and decreased in the rearfoot (p < 0.001).The present data indicate an increased load on the front parts of the foot, which may be due to plantarflexor overactivity or knee flexion, combined with an increased incidence of low foot arches. As a low foot arch does not necessarily increase forefoot load, this deformity can be regarded as secondary.     

Physical activity and self-determined motivation of adolescents with and without autism spectrum disorders in inclusive physical education

The main purpose of this study was to compare the objectively measured physical activity (PA) and the motivation process between adolescents with (n = 25) and without (n = 75) autism spectrum disorders (ASD) in inclusive physical education (PE); and assess the associations of the PA levels to a sequence of motivational processes. Independent t-tests revealed significant PA and motivational process differences between adolescents with and without ASD. External regulation was positively correlated with the percentage of time that adolescents with ASD spent in moderate PA (r₂₅ = 0.58, p < .01) and moderate-to-vigorous PA (r₂₅ = 0.50, p < .05), and this extrinsic motive was associated with their needs of being attached or related in the class (r₂₅ = 0.53, p < .01). No significant associations of PA in PE on the motivational sequences of adolescents without ASD were observed. It is concluded that adolescents with ASD had less PA levels in PE and lower motives toward PE than adolescents without ASD, and external regulation was important in facilitating PA participation in adolescents with ASD.     

Imagery and fear influence height perception

The current study tested whether height overestimation is related to height fear and influenced by images of falling. To assess perceptual biases, participants high (n = 65) versus low (n = 64) in height fear estimated the vertical extents of two balconies using a visual matching task. On one of the balconies, participants engaged in an imagery exercise designed to enhance the subjective sense that they were acting in a dangerous environment by picturing themselves falling. As expected, we found that individuals overestimated the balcony's height more after they imagined themselves falling, particularly if they were already afraid of heights. These findings suggest that height fear may serve as a vulnerability factor that leads to perceptual biases when triggered by a stressor (in this case, images of falling).     

Mastery motivation in adolescents with cerebral palsy

The aim of this study is to describe motivation in adolescents with cerebral palsy (CP) and factors associated with motivation level. The Dimensions of Mastery Questionnaire (DMQ) measures motivation in mastering challenging tasks and expressive elements. It was completed by 153 parents and 112 adolescents with CP. Adolescents (GMFCS in n = 146 – I:50, II:43, III:13, IV:15, V:25) were assessed using the Leiter IQ and Gross Motor Function Measure. Parents completed the Vineland Adaptive Behavior Scale and the Strengths and Difficulties Questionnaire. Motivation scores were highest for mastery pleasure and social persistence with adults and lowest for gross motor and object-oriented persistence. Socio-demographic factors were not strongly correlated with DMQ. Higher gross motor ability (r = 0.24–0.52) and fewer activity limitations (r = 0.30–0.64, p < .001) were associated with persistence in cognitive, motor and social tasks, but not mastery pleasure. Higher IQ was associated with persistence in object-oriented tasks (r = 0.42, p < .001). Prosocial behaviors correlated with high motivation (r = 0.39–0.53, p < .001). Adolescents’ motivation scores were higher than parents’ scores. Adolescents with CP express high mastery pleasure, not related to abilities. High motivation was associated with fewer activity limitations and prosocial behaviors and aspects of family environment. Findings elucidate those at-risk for low motivation, which can influence treatment adherence and participation in challenging but meaningful activities.     

The meaning of beauty: Implicit and explicit self-esteem and attractiveness beliefs in body dysmorphic disorder

Body dysmorphic disorder (BDD) is characterized by imagined or slight defects in one's appearance. We evaluated implicit and explicit biases among individuals diagnosed with BDD (n = 21), individuals with subclinical BDD symptoms (n = 21), and healthy control participants (n = 21). Specifically, we used the Implicit Association Test [IAT; Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: the implicit association test. Journal of Personality and Social Psychology, 74, 1464–1480] to examine automatic associations related to self-esteem, associations between attractive and important, and a physical attractiveness stereotype (associations between attractive and competent). BDD participants had significantly lower implicit self-esteem, relative to control participants, and the subclinical BDD participants were intermediate between these groups. Although no group differences were observed on the implicit Attractive Important IAT; as predicted, BDD participants had significantly stronger implicit associations between attractive and competent than the other groups, in line with a common stereotype about physical attractiveness. Both the Attractive Competent IAT and Self-Esteem IAT were significant predictors of BDD symptom severity, and distress and avoidance during a mirror exposure task. Findings are discussed in light of cognitive-behavioral models of BDD.     

Effects of eye gaze directions of facial images on looking behaviour and autonomic responses in adolescents with autism spectrum disorders

It has been suggested that atypical eye contact of individuals with autism spectrum disorders (ASDs) arises from an unusually high level of autonomic activity elicited by another person's gaze. The present study investigated visual fixation duration and autonomic reactivity (heart rate, skin conductance response) simultaneously, while adolescents looked towards photographs of neutral faces, with either direct eye gaze, averted eye gaze or closed eyes. Both cognitively able adolescents with ASD (n = 31, mean age = 16 years, mean IQ = 104) and typically developing (TD) adolescents (n = 34, mean age = 16 years, mean IQ = 108) looked significantly longer towards the eye region of faces with direct eye gaze compared with faces with averted eye gaze or closed eyes. The adolescents with ASD did not show higher levels of autonomic activity than TD adolescents while they were instructed to look at the eye region. This suggests that looking at the eye region of static faces does not particularly trigger high autonomic arousal in adolescents with ASD.     

