Investigation of tactile defensiveness and self-esteem in typically developing children

Headnote

Abstract: The purpose of this study was to explore the relationship between tactile defensiveness and self-esteem in typical children attending a state school. Thirty-two children aged 8-11 were administered the Touch Inventory for Elementary School Aged Children to measure tactile defensiveness, and the Piers Harris Self Concept Scale to measure self-esteem. A Spearman rank order correlation coefficient revealed a negative correlation (-0.429) which was statistically significant (p=0.014). These findings suggest that there is an inverse relationship between selfesteem and behaviours associated with tactile defensiveness in elementary-schoolaged children. Continued research in this area is recommended.

Headnote

Key words: tactile defensiveness, self.esteem, sensory integration.

Introduction

Tactile defensiveness is characterized by aversive or negative responses to non-noxious stimuli, avoidance of touch and `atypical affective responses to non-noxious tactile stimuli' (Royeen and Lane, 1991, p.112). Feelings of physical discomfort or emotional stress and a desire to escape the situation are often experienced. Tactile defensiveness can interfere with learning and perceptual motor abilities, but the major implications may be in the area of behaviour (Larson, 1982). Common behaviours associated with tactile defensiveness include, but are not limited to, negative reactions and/or withdrawal to touch, increased motor responses and aggressive behaviours such as excessive fighting (Sears, 1981).

Ayres (1979) concluded that the neural mechanisms associated with tactile defensiveness have an impact on emotions and that a child who is tactually defensive can be emotionally insecure. Further, `tactile defensiveness may be a predisposing factor for irregular emotional tone, lability, and an extreme need for personal space' (Wilbarger and Royeen, 1990, cited in Royeen and Lane, 1991, p.113). Age-appropriate social interaction can be difficult for a child with tactile defensiveness as discomfort and fear of touch can reduce the child's ability to interact with peers in a carefree manner (Sears, 1981). At the same time, peers may not understand the reason for these behaviours and may withdraw from a child with tactile defensiveness.

Clinical experience suggests that children with sensory integrative disorders are more apt to have low self-esteem. A child `may realize that in some ways he will always be different ... he is apt to grow up thinking that he is stupid or bad' (Ayres, 1979, p.10).

Since parents, peers and teachers may not understand behaviours associated with tactile defensiveness, life with a child who demonstrates these behaviours can be difficult. 'A vicious circle of negative self concept, unpleasant behavior, and negative reactions by others keeps the child in misery' (Ayres, 1979, p.57). In spite of these theoretical foundations linking tactile defensiveness and psychosocial difficulty, little empirical work has been done to explore these relationships. The current study will explore tactile defensiveness and self-esteem in children.

Statement of need

Touch is a vital component for survival. It warns us of danger and helps us to form intimate relationships with others. Many bodily functions depend on touch, including motor activity, motor planning and perceptual ability. `Finally even emotional and social stability is highly dependent upon tactile sensations' (Royeen, 1987, p.46). Disorders of tactile processing can be very disruptive to a child. A child with tactile defensiveness places as great a distance as possible between the stimulus and himself or herself; experiences fear of pain from tactile stimulation; and encounters a great deal of anxiety about being touched (Ayres, 1964). Clinical experience reveals that in order to maintain some control and to avoid feelings of pain associated with tactile stimulation, children will often avoid contact with textures that evoke discomfort and pain, often including contact with family and peers.

Conner (1994) suggests that the drive for social acceptance is as strong as many biological drives. According to Conner (1994), children with high selfesteem find it easier to make friends and to be accepted into peer groups. He goes on to suggest that social and behaviour problems may be associated with failure to develop peer relations. Thus, low or poor self-esteem may be associated with poor peer relations. La Greca and Stone (1990) found that children with learning disabilities were less accepted and less well liked than other children, and that their self-worth (self-esteem) was low.

Literature review

Tactile defensiveness is a syndrome defined by `feelings of physical discomfort and a desire to escape the situation when certain types of tactile stimuli are experienced' (Ayres, 1964, p.8). It is characterized by a deficit in processing tactile perception, by hyperactivity, distractibility, and by defensive and often aggressive responses to tactile stimulation (Ayres, 1964). Excessive emotional reactions and other behavioural problems are commonly associated with tactile defensiveness (Ayres, 1979). This disorder is often seen in individuals with autism, mental retardation, and in children with developmental delays (Larson, 1982; Royeen, 1985; Baranek et al., 1997).

