Predictors of community participation from preschool to school age in children with cerebral palsy

AIM: To investigate participation frequency patterns and child and family predictors of community participation in young children with cerebral palsy (CP). METHOD: We prospectively assessed participation frequency at preschool (Young Children's Participation and Environment Measure) and again at school age (Participation and Environment Measure-Children and Youth). Linear regressions examined preschool predictors of community school-age participation: preschool child age; sex; gross motor function (Gross Motor Function Classification System [GMFCS]); manual function (Manual Ability Classification System); pain; prosocial behaviour; conduct; family ethnicity; income; and residence type. RESULTS: Children with CP (n = 155, 44% females, 64% classified in GMFCS level I or II), mean baseline age = 4 years 4 months (SD = 1 year 1 month) and at school age = 6 years 7 months (SD = 7 months) had a median community participation frequency at preschool age of 2.8 (interquartile range [IQR] = 1.3) and 2.8 (IQR = 1.6) at school age. Preschool community participation was 2.02 (confidence interval [CI] = -2.20 to -1.83) units lower than at home; at school age, it was 2.40 (CI = -2.59 to -2.22) units lower. Greater prosocial behaviour (child model: R² = 0.26, p = 0.001) predicted higher school age community participation. INTERPRETATION: In young children with CP, community participation was infrequent at preschool age (a few times in the last 4 months) and this persisted into school age. Higher preschool prosocial behaviour predicted community participation at school age. Enhanced awareness of infrequent community participation of preschool children with CP and supporting a child's social behaviours may help facilitate community participation.