The self-concept of young people with spina bifida: a population-based study

The mediating role of anxiety between negative feelings and depression among students with congenital physical disabilities

Congenital physical disability is associated with various psychological challenges, including negative feelings, anxiety, and stress. These challenges will, in turn, predict significant negative emotional well-being among students with congenital physical disabilities, but the mechanisms of these effects are not well known. This study examined whether Negative Emotional Wellbeing Anxiety (NEWA) would mediate the effect of Negative Feelings (NF) and Negative Emotional Wellbeing Depression (NEWD) among students with congenital physical disabilities. Forty-six students with congenital physical disabilities (mean age: 20 years, SD = 2.05; 45.65% females) completed self-rating measures that included sociodemographic variables (age and sex), emotional state for Children to assess negative feelings, and an emotional distress protocol to assess NEWA and NEWD. Results show that NF was positively correlated with NEWA (r = .69, p < .001) and NEWD (r = .69, p < .001), and NEWA was positively correlated with NEWD (r = .86, p < .001). Findings further reported that NEWA significantly mediated the positive relationship between NF and NEWD (a*b = .37, Bootstrap CI95 = .23 and .52) [Sobel test statistic of 4.82 (p < .001)] among students with congenital physical disabilities. The results highlight the importance of screening students with congenital physical disabilities for common psychological challenges and providing suitable interventions.

Experiences of Childhood Sexual Abuse among Visually Impaired Adults in Norway: Prevalence and Characteristics

This study compared the prevalence of childhood sexual abuse among visually impaired children and sighted children in Norway. Visually impaired women and men aged 18–65 who lost their sight before age 18 reported sexual abuse with contact before age 18 more often than did the sighted group, and the abuse of the visually impaired children was more severe. Implications for parents and teachers are presented, and the need for adapted sexual education is stressed.

Women Aging with Childhood Onset Disability

Women with childhood onset disabilities (CODs) are living longer and it is time for holistic nurses to focus on understanding such women from a life course perspective. As women with CODs live into later adulthood, nurses must be prepared to anticipate and assist as needed. Without studies designed to understand the life course of these women, nursing can neither gain a clear understanding of the problems they face with aging nor help prevent the high number of social inequities, secondary conditions, and comorbidities experienced. To begin nursing's exploration of the problems faced by women with CODs, the relevant historical changes and literature associated with aging with a COD are reviewed. Next, the life course paradigm is critically analyzed in relation to the lives of these women. In conclusion, it is posited that the life course paradigm provides the most useful guide for a holistic understanding of women with CODs.

Experiences among children and adolescents of living with spina bifida and their visions of the future

Purpose Transitioning to independence may be problematic for persons with spina bifida (SB). Experiences of young persons with SB may provide insights into this group's needs for support. Therefore, the aim of this study was to investigate children's and adolescents' experiences of living with SB, their social and emotional adjustment, and their thoughts about becoming independent adults. Method Semi-structured interviews were conducted with young persons with SB (N = 8, age range 10-17 years). Social and emotional problems were assessed using Beck Youth Inventories. The interview transcripts were analyzed using qualitative content analysis. Results Three main themes were found: being a person with SB; everyday living as a person with SB; and preparing for life as an adult with SB. Indications of emotional and social problems were most prominent among participants with milder physical disability. Conclusions The findings indicate that young persons with SB may overestimate their independence. Other potentially problematic areas were lack of motivation, planning and preparedness for becoming independent. Research on transition to independence in this group should consider assistance at an early age in planning and executing strategies for independence. In addition, the potentially difficult situation for young persons with mild SB should be investigated further. Implications for rehabilitation Children and adolescents with spina bifida might lack the motivation and skills for planning their future and health care programmes should therefore include preparations for life as an adult. Clinical assessment of the level of independence should specifically distinguish between the activities they know how to do and what tasks they actually execute independently. Routine follow-ups should include screening for problems with social and emotional adjustment. Be aware of a potential condition-severity paradox whereby those with less severe impairment might have an increased risk of developing symptoms of social and emotional problems.

Communication and self-esteem in adults with Down syndrome

BACKGROUND

It is estimated that around 50-90% of people with learning disabilities experience difficulties in communicating. Previous research has linked communication difficulties and self-esteem in other populations, yet this relationship has not previously been investigated for people with Down syndrome.

AIMS

To explore the relationship between communication and self-esteem in adults with Down syndrome. This research also aimed to offer an empowering and inclusive opportunity for adults with learning disabilities to be involved in research.

METHODS & PROCEDURES

Recruitment took place via a charity established for people with Down syndrome. Twelve adults with Down syndrome and an adult they nominated were approached. A qualitative methodology was selected to explore communication and self-esteem. A thematic analysis focused on the qualitative data collected via semi-structured interviews.

OUTCOMES & RESULTS

Major themes within the data revealed that a relationship between communication and self-esteem may exist for adults with Down syndrome.

CONCLUSIONS & IMPLICATION

This study demonstrated that people with Down syndrome may experience low self-esteem that may be linked to communication. The clinical implications of this are considered and areas for future research are identified.

A review of the social, psychological, and economic burdens experienced by people with spina bifida and their caregivers

INTRODUCTION

Despite measures to reduce the incidence of neural tube defects (NTDs), the rate of decline has not been as dramatic as expected. At least 300,000 newborns worldwide are known to be affected by NTDs each year. This comprehensive literature review summarizes the human and economic burden of NTDs to patients and caregivers, with particular focus on spina bifida (SB).

