Research Article

Childhood Educational Experiences of Women

With Cerebral Palsy
Donna Freeborn, PhD, FNP-BC, CNM, and Barbara Mandleco, PhD, RN

The purpose of this study was to examine the childhood experiences of women with cerebral palsy (CP), from the
perspectives of these women. Using the feminist biographical method, eight women with CP participated in two in-
depth interviews. Participants ranged in age from 22 to 55 years and had moderate to severe athetoid or spastic CP.
Four themes emerged: (a) academic experiences, (b) experiences with teachers, (c) experiences with peers, and (d)
coping methods, with both positive and negative subthemes for each theme. Participants with positive academic
experiences and positive interactions with teachers and peers were able to develop better ways of dealing with the
negative experiences they encountered in education and attained higher levels of education. Participants who pri-
marily had poorer educational experiences developed negative coping mechanisms that continued to affect their
lives. Findings support ways in which school nurses can support the educational experiences of students with CP.

Keywords: special education/disabilities; elementary; middle/junior/high; school; qualitative research

Cerebral palsy (CP), a nonprogressive condition
present from birth or infancy, includes various
neurological patterns of dysfunction including
spastic, athetoid, ataxic, or mixed movement pat-
terns. CP may affect all four extremities (quadri-
paresis), only the lower extremities (diaparesis),
or only one side of the body (hemiparesis). It is
characterized by abnormal motor control and/or
posture and may also involve communication
difficulties (Kuban et al., 2008; Turk, Scandale,
Rosenbaum, & Weber, 2001; Wichers, Odding,
Stam, & Van Nieuwenhuizen, 2005).
Children with CP grow up facing issues
not encountered by children without disabilities
(Harrison, 2003). These issues include mild to
severe physical limitations, poor socialization,
limited recreational activities, and stigmatization
(Green, 2003; Lepage, Noreau, Bernard, &
Fougeyrollas, 1998; Pimm, 1996). Stigmatization
is the social disapproval of an individual or group
whose appearance or behavior is not consistent
with mainstream society. The stigmatization
associated with CP is lifelong; it affects not only
the person with CP but also his or her family, edu-
cation experiences, work environment, and even
society in general (Green, 2003; Green, Davis,
Karshmer, Marsh, & Straight, 2005; McLaughlin,
Bell, & Stringer, 2004; Mweshi & Mpofu, 2001).
‘‘The stigmatization associated with CP is lifelong; it
affects not only the person with CP but also his or her
family, education experiences, work environment, and
even society in general.’’
Donna Freeborn, PhD, FNP-BC, CNM, is an assistant professor
in the College of Nursing, Brigham Young University, Provo, UT, USA.
Barbara Mandleco, PhD, RN, is a professor in the College of
Nursing, Brigham Young University, Provo, UT, USA.
JOSN, Vol. 26 No. 4, August 2010 310-319
DOI: 10.1177/1059840510369112
# 2010 The Author(s)

