A specialized apperception test for physically impaired adolescents was developed, and a pilot was conducted using ten nonimpaired and ten impaired adolescents. Ten cards depicting various scenes with physically impaired male and female models were designed to elicit themes that may be particularly relevant for this adolescent population. Two raters evaluated how well each card elicited issues identified in the literature as pertinent to physically challenged adolescents.
Progression through adolescence is demanding for most individuals. Tasks include understanding and coping with physical changes and sexual urges, developing interpersonal relationships, handling the pressures of school and family, as well as attempting to develop a cohesive sense of self. Adolescents with physical impairments face additional challenges. The physical impairment can delay the onset of puberty, set the individual apart from peers, cause family to be overprotective, impair the socialization process, and retard psychosexual development (Blum, 1984).
Because the medical needs of this population tend to be the primary focus, mental health issues often do not receive sufficient attention. However, it is important that the psychological needs of this special group of adolescents be understood by clinicians so that effective services can be provided. One way of furthering this understanding is to develop assessment instruments that will identify relevant psychological issues.
Projective tests usually depict able-bodied individuals. Although these tests are often quite effective in addressing more general psychological issues, they may be inappropriate for the physically challenged adolescent. The present article describes the development of a specialized apperception test for physically impaired adolescents who utilize ambulatory-assisting devices. This test seeks to assist those with physical impairments to express their thoughts, feelings, and experiences, which might otherwise remain unarticulated.
DEVELOPMENT OF THE APPERCEPTION TEST
The initial phase of test development involved a review of the literature to identify the major developmental issues facing physically challenged adolescents. The following six areas were identified: body image/identity development, self-esteem, social relationships/interpersonal skills, independence and interdependence, psychological and emotional challenges, and sexuality.
Body Image / Identity Development
Strax and Wolfson (1984) have noted that identity development is tied to body image. Handicapped adolescents must be aware of their particular impairment and how it affects them before being able to develop a stable self-identity.
Identity development may be more difficult for the physically challenged adolescent because of a lack of appropriate role models. Literary masterpieces typically portray those with physical impairments negatively (Thurer, 1980). In a content analysis of 45 books in a middle-school library, Baskin (1974) found that people with physical impairments were depicted as either helpless or extremely gifted. Bogdan and Biklen (1977) reported that children's stories are filled with hunchbacks, trolls, and other deformed characters who frighten people. These portrayals may impact the identity development of handicapped youths.
Studies examining self-esteem in the physically challenged population have yielded different results. A study of children between the ages of 4 and 8 found that the children with cerebral palsy had lower self-concepts than did those in the control group (Teplin, Howard, & O'Connor, 1981). In contrast, an investigation of children between the ages of 9 and 13 found that the self-esteem scores of the children with cerebral palsy were similar to those of the control group (Ostring & Nieminen, 1982). Magill and Hurlbut (1986) examined the self-esteem of adolescents between the ages of 13 and 18 and found some gender-related differences. …