METHODS

PubMed, PsycINFO, and Embase were searched for studies from January 1976 to November 2010 that included clinical terms, such as NTD, and at least one patient-reported outcome or cost term. A conceptual model was also developed.

RESULTS

Areas of peoples' lives affected by SB included physical and role functioning, activities of daily living, bodily pain, vitality, emotional functioning, mental health, self-esteem, self-image, social functioning, relationships, and sexual functioning. Areas of caregivers' lives affected included activities of daily living, work impact, time consumption, parental responsibilities (including responsibilities to other children), confidence, feelings and emotions, mental health, stress, social impact, psychological adjustment, relationships (with SB child, siblings, other family members), social support, coping strategies, and termination decisions. Cost burdens on patients and caregivers also include out-of-pocket costs, lost wages, or household production due to increased morbidity and mortality, transportation and other nonmedical costs.

CONCLUSIONS

This review highlights the need to provide care and support to individuals with SB and their caregivers. Results also emphasize the importance of effective long-term public health campaigns and/or newer strategies to prevent NTDs, such as SB.

Psychosocial determinants of out of school activity participation for children with and without physical disabilities

Psychosocial determinants of children's out of school participation were examined, using secondary analyses of data from 427 children with physical disabilities (from 12 service locations in Ontario Canada) and 354 children without disabilities, ages 6 to 14. For both groups of children, hierarchical regression analyses indicated that psychosocial variables added significant incremental variance (6% to 14%) to the prediction of active physical intensity and social activity enjoyment, beyond that accounted for by family income, child age and sex, and physical functioning. As well, there were significant psychosocial determinants, with medium to large effect sizes. Athletic competence and hyperactivity had specific effects on active physical activities and social activities, respectively, for both groups of children. Disability-specific determinants included social acceptance, emotional functioning, and peer difficulties (only significant for children with disabilities). It was concluded that psychosocial variables play an important role in children's enjoyment and intensity of participation in leisure activities.

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.

Self-concept development and measurement in children with mild intellectual disabilities

OBJECTIVE

Using a multi-trait-multi-method technique, self-concept was analysed as a function of chronological age in children with mild intellectual disabilities. Also, relations between reading achievement and self-concept were measured.

METHODS

Participants were assessed on the Woodcock Reading Mastery Test-Revised, the Pictorial Scale of Perceived Competence and Social Acceptance and the Self-Description Questionnaire I--Individual Administration.

RESULTS

A median split was run to divide participants into younger and older groups; older participants evidenced coefficients that revealed more multidimensionality, stability and discriminant validity. Also, a significant canonical correlation was found between the Harter Pictorial Scale at Time 1 and WRMT-R at Time 2, chi(2)(8) = 17.99, r = 0.62, p = 0.02.

CONCLUSION

As a whole, these results suggest that children with intellectual disabilities evince self-concept development similar to what would be expected in typically-developing children.

Assessment of parental expressed emotion: associations with adolescent depressive symptoms among youth with spina bifida

OBJECTIVES

A longitudinal multi-method, multi-informant design was utilized to investigate parental expressed emotion (EE) as a predictor of depressive symptoms among adolescents with spina bifida (n=60) and a matched comparison sample (n=65).

METHODS

A newly modified self-administered audiotaped interview methodology was used to assess parental warmth and criticism across the middle adolescent developmental period (ages 14-17). Parent- and youth-reports of adolescent depressive symptoms were obtained at each time point.

RESULTS

Significant cross-sectional associations between parental EE variables and youth depressive symptoms were found for both groups. Significant longitudinal relations between maternal criticism and parent proxy-report of youth depressive symptoms were also found across 2 years for the spina bifida group and across 4 years for both groups.

CONCLUSIONS

This modified measure of parental EE can be used in future pediatric research that focuses on precursors or outcomes of this important parenting construct.

Out-of-school time activity participation profiles of children with physical disabilities: a cluster analysis

OBJECTIVE

To determine out-of-school activity participation profiles of school-aged children with physical disabilities.

METHODS

Activity participation profiles were determined by cluster analysing 427 children's responses on multiple dimensions of participation (intensity, location, companionship, enjoyment, preference) in five activity types (recreational, active physical, social, skill-based, self-improvement). Socio-demographic, child, parent, family and environmental predictors of group membership were determined, along with child functioning, socio-demographic, self-concept and social support variables significantly associated with group membership.

RESULTS

The cluster analysis revealed four groups, labelled Social Participators (a highly social and neighbourhood-focused group), Broad Participators (a group of high participators who enjoy participation), Low Participators (a group with low enjoyment and weak preferences) and Recreational Participators (a group of younger children who participate in recreational activities with family members). The groups showed meaningful differences across a range of socio-demographic, child, parent, family and environmental variables.

CONCLUSIONS

The findings support an affective and contextual view of participation, indicating the importance of motivational theory and a person-environment approach in understanding the complexity of children's out-of-school activity participation.

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

PURPOSE

To examine the relevance of physical disabilities for self-worth and perceived competence in children with cerebral palsy (CP), and to examine associations between behaviour problems and self-worth and perceived competence.

METHODS

The Harter scales for self-worth and perceived competence and a new scale for perceived motor competence were used in a sample of 80 children with CP. Their motor functioning was assessed with the Gross Motor Functioning Measure (GMFM) and behaviour problems with the Child Behaviour Check List administered to parents.

