Introduction

Learning disability is a group of heterogeneous disorders in which there are significant difficulties in listening, reading, writing, reasoning, or mathematical skills in one or more area. Learning disability is excluded when there is a co-morbid sensory disability, emotional disturbance, mental retardation, or environmental, cultural, or economic disadvantage [1].

Prevalence of learning disability is ranging from 2 % to 10 % [2]. However, one study in India showed that learning disability prevalence can be as high as 28 % in children referred for psychiatric evaluation [3], reflecting the magnitude of problem and need for help.

It has been reported that learning disability have a high co-incidence of emotional and behavioral problems in childhood and adolescents age group [4, 5] and low self-esteem [6–8]. Children with learning disability have more failures, negative school reports and academic difficulties compared to non-learning disabled children. Academic failure [9], academic difficulties [10] and thus the negative school report are also known to lower self-esteem. Having a child with learning disability is reported to cause stress in the parents [11, 12]. Having one child with learning disability whilst the other sibling is unaffected, may cause differing attitude and behavior towards them. Different behavior and attitude may lead to different level of contentment in relationship with both. Parental behavior has been reported to be associated with child’s self-esteem [13].

Low self-esteem has been reported with a number of psychological, physical, and social consequences. These are further reported to influence violent behavior, successful adolescent development and transition into adulthood. Other consequences reported are anxiety, substance use, depression and even suicide [14–17]. This highlights the need to identify factors affecting self-esteem in children with learning disability at the earliest. These factors can create hurdles for the child’s development, compounding the problems and worsening the self-esteem.

Even after extensive research no study comparing the self-esteem and maternal attitude between children with learning disability and their non-disabled sibling was found. Also comparison with unaffected sibling will be appropriate as they share the same environment.

Hence, this study was undertaken to understand the self-esteem and factors affecting it in children with learning disability and their unaffected sibling as perceived by their mothers.

Material and Methods

This cross sectional study was performed over 3 mo from September through November 2011 after approval by the Institutional Ethics Committee. Mothers of children diagnosed of learning disability were called and offered to participate in the study. These children were diagnosed as having learning disability by multi-disciplinary team comprising of psychiatrist, pediatrician and psychologist. Children fulfilling inclusion criteria (age 8–18 y, no major physical/psychological comorbidities), their sibling (nearest in age, no learning disability/major physical/psychological comorbidities) and mothers (no major physical/psychological comorbidities) were selected. All children were assessed with Rosenberg self-esteem scale. It is a 10 item scale assessing self-esteem. It is a Likert scale ranging from 0 to 3. The total score ranges from 0 to 30. It is a valid (0.85) and reliable (0.83) test [18]. Mothers were asked to fill semi structured proforma with questions covering demographic data, number of academic failures, academic difficulties, and report from school and Index of parental attitude (IPA) for both the affected child and the unaffected sibling. Index of parental attitude (IPA) is a 25 item scale assessing degree of contentment of relationship between the child and the parent. All were having score ranging from 1 to 7. The total score ranges from 7 to 125. It is a valid and reliable test [19]. Mother and children were independently interviewed by Lahane Sandeep and Nagarale Vivek under the supervision of Shah Henal. Difference between groups was analyzed using Chi-square test and Fisher Exact test. Mann–Whitney Test was also used for non-parametric data wherever applicable. Probability (p) value of < or = 0.05 was considered statistically significant.

Results

Mean age for children with learning disability was 13.84, (14 ± 2.31; range 9–18 y). Mean age for children without learning disability was 13.97, (14 ± 4.74; range 6–21 y).

In children with learning disability, there were 22 boys and 9 girls. In children without learning disability, that is the siblings, there were 16 boys and 15 girls. There was no statistical difference for age and sex between the 2 samples i.e. it was an age and sex cross matched sample.

