Self-esteem during the school years. Its normal development and hazardous decline

Identifying mechanisms of change in a magic-themed hand-arm bimanual intensive therapy programme for children with unilateral spastic cerebral palsy: a qualitative study using behaviour change theory

Background

There has been much research into how to promote upper-limb skills to achieve functional independence in children with unilateral spastic cerebral palsy (USCP). One researched intervention is the Breathe Magic programme, which follows the protocol of hand-arm bimanual intensive therapy (HABIT) whilst, incorporating magic tricks to develop children’s motor skills and bimanual skills. However, whilst research has found the programme to be effective, there has been little consideration of how the intervention leads to a positive outcome: what the psychological, social and physical mechanisms of action are.

Methods

Qualitative semi-structured interviews with 21 children with USCP who participated in the Breathe Magic HABIT intervention, and focus groups with 17 parents and/or carers were undertaken. Analysis was conducted through the lens of the COM-B behaviour change model using a combined deductive framework and inductive thematic analysis. Reliability of coding was confirmed through random extraction and double coding of a portion of responses and the calculation of inter-rater reliability.

Results

Breathe Magic brings about change and positive outcomes by increasing children’s psychological and physical capabilities, providing social opportunities, and enhancing reflective and automatic motivation. Additionally, a number of enablers to engaging in the intervention were identified, particularly under psychological capabilities, social opportunities and both reflective and automatic motivation. Very few barriers were raised; those that were raised were of relatively low frequency of reporting.

Conclusions

By conducting a theory-based qualitative process evaluation, this study demonstrated the mechanisms of change behind the Breathe Magic HABIT intervention for children with USCP. Breathe Magic was found to be a well-structured combination of intended and unintended mechanisms of change. Overall, the success of Breathe Magic was observed through not only its intended mechanisms to enhance hand skills, but also through unintended psychological improvements in children’s hand function, as well as social and motivational benefits resulting from interaction between children and parents.

Outcomes After Surgical Treatment of Spastic Upper Extremity Conditions

Surgical interventions for the spastic upper extremity aim to correct the common deformities of elbow flexion, forearm pronation, wrist flexion and ulnar deviation, and thumb-in-palm deformity. One goal is achieving optimal function and improved limb positioning. Aesthetics of the limb have a profound impact on self-esteem and satisfaction. Surgical deformity correction has not reliably been shown to improve sensory function such as stereognosis. Validated outcome measures are used to present outcomes after surgical treatment of the spastic upper extremity as it relates to motor function and limb positioning, sensory function, and self-esteem.

Functional Capacity and Self-Esteem of People With Cerebral Palsy

OBJECTIVE

We assessed whether functional capacity predicts self-esteem in people with cerebral palsy (CP).

METHOD

We conducted a cross-sectional observational study of 108 people with CP, ages 16-65 yr, who were residents of Spain. Self-esteem was captured using the Rosenberg Self-Esteem Scale (RSES), and functional capacity using the Barthel Index (BI). Sociodemographic characteristics were recorded. The relationship between the RSES score and the BI score was analyzed using linear regression.

RESULTS

RSES scores increased significantly as BI scores increased (regression coefficient = 0.047, 95% confidence interval [0.017, 0.078], p = .003). People with a higher level of education, active employment, and independent living arrangements tended to have better functional capacity and higher self-esteem.

CONCLUSION

Greater functional capacity predicted higher self-esteem; this effect is probably partly mediated by education, employment, and living arrangements.

Trajectories of self-esteem in extremely low birth weight survivors through adulthood

Although the developmental course of self-esteem has been examined in general population samples, there is a lack of research examining the trajectory of self-esteem in populations who experience unique developmental challenges. We compared the trajectory of self-esteem in extremely low birth weight (ELBW; <1000 grams) survivors and normal birth weight (NBW) controls from mid-adolescence through their early 30s. Self-esteem was reported during three follow-up periods (age 12-16, age 22-26, age 30-35). Adjusting for sex, chronic health problems, socioeconomic status, and social support, no difference was noted in self-esteem in the two groups in adolescence, but birth weight status predicted rate of change of self-esteem from adolescence to adulthood. The NBW controls showed the expected, normative increases in self-esteem from mid-adolescence to young adulthood, while ELBW individuals displayed stable, low levels of self-esteem into young adulthood. Our findings highlight that ELBW survivors may not experience the normative trajectory of self-esteem into young adulthood.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (<1000 g) survivors (N = 179) and normal birth weight controls (N = 145) in the world, born between 1977 and 1982. Motor skills were measured using a performance-based assessment at age 8 and a retrospective self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

Self-esteem: a comparative study of adolescents from mainstream and minority religious groups in Pakistan

The present study aimed to investigate the level of self-esteem among religious minority adolescents (Christians and Hindus) by making a comparison with their dominant counterparts (Muslims) in Pakistan. It was hypothesized that adolescents of religious minorities would have lower level of self-esteem than their dominant counterparts. In the present study 320 adolescents participated, in which 160 adolescents belonged to minority religious groups (i.e. 76 Christians and 84 Hindus) and 160 adolescents belonged to dominant religious group i.e. Muslims. To assess self-esteem of the participants, Rosenberg Self-Esteem Scale (Rosenberg in Society and the adolescent self image, Princeton University Press, Princeton, NJ, 1965) was used. One Way Analysis of Variance reveals that religious minority adolescents (Christians and Hindus) inclined to have lower self-esteem as compared to their dominant counterpart (Muslim adolescents).