RESULTS

Self-worth and perceived competence for children with CP were comparable to the Dutch norm sample, except for perceived athletic competence. Within the CP sample, the GMFM showed a domain-specific effect on perceived motor competence. In the multivariate analysis, internalizing problems were associated negatively with all perceived competence scales and self-worth, whereas aggression was positively associated with perceived motor competence, physical appearance, and self-worth.

CONCLUSIONS

Children with CP appear resilient against challenges posed to their self-worth caused by their disabilities. The relevance of the physical disability appears to be domain-specific. For internalizing problems and aggression, different theoretical models are needed to account for their associations with self-worth and perceived competence.

Health values in adolescents with or without inflammatory bowel disease

OBJECTIVE

To examine for differences in and predictors of health value/utility scores in adolescents with or without inflammatory bowel disease (IBD).

STUDY DESIGN

Adolescents with IBD and healthy control subjects were interviewed in an academic health center. We collected sociodemographic data and measured health status, personal, family, and social characteristics, and spiritual well-being. We assessed time tradeoff (TTO) and standard gamble (SG) utility scores for current health. We performed bivariate and multivariable analyses with utility scores used as outcomes.

RESULTS

Sixty-seven patients with IBD and 88 healthy control subjects 11 to 19 years of age participated. Among subjects with IBD, mean (SD) TTO scores were 0.92 (0.17), and mean (SD) SG scores were 0.97 (0.07). Among healthy control subjects, mean (SD) TTO scores were 0.99 (0.03) and mean (SD) SG scores were 0.98 (0.03). TTO scores were significantly lower (P= .001), and SG scores trended lower (P= .065) in patients with IBD when compared with healthy control subjects. In multivariable analyses controlling for IBD status, poorer emotional functioning and spiritual well-being were associated with lower TTO (R(2)=0.17) and lower SG (R(2)=0.22) scores.

CONCLUSION

Direct utility assessment in adolescents with or without IBD is feasible and may be used to assess outcomes. Adolescents with IBD value their health state highly, although less so than healthy control subjects. Emotional functioning and spiritual well-being appear to influence utility scores most strongly.

Self-esteem in children and adolescents with mobility impairment: impact on well-being and coping strategies

AIM

The first aim was to investigate dimension-specific and global self-esteem in children and adolescents with mobility impairment and to analyse the relation between self-esteem and demographic data and disability characteristics. The second aim was to identify the impact of five self-esteem dimensions on well-being and coping strategies.

METHODS

A total of 138 children and adolescents aged 7-18 years with mobility impairment took part in a semi-structured interview. Demographic and disability characteristics were recorded and motor function was assessed. Self-esteem was measured by the 'I think I am' inventory. Perceived overall well-being was measured by a nine-grade visual scale, the Snoopy scale, and coping strategies by the Children's Coping Strategies Checklist.

RESULTS

Although a majority estimated a relatively high level of dimension-specific and global self-esteem, several demographic and disability factors for lower self-esteem were identified. Those who estimated their 'physical characteristics' lower used the coping strategy 'distraction' more often. Three out of five dimensions of self-esteem were positively associated with perceived overall well-being: 'physical characteristics', 'psychological well-being' and 'relationships with others'.

CONCLUSION

Awareness of vulnerability factors for lower self-esteem in children and adolescents with mobility impairment offer health care professionals specific opportunities to enhance self-esteem in this group.

Self-concept in children with spina bifida compared with typically developing children

The literature was systematically reviewed to determine if children with spina bifida have lower self-concept compared with their peers with typical development. Relevant trials were identified by searching electronic databases, supplemented by citation tracking. Of 803 papers initially identified, 15 met the inclusion criteria. Meta-analysis revealed children with spina bifida scored significantly lower than children with typical development for the domains of global self-worth (d=-0.39, 95% confidence interval [CI] -0.65 to -0.12); physical appearance (d=-0.26, 95% CI -0.46 to -0.06); athletic competence (d=-0.45, 95% CI -0.67 to -0.22); social acceptance (d=-0.33, 95% CI -0.55 to -0.11); and scholastic competence (d=-0.43, 95% CI -0.66 to -0.21). There was no difference between the groups for the behavioural conduct domain. Children with spina bifida on average have a lower self-concept than their peers with typical development. Clinicians need to take account of this information in planning the assessment and treatment of this group.

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.

Compound muscle action potentials in newborn infants with spina bifida

The aim of this study was to investigate the relationship between compound muscle action potentials (CMAPs) and neurological impairment in newborn infants with spina bifida. Thirty-one newborn infants (17 males, 14 females, mean gestational age 39 wks [SD 2]; mean birthweight 3336 g [SD 496]) with spina bifida were investigated at a median age of 2 days (range 1-18 d). Motor and sensory impairment and muscle stretch reflexes were assessed and neuroimaging was performed. CMAPs were recorded from the tibialis anterior muscle and the gastrocnemius muscle after percutaneous electrical nerve stimulation. CMAPs were obtained in almost all infants. The area under the curve of the CMAP (CMAP-area) was associated with motor and sensory impairment and with the presence of muscle stretch reflexes, but not with the morphological level of the spinal anomaly. These associations were stronger for the gastrocnemius muscle than for the tibialis anterior muscle. In conclusion, the CMAP-area correlates with neurological impairment in neonatal spina bifida and provides an estimate of residual motor neuron function in affected spinal segments. The assessment of CMAPs after percutaneous electrical nerve stimulation is recommended as an additional instrument to the clinical neurological examination and imaging studies.

