J Dev Phys Disabil (2008) 20:415–423 DOI 10.1007/s10882-008-9106-8 O R I G I N A L A RT I C L E
Locus of Control, Perceived Parenting Style, and Anxiety in Children with Cerebral Palsy Esther Cohen & Gali Biran & Adi Aran & Varda Gross-Tsur
Published online: 12 June 2008 # Springer Science + Business Media, LLC 2008
Abstract In this study we examined interrelations among locus of control (LOC), disease severity, anxiety, and parenting style (PS) in children with cerebral palsy (CP). Thirty children with CP and their 30 healthy siblings completed self-report measures of LOC, anxiety, and perceived PS of the mother. A neurological assessment determined severity of CP. Children with CP, regardless of severity, did not differ from their siblings in LOC, anxiety, or perceived PS. Multiple-regression analyses showed that LOC was predicted only by the acceptance/rejection dimension of PS in children with CP; whereas for their siblings, age, and anxiety were the best predictors. The findings suggest a central influence of the home environment on children’s psychological development. For children with CP, experiencing parental acceptance may enhance development of resilience-related qualities, such as an internal LOC. Keywords Locus of control . Parenting style . Anxiety . Cerebral palsy . Siblings Cerebral palsy (CP) is the most prevalent cause of serious physical disability in childhood (Kuban and Leviton 1994). In recent years, there is growing recognition that the prognosis for a child with CP depends not only on the medical, physical and functional aspects related to the disability, but also, and perhaps primarily, on the child’s psychological characteristics, as well as on psychosocial family variables (Majnemer and Mazer 2004; Schuengel et al. 2006). A review of the literature on mental-health and adjustment of children with CP, in comparison to typically developing children, reveals a complex picture of both risk and resilience. A number of studies, based on varied populations of children with
E. Cohen (*) School of Education, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel e-mail:
[email protected] G. Biran : A. Aran : V. Gross-Tsur The Neuropediatric Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
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CP, show that they may be at risk for various psychological problems such as: generalized feelings of helplessness, low self-esteem, anxiety, low academic achievements, social problems and dependency, as well as, headstrong behaviors (Breslau and Marshall 1985; Heller et al. 1996; Manuel et al. 2003; McDermott et al. 1996). However, McDermott et al. (1996) reported that although a substantial proportion of children with CP experience significant behavioral problems, most do not develop such problems, thus showing resilience. Similarly, children with CP do not differ from children without disabilities in their ability to maintain, in general, positive self-worth, and to perceive their competence as adequate in meeting the demands and expectations appropriate to their developmental stage (Schuengel et al. 2006). It thus becomes clear that a general risk model based on physical disabilities may be too simple for understanding adaptational outcomes in children with CP. This study focused on psycho-social factors: namely, the child’s cognitions with regard to control of personal consequences and their interrelations with perceptions of parenting style as well as with symptoms of anxiety.
Locus of Control The generalized beliefs held by individuals about their ability to control daily reinforcements appear to play a significant role in various aspects of their adaptation and subjective wellbeing (Chorpita and Barlow 1998). Locus of control (LOC) orientations reflect these enduring beliefs along a continuum ranging from “internal LOC”—the perception of being able to control one’s own life events through effort or talent—to “external LOC”—indicating beliefs that one’s life is controlled by powerful others or by chance (Carton and Nowicki 1994; Rotter 1990). In children and adolescents, external LOC orientations are associated with poorer school adaptation, involvement, and achievements (Kee 2005; Nesselroade et al. 2002), as well as with an increased vulnerability towards anxiety and depression (Chorpita and Barlow 1998). LOC has also been found to serve as a predictor of psychological adjustment in youth with chronic illness (Meijer et al. 2002), and as a mediator between illness severity and well-being in children and adults affected by chronic illness (Murray 2003; Ostrander and Herman 2006). LOC in children with CP may therefore be assumed to play an important role in their emotional and behavioral adjustment, and an internal LOC may be considered a protective factor in face of the increased risk of adjustment problems. Studies examining LOC in children with CP report mixed results. Whereas Eggland (1973) found children with CP to demonstrate more beliefs in external control than non-handicapped schoolchildren, Center and Ward (1986) did not find such differences. Moreover, findings by Schuengel et al. (2006) show no differences between children with CP and local norms in their perceptions of personal competence, except for their lower perception of competence in athletic activities. These finding suggest the possibility that the sense of reduced control may be experienced by children with CP only in the specific areas of their handicap, or that it may be generalized to other areas of functioning, depending on other variables unrelated to the disability.
