Self-Perception Issues

16 Self-Perception Issues

All people—children and adults—have mental pictures of themselves that steer the course of their lives. This mental picture, or self-perception, begins to develop at birth, emerges in childhood, and is refined and crystallized in adolescence, but it continues to evolve throughout life. Self-perception is often used as an indicator and even a predictor of mental health (U.S. Department of Health and Human Services [USDHHS], 2010a; Wang and Veugelers, 2008; Wang et al, 2009). Multiple factors influence self-perception (Fig. 16-1). Self-perception has to do with how individuals act, think, and feel about themselves, their abilities, and their bodies. It is also influenced by the response of others to them. This perception, in turn, influences the attitudes each person takes and the choices each person makes throughout life. Children’s self-concept powerfully affects their happiness, academic performance, relationships, creativity, healthy risk-taking, perseverance, resilience, and problem-solving (Neifert, 2005). A positive self-perception is a precious gift that provides the confidence and energy to take on the world, to withstand crises, and to focus outside oneself. It enhances the building of relationships and giving to others. Adolescents (in particular) with a positive self-perception have a significant protective factor to minimize the risk of suicide (Sharaf et al, 2009). Positive self-esteem is protective because it enhances children’s abilities to deal with risk and learn to cope effectively (Riesch et al, 2006). People with a negative self-perception tend to focus on their own needs, trying to get and prove their self-worth. Children and adolescents with low self-perception have limited ability to respond to daily and developmental challenges (Wang and Veugelers, 2008). A negative self-perception drains energy, interferes with building relationships, and often leaves the person feeling like a victim. People with poor self-perception are more likely to participate in negative behaviors such as school absence, smoking, drinking, drug use, and delinquency, and are more likely to experience eating disorders, anxiety, depression, and suicidal behaviors (Slattery, 2008; Wang and Veugelers, 2008). Poor self-esteem can be a symptom of a mental health disorder or emotional disturbance (USDHHS, 2010a).

When children and adolescents are asked to give a self-description, they use physical, social, and psychological dimensions referring to home, school, sports, or activities that they are involved in (Dixon and Stein, 2006). Scharf and Mayseless (2009), in a study evaluating social leadership in elementary students, showed the socioemotional characteristic of positive self-perception as an important quality. This positive self-perception can be in any of six domains: scholastic, peer acceptance, athletic, physical, conduct, or self-worth. Self-esteem is enhanced by linking praise to correction and emphasizing improvement and lifelong learning (academically, socially, culturally, and occupationally).

Assessment of self-perception is not a straightforward task but is interwoven with other data that the provider collects. It may be helpful to think of self-esteem as including cognitive, affective, and behavioral aspects (Reasoner, 2002). The cognitive element emerges as an individual thinks about the discrepancy between the ideal self and the perceived self. The affective component refers to the feelings that emerge when considering the discrepancy between the two selves. The behavioral aspect is seen in traits, such as assertiveness, resilience, and being decisive and respectful of others. Routine anticipatory guidance, education, and counseling, individualized to the child and family, give the provider the opportunity to facilitate the development of positive self-perception and to assist in preventing potential problems. Self-perception problems are often hidden within somatic complaints, and treating these problems requires an awareness and sensitivity to the child or adolescent to identify and deal with them. If done successfully, the child’s life can be significantly affected.

image Normal Patterns of Self-Perception

Components of Self-Perception

The term self-perception may be used interchangeably with terms such as self-concept, self-esteem, and self-image. The term body image refers to one’s picture of and feelings regarding one’s body.

Self-perception, being personal and subjective, includes both a description of the self and an evaluation of that description. The description a person draws and the evaluation a person makes come from thoughts and feelings, beliefs and convictions, observations, understanding, insight, and awareness received both from the self and from others. The three key components of self-perception are significance, worthiness, and competence (Box 16-1). Significance comes from having a sense of belonging; feeling loved and lovable; feeling secure, cared for, and supported; and being accepted and understood unconditionally for whom one is, not what one does. This is the most important component in developing and maintaining a healthy self-esteem. Females are more likely to channel their self-perception into feeling desirable especially through relationships (Slattery, 2005).

Worthiness comes from understanding that as an individual you have a purpose in life. It is feeling valuable, acceptable, meeting personal moral standards, and respecting and feeling good about oneself. It also has to do with being respected and accepted by others. Feeling unconditional love, “no strings attached,” is the cornerstone of self-worth.

