Adjustment to parental SCI

Understanding how children cope with significant life events is a particularly important area of concern in clinical psychology and is the focus of much psychological research. However, there has been little research examining how a child adjusts when a parent has a spinal cord injury (SCI).

Previously, the majority of injuries occurred to people in the younger age group and, therefore, many were not yet parents. Increasingly, injuries are occurring in a wider age group, which means that many people who suffer a spinal cord injury may well already be parents. In the past, studies in this area have tended to focus on how a spinal cord injury might affect practical aspects of day-to-day parenting rather than looking specifically at children's adjustment.

What does previous research tell us?

Two previous studies have examined the impact of parental spinal cord injury on children in terms of adjustment. Both these studies were based in the USA and focused on children born after the parent's injury. Limiting the focus in this way could result in important stressors being missed, which children born before a parent's spinal cord injury will have witnessed. Examples include having to see a parent in hospital or how the SCI may change a family's lifestyle.

A further drawback of one of the previous studies is that it examined adjustment only in grown-up children, who were asked to recall what it was like for them as a child. Arguably, again, this does not capture the essence of the effects of the parental spinal cord injury for the child when they are still a child. With these limitations in mind, there seemed to be a need for further research. This would need to focus on asking the children themselves how they feel and also to focus on children born before the parent's injury, who are likely to have witnessed a great change in their family life. It was hoped that by developing a study which examined adjustment using responses from children and their parents, the factors which are important in aiding adjustment in children might be found. This information could then be used to promote good adjustment in children who were not adjusting well.

The study itself

To address this gap, a study was recently conducted in the UK, incorporating families from a number of spinal injury centres. The families who took part in the study were asked to complete several questionnaires. The parents of children aged between four and 18 years completed a questionnaire looking at the child's adjustment and a brief questionnaire about their own health. Children aged between seven and 18 years were also asked to fill in some questionnaires relating to their own feelings. These looked at issues such as self-esteem, the way the child interpreted what had happened to the parent, the coping strategies the child used and, lastly, whether the child was likely to believe they had control over events in their life. In families where there was a second parent, they also completed a questionnaire about their own health.

What did the study find?

The study was voluntary and although many families were approached to take part, in total only 28 families participated. Despite this small sample, there were some interesting results. The study found that, overall, children’s adjustment was not different to other children of the same age and gender who did not have a parent with a spinal cord injury. A small minority of children did show some signs of difficulties, but this was not apparent in most of the children. This actually supports findings from the previous studies in this field, which found that children tended to be coping well and that some children even reported some positive effects, such as increased feelings of competence. This may also be true in the recent study, where the children’s self-esteem was found to be higher than other children the same age. Unfortunately, due to the way the study was designed, we cannot say if their high self-esteem is a result of the parental spinal cord injury or whether it’s due to other factors. However, it adds support to the general conclusion that children of a parent with an SCI are adjusting well.

Interestingly, a number of factors were found to be particularly helpful in aiding good adjustment in these children. Having a high self-esteem, for example, was important. Also, believing you had some control over what happened in your life (known as internal locus of control) was important.

A few particular coping strategies were also shown to be quite influential. For example, children who coped by criticising themselves or simply giving up and resigning themselves to what had happened tended to do less well. Children who coped by expressing their emotions (positive or negative) tended to adjust better. Lastly, the adjustment in the parent themselves had some influence on the child. Parents who were adjusting well to their injury tended to have a child who was also adjusting well.

What about the future?

Because the study was based on only a relatively small sample, it is difficult to generalise the results to all children of a parent with spinal cord injury.

However, for this small sample the results were encouraging. There are implications from the study for raising awareness about children in families where there is a parent with a spinal cord injury and for developing resources to help children learn about SCI.

There are clinical implications too for using some of the factors which we now know help some children adjust well and designing psychological support around these factors. At present, most spinal centres have psychological support available for adults with spinal cord injury and sometimes their spouses but not for children and wider families. It is hoped that this study will encourage the involvement of children more and encourage further research in this important area.

References for further reading

Alexander CJ, Hwang K and Sipski ML. 2002. Mothers with spinal cord injuries: impact on marital, family, and children’s adjustment. Archives of Physical Medical Rehabilitation, 83, 24–29.

Buck FM and Hohmann GW. 1981. Personality, behaviour, values, and family relations of children of fathers with spinal cord injury. Archives of Physical Medical Rehabilitation, 62, 432–438.

Compas BE. 1987. Coping with stress during childhood and adolescence. Psychological Bulletin, 101(3), 393–403.

Webster G and Hinson LM. 2004. The adaptation of children to spinal cord injury of a family member: the individual’s perspective. SCI Nursing, 21(2), 82–87.

First published in Disability, Pregnancy & Parenthood international, Issue 52, Winter 2005/2006.