Self-esteem, self-concept, and quality of life in children with hemiplegic cerebral palsy

OBJECTIVES

To investigate self-esteem, self-concept and quality of life in children with hemiplegic cerebral palsy (HCP) compared with typically developing peers.

STUDY DESIGN

Cross-sectional evaluation of 86 children (3-16 years; 54 boys; mean age 9.4 +/- 3.7 years) with HCP and age and sex-matched peers. Self-esteem/concept was measured with the Self-Perception Profile for Children (age 8-16; n = 55 pairs) and the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (age 3-7 years; n = 31 pairs). Quality of life was measured with the Pediatric Quality of Life Inventory, version 4.

RESULTS

Significant differences in mean scores ([95%CI] P < .05) favoring the peer group were found for physical competence (HCP 2.8 [2.5, 3.0]; peer 3.2 [3.1, 3.3]), athletic competence (HCP 2.7 [2.5, 2.9]; peer 3.1 [3.0, 3.3]), and scholastic competence (HCP 2.8 [2.6, 3.0]; peer 3.1 [3.0, 3.3]), but favored children with HCP for maternal acceptance (HCP 3.1 [2.9, 3.3]; peer 2.7 [2.5, 3.0]). Quality of life was significantly higher for the peer group for both parent (HCP 54.5 [51.1, 58.0]; peer 80.6 [78.3, 82.9]) and child (HCP 67.6 [62.7, 72.6]; peer 80.6 [78.1, 83.1]) scales.

CONCLUSIONS

Children with HCP experience reduced quality of life and self-concept compared with typically developing peers.

Upper-limb botulinum toxin A injection and occupational therapy in children with hemiplegic cerebral palsy identified from a population register: a single-blind, randomized, controlled trial

OBJECTIVES

The purpose of this work was to assess the effect of botulinum toxin A and occupational therapy compared with occupational therapy alone on body structure, activities participation, and self-perception in a sample of children (aged 3-16 years) with hemiplegic cerebral palsy recruited from a statewide register.

PATIENTS AND METHODS

Participants of this single-blind, randomized, controlled trial identified from a population-based cerebral palsy register received either an individually prescribed and localized injection of botulinum toxin A with 4 sessions of occupational therapy over 4 weeks (intervention) or occupational therapy alone (control). Outcomes were assessed from 2 domains of the World Health Organization International Classification of Functioning, Disability, and Health: body structure (Modified Ashworth Scale and Tardieu Scale) and activities participation (Assessment of Motor and Process Skills, Goal Attainment Scale, Pediatric Evaluation of Disability Inventory, and Pediatric Quality of Life Inventory). Self-perception was also measured.

RESULTS

All of the participants (intervention: n = 21; control: n = 22) provided data at baseline and 3 and 6 months. Mean age was 8.6 years; 23 were boys and 20 were girls. At 3 months, children allocated to receive the intervention performed significantly better in terms of body structure and activities participation. They reported improvements in self-perception for the global self-worth domain. At 6 months, the differences between the intervention and control groups persisted for the measures of body structure but not for activities participation or self-perception.

CONCLUSION

Botulinum toxin A injection combined with a low-intensity occupational therapy program achieves significant improvements in body structure, activity participation, and self-perception.

Social support processes and the adaptation of individuals with chronic disabilities

In a qualitative study examining turning points in life, 15 adults with chronic disabilities (cerebral palsy, spina bifida, or attention deficit disorder) provided information about the nature and meaning of their social support experiences. The study revealed three types of psychological support linked to self-perceptions and enabling beliefs: (a) emotional support (valuing and acceptance leading to perceptions of "being believed in" and a sense of self-esteem), (b) instrumental support (guidance and provision of strategies leading to self-efficacy), and (c) cognitive support (affirmation, confirmation, and new perspectives leading to coherence in self-concept and worldview). The findings have important implications for service delivery with respect to understanding client needs for different kinds of support, especially at periods of transition, and for providing optimal experiences and creating supportive environments. In particular, the role of cognitive support deserves more attention in understanding the adaptation of individuals with chronic disabilities.

Bioecological model for guiding social support research and interventions with pregnant adolescents

Many environmental processes influence the pregnant adolescent and each process can either unlock the potential of the adolescent or act as a barrier to goal achievement or development. Social support is a powerful force in preventing adverse maternal and infant outcomes in the pregnant adolescent, and can come from several sources in the environment. The purpose of this article is to describe the use of the bioecological model of development to frame the complex environmental processes that determine social support received by pregnant adolescents. The bioecological model also can be used to guide mental health assessment of pregnant adolescents.