Life experiences of young adults who have coordination difficulties

BACKGROUND

Little is known about the impact of developmental coordination disorder (DCD) during adolescence and young adulthood.

PURPOSE

This study explored the lived experiences of a nonclinical sample of nine university students who reported having significant coordination difficulties.

METHODS

A phenomenological approach was used that included two in-depth interviews asking participants to recall retrospectively their experiences throughout adolescence. Transcripts were coded to identify themes, and member-checking supported the credibility of findings.

FINDINGS

Strong pathways of resilience were found with participants who employed cognitive and behavioural strategies to manage their motor differences. Key themes emerged related to managing coordination differences including avoidance/withdrawal/adaptation, seeking compatible activities, using humour, and persevering. As adolescents matured, changing social contexts affected their self-efficacy and others' perceptions of them.

IMPLICATIONS

The findings of this study challenge occupational therapists to move beyond impairment-based interventions to ecological interventions that facilitate social and community participation.

Determinants of life quality in school-age children with cerebral palsy

OBJECTIVE

To characterize the quality of life of children with cerebral palsy from the parents' and children's perspectives.

STUDY DESIGN

Ninety-five children were recruited; a parent, and when feasible, the child also completed the Child Health Questionnaire and Pediatric Quality of Life Inventory. A range of predictor variables was measured relating to impairments, activity limitations, personal and environmental factors.

RESULTS

Mean age was 9.3 +/- 2.1 years; 63.2% were male, and almost half had mild motor impairment (47% Gross Motor Function Classification System level I). Mean physical well-being (Child Health Questionnaire) was 39.6 +/- 16.9 with 50% <40; and mean psychosocial well-being was 43.0 +/- 11.3 with 53.8% <40. Similarly, with the Pediatric Quality of Life Inventory, 61% had summary scores <1 SD. Scores of parents and their children were significantly correlated (physical: r = .59, P < .0001; psychosocial: r = .39, P = .01); however, children rated themselves higher.

CONCLUSIONS

Results indicate that quality of life is highly variable in children with cerebral palsy, with about half experiencing a life quality similar to typically developing children. Motor and other activity limitations are indicators of physical but not psychosocial well-being. Family functioning, behavioral difficulties, and motivation are important predictors of social-emotional adaptation. Determinants of life quality may guide resource allocation and health promotion initiatives to optimize health of the child and family.

Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study

BACKGROUND

Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that influence it, and how it compares with QoL of the general population.

METHODS

1174 children aged 8-12 years were randomly selected from eight population-based registers of children with cerebral palsy in six European countries and 743 (63%) agreed to participate; one further region recruited 75 children from multiple sources. Researchers visited these 818 children. 318 (39%) with severe intellectual impairment could not self-report; 500 (61%) reported their QoL using KIDSCREEN, an instrument with scores in ten domains, each with SD=10. Multivariable regression was used to relate QoL to impairments, pain, and sociodemographic characteristics. Comparisons were made with QoL data from the general population.

FINDINGS

Impairments were not significantly associated with six KIDSCREEN domains. Comparison of least and most able groups showed that severely limited self-mobility was significantly associated with reduced mean score for physical wellbeing (7.6, 95% CI 2.7-12.4); intellectual impairment with reduced mean for moods and emotions (3.7, 1.5-5.9) and autonomy (3.3, 0.9-5.7); and speech difficulties with reduced mean for relationships with parents (4.5, 1.9-7.1). Pain was common and associated with lower QoL on all domains. Impairments and pain explained up to 3% and 7%, respectively, of variation in QoL. Children with cerebral palsy had similar QoL to children in the general population in all domains except schooling, in which evidence was equivocal, and physical wellbeing, in which comparison was not possible.

INTERPRETATION

Parents can be reassured that most children aged 8-12 years with cerebral palsy will have similar QoL to other children. This finding should guide social and educational policy to ensure that disabled children participate fully in society. Because of its association with QoL, children's pain should be carefully assessed.

Self-concept of children with cerebral palsy compared with that of children without impairment

This study examined whether the self-concept of children with cerebral palsy (CP) differed from that of children without impairment. Forty-seven children (24 males, 23 females; mean age 11y 8mo [SD 2y 6mo]) with spastic diplegia or hemiplegia were matched with children without impairment. The level of disability of the children with CP was classified as Gross Motor Function Classification System Level I (n=24), Level II (n=16), or Level III (n=7). The 36-item Self-Perception Profile for Children was used to assess six domains of self-concept. No difference was found between the groups for Global Self-worth, Physical Appearance, or Behavioural Conduct. Children with CP scored lower on Scholastic Competence (t(92)=-2.75, p=0.01), Social Acceptance (t(92)=-1.96, p=0.05), and Athletic Competence (t(92)=-3.63, p<0.01) than children without impairment. Males with CP had lower scores for Scholastic Competence (t(46)=-3.54, p<0.01) than males without impairment. Females with CP had lower scores for Social Acceptance (t(44)=-2.31, p=0.03) than females without impairment. Both males and females with CP had lower scores for Athletic Competence than their peers without impairment. These results suggest that children with CP do not have a lower Global Self-worth even though they may feel less competent in certain aspects of their self-concept. Clinicians need to account for this when deciding on management strategies and may need to educate parents, carers, and health professionals that a lower self-concept may not necessarily be associated with a diagnosis of CP.