310
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Although it is clear stigmatization toward
disabled individuals occurs, little is understood
about its impact on the educational experiences
of these individuals, which includes being
excluded from activities, being physically or emo-
tionally mistreated, and being denied appropriate
accommodations (Green et al., 2005). These
negative educational experiences are important
to understand because the socialization experi-
ences and cognitive gains that occur in educa-
tional settings assist the transition to adulthood
(Kingston, Hubbard, Lapp, Schroeder, & Wilson,
2003). Sadly, negative educational experiences for
students with disabilities can cause them to lower
their educational expectations. This is especially
true for females who are more affected by negative
feedback they received during educational experi-
ences than males; consequently, many females
with a disability internalize a belief that they are
inferior to other girls (Crosnoe, Reigle-Crumb,
& Muller, 2007).
However, there is little information on the edu-
cational experiences of women or girls with CP,
even though some studies have explored various
aspects of school experiences of children with
CP. For example, Nadeau and Tessier (2009)
compared social acceptance by peers of school
children with or without CP in four categories,
based on their birth history: preterm delivery with
CP, preterm delivery without CP, term delivery
with CP, and term delivery without CP. Findings
indicated girls with CP, whether preterm or term,
scored consistently lower than boys in all aspects
of social acceptance, including being liked and
having friends, no matter the boy’s birth history.
They also scored highest on being disliked and
being victimized when compared to boys. It is
interesting to note, however, that boys with CP,
whether preterm or term, scored similarly to boys
without CP in each area. No explanations were
provided to explain why the girls with CP scored
lower than the boys.
In another study, Schenker, Coster, and Parush
(2005) compared participation levels of normally
developing students, students with CP who were
in regular classrooms, and students with CP who
were in self-contained classrooms. Except for
snack and meal time, in which participation levels
were similar for all groups, both CP groups scored
significantly lower in all areas of participation
when compared to their typically developing
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Vol. 26 No. 4, August 2010 311
peers. The lowest participation scores for students
with CP were for recess. However, classroom par-
ticipation levels for these same students with CP
who were in regular classrooms were significantly
lower than typically developing students. Indeed,
this study suggests simply mainstreaming students
with disabilities such as CP into regular classes
does not guarantee their participation levels in
academic and school activities will be the same
as typically developing peers.
Davis et al. (2009) found social well-being,
acceptance, participation in activities, and getting
on well at school were important factors in deter-
mining how adolescents with CP rated their qual-
ity of life. Not surprisingly, the adolescents
wanted to be valued and did not want their CP
to interfere with being accepted by peers. They
also wanted to be included in activities, even when
adjustments needed to be made to facilitate their
participation. Finally, they wanted positive experi-
ences at school but acknowledged it was often dif-
ficult to find the right school setting that would
meet their physical, social, and academic needs.
Indeed, the educational experiences of children
and adolescents with disabilities such as CP show
that though they want their experiences to be pos-
itive and similar to their typically developing
peers, they rarely are. In addition, minimal first-
hand information exists in the literature about the
school and educational experiences of women and
girls who have CP. Therefore, the purpose of this
study was to examine the educational experiences
women with CP had as children and adolescents.
METHODOLOGY
The data collection method used for this study
was the feminist biographical method, chosen
because it encouraged participants to tell their life
stories in a biographical way (Broch-Due, 1992;
Denzin, 1989; Popadiuk, 2004; Smith, 1994). The
feminist biographical method emphasizes break-
ing the silence about lives that are so often hidden
and ignored (Denzin, 1989; Pirani, 1992) and is
infused with the conviction that women’s experi-
ences are significant and valuable to record
(Broch-Due, 1992; Gluck & Patai, 1991). The
method also promotes the understanding of
women’s life histories and narratives within a soci-
etal context, providing a holistic view of the roles
312 THE JOURNAL OF SCHOOL NURSING
gender, culture, and power might play in their
lives (Alpern, Antler, Perry, & Scobie, 1992;
Gutierrez, 1992; Mahlstedt, 1999; Stewart,
1994; Waller, 2005). Therefore, the feminist bio-
graphical method offered the means whereby
women with CP could share their life histories,
which could be understood and interpreted not
just on an individual basis but also within the con-
text of being a member of society and a human
being in the world (Nilsen, 1992; Smith, 1994)
and was consistent with the philosophic approach
and study aims.
Participants
After approval by two institutional review
boards, community-dwelling women with CP
were invited to join the study through criterion
sampling (Patton, 2002). Informed consent was
obtained from each participant. Participants were
recruited through organizations providing services
to people with disabilities. Flyers were distributed
by the organizations and posted at locations fre-
quented by women with disabilities. Potential par-
ticipants contacted the researcher by telephone or
e-mail. Inclusion criteria included women with CP
over the age of 18, who had a communication skill
level appropriate for conversation and the ability
to provide consent.
The eight participants ranged in age from 22 to
55 years. Four participants had spastic quadriple-
gia, two had athetoid CP, one had spastic diple-
gia, and one had spastic left hemiplegia. Five
participants were college graduates: three
received master’s degrees, one received a bache-
lor’s degree, and one received an associate’s
degree. Two were attending college. One did not
graduate from high school.
Procedures
Data were generated through two audio
recorded unstructured, face-to-face interviews.
Interviews, that continued until saturation, ranged
from 45 to 135 minutes each and generated over
20 hours of recorded interviews. The first part of
the first interview began with the open-ended
question, ‘‘Tell me about your life and growing up
with CP.’’ Therefore, participants controlled the
topics discussed during the interview. Participants
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were told the interviewer would take notes for
later use, which consisted of a sequential list of
topics raised by the interviewee. In cases where
participants’ articulation was difficult to under-
stand, more detailed notes were taken to assist
with the transcription process. When the intervie-
wee finished her story, the second part of the first
interview began. Here, the interviewer asked for
more information about topics in the same
sequential order and language used by the
interviewee in the first part of the interview. No
questions were asked about topics not initially
introduced by the participants.
A follow-up audio recorded interview was held
7 to 10 days after the first interview, after prelim-
inary analysis of the first interview. This interview
was structured by the researcher; questions were
asked that allowed the participant to clarify or
elaborate on her previous narrative, then the inter-
viewer posed questions about new topics. The use
of an interview guide in the second interview
allowed the interviewer to ask uniform questions
of each participant and clarifying questions of all
participants. This method assisted the interviewer
when there was need for filling in missing details.
Data Analysis
Analysis of interviews occurred throughout and
after the interviewing process. This analysis used
the hermeneutical procedure of comparing the
part to the whole and the whole to the part (Ayres,
2000; Ayres, Kavanaugh, & Knafl, 2003). The pro-
cess is also referred to as the hermeneutic spiral, in
which two levels of analyses occur: within-case
analysis, in which new themes are identified and
personal factors shaping themes and experiences
are identified within each woman’s narrative; and
across-cases analysis, in which themes and rela-
tionships between themes are identified across all
of the participants’ narratives, life documents, and
cultural texts (Ayres, 2000; Ayres et al., 2003).
Study Findings
During data analysis, four themes related to the
educational experiences of these women became
apparent: (a) academic experiences, (b) experi-
ences with teachers, (c) experiences with peers,
and (d) coping methods. In addition, subthemes