Turning points and protective processes in the lives of people with chronic disabilities

In this qualitative study, the authors examined the nature of resilience in people with chronic disabilities. Fifteen people with disabilities identified the factors that helped or hindered them at major turning points, and the triggers and resolutions to these turning points. Turning points were emotionally compelling experiences and realizations that involved meaning acquired through the routes of belonging, doing, or understanding the self or the world. The major protective factors were social support, traits such as perseverance and determination, and spiritual beliefs. Three new protective processes were identified: replacing a loss with a gain (transcending), recognizing new things about oneself (self-understanding), and making decisions about relinquishing something in life (accommodating). These protective factors, processes, and ways in which people with disabilities draw sense and meaning in life have important implications for service delivery.

Increasing self-esteem and school connectedness through a multidimensional mentoring program

High levels of self-esteem and positive school, peer, and family connections represent protective factors against youth involvement in risky behavior. This paper reports findings from year one of the Healthy Kids Mentoring Program, a multidisciplinary mentoring program for fourth-grade students in a Midwestern public school. In October 2000, 28 fourth-grade students were admitted into the program, based on findings from a 55-item survey distributed to all fourth-grade students (N = 283) regarding overall self-esteem, school, peer, and family connectedness and involvement in risky behavior. The program, which ran from January 2000 to May 2000, consisted of four components: 1) relationship building, 2) self-esteem enhancement, 3) goal setting, 4) academic assistance. Pretest-Posttest data showed significant improvements at posttest in mentored students' self-esteem levels and positive connections to school, peers, and family. Mentored students also were significantly less likely to be depressed or involved in bullying and fighting at posttest than at pretest. Compared to nonmentored students, mentored students reported significantly higher school and family connectedness scores at posttest. Recommendations for effective mentoring program design are offered.

Self-esteem of adolescents who were born prematurely

OBJECTIVE

To determine whether there are any differences between the self-esteem of a cohort of adolescents who were extremely low birth weight (ELBW) in comparison with term controls (Cs); and to test the associations between self-esteem and several predefined predictor variables.

BACKGROUND

Self-esteem is considered to play a significant role in psychological adjustment and scholastic success. Little information exists on how adolescents who were ELBW regard themselves.

DESIGN/METHODS

Longitudinal follow-up of a regional cohort of 132/169 (78%) ELBW survivors and 127/145 (88%) sociodemographically matched Cs, born between 1977 and 1982.

MEASURES

Harter Adolescent Self-Perception Profile (1988) with 9 dimensions, including Global Self-Worth, socioeconomic status (Hollingshead), height-for-age and weight-for-age z scores, and Wide Range Achievement Test---Revised (WRAT-R; Reading, Spelling, and Arithmetic).

DATA ANALYSIS

General linear model multiple analyses of covariance were performed to determine whether significant relationships existed between the 9 self-esteem dimensions and the independent variables of birth weight status and gender, and the covariates of age, socioeconomic status, physical development, and academic achievement.

RESULTS

Global Self Worth was similar for ELBW and Cs (means: 3.1 and 3.2). Multivariate effects revealed no interactions, but significant main effects emerged for birth weight status, gender, weight-for-age z scores, age in months, and for all 3 WRAT-R subtests, all effect sizes medium to large. Follow-up analysis of covariance revealed medium-size gender effects for athletic competence (means: 3.1 and 2.6), and physical appearance (means: 2.9 and 2.5), where boys rated themselves significantly higher on both domains; and age effects, where older teens rated themselves better for job competence. Significant but small effect sizes emerged for the following: 1) weight-for-age z scores, where heavier youth rated themselves higher on close friendships, 2) gender, where girls had higher ratings for close friendships, 3) birth weight, where Cs rated themselves higher on athletic competence, and 4) WRAT-R math effect, where children with higher math scores rated themselves better on scholastic competence.

CONCLUSIONS

Overall, ELBW teenagers do not differ significantly from C teenagers on most dimensions of self-esteem. Gender effects emerged on some Harter domains.

Peer support and young people's health

The health problems that young people experience are largely related to psychological and behavioural factors. Peer-led initiatives have a positive effect on several factors that influence young people's health. Self-esteem, self-efficacy and locus of control are particularly important to young people's health. The particular strengths of peer support and reciprocal peer support in achieving effective health promotion are described. Practical issues about establishing effective and sustainable peer support initiatives are discussed.

Neurobehavioural relationships after the onset of puberty

The behavioural and cognitive development were studied of 68 children with and 259 without minor neurological function (MND) at 14 years, when the majority of children showed three or more physical signs of puberty. MND was differentiated into fine manipulative disability, co-ordination problems, choreiform dyskinesia and hypotonia. The normal group was subdivided into those who had been normal at 12 years and those who had had MND. All types of MND were related to cognitive and behavioural problems. Fine manipulative disability was related to behavioural and cognitive difficulties; co-ordination problems to learning difficulties; and choreiform dyskinesia and hypotonia were related to attention difficulties and school failure, notwithstanding normal IQ. Besides MND, socio-economic class, family adversities and female gender contributed to the development of behavioural and cognitive problems. The behaviour of children with MND at 12 years who were normal at 14 years did not differ from that of normal children.