Different theories exist regarding the aetiology of tactile defensiveness. Ayres (1964) postulated that there was an imbalance in the two touch systems in which the epicritic system was not inhibiting the protopathic system, resulting in an `overly protective or defensively oriented individual' (Royeen, 1992, p.7). An imbalance in the tactile system may result in `predominance of the behavioral response system designed for protection and survival ... which may help to explain emotional lability and variations in degree of tactile defensive reactions at any moment within a child' (Larson, 1982, p.592). Fisher and Dunn (1991) proposed that tactile functions are regulated at the spinal-cord level and that this modulation is dependent on higher levels in the central nervous system, especially the reticular activating system. In tactile defensiveness it may be that there is inadequate modulation from the higher brain centres, which cannot effectively integrate information at the level of the spinal cord (Royeen and Fortune, 1990). This theoretical basis for tactile defensiveness remains unclear and needs further development.

Recent literature suggests that tactile defensiveness is one component within the broader category of sensory defensiveness (Knickerbocher, 1980; Royeen and Lane, 1991). Sensory defensiveness is a generalized condition indicating an increased responsivity across multiple sensory systems, not just the tactile system. For the current paper, only a targeted focus on tactile defensiveness will be addressed. The larger issue of sensory defensiveness will not be addressed so that the scope of the investigation is appropriately limited. The reader is referred elsewhere for instrumentation or consideration of more global measures of sensory processing (Dunn and Westman, 1996; Dunn, 1997; Dunn and Brown, 1997).

Self-esteem is defined as `the ability to regard one's self as competent' (Pratt et al., 1989, p.30) and `social acceptance by people who are important to us' (Mayberry, 1990, p.730). Self-esteem is also considered a key aspect of psychological functioning (King et al., 1989). In paediatric practice, the construct of self-esteem is used by occupational therapists as either an explicit or implicit treatment goal for children having almost any problem (Mayberry, 1990).

King et al. (1989) found that among a group of adolescents with cerebral palsy, spina bifida and cleft palate, females demonstrated low scores in social acceptance, athletic competence and romantic appeal, whereas males had low scores in scholastic competence, athletic competence and romantic appeal - all of which contribute to self-esteem. Clinical experience suggests that the abnormal motor behaviour associated with cerebral palsy can interfere with the child's ability to develop self-concept and that needs, feelings and physical abilities may be impaired, thus contributing to low self-esteem. Brooks (1994) suggests that children with attention deficit hyperactivity disorder (ADHD) and learning disabilities are at risk for developing low self-esteem. Children diagnosed with ADHD, oppositional defiant disorder and conduct disorder were described by Grizenko et al. (1993) as having common secondary problems such as low self-esteem. Yet, after treatment in a multi-dimensional programme, the children reported `higher self-esteem, lower depressive affect, and an improved outlook on their future' (p.132). Considering the constructs of tactile defensiveness and self-esteem concomitantly, the current pilot investigation was designed to explore whether the presence of behaviours associated with tactile defensiveness is correlated with self-esteem.

Hypothesis

The null hypothesis was applied, stating that there is no statistically significant relationship between degree of tactile defensiveness and self-esteem. The alternative hypothesis is that there will be a statistically significant relationship between degree of tactile defensiveness and self-esteem among a population of typical children attending public school.

Measurement tools

The Touch Inventory for Elementary School Aged Children (TIE) (Royeen and Fortune, 1990) is a screening tool to rate the degree of behaviours associated with tactile defensiveness. It is used with children from 6 to 12 years of age, who have the language competency of a 6-year-old, an IQ of at least 80 and who demonstrate no physical disabilities (Royeen and Fortune, 1990). The authors of the TIE assumed that there are stereotypical responses of tactile defensiveness and that this Likert scale test measures the degree of behaviours associated with tactile defensiveness. The TIE has established validity (Royeen, 1985) and reliability of 0.80 (Royeen, 1986; Royeen, 1987; Royeen and Fortune, 1990) and 0.91 (Bennett and Peterson, 1995).

The Piers Harris Children's Self-Concept Scale (Piers, 1984) is an 80-item, self-report measure used to determine children's feelings about themselves. It is intended to be used with children and adolescents aged 8-18 years of age. The inventory is not recommended for use with children who are `overtly hostile, uncooperative, uncommunicative, prone to distortions, or disorganized in their thinking' or with children with low verbal ability, or with moderate to severe mental retardation (Piers, 1984, p.3). Although no validity or reliability data were available, the Piers Harris is a commonly used test in practice and research (Zimmerman et al., 1987).

