Perceptions of children's attitudes towards peers with a severe physical disability.

Despite the existence of a plethora of empirical and anecdotal studies assessing attitudes towards persons with disabilities, the vast majority of these deal primarily with adult perceptions and societal views (Olkin, 1999; Smart, 2001; Yuker, 1988). Harris' (1991) annual poll of American attitudes toward persons with disabilities found the two most common sentiments were admiration and pity. In addition, most Americans surveyed felt that persons with disabilities were fundamentally "different" than those without disabilities. Previous literature regarding societal attitudes in the U.S. and abroad suggest persons with disabilities have historically been perceived as economic burdens (Gallagher, 1995), dangerous (Schmitt, 1999), asexual (Milligan & Neufeldt, 2001; Olkin, 1999), negatively perceived (Antonak & Livneh, 2000; Byrd & Elliott, 1988), helpless/dependent (Livneh, 1991), having sinned and weak (Bickenbach, 1993), and marked for sterilization and/or death (Gallagher, 1995).

Conversely, relatively little has been done with regards to assessing children's attitudes, and available studies in this area have generally focused on preschoolers perceptions of disabilities (Diamond & Hesteness, 1996; Diamond, Le Furgy, & Blass, 1993; Smith & Williams, 2001; Stalker & Connors, 2004). In addition, several studies have shown that both children and adults share similar attitudes or perceptions; for example, having a more positive attitude toward persons with physical disabilities than those with developmental or psychiatric disabilities (Ashman, 1984; Furnham & Pendred, 1983; Woodward, 1995). However, in specifically searching for studies exploring the attitudes of Hispanic children toward disability, no available research was found.

Therefore, the purpose of this pilot study was to explore the differential attitudes of primarily Mexican-American children towards a child with a disability versus a child without a disability. Specifically, this study evaluated the attitudinal responses of Mexican-American children between the ages of eight and 12 years towards a photograph of a 10-year-old girl in a wheelchair and a 10-year-old girl sitting in a kitchen chair. The research questions posed were: a) Are there ethnic differences in children's attitudes toward viewing someone with a presumed physical disability versus someone without a visible disability; b) Is there a gender difference in children's attitudes toward viewing someone with a presumed physical disability versus someone without a disability; c) Are there differences in children responses when shown the photograph of a girl in a wheelchair first versus a girl in a kitchen chair; and, d) What preconceived differences do children have regarding viewing a girl in a wheelchair versus one in a kitchen chair in relation to the perceived number of friends one has, prospective career options, prospective relationship options, perceived causality of their situation, school grades, perceived spare time activities, and perceived skills/deficits.

Relevant Literature

Attitude Defined

Plotnik (1996) defines attitude as "any belief or opinion that includes a positive or negative evaluation of some target (an object, person, or event) and that predisposes us to act in a certain way toward the target" (p. 540). Attitudes have a cognitive, behavioral and affective component which may not necessarily be congruent with one another. Many persons behave in socially desirable ways so as to not draw criticism from members of society. For example, an individual who perceives persons with disabilities as economic burdens to the welfare system (cognition), may be overly cordial and friendly when encountering someone with a visible disability on an elevator (perceived as a behavioral gesture of a positive attitude), however, may have strong negative feelings toward this population (affect).

Wyer and Lambert (1994) define "person perception" as the process by which people form impressions and make judgments about the traits and characteristics of others. These perceptions involve evaluating an individual's physical appearance and rationalizing why an individual looks, dresses, and appears as he/she does. Person schemas are formed where we then attempt to fit an individual into some pre-existing stereotype we have about the population in question. Subsequent to deriving certain formulations with regards to our impressions, we may then behave in certain ways toward such an individual(s).

