Monday, November 19, 2007

Impact of Treatment on Self-Concept

This doesn't exactly have to do with autism, but I thought it would be of interest to my readers nonetheless.

Strength training can have unexpected effects on the self-concept of children with cerebral palsy.
Dodd KJ, Taylor NF, Graham HK.
Musculoskeletal Research Centre, School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Victoria, Australia. K.Dodd@latrobe.edu.au

PURPOSE: This study was designed to evaluate the effect of a home-based progressive resistance strength-training program on the self-concept of children with cerebral palsy. METHODS: A randomized, controlled trial was used to evaluate the effects of a six-week strength-training program on self-concept immediately after completion of the program (week six) and at a follow-up session held 18 weeks after the initial assessment. Seventeen children [eight boys, nine girls; mean age 12.1 years (SD 2.5)] with spastic diplegic cerebral palsy were recruited. Participants in the experimental group completed a home-based progressive resistance strength-training program using three exercises to strengthen the major support muscles of the lower limb. Participants in the control group undertook their normal daily activities. Self-concept was measured by the Self-Perception Profile for Children. RESULTS: Overall, the self-concept of both groups was positive at baseline and at six and 18 weeks. However, compared with controls, the experimental group showed decreased self-concept in the domain of scholastic competence and a trend for a decrease in social acceptance at six weeks. At follow-up, the experimental group had reduced self-concept in the domains of scholastic competence and social acceptance compared with the control group. CONCLUSION: These unexpected results suggest that participation in a relatively short home-based strength-training program may have an inhibitory effect on the self-concept of children with cerebral palsy. Despite the inhibitory effect, self-concept in the experimental group remained positive after strength training, suggesting that clinicians should not be overly concerned about the psychological effects of the intervention.


I believe this study has implications of note on the kinds of outcome measures that should be considered in disability treatment trials. Effectiveness is obviously not the only consideration that matters.

15 comments:

  1. This line is a bit of a worry:

    "clinicians should not be overly concerned about the psychological effects of the intervention."

    How about the inhibitory effect being tied to doing something intensively that you have no aptitude for. Does that sound familiar?

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  2. That is very interesting. I have been claiming for some time that parents who "treat" healthy children for perceived problems like "shyness" with homoeopathic remedies, are harming the self image of their children ("I am getting medicine, therefore there must be something wrong with me").

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  3. Wow, I am glad to see that negative outcome research reports do exist! Now if some of the more glaring and glowingly blatant misrepresentative autism researchers would follow suit maybe we could start do beleive that they aren't just charlatans. (Snide remark for all of the wonder cure folkses.)

    I agree with Alyric that the last line of that abstract is disconcerting, self esteem is a terrible thing to corrupt. Perhaps they needed to have some positive affirmations along with the strength training so the studied could feel better about what they were being subjected to.

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  4. Despite the inhibitory effect, self-concept in the experimental group remained positive after strength training, suggesting that clinicians should not be overly concerned about the psychological effects of the intervention.

    WTF?!? Don't worry about something that does harm as long as the harm does not bring one down into an official category of "not well?" Whatever happened to "First Do No Harm?" That's ridiculous! If it has no positive effects, and especially if it has negative effects, don't bother to do it, period.

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  5. Is it just me, or does that study seem so.....unscientific?

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  6. I'd like to see those same clinicians maintain a lack of concern when a patient sues them for psychological damage.

    Disappointing to read this from a university in my home town!

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  7. John Best (Not Jr.)11/25/2007 6:17 PM

    Joseph,
    My name is John Best. I am NOT the John Best Jr. you rightly criticize in your blog. Unfortunately though, when I google 'John Best' your criticism of John Best Jr. is number one. I would hate to think of anybody linking me to this despicable fellows comments. Could you please use his full name, and some other identifying information to separate your blog from me? Thank You, John Best, State College, PA. Please email me regarding this issue at john@elmdas.com. Thank You.

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  8. John Best (Not Jr.)11/25/2007 6:20 PM

    Joseph,
    Please contact me about this John Best Jr. blog. My name is John Best too, and your blog Googles #1 for 'John Best'. I don't like being associated with this fellows comments. Thanks for looking following up. Regards,
    John Best.

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  9. Too often we overlook the psychological effects of what we say and do with our children.