Executive functioning as a predictor of peer victimization in adolescents with and without an Autism Spectrum Disorder

The present study examined pragmatic language and executive functions (EF) as predictors of peer victimization in three groups: high-functioning adolescent boys with an Autism Spectrum Disorder (ASD) (n = 30); typically developing adolescent boys (n = 40); and adolescent boys (n = 22) without ASD with special education needs (SN). Controlling for age and bullying others, regression analyses revealed EF as measured by the Behavior Rating Inventory of Executive Functioning (Gioia et al., 2000) to be a significant predictor across all types of peer victimization (physical, social, and verbal) regardless of group membership. It is concluded that EF may play a pivotal role in explaining why some SN adolescents with and without ASD are at-risk for peer victimization.     

Accelerometer-determined physical activity and walking capacity in persons with Down syndrome,Williams syndrome and Prader–Willi syndrome

In this study we describe by use of accelerometers the total physical activity (PA), intensity pattern and walking capacity in 87 persons age 16–45 years with Down syndrome (DS), Williams syndrome (WS) and Prader–Willi syndrome (PWS). Participants were recruited from all over Norway, and lived either with their parents or in community residences with support.On average the participants generated 294 counts per minute (cpm) or 6712 steps per day, with most of the day spent in sedentary activity, 522 min/day, followed by 212 min/day in light PA, 71 min/day in lifestyle activity and 27 min/day in moderate-to-vigorous physical activity (MVPA). Inactivity was prevalent, as only 12% meet the current Nordic recommendations for PA.When compared, no differences for total physical activity or time in MVPA were observed between the three groups. However, participant with DS spent a mean of 73 min/day less and 43 min/day less in sedentary activities compared to participants with PWS and WS, respectively, (p = 0.011, 95% CI: ?10.9; ?80.1). In addition the DS-group spent a mean of 66 min/day more in light PA than the PWS-group and 41 min/day more than the WS-group, (p < 0.001, 95% CI: 29.3; 79.7). Participants with PWS spent on average 30 min/day less in lifestyle activities compared to both participants with DS and WS, (p < 0.001, 95% CI: ?14.2; ?45.4). No association between total PA and BMI were observed. Males were more active than females across all diagnoses. Males accumulated on average 85 counts per minutes more than females, (p = 0.002, 95% CI: 33.3; 136.7), 2137 more steps per day, (p = 0.002, 95% CI: 778; 3496). The mean walking capacity during six-minutes was 507 m (SD 112 m) for males and 466 m (SD 88 m) for females. Distance walked during testing decreased with 33.6 m when comparing normal or underweight participants to overweight participants, and 78.1 m when comparing overweight to obese participants (p < 0.001 95% CI: ?40.4; ?85.8). When adjusted for BMI no differences in walking capacity between the three genetic conditions were observed.     

Contrasting deficits on executive functions in Chinese delinquent adolescents with attention deficit and hyperactivity disorder symptoms and/or reading disability

Many studies reported high prevalence of reading disability (RD) and attention deficit hyperactivity disorder (ADHD) among delinquent adolescents. Very few have examined their cognitive profile. The present study compared the executive functions (EFs) and severity of delinquency in delinquent adolescents with RD and/or ADHD symptoms (AS). Delinquents with AS (n = 29), RD (n = 24), comorbidity AS + RD (n = 35) were recruited from juvenile institutions along with typically developing controls (n = 29) from local schools; all completed EF assessments and self-report questionnaires on delinquency. Results showed that pure AS group exhibited impaired inhibition while the pure RD group was weak in processing speed and visual memory. The comorbidity group showed unique impairments in interference control and significantly higher delinquency severity. The present findings suggest that comorbidity AS + RD may influence delinquency severity. It also provides a more comprehensive picture of the unique EF deficits associated with different groups, allowing for better matching for future identification and intervention programme.     

Empathic accuracy in adolescents with autism spectrum disorders and adolescents with attention-deficit/hyperactivity disorder

In research on theory of mind (ToM) in individuals with an autism spectrum disorder (ASD) mainly static mind-reading tasks were used. In this study both a static (Eyes Test) and a more naturalistic (empathic accuracy task) ToM measure were used to investigate the perspective taking abilities of adolescents with ASD (n = 13), adolescents with attention-deficit/hyperactivity disorder (ADHD; n = 13) and typically developing adolescents (n = 18). An innovative aspect concerns the standard stimulus tapes of the empathic accuracy task, which showed interactions between dyads of one adolescent with ADHD and one adolescent without ADHD. In this way, we were able to compare the ‘readability’ of the thoughts and feelings of adolescents with and without ADHD. The results clearly demonstrate the impairment in perspective taking abilities of adolescents with ASD, both on the static and naturalistic mind-reading task. Moreover, the empathic accuracy task seems to be a useful and promising method to assess ToM abilities in adolescents, with or without clinical problems. Finally, thoughts and feelings of target persons with ADHD seemed to be less easy to read than the thoughts and feelings of typically developing target persons.     

