Self-worth, perceived competence, and behaviour problems in children with cerebral palsy

Self-concept in institutionalized children with disturbed attachment: The mediating role of exploratory behaviours

BACKGROUND

Self-concept is seen as both an outcome of sociocognitive and emotional development, and a factor in social and mental health outcomes. Although the contribution of attachment experiences to self-concept has been limited to quality of primary attachment relationships, little is known of the effects of disturbed attachment on self-concept in institutionalized children. Thus, the current study examined associations between disturbed attachment behaviours in institutionalized children and self-concept, testing limited exploration as an explanatory factor.

METHODS

Thirty-three institutionalized children, aged 4-12, participated in a multimethod and multi-informant assessment of disturbed attachment behaviours (i.e., Disturbances of Attachment Interview and Behavioral Signs of Disturbed Attachment in Young Children), self-concept (i.e., Pictorial Scale of Perceived Competence and Social Acceptance for Young Children), and exploratory behaviours (i.e., Student Exploratory Behaviours Observation Scale). Analyses were conducted using bootstrapping techniques.

RESULTS

Global self-concept converged with teacher-rated children's self-concept, except for physical competence domain. Disturbed attachment behaviours were identified in 62.5% of the children, and this was associated with lower levels of exploration and lower scores on self-concept, compared with children without disturbed attachment behaviours. Furthermore, exploratory behaviours mediated the effects of disturbed attachment behaviours on self-concept.

CONCLUSIONS

Institution-reared children with disturbed attachment behaviours were likely to have a negative perception of self and one's own competences. Limited exploratory behaviours explained this linkage. Targeting disordered attachment in children reared in institutions and their caregivers should become a high priority as a means for preventing socioemotional development issues.

Self-concept of children with cerebral palsy measured using the population-specific myTREEHOUSE Self-Concept Assessment

Self-concept is an individual's perception of him/herself. Research into the self-concept of children with cerebral palsy (CP) has been sparse due to the lack of a population-specific self-concept instrument. Using the new myTREEHOUSE Self-Concept Assessment, this study investigated the self-concept of children with CP in relation to age, gender, motor, communication and cognitive function. Children with CP aged 8-12 years (n = 50; 29 males; mean 10 years 2 months; GMFCS-E&R I = 36, II = 8, III = 5, IV = 1) completed myTREEHOUSE and a standardised intelligence measure. Most children reported positive self-concept from all three myTREEHOUSE Performance Perspectives and over half (60%) fell within the Low range for the Personal Concern Score. Self-concept was not associated with age, gender, motor function, or communication function. However, for cognitive function, associations were observed for Social Skills (Below Average > Average cognitive function; Cohen's d = 1.07) and Learning Skills (Above Average > Average cognitive function; Cohen's d = 0.95) domains when rated from a Personal Performance Perspective. As the first study of the self-concept of children with CP using a CP-specific assessment, this study offers important insights into what children with CP think about themselves. Generally, the self-concept of children with CP was sound. Future research on environmental facilitators and barriers to robust self-concept development is recommended.

Systematic review of self-concept measures for primary school aged children with cerebral palsy

This study involved a systematic review aimed to identify self-concept measures that provided published psychometrics for primary school aged children (8-12 years) with cerebral palsy (CP). Six electronic databases (PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Web of Science) were searched to identify assessments that (1) measured self-concept; (2) in children aged 8-12 years; (3) with CP; (4) with psychometrics available. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to evaluate psychometric properties and the CanChild Outcome Measure Rating Form was used to evaluate clinical utility. Search yielded 271 papers, of which five met inclusion criteria. These papers reported five measures of self-concept with psychometric properties for the target population: the Rosenberg Self-Esteem Index, Self-Description Questionnaire-I, Self-Perception Profile for Children (original) and two separate modifications of the Self-Perception Profile for Children. Currently, no self-concept measures published in English had sufficient psychometric data for children with CP. The Self-Description Questionnaire-I and the Self-Perception Profile for Children were promising options. Further research is required (a) to determine self-concept construct components important for children with CP and (b) to examine the relative strength, validity, reliability and clinical utility of self-concept measures for the target population.