Perceived health in young adults with spina bifida

The aims of this study were to compare the perceived health of young adults with spina bifida with a population without disability, and to determine the effect of the disease characteristics and resulting impairments on perceived health. This cross-sectional study is part of the Adolescents with Spina Bifida in the Netherlands study. Data were collected by physical examination and a questionnaire. In total, 179 patients (age range 16-25y) participated in the study and perceived health data were completed for 164 participants (92 females, 72 males; mean age 20y 7mo [SD 2y 9mo]). Twenty-six participants had spina bifida occulta and 138 had spina bifida aperta, of whom 115 also had hydrocephalus. Perceived health was measured with the Medical Outcome Study 36-item Short-form Health Survey (SF-36), a generic health status measure. SF-36 scores of young adults with spina bifida were below those of an age-matched population group for six of the eight domains. This difference was largest for the physical functioning domain. Although these differences were statistically significant they were small. Findings for the emotional health domains (vitality, mental health, role problems due to emotional problems) did not differ at all from the population group.

Acquisition of autonomy skills in adolescents with myelomeningocele

This study describes ages of acquisition (AOA) of typical adolescent autonomy skills in a regional cohort of individuals with myelomeningocele (MM), aged 12 to 18 years, with a mean age of 14 years 11 months (SD 2y 5mo). Prospectively collected data over 10 years were analyzed. Regression analysis, using Generalized Estimation Equation, provided 50th centile and 75th centile AOA for each skill. One hundred and fifty-eight participants (90 males, 68 females) attended 378 annual patient visits. Patient contacts were equally distributed across age and physical severity groupings. Twenty-four percent of participants had functional lesion levels at or above L2, and 38% between L3-L5, 38% at S1 or below. Eighty-four percent had shunted hydrocephalus, 24% were independent in ambulation, and 69% achieved toileting independence before adolescence. AOA for autonomy skills were delayed by 25 to 30% when compared with typically developing adolescents. Differences in cognitive ability explained the variance in median ages for skill acquisition (p=0.01) more than physical lesion level. Participants acquired community skills at a median age of 16 years 6 months. Twelve percent of 18-year-olds drove cars (9% with supervision, 3% independently), regardless of physical lesion severity. We conclude that adolescents with MM acquire the majority of autonomy skills 2 to 5 years later than their typically developing peers. This study establishes AOA timelines for autonomy skills in adolescents with MM.

The relationship between function, self-perception, and spinal deformity: Implications for treatment of scoliosis in children with spina bifida

The purpose of this study was to determine the relationship of spinal deformity with physical function and self-perception in children with spina bifida. Ninety-eight eligible children with scoliosis and spina bifida were identified; 80 of them (82%) consented to participate. Spinal deformity was measured in many ways, including scoliosis, coronal balance, and pelvic obliquity. Measures of physical function included the Sitting Balance Scale, Jebsen Hand Scale, Hoffer Ambulation Scale, the Spine Bifida Spine Questionnaire, and the Activities Scale for Kids (ASK). Self-perception was determined with Harter's Self-Perception Profile. No relationship was found between spinal deformity and overall physical function (ASK). Of all aspects of spinal deformity, only coronal imbalance was significantly related to only one aspect of physical function (ie, sitting imbalance). No aspect of spinal deformity was related to self-perception. In conclusion, surgeons should be clear in their indications for surgery and recognize that in the short term the potential benefit of surgery may be, at best, to improve only sitting balance.

Parent functioning in families of preadolescents with spina bifida: longitudinal implications for child adjustment

The purpose of this study was to test a strength-of-association model regarding possible longitudinal and bidirectional associations between parent functioning and child adjustment in families of children with spina bifida (n = 68) and families of able-bodied children (n = 68). Parent functioning was assessed across 3 domains: parenting stress, individual psychosocial adjustment, and marital satisfaction. Child adjustment was indexed by teacher-reported internalizing and externalizing symptoms, self-reported depressive symptoms, and observed adaptive behavior. Findings revealed that all 3 parent functioning variables predicted child adjustment outcomes, and that such results were particularly strong for externalizing symptoms. Associations between parent functioning and child adjustment tended to be in the direction of parent to child and were similar across both groups. These findings have implications for potential interventions targeted at helping families manage the transition into early adolescence in families of children with spina bifida as well as families of healthy children.

Neuropsychological profile of young adults with spina bifida with or without hydrocephalus

OBJECTIVES

To determine the relative impact of hydrocephalus and spinal dysraphism in young adults on intellectual and cognitive functioning. Sub-groups of patients with congenital hydrocephalus and/or spina bifida were assessed between 1995 and 2003. The entry criteria were that individuals should have (i) intact global function, (ii) average verbal intelligence (or above), and (iii) should not have clinical depression. There were three sub-groups: patients with hydrocephalus and spina bifida, patients with hydrocephalus without spina bifida, and patients with spina bifida without hydrocephalus.

METHODS

Patients were neuropsychologically assessed as part of their normal clinical assessment during their annual medical review. Each individual completed a screening battery assessing global functioning, verbal intelligence, and mood. In addition they completed additional tests including measures of emotional intelligence, memory, attention, and executive function. Results were analysed to compare the performance of the patient sub-groups and to compare them to a healthy control group.