Determinants of participation in leisure activities among adolescents with cerebral palsy

Studies have identified restrictions in engagement in leisure activities for adolescents with disabilities. Participation is a complex construct and likely influenced by a variety of factors. These potential determinants have not yet been sufficiently explored in the population of adolescents with cerebral palsy (CP). The objective of this study is to estimate the potential influence of adolescent characteristics and environmental factors as determinants of participation in leisure activities for adolescents with CP. A cross-sectional design was used. Participants were adolescents (12–19 years old) with cerebral palsy. Participants were assessed with the Vineland Adaptive Behavior Scale – II, Gross Motor Function Measure, Gross Motor Function Classification System, Manual Ability Classification System and completed the Self-Perception Profile for Adolescents, Dimensions of Mastery Questionnaire, Strengths and Difficulties Questionnaire, Family Environment Scale, the European Child Environment Questionnaire and the Preferences for Activities of Children. The main outcome measure was the Children's Assessment of Participation and Enjoyment. 187 adolescents (age M = 15.4; SD = 2.2) completed the study. Multivariate models of participation in leisure revealed associations with factors related to the adolescents’ functional characteristics and attitudes, the family environment, socioeconomic status, and contextual factors such as school type, and collectively explained from 28% (diversity of skill-based activities) up to 48% (intensity and diversity of self-improvement activities) of the variance in intensity and diversity in five leisure participation domains (diversity: r² = .33 recreational; r² = .39 active-physical; r² = .33 social activities). Adolescent's mastery motivation, self-perception and behavior were individually associated with participation in different activity domains, but did not strongly predict participation within multivariate models, while preferences for activities were strong predictors of participation in all domains, except for skill-based activities. Engagement in different types of leisure activities is important for adolescents’ development and well-being. Health care professionals should consider adolescents’ and families’ characteristics to promote participation in leisure activities.     

Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): Recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement

During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n = 70 hospitalizations, mean age = 15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean = 84.3 (±94.9) days), patients doubled on average their GAFS scores (mean = 17.66 (±9.05) at admission vs. mean = 31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [n = 20 (28%), including epilepsy: n = 10 (14%) and painful medical conditions: n = 10 (14%)], environmental causes [n = 17 (25%) including lack of treatment: n = 11 (16%) and adjustment disorder: n = 6 (9%)], and non-ASD psychiatric condition [n = 33 (48%) including catatonia: n = 5 (7%), major depressive episode: n = 6 (9%), bipolar disorder: n = 4 (6%), schizophrenia: n = 6 (9%), other/unknown diagnosis: n = 12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge. Severity of autism at admission was the only negative predictor (p < .001). Painful medical conditions (p = .04), non-ASD psychiatric diagnoses (p = .001), prior usage of specialized ASD care programs (p = .004), functional language (p = .007), as well as a higher number of challenging behaviors upon admission (p = .001) were associated with higher GAFS scores at discharge. Clinical severity at admission, based on the number of challenging behaviors (r = .35, p = .003) and GAFS score (r = −.32, p = .008) was correlated with a longer inpatient stay. Longer hospitalization was however correlated (r = .27, p = .03) with higher GAFS score at discharge even after adjustment for confounding factors. Challenging behaviors among adolescents with ASD may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic illness such as epilepsy or acute pain. The management of these behavioral challenges requires a unified, multidisciplinary approach.     

Picture me playing—A portrait of participation and enjoyment of leisure activities in adolescents with cerebral palsy

In recent years attention has been paid to the participation levels of children and youth with Cerebral Palsy (CP), particularly the extent to which they have the opportunity to be involved in and enjoy leisure activities. The objective of this study is to describe the level of participation and enjoyment in leisure activities among adolescents with CP and to identify potential differences in participation patterns related to sociodemographic attributes. A cross-sectional design was used. Participants were 175 adolescents 12–20 years old (M = 15.3; ±2.2), GMFCS I = 55/II = 43/III = 13/IV = 18/V = 39 who completed the Children's Assessment of Participation and Enjoyment (CAPE). The types of activities participants engaged in most frequently were social and recreational activities, whereas self-improvement and skill-based activities were least frequent. Social activities were the activities they enjoyed most. In general, participation decreases, as youth grow older. Girls engaged in more self-improvement activities than boys. Adolescents who study in special segregated schools experienced a lower diversity and intensity of engagement in all leisure activity domains. Adolescents who were not ambulatory and those presenting with more severe manual ability limitations participated less in all activity types except skill-based activities. Adolescents with CP place a high value on the ability to engage in activities of their own choosing and on interacting with friends. Engagement in a variety of leisure activities is important for a healthy development. Understanding the leisure patterns and preferences of this population, in addition to the contextual factors, may help in the elaboration of interventions and programs to promote a healthy development for this population.