The effectiveness of a physical activity stimulation programme for children with cerebral palsy on social participation, self-perception and quality of life: a randomized controlled trial

OBJECTIVE

To determine the effects of a six-month physical activity stimulation programme on social participation, self-perception and quality of life in children with cerebral palsy.

DESIGN

Multicentre randomized controlled trial with concealed allocation, blinded assessments and intention-to-treat analysis.

SETTING

Paediatric physiotherapy practices, special schools for children with a disability, and the child's own home.

SUBJECTS

Forty-nine children with spastic cerebral palsy (28 male), aged 7-13 years, able to walk with and without walking aids.

INTERVENTIONS

The intervention group followed a six-month physical activity stimulation programme involving counselling through motivational interviewing, home-based physiotherapy and four months of fitness training. The control group continued regular paediatric physiotherapy.

MAIN MEASURES

Outcomes included social participation in domestic life, social participation in recreation and leisure (Life-Habits for Children questionnaire and Children's Assessment of Participation and Enjoyment questionnaire), self-perception (Harter's Self-Perception Profile for Children) and parent-reported quality of life (Cerebral Palsy Quality of Life Questionnaire). Assessments were performed at baseline, at six months (except quality of life) and at twelve months.

RESULTS

Intervention resulted in a positive effect on social participation in domestic life at twelve months (mean between-group difference = 0.9, 95% confidence interval (CI) = 0.1 to 1.7 [1-10 scale], P = 0.03), but not at six months. No significant effects were found for social participation in recreation and leisure, self-perception at six months and twelve months or for quality of life at twelve months.

CONCLUSIONS

The combination of counselling, home-based physiotherapy and fitness training was not effective in improving social participation in recreation and leisure, self-perception or quality of life, but did show a potential for improving social participation in domestic life over the longer term.

Sintomas internalizantes na adolescência e as relações familiares: uma revisão sistemática da literatura

Este artigo teve como objetivo realizar uma revisão sistemática de literatura, nacional e internacional, no período de 2005 a 2010, sobre os sintomas internalizantes na adolescência e as relações familiares. Inicialmente, foi realizado um levantamento dos artigos indexados nas bases de dados Academic Search Premier, Education Resources Information Center (ERIC), ISI Web of Knowledge, Lilacs, MEDLINEwith Full Text e SciELO (Scientific Electronic Library Online), utilizando-se os descritores, em português, "problemas internalizantes" ou "sintomas internalizantes" e "adolescência ou adolescente ou jovem" e "família"; e, em inglês, "internalizing problems or internalizing symptoms" and "adolescence or adolescent or teenager" and "family". Os artigos foram classificados de acordo com o ano de publicação, o país, a metodologia, o instrumento de mensuração para comportamentos internalizantes e, ainda, quanto à temática principal. Na literatura internacional, constatou-se um predomínio de estudos empíricos e de caráter quantitativo, realizados preponderantemente pelos Estados Unidos. No Brasil, observou-se uma grande escassez de estudos integrando as temáticas da sintomatologia internalizante na adolescência e as relações familiares. Foram encontrados somente dois artigos, o que indica a necessidade de realização de mais pesquisas nesta área em nosso país.

Ambulatory activity of children with cerebral palsy: which characteristics are important?

AIM

To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics.

METHOD

  Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated. Ambulatory activity was measured during 1 week with a StepWatch activity monitor as steps per day, and time spent at medium and high step rates. Multiple linear regression analyses were performed following a backward selection procedure until only independent variables with p<0.05 remained in the model. Ambulatory activity outcome parameters served as dependent variables, and disease, personal, and environmental characteristics as independent variables. Ambulatory activity was corrected for body height.