Competence comes from feeling capable, confident, adequate, in control, and able to approach new tasks and deal with life optimistically, hopefully, and with courage. Males are more likely to channel their self-perception into feeling capable especially through significance and achievement (Slattery, 2005). Competence is one part of resilience—the inner strength to cope with any challenge one faces in life (Brooks, 2010). Competence is measured in terms of cognitive, physical, or social skills.

Children who feel significant, worthy, and competent confidently initiate activities, explore the environment, take risks, and rebound from disappointments. Appreciating themselves, they are able to reach out to and interact with others, accepting and offering love, respect, and encouragement. Perry (2001) describes an active learning process beginning with a child’s natural curiosity that leads to mastery and accomplishment, thereby growing a child’s self-esteem and resilience (Box 16-2).

Children who do not feel significant, worthy, and competent look increasingly to external measures, such as those listed in Box 16-3, to try to create a positive self-perception. Physical attractiveness, socioeconomic status, and intelligence (academic achievement) are three measures frequently used in society to evaluate people. State of physical health, temperament, coping style, and an overly protective environment are other factors that affect self-perception. However, undue or excessive emphasis on external measures causes children to compare themselves with others, adopting the description and evaluation others make of them. Most of us are what we think others think we are (Dobson, 1999), or “If you think you can’t, you can’t” (Neifert, 2005). Children whose self-perception is based on a comparison of themselves with others feel and describe themselves as insecure, inferior, and inadequate. Attempting to prove themselves, they often become both bossy and aggressive, or people pleasers and approval seekers. Red flags for self-perception are listed in Box 16-4.

Developmental Stages

The development of children’s self-perception is closely tied to normal growth and development. Each stage of growth and development provides opportunities to learn about the self and interact with and observe others and the environment. Transient periods of low self-esteem are a normal part of development and can occur when a child is working on mastering new skills or sets new goals. Self-perception can change as a result of relationships or experiences or can be maintained in spite of contrary evidence (e.g., the adolescent cheerleader who is loved and is successful in school and relationships, yet is anorexic and feels she is never “good enough”).

One theoretic perspective that can be useful clinically is to view the development of self-perception as occurring in two stages (Box 16-5). The first stage, emergence of the self, occurs in infants, toddlers, and preschool-age children. Parents and caretakers play a key role during this stage. Infants as early as 4 months old learn that they are separate individuals who affect others by their behavior, thus laying the foundation for self-development (Rochat and Striano, 2002). This is best accomplished in a supportive environment where infants come to view the world (their parents and caretakers) as responsive to their needs, both physical and emotional.

Toddlers, with their new motor, cognitive, and language skills, learn to explore their capabilities and limits and make others aware of their needs, desires, and concerns. They thrive with positive acceptance, praise, and guidelines that set limits while allowing them to make choices.

As preschoolers’ feelings of competence begin to emerge, and with better self-recognition, they demonstrate increasing use of personal pronouns and pretend play (Lewis and Ramsay, 2004). At this age children become aware of discrepancies in abilities and discover their whole body, including the differences in sexes. Preschoolers internalize parents’ demands and move away from seeing the self as the center of the world. Parents and teachers can begin to coach the preschooler in early problem-solving skills. Siblings and peers play an increasingly important role in the preschooler’s life. When 4- to 7-year-old children are asked to describe themselves, they give categorical identification, describing themselves according to basic features with concrete, often external facts (Dixon and Stein, 2006).

Refining the self, the second stage of self-development, occurs in school-age children and adolescents as they developmentally become more self-aware. Friendships, peers, and the time spent in various activities play increasingly larger roles in shaping the child’s character and personality and thus self-perception. As early as 5 to 10 years old, children will cite themselves, not adults, as the authority on self-knowledge (Burton and Mitchell, 2003). Cultural stereotypes, such as those found in magazines, television, billboards, and the Internet, influence the child’s perception of society’s “ideal” self. School-age children are preoccupied with evaluating themselves on the basis of external evidence: cognitive and physical skills, achievements, physical appearance, social abilities and acceptance, and a sense of control. They are particularly prone to comparing themselves with others, making them more vulnerable to social pressure. Any deviation from what society considers “normal” is subject to criticism and ridicule.

From 8 to 11 years old, when asked to describe themselves, school-age children give comparative assessments detailing linear, often rigid and rule-based descriptions that compare themselves with peers (Dixon and Stein, 2006). Research stresses the importance of assessing peer perception hand-in-hand with self-perception in determining social functioning (Salmivalli et al, 2005; Troop-Gordon and Ladd, 2005).

