Cross-Sectional Associations Between Functional Independence and Behavioral Problems in Children with Cerebral Palsy: The Relational Roles of Family Impact and Maternal Self-Blame
Healthcare (Switzerland), vol.14, no.14, 2026 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: 14 Issue: 14
- Publication Date: 2026
- Doi Number: 10.3390/healthcare14142038
- Journal Name: Healthcare (Switzerland)
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, Health Research Premium Collection (ProQuest)
- Keywords: CBCL Total Problems, cerebral palsy, family impact, maternal cognitive emotion regulation, maternal self-blame, parental bonding, parent–child relations
- Istanbul University-Cerrahpasa Affiliated: Yes
Abstract
Background/Objectives: Children with cerebral palsy, a permanent neurodevelopmental condition that primarily affects movement and posture, exhibit higher rates of behavioral problems. This study examined the cross-sectional associations linking child functional independence in motor and cognitive domains and maternal self-blame to family adaptation and child behavioral presentations within an integrated analytical framework. Methods: In a cross-sectional design, 79 child–mother dyads in the cerebral palsy group and 62 dyads in a typically developing control group involving children aged 6 to 18 years were evaluated using the Child Behavior Checklist, Functional Independence Measure for Children, Parental Bonding Instrument, Parent–Child Relationship Scale, Impact on Family Scale, and Cognitive Emotion Regulation Questionnaire. Path analysis using full-information maximum likelihood examined the relational structures exclusively within the cerebral palsy group. Results: Group comparisons indicated that the cerebral palsy group scored significantly higher on child behavioral total problems and all syndrome subscales than the controls. Sensitivity analyses revealed that while elevated child behavioral difficulties remained robust after adjusting for demographic imbalances, differences in parental overprotection and maternal self-blame attenuated to non-significance. Within the structural model, maternal self-blame was the only exogenous variable significantly associated with adverse family impact. Direct and indirect relational pathways from child cognitive functional independence and motor parameters to child behavioral total problems through family impact did not reach statistical significance. Conclusions: Child behavioral difficulties and family-level adaptation challenges in cerebral palsy represent cross-sectional patterns organized through distinct parallel systems rather than a single interconnected pathway. These findings suggest the potential utility of routine clinical screening for maternal cognitive emotion regulation patterns and identify maternal self-blame as a hypothesis-generating target for future longitudinal intervention trials.