RESULTS

Children took more steps during school days (5169 steps, SD 1641) than during weekend days (4158 steps, SD 2048; p<0.001). Higher GMFCS level, bilateral CP, and higher age were associated with lower ambulatory activity on school days (R(2) ranged from 43-53%), whereas bilateral CP, higher age, and no sport club participation were associated with lower ambulatory activity in the weekend (R(2) ranged from 21-42%). Correcting for body height decreased the association with age.

INTERPRETATION

Interventions should focus at increasing physical activity at the weekend for children with bilateral spastic CP.

Profiles of self-concept, goal orientation, and self-regulation in students with physical, intellectual, and multiple disabilities: Implications for instructional support

The present study explored physical self-concept, goal orientation in sport, and self-regulation in regard to a motor task, in 75 secondary students with physical, intellectual, and multiple disabilities, who were educated in the same special education units. It was found that students with intellectual disabilities generally presented a positive profile in all three psychosocial constructs, whereas students with physical disabilities presented low scores in most measures. Students with multiple disabilities did not differ essentially from students with intellectual disability in regard to physical self-concept and goal orientation; however, they compared unfavorably to them regarding self-regulation. The delineation of a distinct and defendable profile of self-concept, goal orientation, and self-regulation for each disability group allows the formulation of proposals for the implementation of appropriate instructional programs for students belonging to the above mentioned categories.

LEARN 2 MOVE 7-12 years: a randomized controlled trial on the effects of a physical activity stimulation program in children with cerebral palsy

BACKGROUND

Regular participation in physical activities is important for all children to stay fit and healthy. Children with cerebral palsy have reduced levels of physical activity, compared to typically developing children. The aim of the LEARN 2 MOVE 7-12 study is to improve physical activity by means of a physical activity stimulation program, consisting of a lifestyle intervention and a fitness training program.

METHODS/DESIGN

This study will be a 6-month single-blinded randomized controlled trial with a 6-month follow up. Fifty children with spastic cerebral palsy, aged 7 to 12 years, with Gross Motor Function Classification System levels I-III, will be recruited in pediatric physiotherapy practices and special schools for children with disabilities. The children will be randomly assigned to either the intervention group or control group. The children in the control group will continue with their regular pediatric physiotherapy, and the children in the intervention group will participate in a 6-month physical activity stimulation program. The physical activity stimulation program consists of a 6-month lifestyle intervention, in combination with a 4-month fitness training program. The lifestyle intervention includes counseling the child and the parents to adopt an active lifestyle through Motivational Interviewing, and home-based physiotherapy to practise mobility-related activities in the daily situation. Data will be collected just before the start of the intervention (T0), after the 4-month fitness training program (T4), after the 6-month lifestyle intervention (T6), and after six months of follow-up (T12). Primary outcomes are physical activity, measured with the StepWatch Activity Monitor and with self-reports. Secondary outcomes are fitness, capacity of mobility, social participation and health-related quality of life. A random coefficient analysis will be performed to determine differences in treatment effect between the control group and the intervention group, with primary outcomes and secondary outcomes as the dependent variables.

DISCUSSION

This is the first study that investigates the effect of a combined lifestyle intervention and fitness training on physical activity. Temporary effects of the fitness training are expected to be maintained by changes to an active lifestyle in daily life and in the home situation.

TRIAL REGISTRATION

This study is registered in the Dutch Trial Register as NTR2099.

Behavioural and emotional symptoms of preschool children with cerebral palsy: a population-based study

AIM

To describe behavioural and emotional symptoms among Icelandic preschool children with cerebral palsy (CP).

METHOD

Children with congenital CP, assessed with the Child Behavior Checklist/1½-5 (CBCL/1½-5) and Caregiver-Teacher Report Form (C-TRF), were enrolled in the study. A comparison group was recruited from the general population. Thirty-six children (53% males) with CP were assessed at a mean age of 4 years 11 months (SD 5 mo, range 4-6 y); 26 (72%) had bilateral distribution of symptoms and 32 (89%) had spastic CP. Thirty (83%) were at Gross Motor Function Classification System levels I or II and six at levels III or IV. For comparison, 110 (43% males) and 120 (48% males) children were assessed with the CBCL/1½-5 and the C-TRF respectively, at a mean age of 4 years 6 months (SD 6 mo, range 4-6 y).