Self-perception continues to be refined during early adolescence, and solidifies in later adolescence. Adolescents are defining who they are; where they are going; and how they are getting there. Early adolescents, from 12 to 15 years of age, provide descriptions of themselves with interpersonal implications that lack flexibility and detail their sense of self based on relationships, with personal characteristics as the basis and reason for relationships (Dixon and Stein, 2006). Early adolescents are still highly dependent on cultural stereotypes and peer acceptance, with physical and emotional changes being the main focus of self-evaluation. Self-concept may decline across late childhood and early adolescence and then become increasingly differentiated as the child matures. Body image formation, a crucial element in shaping identity, is finalized at this stage and is derived more from peers than parents (Putnick et al, 2008). Any defect, disability, or discrepancy between what is seen and what is visualized as ideal is magnified and significant in the adolescent’s eyes.

Middle adolescents, not yet comfortable with their bodies, spend much time focused on their appearance, trying on various looks. Part of the development of body image includes developing a sense of sexual self or becoming comfortable with one’s sexuality, assuming culturally defined sexual roles, behaviors, and activities (Dixon and Stein, 2006). Self-esteem, shown to have low stability during childhood, is increased throughout adolescence (Trzesniewski et al, 2003).

In the late adolescent years (15 to 19 years), as older teens mature behaviorally, emotionally, and cognitively, they are able to integrate family, peer, education, social, cultural, and community into their self, and establish an independent self with vocation, relationships and values (Dixon and Stein, 2006). At this stage adolescents may begin to develop their own life story with important memories that help to make sense of their past, present, and future (McLean, 2005).

It is important, especially in adolescence, to evaluate self-concept over multiple domains (Putnick et al, 2008). Areas to be evaluated in the adolescent include academic achievements (scholastic competence), athletic achievements, peer (social) acceptance, physical appearance and attributes, interpersonal acceptance (close friendships, romantic appeal), moral behaviors as compared with internal standards, sense of control over personal accomplishments, relationships, and participation in activities.

A study by Putnick and colleagues (2008) showed the way a child perceives parenting behaviors can indirectly influence the child’s self-concept. This is especially true during the stress of the transition to adolescence. Teenagers had positive self-concept when they perceived their parents as being accepting (parent involved), with some degree of strictness (supervision), and granting of psychological autonomy. Donaldson and Ronan (2006) showed that participation in sports and perceived competence had a positive effect on self-concept, resulting in confidence and greater social skills. Another study of adolescent self-esteem examined eight domains identified across a number of instruments: personal security, home and parents, peer popularity, academic competence, attractiveness, personal mastery, psychological permeability, and athletic competence (Quatman and Watson, 2001). Of the eight domains, only peer popularity and academic competence showed no significant difference between genders, although boys still exceeded girls in all eight. Parents and home life, personal security, academic competence, and personal mastery were the four domains that strongly influenced global self-esteem. Low priority was assigned to athleticism. The authors concluded that boys seem to have an “at homeness” in the world, both in the home and outside, where they feel confident and masterful, not undone by adversity. In contrast, girls felt significantly less confident and masterful and more psychologically vulnerable.

Developmental Assets, Thriving, and “Sparks”

Developmental assets are positive experiences, relationships, opportunities, and personal qualities that are building blocks to help children and adolescents grow into healthy, caring, and responsible adults. In 1990, based on extensive research studies, the Search Institute identified 40 assets related to child and adolescent development, risk prevention, and resiliency (Search Institute, 2010a). The assets are found in eight areas of human development and are grouped into external and internal assets. External assets are factors in the environment (home, school, community) that (1) support, (2) nurture and empower, (3) set boundaries and expectations, and (4) speak to constructive use of time. Internal assets are attitudes that include: (1) a commitment to learning, (2) positive values, (3) social competencies, and (4) positive identity. The assets are described in the asset checklist (Fig. 16-2).

Assets are applicable to all young people regardless of gender, ethnic heritage, economic situation, or geographic location. Research shows that the more assets a young person has, the more likely he or she is to make wise decisions and choose positive lifestyles while avoiding harmful or unhealthy choices. Most children and adolescents have fewer than 20 assets, and boys experience 3 fewer than girls (Search Institute, 2010b,e). Developmental assets promote positive attributes and behaviors, including exhibiting leadership, maintaining good health, valuing diversity, and working to succeed in school. The assets have also been shown to be protective against high-risk behaviors such as problem alcohol use, violence, illicit drug use, and sexual activity. Evidence shows positive protective effects on tobacco use, depression and attempted suicide, antisocial behavior, school problems, driving and alcohol, and gambling (Search Institute, 2010d).