Problems with Attitude Assessment

Several researchers have focused attention on how attitudes are measured and inherent researcher bias regarding attitude measurement toward disability (Antonak & Livneh, 2000; Wright, 1988). Wright (1988) for example, has criticized researchers studying attitudes toward disability in several ways. She emphasized how researchers tend to make the disability the most salient aspect of the study design without accounting for other factors that help form attitudes such as education, vocation, socioeconomic status, physical appearance, stranger status, etc. Wright further argues how people typically tend to rate relationships with a stranger more negatively than with someone they know, as is often the case in many attitude surveys. She also cited how many attitude surveys have negative loaded questions (e.g., "Should persons with disabilities pay more for auto insurance?") which carries a negative connotation regarding the driving abilities of persons with disabilities. Finally, Wright argues that researchers focus on obtaining statistically significant results pertaining to the differences between those with/without disabilities in order to publish their findings. Conversely, the belief that non-significant findings may not be publishable can lead researchers to discard such results; a practice which Wright argues negates the similarities between persons with/without disabilities. Similarly, Antonak and Livneh (2000) have been critical of the over 40 attitude surveys in terms of their reliability, validity, negatively laden questions, and overt surveys on attitudes where respondents reply in socially desirable ways. They advocate for surveys that have been shown to be reliable and valid, are multidimensional, balanced in terms of positively and negatively worded questions, and do not overtly assess disability attitudes.

Literature on Children Attitudes Toward Disability

One of the earliest studies on children attitudes toward disability found that younger children held less realistic opinions of children with physical disabilities than those held by older students (Rapier, Adelson, Carey, & Croke, 1972). Specifically, Rapier et al. found that as participants increased in age, their ability to assess the capabilities and strengths of children with disabilities was more positive. Participants in a 6th grade study generally reported that children with physical disabilities needed minimal assistance, were curious, friendly, and possessed the ability to work quickly. The younger group of 4th graders participating, however, reported that children with physical disabilities were very curious, friendly, and required lots of assistance. Similarly, Diamond, Le Furgy, and Blass (1993) found that more positive opinions of a boy in a wheelchair were given as the age of the participants increased in terms of capabilities and friendliness.

When considering functional abilities as opposed to traits, Diamond and Hesteness (1996) found that preschools were able to correctly identify areas of functional impairment for individuals with a physical or visual disability pertaining to mobility difficulties. Similarly in an earlier study, Diamond et al. (1993) reported that children as young as three years of age did not discriminate against gender or presence/absence of a disability when choosing a playmate; however, at four years of age, children do begin select a student to play with based on gender and the presence of a disability as factors in making their choice. Smith and Williams (2001) also reported similar findings to Diamond and Hesteness (1996), however, Smith and Williams observed that children as young as four years were able to differentiate abilities affected by emotional/behavioral disabilities as opposed to physical disabilities. Furthermore, Smith and Williams (2001) reported that the participants were able to differentiate between the types of disabilities more accurately as age increased. Their findings were similar to those of Rapier et al. (1972) in that younger children held less realistic perceptions of their classmates with severe physical disabilities.

Roberts and Smith (1999) reported that participants from their study held negative attitudes towards children with disabilities in areas that were not affected by the impairment. Smith and Williams (1999) also found that non-disabled preschoolers perceived that persons with physical disabilities were also believed to have cognitive disabilities as well. Wright (1983) referred to this as "spread phenomenon" whereby one aspect of an individual's disability permeates all aspects of his/her life.

Differences in attitudes based on gender and disability have also been reported, generally indicating that girls possess a more positive attitude toward disability than do boys (Archie & Sherrill, 1989). Rapier et al., for example found that boys viewed children with disabilities as requiring more assistance and were perceived as unhappy, yet reported that the children with disabilities were more social. Conversely, girls perceived that children with disabilities required less assistance or help, but did not perceive them as interesting or as friendly. Interestingly, Archie and Sherrill (1989) found that girls were more open to choosing a child with a disability as a friend, and were also more likely view the children as requiring less assistance. Finally, Diamond and Hesteness (1996) in their study of preschool students and attitudes toward deafness, found that significantly more girls responded that they would befriend someone with a hearing impairment.

