Mental health problems in children with neuromotor disabilities

Question 1

What are some neuromotor disorders?

Answer 1

1. CP
2. Muscular dystrophy
3. Spina bifida

Question 2

What are some symptoms of neuromotor disorders?

Answer 2

1. Weakness
2. Hypotonia
3. Spasticity
4. Dystonia
5. Contractures
6. Sensory disorders
7. Cognitive deficits

Question 3

What are some of the effects of musculoskeletal pain?

Answer 3

1. Isolation
2. Frustration
3. Sadness
4. Anxiety
5. Difficulty concentrating
6. Increased crying
7. Irritability
8. Lower activity levels

Question 4

What are some medical comorbidities associated with neuromotor disorderS?

Answer 4

1. Seizures
2. Dysphagia
3. Feeding difficulties
4. Aspiration
5. Recurrent pneumonia
6. GER
7. Constipation
8. Sleep apnea

Question 5

What communication, cognition and learning issues can be associated with neuromotor disorder?

Answer 5

1. Social-emotional dysfunction
2. Executive dysfunction
3. Cognitive dysfunction
4. Mild to profound intellectual disability
5. LD

Question 6

What questions should be asked re: body structures?

Answer 6

1. Specialized clinicians (eg, an orthopedic surgeon) should monitor for secondary musculoskeletal disorders
2. Assess and treat constipation and gastroesophageal reflux disease (especially with unexplained sleep or feeding difficulties), voiding difficulties, sleep disturbances and seizures
3. Review feeding, including method, timing and environment, and manage symptoms of coughing, gagging and choking; consider referral to a feeding and swallowing team at a local children’s treatment centre or paediatric hospital
4. Inspect the skin, back and joints, particularly under supportive devices. Consider reassessment by an orthotist, occupational therapist or orthopedic surgeon
5. Ensure regular follow-up with the child’s dentist, optometrist and/or ophthalmologist and audiologist

Question 7

What should be assessed re: functions?

Answer 7

1. Determine developmental levels across functions (ie, “developmental age”)
2. Note mismatches between “developmental age” and expectations across environments
3. Therapists should attend medical appointments or provide a report summarizing findings
4. Consider augmentative communication methods (visuals, technology) through speech and language therapy or a technology access referral
5. Supplement monitoring with a mental health screening checklist to help track symptom severity over time

Question 8

What should be assessed re: home environment?

Answer 8

1. Review family structure, physical environment and parent-child interactions
2. Identify the family’s psychosocial supports and stressors (eg, bereavement, moves, illness, financial difficulties, conflict and separations) and overall well-being
3. Consider referrals for social work, case coordination (eg, at a children’s treatment centre) or adult mental health care
4. Consider discussing referral to an early interventionist (early developmental therapist) or a behaviour or mental health therapist if you have concerns regarding parent-child interactions
5. Consider discussing potential benefits and options for referral for parental respite care

Question 9

What should be assessed re: school environment?

Answer 9

1. A collateral history should be obtained directly from the child’s teacher (verbal or written)
2. A review of the child’s functioning and participation in school should include:
   a) classroom placement (integrated, specialized and/or supported) and level of work
   b) school’s understanding of the child’s function and mental health symptoms
   c) school interventions to address mental health symptoms (eg, difficult behaviours)
   d) psychoeducational or other assessments
   e) assistive devices or supports (seating, communication tools)
   f) the child’s level of participation across school activities
   g) the parent-teacher relationship
3. Encourage parents to meet regularly with school personnel
4. Provide an advocacy letter outlining the child’s diagnosis, function levels and specific needs

Question 10

What should be assessed re: participation and individuals factors?

Answer 10

1. Review and emphasize the benefits of recreation
2. Ask the child about favourite activities (“What do you find the most fun?”)
3. Encourage parents to communicate with community agencies about recreational programs
4. Discuss the potential benefits of being active with and exposed to other individuals with disabilities
5. Consider involving a physiotherapist or other therapist to help access recreational opportunities
6. Consider re-referral to a physiotherapist or occupational therapist to assess whether a child’s mobility is optimal (eg, is a motorized chair needed?)

Question 11

What are the CPS recommendations re: assessment and promotion of mental health in child or adolescent living with neuromotor disability?

Answer 11

1. Mental health should be considered contextually, in the child-environment system, necessitating a broad assessment of ICF domains.
2. Addressing mismatches in a child’s multiple environments (home, school, recreation) compared with functional abilities (motor, communication, social-emotional skills) can improve participation levels. Physicians should consider providing a medical letter to caregivers with specific information about a child’s functional abilities, medical diagnoses and recommended supports, such as assistive technologies and strategies.
3. A consistent coordinating physician is best able to identify and manage the many possible sources of physical discomfort that may be affecting a child’s mental health symptoms.
4. A coordinating physician can also be a source of information, compassionate care and referrals for parents who have difficulty meeting their child’s complex needs.
5. The child’s history should be compiled directly from multiple sources, including from the child and his/her family members, educators and therapists, through face-to-face meetings, written reports and telephone conversations.