Distribution of families was class 1(9.7 %), 2(67.7 %), 3(12.9 %) and 4(9.7 %), according to Kuppuswamy’s SES Classification. Most of mothers were housewives (87.1 %). Rest were self-employed and semi-skilled workers (6.5 % each).

The total score for self-esteem was lower in children with learning disability compared to unaffected siblings. For learning disability group, mean was 17.87 with SD of 2.26, while for sibling group, mean was 20.65 with SD of 4.06. This was statistically significant (p 0.00).

To gain insight into which issues are differing between the two groups, a comparison was done between the statements of the two groups.

Scores were lower in nine out of the ten statements. One statement revealed a high value, which may be due to the fact that children with learning disability, even with low self-esteem, do not feel themselves useless (Table 1).

Table 1 Rosenberg self-esteem scale statements
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Three statements showed statistically significant difference. These were “when they felt they do not have much to be proud of” and “a fewer number of good qualities”. They were also inclined to consider themselves as failures (Table 1).

Total difference in maternal attitude between the two groups was statistically significant (p 0.00). For learning disability group, mean was 55.06 with SD of 15.38, while for sibling group, mean was 44.39 with SD of 12.68. Higher the score, worse is the attitude.

Index of parental attitude and contentment in relationship was worse for children with learning disability in all except in two domains. In these two domains it was equal; “feeling of hatred toward child” and “the wish that they did not had this child” (Table 2).

Table 2 Index of maternal attitude with significant p values
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Five domains were individually statistically significant. These were when mothers reported that the children were getting on their nerves and interefered with their daily activities. Further they also believed that they did not understand the child nor loved their child and wished their child was more like other children (Table 2).

In other factors according to the mother, number of failures, negative report from the school, difficulties in reading, writing and memory adversely affected child’s self-esteem.

Discussion

Aim of the present study was to compare self-esteem and maternal attitude between children with learning disability and unaffected siblings. Self-esteem was found to be lower in children having learning disability as compared to unaffected siblings. Result corroborates with the findings of previous studies done in which comparison done between student having learning disability and their fellow students in university [6] in school [7] or having co-morbidity, like attention deficit hyperactivity disorder [9]. In the parameter of self-esteem, children with learning disability felt they do not have much to be proud of and have a fewer number of good qualities. They perceived themselves as failures. This was an important finding since the environment was similar for the siblings. This sense of failure comes with experiences in school and at home. This is a modifiable condition. The effect of this can be mitigated by empathy, support and concentrating on strengths [20, 21].

In factors affecting self-esteem, index of maternal attitude was unfavorable; this was also in accordance with the previous studies [12]. Mothers perceived more academic failures; academic difficulties and negative school reports as causing low self-esteem in child when compared to the sibling. Previous studies have also documented similar effects of failures and poor performance [9, 10].

Mothers perceived child was causing stress “my child is getting on my nerves” in them may be the cause of negative attitude towards them in accordance with previous studies [21, 22]. Less contentment in relationship may lead to poor emotional bonding and feeling that the parents do not understand the child. Previous study showed that parents with poor emotional bonding felt they do not understand child [23].

Less contentment in relationship may lead to feeling like parent do not love their child and wished that child was more like others they know of.

Thus, there is a definite difference in maternal contentment which is based on their unfulfilled expectations from their children. Laying a high premium on academics leads to a sense of disappointment. Assessing self-esteem in children with LD is essential as is identifying factors affecting it. Parent should be involved so that there is improvement in the attitude and contentment in the relationship.

Parents should be encouraged to build on child’s strengths rather than focusing on only academic failures reports and weaknesses. This will increase contentment in the relationship and self-esteem of the child. Similarly school report can include remark about child’s strengths. All of these will lead to increase in self-esteem of the child.

Limitations of the study were small sample size and cross sectional design and mothers pre morbid personality was not taken into account. Conclusion can be drawn that self-esteem is lower in children with learning disability. In factors affecting self-esteem, index of maternal attitude is unfavorable and academic difficulties, academic failure and negative school reports are found to be contributory.