RESULTS

Sixteen children (48%) with CP had high scores on total problems scale of the CBCL/1½-5 and 20 (65%) on the C-TRF compared with 18% of the comparison group, both on the CBCL/1½-5 and the C-TRF (p<0.001). Children with CP had higher scores on all subscales of the CBCL/1½-5 and the C-TRF, except somatic complaints. Attention difficulties, withdrawn, aggressive behaviour, and anxious/depressed symptoms were most pronounced among children with CP.

INTERPRETATION

A large proportion of preschool children with CP have substantial behavioural and emotional difficulties, which need to be addressed in their treatment.

Self-concept of children with intellectual disability in mainstream settings

BACKGROUND

Positive self-concept is an important educational outcome for individuals with disability.

METHOD

Perceived competence and acceptance of 17 children with intellectual disability, included in mainstream classes, were assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA) and compared with (a) independently rated academic work samples and measures of social status, and (b) measures of perceived competence and acceptance reported for other populations of individuals with and without disability.

RESULTS

Perceived competence and acceptance were positive and comparable to previously reported results for individuals with disability and young children without disability. The children's perceived cognitive competence was not consistent with ratings of their work samples but their perceived peer acceptance was more consistent with peer ratings of social status.

CONCLUSION

Children with intellectual disability remained positive at an age when self-concept is likely to be negatively impacted by comparisons with higher performing peers.

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life

PURPOSE

To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.

METHODS

A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers-Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.

RESULTS

Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p < 0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p < 0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.

CONCLUSION

Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.

Course of behaviour problems of children with cerebral palsy: the role of parental stress and support

BACKGROUND

Cerebral palsy (CP) is a well-recognized neurodevelopmental condition persisting through the lifespan. In many individuals with CP, motor disorders are accompanied by other disturbances, including emotional and behavioural problems. Little is known on the course of such problems, also in relation to possible exacerbating or mitigating factors. Aims of this study were to test whether parental stress and support, apart from the severity of CP of the child, played a significant role in the course of behaviour problems.

METHOD

The participants aged 9, 11 and 13 were assessed (baseline) and followed up after 1, 2 and 3 years. Situational and relational sources of support and stress for the primary caregiver were rated with a questionnaire: (CBCL), behaviour problems with the Child Behaviour Checklist. Physicians rated motor ability using the Gross Motor Function Classification System.

RESULTS

Behaviour problems of children with CP started significantly higher than in the general population, but diminished over the 3-year period. Older children showed less problems overall, and girls showed less externalizing problems than boys. Children with the most severe CP had more externalizing problems; effects on internalizing problems were not significant. Across time, an excess of stress vs. support related to parents' socio-economic and living situation and to parents' social relationships was positively related to total behaviour problems, internalizing and externalizing behaviours of children.

CONCLUSIONS

Levels of behaviour problems are elevated but diminish during adolescence for children with CP. Severity of CP plays a role as well as the family context in terms of the stress and support that caregivers experience.

Parents' reactions to the diagnosis of cerebral palsy: associations between resolution, age and severity of disability

BACKGROUND

For parents, receiving a diagnosis, typically in early childhood, that their child has cerebral palsy may conjure up high distress and anxiety. Resolution of these initial reactions may help parents to focus on the challenges and needs of their children.

AIMS

of the study were to test whether parents of older children displayed resolution more often than parents of younger children, and whether parents of children with less severe cerebral palsy also showed more resolution.

METHOD

Resolution of reactions to diagnosis was assessed with the Reaction to Diagnosis Interview, in a clinic-based sample of 255 parents of children with cerebral palsy aged between 1.4 and 17.3 years. Physicians rated motor ability using the Gross Motor Function Classification System.

