Language performance in children with cerebral palsy: the role of cortical auditory processing beyond motor and cognitive factors.

BACKGROUND: Language impairments in children with cerebral palsy (CP) are often attributed to motor limitations; however, the contribution of central auditory processing remains insufficiently understood. Cortical auditory evoked potentials (CAEPs) provide an objective means of assessing auditory cortical processing and may offer insight into the neurophysiological mechanisms underlying language outcomes. OBJECTIVE: To examine the relationship between cortical auditory processing and language performance in children with cerebral palsy (CP) and to determine whether electrophysiological measures remain associated with language outcomes after adjustment for motor severity, cognitive status, age, and hearing status. METHODS: This cross-sectional case-control study included 48 children with CP and 48 age- and sex-matched typically developing controls. Language performance was assessed using standardized language measures, and CAEP components (P1, N1, and mismatch negativity [MMN]) were recorded using electroencephalography. Group comparisons, correlation analyses, ANCOVA, and multiple linear regression analyses were performed while accounting for demographic and clinical covariates. RESULTS: Children with CP demonstrated significantly prolonged CAEP latencies, altered amplitudes, and lower receptive and expressive language scores than controls (all p < .001). Within the CP group, N1 latency showed the strongest correlation with language performance (r = -0.989, p < .001). In the multivariable regression model, N1 latency (β = -0.700, p < .001), GMFCS level (β = -0.299, p < .001), cognitive status (β = 0.090, p = .006), and hearing status (β = -0.095, p = .002) remained statistically associated with total language scores when entered into the same model, whereas age was not (p = .390). The model explained 98.7% of the variance in language performance (R² = .987). CONCLUSIONS: Cortical auditory processing measures remained significantly associated with language performance after adjustment for motor severity, cognitive status, age, and hearing status. These findings support the potential value of CAEP measures as complementary neurophysiological markers for the assessment of language impairment in children with cerebral palsy.