Keeping Current #96-1

The Importance of Self-Esteem: Implications for Practice

Colleen Willoughby, Child and Parent Research Institute (CPRI)
Gillian King, Thames Valley Children's Centre and Neurodevelopmental Clinical Research Unit (NCRU)*, McMaster University
Helen Polatajko, University of Western Ontario

^{©1996 Willoughby, C., King, G., & Polatajko, H.;
Published and distributed by the Neurodevelopmental Clinical Research Unit (NCRU)
*As of Oct. 1, 1998, the NCRU is called CanChild Centre for Childhood Disability Research}

Many people are interested in the construct of self-esteem. We need only turn on a television or radio talk show or take a trip to the book store to hear about "101 Ways to Improve Self-Esteem." Self-esteem is a "hot topic" in most pediatric settings as well. As clinicians, we rarely think about a child without considering his or her self-esteem, even if it was not a specific consideration in the child's referral. But why? Where does this concern with self-esteem come from?

In large part the concern with self-esteem is due to it being an important aspect of psychological functioning (Crocker & Major, 1989). Self-esteem is associated with depression, anxiety, motivation and general satisfaction with one's life (Harter, 1986; Rosenberg, 1986). Given these associations, children and adolescents who lack self-esteem may be more dependent on their parents and have lower academic and vocational goals. Hence it is not surprising that parents and clinicians want to foster self-esteem in young people.

Given the widespread interest in self-esteem in the general population and among clinicians, it is important that we all have the most current understanding of self-esteem.

How is self-esteem different from self-concept and self-efficacy?

Webster's dictionary defines self-esteem as "a confidence and satisfaction in oneself" and self-concept as "the mental image one has of oneself " Self-esteem is considered to be the overall value that one places on oneself as a person (Harter, 1989), whereas self-concept is viewed as the body of self-knowledge that individuals possess about themselves (Rosenberg, 1986). Hence self-esteem is an evaluative term and self-concept is a descriptive term.

Self-efficacy is another construct which is frequently confused with self-esteem. It refers to one's estimation of how well one can execute the actions necessary to deal with life events (Bandura,1982). An important difference between self-efficacy and self-esteem is that perceptions of self-efficacy vary depending on the life event in question whereas self-esteem is a relatively stable way in which we view ourselves that is established early on in life. Therefore, it may be more realistic for clinicians to address clients' perceptions of self-efficacy than to focus on their feelings of self-esteem, which are less likely to change. More clinical research is necessary to help us understand to what extent therapeutic interventions can influence children's and adolescents' perceptions of self-efficacy.

In the meantime, more precise and consistent use of the terms self-esteem, self-concept, and self-efficacy will facilitate communication among disciplines, avoid confusion, and help make treatment goals and objectives more accurate and attainable.

Do children with disabilities have lower self-esteem than children without disabilities?

Although many of us may assume that children and adolescents with disabilities have lower self-esteem than same-aged peers without disabilities, studies have found little evidence that the self-esteem of the two groups is significantly different (see e.g., Appleton et al., 1994; Arnold & Chapman, 1992).

There have been a number of empirical studies of the self-esteem of adolescents with physical disabilities (for a review, see King, Schultz, Steel, Gilpin, & Cathers, 1993). The majority of these studies have employed standardized measures of self-esteem but have used convenience samples from clinic populations, which limits their generalizability. These studies provide little evidence to support the common assumption that adolescents with disabilities have low self-esteem. In a meta-analytic study, Lavigne and Faier-Routman (1992) recently concluded that well-designed studies employing careful matching or comparisons with norms do not indicate significant differences between children with physical disorders and able-bodied children. These findings parallel conclusions drawn by several researchers (e.g., Crocker & Major, 1989; La Greca, 1990). According to Crocker and Major (1989), there is little empirical evidence that members of any stigmatized group have low self-esteem.

How can we clarify whether a child's self-esteem is low?

It is important to evaluate the child's self-esteem objectively with a psychometrically and conceptually sound measure. For a young child, or anyone with a mental age of under eight years, it may be most helpful to use both self-report and observer-report measures as it is only at about age eight that children begin to be able to verbalize their self-esteem. For children eight years and over, a self-report measure alone may be more helpful to access information on the child's perceptions of self-worth than information from a secondary source (Willoughby, King, & Polatajko, in press). This is because, conceptually, self-esteem is a construct residing within the individual. There is a general consensus that self-report measures are preferable to the reports of others, such as parents or teachers (see e.g., Harter, 1990).