Researchers have also attempted to understand how children identify an individual as being disabled and what they believe to be the cause of various types of disabilities. Diamond (1993) found that two-thirds of the preschoolers in her study provided some type of explanation as to why a child had a disability. She hypothesized that the rationalization of the children could be grouped into three categories: in reference to the age of the child, the assistive devices used, or an accident of some traumatic type to the individual. In a similar study, Stalker and Connors (2004) studied the perceptions of children whom had siblings with disabilities and what the able-bodied sibling attributed as the cause of his/her sibling's disability. Common themes centered around medical complications, negligence, or for spiritual reasons including punishment for having sinned.

Overall, available literature regarding children attitudes toward disability may begin to be formulated as young as age three. Children appear to be able to differentiate between functional abilities with some accuracy despite some evidence of the spread effect, and perceptions of abilities improve with the age of children surveyed. In addition, girls seem to possess a more positive attitude than boys toward children with disabilities, despite the fact that this is not exclusively bore out in the literature. The current study explored primarily Mexican-American children's attitudes toward a Mexican-American girl with a perceived physical disability and a Mexican-American girl without a disability.

Method

Participants

Study participants were 30 elementary school students between 8-12 years of age from a school in South Texas. Twenty-one or 66% of the 30 students were of Hispanic origin, seven were White, and two were Asian. Gender was almost evenly split with 16 girls, and no students reported having a disability.

Procedure

The authors obtained approval from their university institutional review board regarding the use of human participants. The study involved deception of the children and their parents, in that parental approval letters indicated the children would be participating in a study that was going to assess their attitudes toward other children. No mention of disability was provided at the time in order to minimize the impact of any pre-interview discussions between students, their parents, or teachers regarding persons with disabilities. This was done in an effort to reduce potential contamination effects or bias from forming newly influenced opinions. A full debriefing, however, was provided following the study.

Investigators used a digital camera and took 16 pictures (eight each) of two Hispanic 10-year-old girls with very similar physical features except one was sitting in a wheelchair while the other was sitting in a regular kitchen chair. Investigators selected one picture of each of the two girls, specifically looking for a neutral facial expression (e.g., not smiling or frowning). Both girls' pictures were taken with a neutral background, and both were dressed in jeans, a T-shirt and running shoes.

Students were recruited from the fourth and fifth grade classes via teachers handing out parental informed consent forms which also included a general explanation about the study's purpose. Three forms were provided in both English and Spanish pertaining to purpose of the study, informed consent to participate, and informed consent to audiotape student responses. Students who returned with completed consent forms were forwarded to investigators for interview. The first author then visited the school on two separate occasions after having first coordinated with the principal days/times and room availability for interviewing. Students were scheduled to be interviewed in 15 minute intervals. A tape recorder was used for open-ended questions to be later analyzed for inter-rater reliability of categorized responses. There were 17 questions in all, however, open-ended questions allowed the investigators to follow-up with additional questions when certain responses were obtained.

All students viewed both photographs of the child in a wheelchair and the other in a kitchen chair. The order with which photographs were presented was deemed important in potentially influencing the participant's perceptions of the second photograph. As such, presentation order of the photographs was randomly assigned whereby some students viewed the girl in the wheelchair first followed by the girl in a kitchen chair, and vice versa. As discussed later, investigators factored this variable into their statistical analysis. Finally, all interviews were recorded for review regarding accuracy of interpretation and latter reviewed by the authors for inter-rater reliability.

Instrument

The survey developed for the current study was primarily designed based on hypothesized societal attitudes regarding persons with physical disabilities. Neutrally worded questions pertaining to ability to work, rear children, get married, go to college and perceived skills were some of the questions posed to participants. A 17-item semi-structured questionnaire (open-ended and yes/no response type questions) was developed by the authors. Three questions were also in a binomial format where students could only give one response or another. Seven other questions were open-ended and allowed students the option of answering however they wished. The two remaining questions were checkmark type responses with four options. One question specifically asked if the student knew someone in a wheelchair and to identify the relationship to that person. In conforming with Antonak and Livneh's (2000) as well as Wright's (1988) recommendations for attitude scale development, questions were all neutrally worded so as to not perpetuate a negative bias. In addition, survey items did not overtly address disability, thereby hopefully minimizing socially desirable responses. Contrary to Wright's recommendations, however, the wheelchair was intentionally made the most salient feature of the photograph differences. Other then the photograph, no other additional information was provided about either photographed girls.

