Handicapped and Able-Bodied Children's Ideas of Health

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Handicapped and Able-bodied Children's Ideas of Health

In the early 1970s, in response to the Civil Rights movement, attention turned to the rights of disabled persons, including children. The Education for All Handicapped Children Act (Public Law 94-142), stating that handicapped children have the right to a free public education in the least restrictive environment possible, was passed in 1975. This historic legislation institutionalized the idea that handicapped youngsters have the same rights as other children and rests on the premise that children are more alike than they are different.

Simultaneously with the focus on integrating handicapped individuals into the mainstream of society came increasing interest in health promotion, physical fitness, and self-actualization for everyone. Studies on views of health found in the literature [1] and held by various segments of the public [2-7] proliferated as attempts were made to define that elusive quality being promoted. Twenty-five years have passed since the first studies were published, but the work continues. Because it is assumed that health beliefs are formed during childhood, much of this work has been conducted with child subjects.

Though several studies with children use social expectancy theory to test various aspects of the Health Belief Model, [8-10] most are based on Piaget's cognitive developmental framework [5,11-16] and examine ideas of illness more frequently than ideas of health. One study [17] is based on a phenomenological view of health though it, too, draws on developmental principles.

Cognitivie developmental theory was first postulated by Piaget. [18] According to this theory, children assimilate incoming stimuli from the environment into existing cognitive structures and gradually modify these structures through accommodation. Their ideas pass through a series of four stages that reflect concrete to abstract thinking.

Studies of children's ideas of health and illness seem to follow a similar pattern to that outlined by Piaget. [3-5] Most indicated that children ages six-12 see health as a series of prescriptive practices over which they have some control. Younger children are more egocentric and use concrete, behavioral cues to define health, while older ones are able to consider more abstract hypothetical views. [11]

Ideas of illness seem to follow a similar progression. Bibace and Walsh, [13] after a study of 72 healthy children's concepts of illness, outlined a sequence of illness beliefs using Piaget as a framework. Studies by Brewster [19] of 50 chronically ill children, Feldman and Varni [20] with children with spina bifida, and Young and colleagues, [21] using a mixed group, all demonstrated that ill and handicapped children have ideas about illness that differ little from that outlined by Bibace and Walsh. No studies have examined both able-bodies and handicapped children's ideas of health, as opposed to illness, however.

Children with handicaps have different kinds of experiences than their able-bodied peers. Therefore, though the structure of their ideas may be developmentally similar, one would expect the content to differ. Furthermore, if health is a phenomenon known by the experiencing person that develops during childhood, then experiences might determine perceptions about one's own health status and behavior, called health self-concept. [17] Finally, past studies have shown that normal children view their handicapped peers negatively [22,23] and that this negative view is held more strongly by boys than by girls. [22-26] Effects of age and cognitive development on views of handicapped children are not as well documented. [24]

Natapoff, [27] after a study of 264 healthy children, suggested that those older than age seven or eight believe it is possible to be part health and part not healthy, and that health is perceived as long-term while sickness is short-term. …