RESULTS

Overall, the responses of 81.6% of the parents were predominantly indicative of resolution. Unresolved reactions were significantly more often found among parents of younger children and parents of children with more severe motor disabilities. Among parents of teenage children, resolution was more often apparent from a focus on action to better the lives of their children, whereas in parents of younger children, it was more apparent from their focus on constructive thoughts and information seeking.

CONCLUSIONS

Given time, the large majority of parents may resolve their reactions to the diagnosis that their child has cerebral palsy. Parents of the most severely affected children may need specific support which, given the age trends, might be aimed at different resolution processes for parents of younger and older children.

Stress in parents of children with cerebral palsy: what sources of stress are we talking about?

BACKGROUND

Parents of children with cerebral palsy (CP) often experience high levels of stress. Little is known however on the different sources of stress parents experience. The purpose of the present study was to explore the relation between aspects of parental distress in the parenting role and the child's limitations in functional skills and the child's behavioural difficulties, in parents of children with CP.

METHODS

A cross-sectional study among 42 parents of ambulatory children with CP (age 3-8 years; GMFCS levels I-III) was performed, using the Parenting Stress Index (PSI), the Paediatric Evaluation of Disability Inventory (PEDI) and the Vineland Adaptive Behaviour Scales (VABS).

RESULTS

Regression analysis revealed that the PEDI Functional Skills and VABS Maladaptive behaviour scores explained 27% of the total variance in the PSI Parent domain total stress score. Maladaptive behaviour did significantly contribute to parental stress scores for the Parent domain subscales Attachment, Relationship with spouse, Depression, and, in particular, Sense of competence.

CONCLUSIONS

Parents' functioning can be affected by behavioural aspects of the child with CP, and sense of competence could be an important variable in this relation. This emphasizes the importance of the development of specific interventions that support the family as a whole.

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.

Pain characteristics and their association with quality of life and self-concept in children with hemiplegic cerebral palsy identified from a population register

OBJECTIVES

To describe and characterize the prevalence and quality of pain in a population-based community sample of children with hemiplegic cerebral palsy.

METHODS

Outcomes were assessed from 2 domains of the World Health Organization International Classification of Functioning, Disability and Health: body structure/function (upper limb spans, modified Ashworth scale, Tardieu scale, sensory function), activities-participation (Assessment of Motor and Process Skills), Pediatric Quality of Life Inventory (PedsQL), and self-perception (Harter Self-Perception Profile).

RESULTS

There were 107 participants of age (mean, 95% confidence interval) 8.94 years (8.23 to 9.65); 61 (57%) were boys and 58 (54%) had hemiplegia affecting the right side. Fifty-one (48%) reported pain. Pain mostly affected the involved side (n=28, 55%) and lower limb (n=19, 37%). Eighteen (35%) reported moderate to severe pain. Thirty-five (69%) said pain impacted on movement/activity and was of an aching quality (n=29, 57%). Mean (95% confidence interval) quality of life according to Pediatric Quality of Life Inventory was significantly lower for children experiencing pain compared with children experiencing no pain [parent 50.2 (45.9 to 54.5) vs. 60.1 (55.1 to 65.1), P<0.01; child 60.5 (55.4 to 65.6) vs. 75.8 (68.4 to 83.2), P<0.01]. The self-perception domains of Scholastic Competence [no pain, 3.02 (2.78 to 3.26); pain, 2.55 (2.31 to 2.79) P<0.01] and Behavioral Competence [no pain, 3.33 (3.07 to 3.60); pain, 2.88 (2.70 to 3.06) P<0.01] were significantly lower in children with pain aged > or =8 years.

DISCUSSION

Pain is common in children with hemiplegic cerebral palsy with qualities suggesting a nociceptive origin. Pain is associated with lower quality of life and self-perception. Results suggest clinicians should assess and actively manage pain in this population.