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Parenting Style Development of LOC in children has been linked to parenting style (PS). Internal LOC was shown to be associated with an accepting and autonomy-supporting PS (Carton and Nowicki 1994; Chorpita and Barlow 1998), parental warmth (Dew and Huebner 1994; Krampen 1989; Suchman et al. 2007), and parental protectiveness and attentiveness (Dew and Huebner 1994). Parents raising a child with CP are faced with the special challenge of successfully conveying to these children a sense of parental acceptance and support of their autonomy, in spite of the children’s great need for tangible help. Very limited research has been conducted on the perceptions of children with CP with regard to their parents’ PS (Harper 1984), but it appears to be significant for their quality of life (Aran et al. 2007).
Anxiety There is some evidence showing that children with CP exhibit higher levels of anxiety in comparison to typically developing children (McDermott et al. 1996). In non-handicapped children, anxiety was found to be associated both with parental child-rearing practices, and with perceived control (Barlow 2002; Bõgels and Brechman-Toussaint 2006; Chorpita et al. 1998; Muris et al. 2004; Rapee 2001). However, interrelations among these constructs remain unclear. Some models of anxiety, implicate cognitive factors such as children’s locus of control as a mediating factor linking parental over-control to child anxiety (Barlow 2002; Chorpita et al. 1998; Rapee 2001), but strong evidence for this model is still lacking (Muris et al. 2004). The present study aimed to investigate the interrelations among LOC, perceived parenting style, and anxiety in children with CP. We used the children’s siblings as a control group to decrease the levels of variance due to familial influences. Additionally, we examined differences in LOC, anxiety, and perceived parenting style as a function of the severity of CP.
Method Participants Participants comprised 30 children with CP (15 males, 15 females; ages: M=11.66, SD=3.17; range=6–18) and their 30 siblings (13 males, 17 females; ages: M=12.16, SD=3.67; range=6–18). Six of the sibling pairs were twins. No significant age difference emerged between the two groups. Inclusion criteria for children with CP were: an unequivocal diagnosis of CP, age 6–18, normal intelligence, attendance in a regular school, and no other known major disorders. Inclusion criteria for siblings were: a healthy child, closest in age to the sibling with CP, attending a regular classroom in a regular school. Fifty families with mainstreamed school-age children with CP were approached, and 42 (84%) agreed to participate. Nine children were excluded due to intellectual limitations, and three others were excluded because no
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sibling met the inclusion criteria. The group of children with CP included 27 diagnosed with spastic CP (12 quadriplegic, eight diplegic, and seven hemiplegic), two were hypotonic, and one was dyskinetic. The mean IQ score, available only for the children with CP, was 92.52 (SD=17.91; range=72–124), based on either the verbal score of the Revised Wechsler Intelligence Scale for Children (Wechsler 1974), or the achievement score on the Kaufman Assessment Battery for Children (Kaufman and Kaufman 1983). Using Abramson et al. (1982) criteria for socioeconomic level, participants’ socioeconomic status was almost equally divided between high (36.7%), middle (30%), and low (30%), Measures Locus of control was assessed by the children’s self-report on the Locus of Control Scale for Children (Nowicki and Strickland 1973) in its Hebrew version (Lufi and Parish-Plass 1995). The 40-item scale yielded a single score, with higher scores indicating more external LOC. Internal reliability was α=0.63, similar to that reported by Nowicki and Strickland. Parenting style was assessed via a shortened 40-item Hebrew version (Cohen et al. 2008) of the maternal form of the Children Reports of Parent Behavior Inventory (Schaefer 1965), with reported internal reliability of α=0.80. The child’s ratings yielded a score on each of the following four scales: acceptance, rejection, autonomy, and control. In the present study, the high significant correlations obtained between the acceptance and rejection scales (r=−0.70, p