RESULTS

Patients with hydrocephalus (with or without spina bifida) were significantly impaired on the vast majority of all test scores as compared to patients with spina bifida and healthy controls. They were particularly poor on measures assessing executive function. By contrast for patients with spina bifida with no associated hydrocephalus, the significant majority of all test scores fell within the average range or above.

CONCLUSIONS

The neuropsychological profile of patients with hydrocephalus is one of relative impairment and this is so whether or not spina bifida is present. In spina bifida alone, in the absence of hydrocephalus, cognitive function is relatively spared.

Impact of urinary incontinence on self-concept in children with spina bifida

PURPOSE

Low self-concept and self-esteem are thought to be the main predictors of psychological problems in children and adolescents. Children with spina bifida are thought to be at an increased risk for low self-concept and self-esteem given their disabilities. We examined the impact of urinary continence on self-concept in children with myelomeningocele.

MATERIALS AND METHODS

A total of 50 patients 7 to 19 years old with spina bifida were evaluated using the Hartner self-perception profile. Each patient was asked to self-rate on a scale of 1 to 4 using specific domains of self-concept, including scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth. Continence and several other factors, namely ambulatory status, family situation and insurance status, were reviewed simultaneously.

RESULTS

There were no statistically significant differences between continent patients with spina bifida and controls. Overall children with spina bifida rated lower in scholastic competence, social acceptance and behavioral conduct than controls. Girls with spina bifida scored lower in perceived athleticism, physical appearance and global self-worth than boys with spina bifida. Continent girls were self-rated higher in social acceptance and global self-worth than incontinent girls. Continent boys were self-rated higher in scholastic competence, social acceptance, physical appearance and behavior compared to incontinent boys.

CONCLUSIONS

Continence is associated with better self-concept in children with spina bifida and incontinent girls are at particularly high risk for poor self-esteem. Urologists' efforts to promote continence are likely to have a positive effect on self-concept in boys and girls with spina bifida.

DESMOPRESSIN FOR THE TREATMENT OF NOCTURNAL BEDWETTING IN PATIENTS WITH NEURAL TUBE CLOSURE DEFECTS

PURPOSE

We evaluated desmopressin (DDAVP) treatment in patients with neuropathic bladder secondary to neural tube closure defects (NTDs) and nocturnal incontinence.

MATERIALS AND METHODS

We selected 25 patients, that is 10 males (40%) and 15 females (60%), between ages 7 and 16 years (mean 9.8) with neuropathic bladder secondary to NTDs without a ventricular-peritoneal shunt. All had a low pressure bladder and presented with daytime continence between catheterizations but had persistent nocturnal urine loss 7 nights weekly. They underwent treatment with oral DDAVP according to a certain design, namely an initial dose of 0.2 mg for 3 weeks, which was increased to 0.3 or 0.4 mg for another 3 weeks in nonresponders. The average dose was 0.2 mg. At the effective minimal dose (bedwetting decrease greater than 50%) patients continued for 6 months and then decreased by intervals of 0.05 mg every 2 weeks. In the event of recurrence treatment continued for 1 year.

RESULTS

All patients responded to treatment during the nighttime hours except 1 who suspended treatment after 4 weeks. There were no adverse effects from DDAVP.

CONCLUSIONS

Treating nocturnal bedwetting with DDAVP in patients with NTDs was effective and safe. Nevertheless, to our knowledge treatment duration has not yet been determined.

Sexual abuse of deaf children. A retrospective analysis of the prevalence and characteristics of childhood sexual abuse among deaf adults in Norway

OBJECTIVE

North American studies conclude that deaf children may have a 2-3 times greater risk of sexual abuse than hearing children. No comparative studies are available in the Nordic countries. The present study was initiated to estimate the prevalence of childhood sexual abuse among deaf children in Norway, describe the nature of the abuse, and to examine risk factors.

METHOD

A self-administered questionnaire was sent in 1999 to all 1150 adult deaf members of the Norwegian Deaf Register. The Deaf Register includes all deaf Norwegians. The questionnaire, which was also available videotaped in sign language, was an adapted version of a questionnaire used in a Norwegian survey among the general adult population in 1993. The results from this earlier study were used as a comparison group.

RESULTS

Deaf females aged 18-65 who lost their hearing before the age of 9 (N = 177) reported sexual abuse with contact before the age of 18 years more than twice as often as hearing females, and deaf males more than three times as often as hearing males. The abuse of the deaf children was also more serious. Very few cases were reported to parents, teachers, or authorities.

CONCLUSIONS

Deaf children are at greater risk of sexual abuse than hearing children. The special schools for the deaf represent an extra risk of abuse, regardless of whether the deaf pupils live at home or in boarding schools.

A multimethod, multi-informant, and multidimensional perspective on psychosocial adjustment in preadolescents with spina bifida

This study examined the psychosocial adjustment of preadolescents with spina bifida in relation to a comparison sample of able-bodied preadolescents (8- and 9-year-olds; n = 68 in each sample). The study also examined the potential clinical utility of a narrowband multimethod, multi-informant, and multidimensional perspective on the assessment of psychosocial functioning in children and adolescents with pediatric conditions. Findings revealed that children with spina bifida tended to be socially immature and passive, less likely to have social contacts outside of school, more dependent on adults for guidance, less competent scholastically, less physically active, less likely to make independent decisions, and more likely to exhibit attention and concentration difficulties. No group differences were found for externalizing symptoms, affective functioning, or global self-worth, suggesting resilience in these domains for the spina bifida sample. Findings also suggest that low socioeconomic status and the presence of a physical disability may be additive risk factors for certain psychosocial adjustment difficulties.

