Self-determined behaviors of young children with cerebral palsy

Self-determined behaviors refer to children taking an active role in knowing needs, making choices, solving problems, and interacting with others. The aims of this research were to: 1) identify determinants of self-determined behaviors of children with cerebral palsy (CP); and 2) determine whether self-determined behaviors, frequency, and enjoyment of participation differed between children who are more playful and less playful. Participants in study I were 429 children with CP (18 to 60 months, 56% boys) and their parents. The measures were the Early Coping Inventory, Test of Playfulness (ToP), Gross Motor Function Classification System (GMFCS), Health Conditions for Children with CP, Family Expectation of Child, and Family Support to Child. Structural equation modeling was used to test two models of self-determined behaviors. For children with walking mobility (GMFCS levels I-II), the model explained 60% of variance in self-determined behaviors. The determinants were cognitive-behavioral function and family provided opportunity to support their child's self-determined behaviors. For children with limited mobility (GMFCS levels III-V), the model explained 68% of variance in self-determined behaviors. The determinants were cognitive-behavioral function, playfulness, and family provided opportunity. Participants in Study II were 127 children with CP: walking mobility (more playful, n=40; less playful, n=39) and limited mobility (more playful, n=24; less playful, n=24). The measures were Early Coping Inventory, Child Engagement in Daily Life measure, ToP, GMFCS, and Health Conditions for Children with CP. ANCOVA or Mann-Whitney U test was used to examine the difference of playfulness on dependent variables based on number of covariates. Children with walking mobility who are more playful had more effective self-determined behaviors than children who are less playful (p<.02). Children with limited mobility who are more playful had greater enjoyment of participation than children who are less playful (p<.01). The findings support children's learning and understanding, communication, controlling emotions and behaviors, playfulness, mobility, and family provided opportunity for their child to try things as important considerations to support self-determined behaviors. Service providers are encouraged to appreciate the multi-dimensional nature of self-determination, support children from a holistic perspective, and value team collaboration to enhance children's self-determined behaviors.