What do we do if assessment results and clinician beliefs are inconsistent regarding self-esteem?

There may be times when the clinician disagrees with the child's self-report and thinks that the child has reported inaccurately or has an unrealistic, inflated self-esteem. The clinician may then choose to address self-esteem despite the client's self-report results. Nonetheless, we should keep in mind that to address an area which a client tells us is not a problem is inconsistent with the philosophies of client-centred practice and family-centred service. Client-centred practice recommends that the client's perceptions of his or her problems supersede those of the clinician (Canadian Association of Occupational Therapists, 1993).

Most often, clinicians who carefully consider the child's situation and who have a good understanding of the differences between the "self" terms, will find that they are addressing areas of self-concept (or self-efficacy), rather than self-esteem. When this is the case, it is recommended that we only address the domains of self-concept that are identified as low and are important to the client (Harter, 1986). If the clinician seriously questions the validity of the client's responses, one solution would be to readminister the scale at a later date, once the client and clinician have had a chance to establish a more trusting relationship.

What are the implications for practice?

In summary, we will move the field forward and improve our clinical practice by:

1. Using consistent definitions and, if in doubt, asking each other to clarify what we mean by self-esteem, self-concept, or self-efficacy.
2. Paying more attention to the notion of self-efficacy (one's estimation of how well one can execute the actions necessary to deal with life events). This aspect of how one views oneself is often confused with self-esteem, and may make treatment goals more accurate and attainable (since self-efficacy is more amenable to change than self-esteem).
3. Providing information to parents of young children about ways to foster the development of good self-esteem. These include setting challenges that children can handle, praising good results but honestly telling children when they haven't done well, and helping children not generalize from temporary failures (Seligman, 1995).
4. Not assuming that our clients have low self-esteem simply because they have a disability.
5. Assessing self-esteem, self-concept, and/or self-efficacy using conceptually and psychometrically sound measures.
6. Addressing self-esteem or self-concept only when the client reports low self-esteem or describes his/her self-concept as poor in areas he/she perceives to be important.

References

Appleton, P. L., Minchom, P. E., Ellis, N. C., Elliot, C. E., Boll, V., & Jones, P. (1994). The self-concept of young people with spina bifida: A population-based study. Developmental Medicine and Child Neurology, 36, 198-215.

Arnold, P., & Chapman, M. (1992). Self-esteem, aspirations and expectations of adolescents with physical disability. Developmental Medicine and Child Neurology, 34, 97-102.

Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 31, 122-147.

Canadian Association of Occupational Therapists in cooperation with Health Canada and the Canada Communication Group-Publishing, Supply and Services Canada. (1993). Occupational Therapy Guidelines for Client Centred Mental Health Practice. Author

Crocker, J., & Major, B. (1989). Social stigma and self-esteem: The self-protective properties of stigma. Psychological Review, 26, 608-630.

Harter, S. (1986). Processes underlying the construction, maintenance, and enhancement of the self-concept in children. In J.Suls & A.G. Greenwald (Eds.), Psychology perspectives on the self (Vol. 3, pp. 136-182). Hillsdale, NJ: Erlbaum.

Harter, S. (1989). Causes, correlates, and the functional role of global self-worth: A life span perspective. In J. Kolligian and R. Stennberg (Eds.), Perceptions of competence and incompetence across the life span (pp. 67-97). New Haven, CT: Yale University Press.

Harter, S. (1990). Issues in the assessment of the self-concept of children and adolescents. In A. M. La Greca (Ed.), Through the eyes of the child: Obtaining self-reports from children and adolescents (pp. 292-325). Boston, MA: Allyn and Bacon.

King, G. A., Schultz, I. Z., Steel, K., Gilpin, M., & Cathers, T. (1993). Self-evaluation and self-concept of adolescents with physical disabilities. The American Journal of Occupational Therapy, 47, 132-140.

La Greca, A. M. (1990). Social consequences of pediatric conditions: Fertile area for future investigation and intervention? Journal of Pediatric Psychology, 15, 285-307.

Rosenberg, M. (1986). Self-concept from middle childhood through adolescence. In J. Suls (Ed.), Psychological perspectives on the self (Vol. 3, pp. 107-136). Hillsdale, NJ: Erlbaum.

Seligman, M.. (1995). The optimistic child. Boston, MA: Houghton Mifflin.

Willoughby, C., King, G., & Polatajko, H. (1996). A therapist's guide to children's self-esteem. The American Journal of Occupational Therapy, 50, 124-132.