Factors associated with self-esteem in pre-adolescents and adolescents with cerebral palsy

Predictors of self-esteem were examined in 50 pre-adolescents and adolescents with cerebral palsy. On average, self-esteem was high, although 30% scored below a cut-point for low self-esteem. Self-esteem was bivariately associated with female gender, better physician-assessed functional ability, greater perception of the impact of the disability, and higher perceived parent overprotectiveness. In a multivariate model, only perceived impact of the disability remained significant.

Health values of adolescents with cystic fibrosis

OBJECTIVES

To assess health values (utilities) in adolescents with cystic fibrosis (CF) and to evaluate how health status and clinical factors affect their health values.

METHODS

Adolescents 12 to 18 years of age completed the Child Health Questionnaire (CHQ), Health Utilities Index Mark 2 (HUI2), and 3 health value measures: the visual analog scale (VAS), time tradeoff (TTO), and standard gamble (SG). Severity of illness was measured by percent of predicted forced expiratory volume in 1 second (FEV(1)) and frequency of pulmonary exacerbations.

RESULTS

The mean age (+/- SD) of the 65 adolescents was 15.1 (+/- 2.1) years; 53.8% were male; their mean FEV(1) was 72.8% (+/- 27.0%) predicted. The mean TTO utility was 0.96 (+/- 0.07) and the mean SG utility was 0.92 (+/- 0.15). In multivariable analysis, the General Health Perceptions domain from the CHQ was the only health status scale significantly associated with the VAS, TTO, and SG. No clinical or demographic measures were significantly related to both TTO and SG scores.

CONCLUSIONS

Direct utility assessment in adolescents with CF is feasible. Their TTO and SG utilities are generally high, indicating that they are willing to trade very little of their life expectancy or take more than a small risk of death to obtain perfect health. Their self-rated health perceptions are related to their health values, but, as in adult populations, only moderately so, indicating that health values are highly individualistic. Therefore, health values should be ascertained directly from adolescents.

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.

'If I had a friend in a wheelchair': children's thoughts on disabilities

The purpose of the present study was to examine what notions there are among ordinary preschool children and schoolchildren about physically handicapped children using wheelchairs. Forty-eight children-16 children of preschool age (half boys, half girls, aged around 6), 16 children in primary school class 2 (half boys, half girls, aged around 8) and 16 children in class 4 (half boys, half girls, aged around 8)-constituted the investigated group. The method used was a combination of drawings produced by the children themselves serving as a projective image, interview questions in connection with the drawings and a self-assessment scale, based on Osgood's semantic differential technique. The results showed that most children had favourable attitudes towards a child in a wheelchair. They were willing to include the disabled child in their games and recreational activities, and they considered that the disabled child would have many friends and a high self-esteem. However, they saw real obstacles for the disabled child both in play situations and in other environmental settings. No tangible differences between the sexes could be found; however, differences by age were present. The results were discussed with regard to earlier research and topics for further research are suggested.

Psychosocial sequelae in 29 children with giant congenital melanocytic naevi

Giant congenital melanocytic naevus (GCMN) may be expected to affect psychosocial functioning of children and their parents due to deviant appearance and painful treatment. To obtain insight into clinical aspects and psychosocial functioning of those suffering from GCMN, 29 children diagnosed with GCMN syndrome or single GCMN received a dermatological examination, were interviewed, and their mothers and teachers completed standardized questionnaires on the child's competence and behavioural/emotional problems and their own adjustment. Social problems were reported for 30% of the patients and behavioural/emotional problems for 25.9%. There was no correlation between visibility of the naevus, treatment or child age and psychological problems. Mothers reported considerable psychosocial burden. It is concluded that children with GCMN are at increased risk of social and behavioural/emotional problems, and mothers suffer considerable psychological impact of their child's condition.

Measuring the self-esteem of adolescents with mental health problems: theory meets practice

Occupational therapists frequently address the self-esteem of young clients despite little empirical evidence that the clients have low self-esteem to begin with, and that occupational therapy intervention is effective in addressing self-esteem. This article examines the self-esteem of 39 adolescents with mental health problems referred to a pre-vocational programme in an effort to compare clinical practice with empirical findings. The Self-Perception Profile for Adolescents and the Importance Rating Scale for Adolescents are employed to compare the self-esteem of the adolescents with mental health problems with the normative sample, prior to (n = 39) and upon completion of the pre-vocational programme (n = 14). Results indicate no difference between the two groups' self-esteem and no change in self-esteem scores following participation in the pre-vocational programme. Global self-esteem is significantly correlated with physical appearance and behavioural conduct (n = 39). Competence-importance discrepancy scores are significantly related to global self-esteem (n = 14). This finding supports the theory that it is the domain of self-concept which is low and important to the adolescent which will influence his/her self-esteem. These results are consistent with previous studies. Possible explanations for the discrepancy between clinical perceptions and objective findings are discussed. Implications for practice are presented.

Perception of health status and quality of life of extremely low-birth weight survivors. The consumer, the provider, and the child

In neonatal intensive care, parents make important clinical management decisions in conjunction with health professionals. Little information is available in the literature, however, on whether the preferences of health care professionals, parents, and children differ for the resulting health outcomes. This article compares the preferences of these stakeholders for four to five hypothetical health states that are common to extremely low-birth weight infants. The findings have conceptual and practical implications for decision making in the neonatal intensive care unit.

