Evidence map›Paper›PMID 41955499›Full record

ArticleDevelopmental medicine and child neurology2026

The cerebral palsy directed acyclic graph: A structural causal model of aetiology.

Shona Goldsmith, Sarah McIntyre, Nadia Badawi, Bernard Dan, Steven Day, Kate Himmelmann, Sandra Julsen Hollung, Bo Jacobsson, Gija Rackauskaite, Robert J Reynolds

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Developmental medicine and child neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Shona GoldsmithCerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0003-3903-6142
Sarah McIntyreCerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0002-0234-1541
Nadia BadawiCerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0001-6828-1636
Bernard DanUniversité Libre de Bruxelles (ULB), Faculty of Psychology, Educational Sciences and Speech and Language Therapy, Brussels, Belgium.ORCID https://orcid.org/0000-0002-2051-9876
Steven DayMortality Research & Consulting, Inc., Diamond Bar, CA, USA.ORCID https://orcid.org/0000-0001-8305-5813
Kate HimmelmannDepartment of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID https://orcid.org/0000-0002-3959-9554
Sandra Julsen HollungNorwegian Quality and Surveillance Registry for Cerebral Palsy, Vestfold Hospital Trust, Tønsberg, Norway.ORCID https://orcid.org/0000-0002-7486-7454
Bo JacobssonDepartment of Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden.
Gija RackauskaiteDepartment of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Robert J ReynoldsMortality Research & Consulting, Inc., Diamond Bar, CA, USA.ORCID https://orcid.org/0000-0003-1070-8996

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimTo describe the development of the initial version of the cerebral palsy (CP) directed acyclic graph (DAG). DAGs are visual representations of causal assumptions and powerful tools for representing and communicating complex causation.

methodAn international working group of clinicians, researchers, and individuals with lived experience developed the CP-DAG, using methods adapted from the US National Aeronautics and Space Administration's risk modelling approach. The team developed a network of nodes and causal links spanning prenatal, perinatal, neonatal, and postneonatal pathways, along with a node dictionary ('DAGtionary'). Iterative drafts were created with feedback incorporated from presentations at international meetings and workshops.

resultsAs of August 2025, the CP-DAG includes 106 nodes and 378 links, yielding a network density of 6.8%. It spans known and hypothesized causal pathways across biological, clinical, and social domains. The accompanying DAGtionary contains concise definitions and references for each node, totalling 210 citations.

interpretationThe CP-DAG provides a visual, evidence-linked representation of causal reasoning in CP. It offers a foundation for identifying knowledge gaps, directing future research to under-researched areas, and, eventually, for probabilistic modelling. This initial version is intended as a starting point. We call on the global CP disability community to contribute to its ongoing refinement.

Indexed as

CausalityCerebral PalsyHumans

Identifiers

PMID41955499
PMCPMC13649292

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.