Research design

Sample

Three-hundred-and-fifty letters including informed consent and a description of the study were sent to parents with children in the third to fifth grades attending Rocky Mount Elementary School in Rocky Mount, Virginia. The parents were asked to return the consent forms to the teachers through their children. Thirty-nine consent forms were returned. On the day of testing, seven children were absent from school, so the sample consisted of 32 children in the third, fourth and fifth grades (ages 8-11). Of those children, 20 were male and 12 were female. The mean age of the sample was nine and the median grade was the fourth.

Methods

A pilot study was conducted using a sample of five children similar to those in the actual study to validate procedures and methods. The children were administered the modified version of the TIE and the Piers Harris Scale. A few modifications (gathering of demographic data; which test to administer first) were made prior to beginning the actual study to make the data collection run as smoothly as possible.

The TIE was administered in an adapted form suitable for use with an entire class rather than each child individually. Each child had their own response sheet numbered 1-26 with optional responses of 'no', 'a little' or 'a lot' for each question. The test administrator read each question aloud and gave every member of the class time to respond. Other test procedures, scoring and interpretation were followed as outlined (Royeen and Fortune, 1990). Administration and scoring procedures as outlined in the manual were followed (Piers, 1984).

Actual data collection occurred in the cafeteria of the elementary school. The children were assembled, given pencils and instructed to listen to all directions. The first author of this study and a research associate administered the assessments to the entire group of children at the same time.

The TIE was administered first. The total time to administer the TIE was about 10 minutes. After administration of the TIE was completed and collected, the Piers Harris Scale was administered. The test took about IS-20 minutes to administer.

Data analysis

A scatterplot confirmed that a linear relationship existed between the scores from the TIE and those from the Piers Harris Scale. The Spearman rank order correlation coefficient was calculated to examine the correlation between test scores. A two-tailed test of significance was applied since the data analysis could have led to a rejection of the null hypothesis in either a positive or a negative direction (Portney and Watkins, 1993).

Results

A scatterplot revealed that the relationship between scores from the TIE and Piers Harris Scale was in a negative direction. The Spearman rank order correlation coefficient was calculated to examine the correlation between test scores. Nonparametric data analyses such as the Spearman make few assumptions about population data and accept data from small samples (Royeen and Seaver, 1986; Portney and Watkins, 1993). The sample used in this study was small and was not chosen in a random fashion, so it therefore best fitted the criteria for the Spearman rank order correlation coefficient. A negative correlation (-0.429) was found, which was statistically significant (p=0.014). The null hypothesis was therefore rejected.

Discussion

The results of this study demonstrated that, with this sample of children, an inverse relationship exists between scores from the TIE and the Piers Harris Scale. This evidence suggests that there is a statistically significant relationship between the degree of behaviours associated with tactile defensiveness (measured by the TIE) and low self-esteem (measured by the Piers Harris Scale). This relatively simple correlational study reveals a profound relationship between a sensory integrative disorder (tactile defensiveness) and psychosocial processing (self-esteem). Further investigation and replication is needed to validate this finding over time and across settings. However, this preliminary study does support the theoretical link between sensory integrative process and psychological/emotional development in children.

Clinical applications

The goal to improve self-esteem is often seen in a paediatric treatment plan (Mayberry, 1990). Various researchers have suggested that information about self-esteem in individuals with disabilities can be used by occupational therapists to help clients determine what is important in their lives, as well as to improve self-esteem and overall functioning (Mayberry, 1990; Magill-Evens and Restall, 1991). Results from this study indicated the need to address self-esteem with children who are tactually defensive. This, in turn, may improve a child's overall functional performance. Modifications can be made to the child's environment so that he or she has more control over tactile experiences. `As the child begins to trust his environment and relax with his classmates, he may slowly "gravitate" into closer physical proximity with them and eventually become a part of the group' (Sears, 1981, p.568). This gradual acceptance by peers and better understanding of special needs from parents and teachers may lead to increased selfesteem. Self-esteem issues can be addressed during treatment as part of sensory integration therapy. It has been assumed that an increased self-esteem will help a child participate more fully in group activities, improve academic performance, and eventually affect all other aspects of the child's life.

Delimitations

The sample size was small and limited to children in one geographical area. The TIE was modified to use with a group of children instead of individually.

Future research should include reliability analysis of the Piers Harris Children's Scale.

Acknowledgments

This research was conducted in partial fulfilment of the Master of Science degree in occupational therapy at Shenandoah University in Winchester, VA, for the first author.

The pioneering work of Dr Ayres is acknowledged as the impetus behind this research.

References

References

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