Eating disorders in adolescents and young women with spina bifida

This is the first report of the association of spina bifida and eating disorders. Five patients were diagnosed rather late in the course of their illness. They all had been overweight premorbidly and had been urged to lose weight for years in order to improve their mobility. As they dieted, they experienced their weight loss as a source of power that could somehow compensate for their losses and neurologic limitations. They responded to a multidisciplinary intervention. Clinicians taking care of patients with spina bifida need to be cognizant that they may be at risk of developing an eating disorder. Such awareness should influence the quality of nutritional counseling (prevention aspect) and the clinical assessment of sudden weight loss (early intervention).

Selected factors influencing self-concept among hospitalized Chinese school-age children with a chronic illness

A correlational descriptive study was conducted to investigate self-concept and selected influencing factors among hospitalized Chinese school-age children with a chronic illness. The purposive sample was composed of 122 school-age children with chronic illnesses, such as nephrotic syndrome, leukemia, and congenital heart disease, who were admitted to three major teaching hospitals in Shanghai City. The children's medical records, demographic forms, and the Piers-Harris Self-concept Scale (PHSCS) were used to collect the data. Descriptive statistics, and stepwise multiple regression were used to analyze the data utilizing the SPSS program (SPSS Inc, Chicago, IL, USA). The results of this study showed that the majority of hospitalized Chinese school-age children with a chronic illness had at least an average level of self-concept. Academic achievement (grade point average) was a strong predictor of self-concept, as are most of its subconcepts, including social behavior, academic competence, and physical appearance and attributes. Age was a significant predictor of overall self-concept, social behavior, and popularity subconcept. Sex was a significant predictor of self-concept subconcepts such as social behavior, anxiety, and popularity. Duration of illness was a significant predictor of physical appearance and attributes. In addition, the type of illness was a significant predictor of popularity. It can be concluded that the importance of school education should be emphasized by hospital and school nurses for the purpose of helping such children build a positive self-concept concerning their age, sex, academic achievement, type of illness, and duration of illness. Recommendations for further research have been suggested.

Psychosocial adjustment of children with spina bifida

It was the aim of the present prospective study to investigate the influence of age, sex, intellectual function, and school type as well as of hydrocephalus, the level of lesion, and of the degree of handicap on the psychosocial adjustment of children with spina bifida. Seventy-five patients with spina bifida, aged 6 to 16 years were assessed concerning their psychosocial adjustment and their intellectual function by use of standardized instruments. The findings were compared with those of nondisabled controls, matched for age and sex. Children with spina bifida showed a tendency to be at an increased risk for psychosocial maladjustment. Influencing factors were age, sex, and the degree of handicap. Twelve- to 16-year-old boys and girls displayed significant adjustment problems in specific areas in comparison with their controls. There was a tendency for children with spina bifida to be attending inappropriate school types according to their intellectual abilities. Perhaps the most striking finding of our study was that children with spina bifida who attended a school for disabled children, even though it might be an IQ-appropriate setting, had a higher rate of psychosocial maladjustment than the disabled children in mainstream schools.

Self-perceptions of preschool children with spina bifida

The purpose of this study was to compare self-perceptions of 21 preschoolers with spina bifida with those of 21 physically able preschoolers. Each child was asked to draw a self-portrait, fill in the most important body parts on an outline of a child, complete the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, and rate feelings about self, family, peers, and health care professionals. The spina bifida group drew significantly fewer legs, feet, and trunks than physically able children. The preschoolers with spina bifida rated themselves as significantly different on physical and cognitive competence but not on maternal or peer acceptance. Clinical nursing implications of these data are discussed.

Adolescents with physical disabilities: some psychosocial aspects of health

PURPOSE

To examine the psychosocial issues related to growing up with a physical disability.

METHODS

Adolescents with physical disabilities aged 11-16 years were compared with a Canadian national sample of adolescents using the Health Behaviours in School-Aged Children (HBSC), a World Health Organization Cross-National Study survey.

RESULTS

Adolescents with physical disabilities reported good self-esteem, strong family relationships, and as many close friends as adolescents in the national sample. However, adolescents with physical disabilities participated in fewer social activities and had less intimate relationships with their friends. They had more positive attitudes toward school, teachers, and their fellow classmates than the national sample, but fewer had plans for postsecondary education. The majority of adolescents with physical disabilities reported that they had not received information on parenthood, birth control, and sexually transmitted diseases.

CONCLUSIONS

There are a number of critical areas of risk for adolescents with physical disabilities to which health promotion efforts should be directed. These include lower levels of peer integration, heightened adult orientation, low educational aspirations, and poor knowledge of sexuality.

How local is the impact of a specific learning difficulty on premature children's evaluation of their own competence?

The aim of this study was to determine whether children's perceptions of their own competence levels reflected their actual strengths and weaknesses (Specificity Hypothesis) or transcended these (Generality Hypothesis). Harter and Pike's measure of self-perception was administered to 163 prematurely born 6-year-olds with or without motor co-ordination and/or reading problems. Associations between children's self-perceptions and their scores on standardised tests of motor co-ordination and reading were assessed in three distinct ways. These analyses produced converging results: self-perceptions of physical competence were associated specifically with performance on the Movement ABC Test, and self-perceptions of cognitive competence were associated specifically with performance on the BAS Word Reading Scale. Our results support the Specificity Hypothesis.