Building on the initial research done with adolescents, the Search Institute has now created Developmental Asset Lists for Adolescents (ages 12 to 18), Middle Childhood (ages 8 to 12), Grades K-3 (ages 5 to 9), and Early Childhood (ages 3 to 5). The asset lists have been translated into 14 different languages. All of these are accessible without charge at the Search Institute website ( Common threads and unique features for each developmental age group are reflected in the asset lists. The middle childhood assets include the transition toward emerging self-hood and self-regulation. The early-childhood assets respond to early childhood issues with essential ingredients that relate to school readiness, school success, and a happy productive life.

The latest research coming from the Search Institute has to do with the concepts of thriving and sparks (Search Institute, 2010c,d). Thriving “focuses on how an individual is ‘doing’ at any given point in time as well as the path that he or she is taking into the future.” Thriving indicators are “constructive behaviors, postures, and commitments that societies value and need in youth.” Sparks, as identified by Benson (2008), are “something inside your teenager that gets him excited. Sparks are the thing that gives teenagers (and actually all people) meaning.” Sparks are “an interest, talent, skill, asset, or dream that truly excites young people and helps them discover their true passions.” Using sparks help young people develop positive self-perception and discover and cultivate talents and interests that shape the rest of their lives. The 10 most common sparks identified by American teenagers are listed in Box 16-6.

Environmental Influences

A variety of factors influence the development of self-perception. Some of the more noteworthy ones include significant relationships, attachment, temperament, heredity, health, race, ethnicity and culture, social experiences, stress and trauma, and media and technology.

Significant relationships include parents or parent figures, siblings and other family members, and ongoing caretakers. Parents contribute significantly to a child’s self-evaluation and feelings of self-worth through parental acceptance and psychological control exerted over their child (Putnick et al, 2008). If parents are struggling and divorce occurs, a negative effect on the child’s self-esteem may occur (Dalgas-Pelish, 2006). Perceived social support and feelings of connectedness with family (or other caring adults) are protective of and associated with high self-perception. That support can buffer adolescents from feelings of loneliness and social isolation (Sharaf et al, 2009).

As self-esteem develops there are some differences between boys and girls. Boys tend to focus more on achievement, whereas girls look to relationships. Girls look to their mothers as role models, and boys look to their fathers. At the same time, a father’s positive interaction with his daughter helps her to feel cared for, protected, and respected. A mother’s positive interaction with her son helps him to build confidence, believe in himself, and set his own goals (Slattery, 2008).

Studies have shown that first-born children have higher levels of self-worth (Shebloski et al, 2005). As children get older, peers and authority figures also have an influence. Constant unconditional acceptance and love, empathy, and an attitude of understanding, coupled with appropriate limits and boundaries, are the most important interactions these significant others offer. Time spent with and encouragement given to the child, both in being together and in doing things, in addition to sharing life’s happenings (listening, talking, and problem-solving), are also essential ingredients (see the Parenting Pyramid discussed in Chapter 4). A key component in children’s development of positive self-perception is the sturdy base built by positive relationships. By feeling, seeing, and hearing these continual reinforcements, children internalize or know that they are significant, worthy, and competent.

Glascoe and Leew (2010) identified six positive parenting behaviors and perceptions that predicted average to above-average development in young children. Children with developmental assets that prepare them for school are less likely to have low self-esteem. Additionally, Glascoe and Leew (2010) identified four psychosocial risk factors. The parenting behaviors and risk factors are listed in Table 16-1. Riesch and colleagues (2006) reviewed individual, family, and environmental factors that predict poor self-esteem. Improving the parent-child communication process may reduce the risk of low self-esteem. In contrast, Neifert (2005) has identified six common errors that parents unintentionally make that chip away at their child’s self-esteem (Box 16-7). A study of French-Canadian children who experienced verbal aggression from parents (e.g., rejection, demeaning, terrorizing, criticizing, or insulting) showed significantly lower self-esteem. These children perceived themselves as less competent, less comfortable, less worthy, and more prone to depression (Solomon and Serres, 1999). In general, peers and authority figures serve to confirm or deny what is taught at home.

TABLE 16-1 Positive Parenting Behaviors and Psychosocial Risk Factors Affecting Child Development and Self-Perception

Positive Parenting Behaviors and Perceptions Psychosocial Risk Factors

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Jul 24, 2016 | Posted by in PEDIATRICS | Comments Off on Self-Perception Issues

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