The questions created for the survey were developed primarily from psychosocial literature regarding societal attitudes toward persons with disabilities. Overall, questions dealt with whether the girls in the photographs attended regular or special education classes (spread concept of physical disability to include cognitive ability); what activities participants felt they could do better or worse than the girls in the photographs; why the girls in the pictures were in their situations (punishment for having sinned); whether the girls appeared happy, sad, worried or angry (requirement of mourning); what the girls thought about and did in their spare time (dwell on being cured/walking); how many friends the girls likely had (social isolation); whether the girls would work when they got older (perception of being incapable or helpless), and if so, what kind of career (perceived cognitive ability--spread); whether the girls would likely get married (asexual--social desirability); whether they would likely go to college (cognitive spread effect); and whether participants felt either of the photographed girls had done something wrong (punishment for having sinned). Questions were intentionally vague so as to not influence participant responses in any way. The analyses used for the study included binomial tests and chi-square as well as frequency data using SPSS 11.0 version software.

Results

Descriptive Statistics 

This pilot study represents a first in assessing primarily Hispanic elementary student attitudes toward a Hispanic peer with a perceived visible physical disability. Sixty-six (n = 21) of the 30 participants were Hispanic, seven were White (23%), and two were Asian (6%). Student age groups ranged between ages 8-12 of which 16 were girls. Twenty-five (83%) reported being born in the United States, four were born in Mexico, and one other. English was reported as the first language for 13 (43%) of the students, Spanish was the first language for 10 (33%) of the students, and seven reported being bilingual.

Quantitative Statistics

For purposes of description, the girl who appeared in a wheelchair in the photograph is designated as (W) and the girl not in the wheelchair (NW). The questions with primarily yes/no type responses were subjected to binomial tests regarding participant responses to viewing the photograph of the child sitting in a wheelchair and the child sitting in a kitchen chair. Chi-square analyses were conducted with multiple response type questions as explained later. In order to capture all possible effects for this pilot study, no correction adjustments were made to control for Type I error.

Gender differences. The first such question was "Do you think the girl in the photo usually passes or fails her courses?" All 30 students indicated W usually passes her courses (two-tailed, p <.05), whereas five males and four girls indicated NW usually fails her courses (p < .05). The next binomial test question was "Do you think she takes regular classes or special-education classes?" Results were non-significant between males viewing both photographs with five out of 14 males believing W was in special-education and five out of 16 girls believing the same. However, 14 out of 16 girls responded significantly noting that NW was in regular education (two-tailed, p < .05), suggesting that girl participants may have perceived the girl in the wheelchair as possessing a mental disability as well.

Regarding the question "Do you think this girl will work when she gets older?", both genders scored statistically significant in that they believed both photographed girls would work when they were older (two-tailed, p <.05). Similarly, the question "Do you think this girl will be able go to college?", both genders overwhelmingly agreed that both photographed girls would be able to go to college (two-tailed, p < .05). Approaching statistical significance was the question "Do you think this girl has ever done anything wrong?", where six of the 16 girls believed W had done something wrong and 12 out of 16 believed NW had done something wrong. Finally, regarding the question "Do you think this girl will ever get married and have a family?", both genders statistically significantly agreed that both photographed girls would get married and have a family (two-tailed, p < .05).

Ethnic Differences. In exploring ethnic differences of opinion, the sample was collapsed into Hispanic students (n=21) and non-Hispanic students (n=9). Both groups significantly agreed that both photographed girls would be able to attend college (two-tailed, p< .05). Opinions were not as clear-cut regarding the question as to whether each photographed girl was passing their courses. All Hispanic students believed the girl in the wheelchair was passing her courses, but only 14 of 21 believed NW was passing her courses. The same occurrence was found among non-Hispanic students as all nine believed W was passing her courses compared to seven of nine after viewing NW. This finding occurred regardless which photograph the students were shown first (two-tailed, p < .05).

