Self-Worth of children with cerebral palsy: Is there something in the wind?

1. Self-Worth of children with cerebral palsy:Is there something in the wind? Line Nadeau, Ph.D. Université Laval CIRRIS

3. Overview • Global Self-Worth and Perceived competences • Global Self-Worth and Perceived competences in children with CP • Case study • Follow-up study and results • Future directions (research and intervention)

4. Global Self-Worth • Global self-worth (also referred to as self-esteem): definition James (1892) Cooley (1902)

5. Harter’s Self-Worth model Susan Harter

6. Global Self-Worth Really Sort of Sort of Really True true true true   Some kids are happy BUT Other kids   with themselves as a are often not person happy with themselves   Some kids are not BUT Other kids   happy with the way think the way they do a lot of things they do things if fine Examples of Harter’s Social Perception Profile for Children

7. Perceived competence Really Sort of Sort of Really True true true true   Some kids find it BUT Other kids   hard to make have as many friends friends as they want   Some kids usually get BUT Other kids   into trouble because usually don’t of the things they do do things that get them into trouble Examples of Harter’s Social Perception Profile for Children

8. Perceived competence Really Sort of Sort of Really True true true true   Some kids wish BUT Other kids   their phisical like their appearance was physical different appearance the way it is   Some kids do very well BUT Other kids   at all kinds of sports don’t feel that they are very good when it comes to sports. Examples of Harter’s Social Perception Profile for Children

9. Literature • Self-Worth • Essential dimension of social development • Children with CP and self-worth • Risk on social development

10. Literature on Self-Worth CP: not a risk factor Risk = domains specific • Gender • Perceived impact of CP

11. Conclusions • Children with CP are resilient against possible risk to their self-worth • To concentrate on treating the presenting physical problems rather than placing an emphasis on the effect of disability on self-worth

12. Good news???

13. Case study

14. Follow-up study Nadeau L. & Tessier R. (2006). Social Adjustment of Children with Cerebral Palsy in Mainstream Class: Peer Perception. Developmental Medicine and Child Neurology 48: 331-336. Children with CP (n=60) Comparison children (n=57) • Born at term • Without physical disability • 9-12 years • Same classroom • Matched for gender, age, parents' education level and family income • Hemiplegia or diplegia • Gross Motor Function Classification Scale(GMFCSlevels I-II) • Mainstream class • 9-12 years

15. Participants * p<.05

16. Global Self-Worth and perceived competence within specific domains Harter (Time 1) 1.6 3.6 4.0 3.6 3.8

17. Global Self-Worth and perceived competence within specific domains Harter (Time 2) 1.8 3.2 3.6 3.3 3.4

18. Parents (CBCL), teachers (TRF) and peer’s assessment (RCP) 5.0 2.0 .48 .54 .11 -.30

19. Children with CP have positive view of themselves Global Self-Worth Domains In short • Children with CP were perceived by parents, teachers and peers as having social adjustment problems • Social Problems • Victimization • Withdrawal + -

20. Is there something in the wind? • Def. – There is something fishy going on.

21. How does perception by others impact on self-worth?

22. Question • Do global self-worth and perceived competence vary according to their social status in the peers group?

23. Social status assessment (peers) n=943 (Coie et al., 1983) • Popular: + nominations • number of nominations: question: 'who do you like to play with most’? • Rejected: – nominations • number of nominations: question: 'who do you like to play with least’?

24. Social Status by group 117 children CP-Popular (n=25) Comparison-Popular (n=40) CP-Rejected (n=35) Comparison-Rejected (n=17)

25. Global Self-Worth and perceived competence within specific domains Harter (Time 1) 4.0 1.6 3.6 3.6 3.8

26. Global Self-Worth and perceived competence within specific domains Harter (Time 1) 3.4 1.8 3.2 3.2 3.4

27. Discussion • Social Acceptation and Athletic Competence: positive self-evaluation • Rejected children (with or without CP) rated their competence as lower than popular children • Behavioral Conduct and Global Self-Worth: Maybe there is something in the wind… • Why did rejected children with CP rated themselves positively whereas rejected children without CP were found to have a significantly lower global self-concept?

28. Futures directions • Research • Physiological response to stress • Clinical Interventions • Multi-Informant Approach • Associated symptoms (depression) • Problem-solving strategies

29. Remerciements… • Social Science and Humanity Council (SSHRC) • Fonds de recherche en Santé du Québec (FRSQ) • CIRRIS • Research Team • Marie Larose • Marie-Hélène Ouellet • Annie Fraser • Réjean Tessier

30. Publications • Nadeau L. Tessier R. Social adjustment at school: Are children with cerebral palsy perceived more negatively by their peers than other at-risk children? (in press). Disability and Rehabilitation. • Nadeau L., Routhier ME, Tessier R. (2008). The performance profile on the Wisconsin Card Sorting Test of a group of children with cerebral palsy aged between 9 and 12’. Developmental Neurorehabilitation, 134-40. • Nadeau L. & Tessier R. (2006). Social Adjustment of Children with Cerebral Palsy in Mainstream Class: Peer Perception. Developmental Medicine and Child Neurology 48: 331-336.

31. Thank you…