    The lack of concern over the psychological effects of this intervention is disgraceful and quite demeaning to the children and their families.

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  10. John Best: I'm sorry to hear that. It's unfortunate that when someone Googles your name, they would come across my page on John Best Jr. There's a reason why it's #1 on the search results. And that's because appalled bloggers have used it as a reference to examples of John's ideas and behavior. I think that page provides a relevant service, and I'm not willing to give it up. Do you have any suggestions? I could add a link to a page of your choice.

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  11. Hi! I'm a behavior therapist that works with autistic children. I just started my own blog at http://autismchronicles.com. I've found your blog very informative and I've added to my blogroll.

    Thanks!

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  12. Dear Joseph,

    My name is Isabelle and I'm a member of the WEGO Health Community [http://www.wegohealth.com]. I realize that you may be busy at this time but I wanted to quickly get in touch with you to let you know a little bit about what we're doing at WEGO Health.

    We are a relatively new health website and we are trying to grow our Autism community. Our mission is articulated nicely here [http://www.wegohealth.com/our-mission.html].

    We have a community message board dedicated to Autism. Please feel free to browse it here: [http://forums.wegohealth.com/forums/viewforum/48_47/. I hope you’ll take a few minutes to introduce yourself in the forum. I believe that our members would be very interested in learning more about your experiences and your blog, You will need to first sign up [http://www.wegohealth.com/signup/]

    Below are a few pages that our research team has pulled together on Autism. All of the content on our site can be rated and reviewed by community members like yourself.

    Child Autism [http://autism.wegohealth.com/child-autism.html]
    Autism Spectrum Disorder [http://autism.wegohealth.com/autism-spectrum-disorder.html]
    Autism Research [http://autism.wegohealth.com/autism-research.html]

    Thanks in advance for visiting these links and I hope to hear back from you soon. Please feel free to contact me at the email address below.

    Best regards,
    Isabelle
    WEGO Health Community
    expert-supported health communities

    E-mail: isabelleo@wegohealth.com
    Website: www.wegohealth.com

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  13. Joseph,
    My name is Anthony Peake. I am a fellow blogger. You may be interested to know that the understanding of autism is of great importance to some members of my blog. Three have severely autistic children and all have similar ideas to yourself with regard to the 'illness'. One member is in the process of writing a book called "God's Children" which has an alternative Earth where autism is the norm.

    You may also find my overall theory of interest. May I suggest you check out my blog (it is approaching the maximum 100 contributors and is proving very popular) and maybe consider joining in.

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  14. zI am outraged that a new organization such as CNN allows such misnomers to continue to spread.
    I speak as a father, a scientist and a pediatrician... mind you I became a pediatrician to help children... instead of becoming a plastic surgeon who work on people like Ms. McCarthy for pure cash.
    There has been no scientific evidence showing any relationship between autism and vaccination. One of the best studies refuting the connection between vaccines and autism was preformed in one of the Scandinavian countries where there is social health care ... allowing medical records being available on majority of the population. A population that has the one of the least Genetic variability as compared to the United States (secondary to our diversity.) The rates of Autism was the same for pt who were vaccinated vs. those who opted out of vaccinations.
    Unfortunately in our country some parents, actually most do not want to face the most obvious cause of Autism.
    The GENES they (as in Case of Ms. McCarthy) passed on to their children. It is great to pass on the blame to vaccination... which through out this century a have save numerous lives of children (too many to quantify).
    I care for health of children deeply... whether they a minor cold, autism or childhood tumors. I am truly sorry that her child has autism, but to spread falsehoods is not the cure to autism.
    To care for children in our country and to give to research for childhood disease is the answer. The amount of money spend on pediatric disease research in our country is dwarfed by the money spent in adult research... and even more by our many other spendings.
    If Ms. McCarthy truly cares for her child and well fare of other children, she should come to grips with the fact that her son has Autism, it is no ones fault, and to help gather public support for Scientific research. Otherwise by spreading her falsehoods, she can cost the life of many children to be cut short when they end up contracting one of the childhood diseases that the vaccines would help to protects.

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  15. Anon, I appreciate your comment, but this is an old thread and not on topic. You might want to visit the Autism Hub for discussion on that.

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