Regarding the question as to whether the photographed girls would work when they became older, all Hispanics students indicated W would, compared to 19 of 21 for NW. Among non-Hispanic students, eight of nine believed W would work and only five of nine opined NW would work. The question dealing with whether either girl had ever done anything wrong, non-significant results were found, although eight of 13 Hispanic students believed W had done something wrong versus 15 Hispanic students who believed NW had done something wrong. This finding either nullifies the disability as having sinned belief or students may have viewed W in a more angelical light as is sometimes found in the literature (Olkin, 1999). Finally, both Hispanic and non-Hispanic students agreed that both photographed girls would marry and have a family (two-tailed, p < .05). No other significant ethnic difference between questions was found.

Age Differences. In this analysis, eight and nine-year-olds were collapsed into one category, and 10-12-year-olds were collapsed into another. In analyzing the question as to whether both photographed girls would work when they got older and separately be able to go to college, both groups by age statistically significantly agreed that both girls would be able to pursue these options (two-tailed, p < .05). Statistical significance was noted with the question as to whether either photographed girls passed or failed their courses. All 15 of the eight and nine-year-olds indicated W passed her courses, whereas only eight of 15 indicated NW passed her courses. Among the older age group, all 15 believed W passed her courses, and 13 of 15 believed NW passed her courses. Non-significant differences were noted between groups in response to the question as to whether or not either photographed girl was in special-education.

Chi-square Results

Three questions were subjected to chi-square analysis in relation to ethnicity, age and gender. The first looked at gender differences in response to whether the photographed girls appeared to be happy, sad, angry or worried/scared. There were no statistically significant differences in perceived emotions for NW despite the fact that five of 14 male and five of 16 girls believed NW appeared sad. However, eight male, [chi square] (3, n = 8) = 8.28, p <. 05 and 11 girls [chi square] (2, n = 11) = 9.87, p <. 05 respectively perceived W to be happy. When age was considered regarding perceived emotions of the photographs, only the older age group's responses were statistically significant in identifying W to be happy (n = 10) compared to viewing NW as happy (n = 4), [chi square] (3, n = 15) = 14.6, p <. 05.

Regarding ethnicity differences in the photographed girl's perceived emotions, only the Hispanic students scored statistically significant in relation to viewing W as happy (n = 12) as opposed to NW, where only three viewed her as happy, six as sad, and nine as worried [chi square] (3, n = 21) = 13.09, p < 05. One final significant ethnic difference was the Hispanic students believed the girl wheelchair user had fewer friends than the non-disabled girl [chi square] (3, n = 21) = 10.05, p < 05.

Finally, there were no significant differences between groups regarding which photograph they were presented with first across age, gender and ethnicity. Likewise, there were no differences between students who previously knew of someone with a disability (in a wheelchair) versus those students who did not know someone.

Qualitative Statistics

There were also several questions which required follow-up open-ended questions from investigators that were tape-recorded and reviewed for inter-rater reliability (97%). Responses were categorized based on the frequency of response, and similarly recorded responses were classified in each category after being agreed upon. In response to the question regarding what participants believed they could do better than the two photographed girls, 20 out of 30 expressed being able to perform some physical activity (i.e., walk, sports) better than W because "she is in a wheelchair." Conversely, when asked what the photographed girls could do better than respondents, only four believed W had better academic skills compared to 12 who believed NW was better academically. When asked why respondents thought the girls were "in their situation", 27 of 30 responded that W was in her situation because of some type of accident, primarily motor vehicle. A follow-up question as to why respondents believed the photographed girl was either happy, sad, angry or worried, 13 and 22 respectively for W and NW perceived this from their facial expression, and 11 respondents re: W stated that either she was sad "because she was in a wheelchair" or happy "because she is still alive and has family and friends."

When asked what participants perceived the photographed girls thought about in their spare time, 16 of 30 suggested W thought about "being able to walk again" or "dreamt about walking." Eleven participants also believed W spent most of her day "watching TV" or "doing her homework." Finally, when asked what question they would most like to ask the photographed girls, 19 were curious as to how W "came to be in a wheelchair."

