The question of whether **cerebral palsy (CP) is being hidden under the autism diagnosis umbrella** touches on complex issues of neurodevelopmental disorder classification, diagnostic overlap, and clinical practice. While CP and autism spectrum disorder (ASD) are distinct conditions with different primary features, there is significant clinical and research evidence showing overlap in symptoms, co-occurrence, and diagnostic challenges that can sometimes blur the lines between them.
**Cerebral palsy** is primarily a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing fetal or infant brain. It mainly affects motor function, muscle tone, and coordination. In contrast, **autism spectrum disorder** is characterized by difficulties in social communication and interaction, alongside restricted and repetitive behaviors, with a neurodevelopmental basis affecting brain connectivity and function.
### Overlapping Symptoms and Diagnostic Challenges
One key reason CP might sometimes be “hidden” or confused under autism diagnoses is the presence of **motor impairments and developmental delays** in both conditions. For example, children with autism often exhibit **early motor abnormalities**, including hypotonia (low muscle tone), delayed motor milestones, and coordination difficulties, which are also hallmark features of CP[3]. A systematic review found that early muscle hypotonia is common in children later diagnosed with autism, but hypotonia is not unique to autism and occurs in other neurodevelopmental disorders, including CP[3].
Moreover, children with CP frequently have **co-occurring neuropsychiatric impairments**, including autism-like symptoms. A population-based study showed that about one-third of school-aged children with CP have neuropsychiatric impairments, which may include features overlapping with ASD[6]. This overlap can complicate diagnosis, especially in young children where developmental trajectories are still emerging.
### Diagnostic Criteria and Evolution
The diagnostic criteria for autism have broadened significantly over the past decades, contributing to increased autism diagnoses. For instance, the DSM (Diagnostic and Statistical Manual of Mental Disorders) only separated autism from schizophrenia in 1980, and since then, the definition of ASD has expanded to include a wider spectrum of symptoms and severities[4]. This broadening can sometimes lead to children with motor impairments and developmental delays being diagnosed with autism when their primary condition might be CP or another neurodevelopmental disorder.
Screening tools and clinical assessments also play a role. In some low-resource settings, screening for neurodevelopmental disorders often uses broad tools that may not clearly differentiate between CP, autism, epilepsy, and ADHD[1]. For example, in a Kenyan study, children screened positive for neurological disorders showed overlapping symptoms across these conditions, making precise diagnosis challenging[1].
### Co-occurrence and Misdiagnosis
It is important to note that **CP and autism can co-occur**. Children with CP may also meet criteria for ASD, and vice versa. This co-occurrence can lead to complex clinical presentations where one diagnosis might overshadow the other. For example, a child with CP who has significant social communication difficulties might receive an autism diagnosis, while the underlying motor disorder is less emphasized.
However, this does not mean CP is being deliberately “hidden” under autism. Rather, it reflects the **complexity of neurodevelopmental disorders**, where overlapping symptoms and co-morbidities require careful, multidisciplinary assessment. Misdiagnosis or delayed diagnosis can occur, especially in settings with limited access to specialized neurological and developmental evaluations.
### Clinical Im