Discussion

Overall, some of our findings essentially affirm previous attitude assessment results as well as psychosocial theory, however, other findings represent interesting new ideas about the population tested. The fact that this appears to be a first-time study of 812 year old primarily Hispanic students regarding their attitudes toward physical disability bordering Mexico also carries some implications. Mexican culture as well as other minority group studies have shown these to be collectivistic groups in that the needs of the family comes first before the needs of the individual (Sue & Sue, 1999). In addition, Mexicans tend to be a dignified, respectful and religious people. Some of these beliefs may have influenced student opinions here.

First, it appears that the vast majority of students in this age range are essentially being schooled with students with disabilities largely as a result of mainstreaming legislation. As such, it is not surprising for our results to show that the majority of students when analyzed by age, ethnicity and gender difference believed the girl in the wheelchair would likely work, marry, have a family, and attend college. Conversely, some students (33%) believed W was in special-education which would support Wright's (1983) concept of the "spread" phenomena whereby these students believed the girl's physical disability also implied a mental disability existed as well. This conflicted somewhat however with the finding that all students believed W was passing her courses compared to NW where only 66% believed she was passing her courses. Of course if some believed W was in special-education, this would tend to answer the discrepant opinions as to how NW was better academically in some instances but not others.

In attempting to explore the concept of disability for having sinned, twice as many girl respondents (12) believed NW had done something wrong. Although this only approached statistical significance, results suggest that W was perceived more innocently than NW among the girls. In addition, the question itself was open for interpretation by respondents, so it was difficult to assess what frame of reference they were using as well as their interpretation of what having done something wrong actually meant. Finally, the majority of students believed W spent much of her time thinking about walking. The perception that people in wheelchairs dwell on or think about being cured is not uncommon in society and has previously been demonstrated elsewhere (Grayson & Marini, 1996). In addition, almost 60% of the students stated that if they could ask W one question, it would be how she came to be in a wheelchair. This natural curiosity has been validated in numerous studies concerning interaction dynamics between persons with/without disabilities. Although many persons with disabilities have indicated they would rather not discuss their disability unless otherwise asked about it, studies show that non-disabled persons want to know what happened and would rather have such information volunteered (Comer & Piliavin, 1975; Evans, 1976; Fichten, & Bourdon, 1986).

Overall, it appears that the majority of students in this study held more positive or at least optimistic attitudes toward the girl in the wheelchair regarding her academic, career and personal future. Mainstreaming and the Americans with Disabilities Act may well be having a direct impact regarding greater exposure to persons with physical disabilities and minimizing the anxiety and uncertainties of interacting with this population. The implications for rehabilitation counselors may simply be to assure clients who feel discriminated against that attitudes appear to be becoming more acceptable among younger generations as well as polls of adult Americans (Harris, 1991). For rehabilitations educators, continued vigilance in dispelling myths that persons with physical disabilities dwell on being cured or walking again would be prudent. Counselors may otherwise make the disability salient by imposing their own beliefs and bias which can interfere with the counseling process (Grayson & Marini, 1996).

Study Limitations

The present study represents a convenience sample of students from specific classes from one fairly progressive and well funded school in South Texas. Relatedly, was the much smaller comparison group re: ethnicity/race. Perhaps future research could involve larger populations of children more evenly representing various ethnic/racial groups from different schools in different states. Our results therefore, do not generalize well to the population at large.

A final limitation pertains to whether the decision to use two girls vs some other gender combination would have yielded different results. Future studies could explore gender differences as well as age and/or disability differences as well. In this instance, a decision was made to have as much in similar as possible thereby leaving the wheelchair as the most salient factor.

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Leonel Longoria

University of Texas Pan-American

Irmo Marini

University of Texas Pan-American

Irmo Marini, Dept. of Rehabilitation, The University of Texas-Pan American, 1201 W. University Drive, Edinburg, TX 78541. Email: [e-mail].