were found for each theme. A discussion of each
follows.
Academic Experiences
When talking about their academic experi-
ences, two subthemes emerged: special education
and mainstreaming. Special education was identi-
fied by participants as being either a self-
contained classroom for students with special
needs (separate classes for students with beha-
vioral, educational, or physical disabilities where
extra teachers or aides assist them as needed) or
remedial classes (separate classes for students
unable to keep up with academic work in other
classes). Mainstreaming was described as being
in classes with and doing the same work as typi-
cally developing students.
Special education. One participant spent all of
her school years in special education classes. She
was not taught to read or write and recalled being
taken on a number of field trips. She stated, ‘‘They
thought I was dumb so they didn’t teach me much.’’
However, as an adult, she not only learned to read
and write but found she had a talent for writing
and now spends much of her time writing short
stories and poems.
The assumption of low cognitive functioning
by school personnel was apparent in the lives
of the other participants as well, as evidenced
by most spending some time in special educa-
tion classes during the school day. Although
not tested prior to placement in a special self-
contained special education classroom, the par-
ticipants had to be tested to prove they could
handle the higher academic expectations when
their parents asked to have them transferred
to a regular class. Experiences in special educa-
tion classes or self-contained classrooms were
described in negative terms. One participant
stated:
I’d reached the peak in my learning, but I wasn’t learn-
ing, they weren’t teaching me the grade level appropri-
ate things anymore. I was still learning how to count
change and currency when I was 9 or 10 years old even
though I knew how to do all that stuff already.
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Vol. 26 No. 4, August 2010 313
In addition, although participants wanted to
learn and be challenged academically, these edu-
cational desires were often ignored. For example,
one participant said, ‘‘I think if I hadn’t had CP, the
teachers might have been more aware of my academic
abilities.’’
‘‘Although participants wanted to learn and be
challenged academically, these educational desires
were often ignored.’’
Mainstreaming. Even when students were main-
streamed, their academic needs were not always
met. For example, one participant showed high
academic achievement through elementary, mid-
dle, and junior high school and was mainstreamed
because she scored high on an IQ test. However,
she was denied the opportunity to take advanced
placement classes in high school because the
classes were taught in a part of the school that was
not accessible to her wheelchair.
When a participant was mainstreamed, it may
only have been on a provisional basis. For exam-
ple, one participant was told she could attend the
regular fifth grade; but, her parents were told if
she did not improve within the year, she would
be put back in a self-contained classroom. In addi-
tion, she had to work extra hard and get special
tutoring to catch up with her peers because her
level of achievement in special education classes
was below the level of regular fifth graders.
Experiences With Teachers
A second theme regarding participants’ primary
and secondary education revolved around experi-
ences with teachers. This theme was divided into
two subthemes: negative experiences and positive
experiences. Sadly, the negative experiences far
outweighed the positive experiences. A discussion
of each follows.
Negative experiences. Many participants shared
negative experiences about their teachers. For
example, one participant was yelled at many times
by one of her elementary school teachers and
314 THE JOURNAL OF SCHOOL NURSING
said, ‘‘For whatever reason, she just did not work
with disabled children very well. She was very mean
and vindictive.’’ Other participants described
how they were talked down to or ignored by
teachers.
Five participants also felt teachers were not
aware of their academic capabilities because the
participants had difficulty writing and required
the assistance of aides. For example, one partici-
pant described numerous situations where she
was questioned by a teacher about her work.
I was accused of cheating every year until I grad-
uated from high school because the
teachers . . . I think their perception was, ‘‘She has
a disability and there has to be something cogni-
tively the matter with her and her assistants are
giving her the answers.’’
She was not only upset that her integrity was
questioned but, like other participants, was fru-
strated with teachers’ assumptions that just
because her speech was difficult to understand,
she walked differently, or was in a wheelchair, she
had no abilities. In addition, more than one parti-
cipant said they were more likely to be mistreated
by adults and teachers at school than other
students.
Another participant described a time in high
school she thought she found a perfect place to
use her abilities: She worked on the yearbook
staff, served as editor her junior year, and
expected to be named the editor of the yearbook
her senior year. However, a new teacher was
assigned to be the yearbook advisor when she was
a senior and chose a student with no experience—
someone who had never even worked on the year-
book staff—to be editor instead. The participant
stated she felt hurt and rejected by the actions and
limiting assumptions of the new teacher.
Four participants also described experiences
where teachers seemed afraid that the disability
was giving the women an unfair advantage over
other students. In fact, often after asking for
accommodations that would allow participants
to more easily keep up with the class, teachers
questioned their motives. One participant
explained:
There’s a certain amount of accommodations that
they’ll give you but there’s sort of this unspoken princi-
ple of, ‘‘We don’t want you to get this sense of entitle-
ment.’’ So I think I was kind of always on guard with
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that as far as making sure that nobody perceived me as
feeling like I was entitled.
This participant is severely impaired by her CP
and has minimal use of only one hand. In school,
she dictated her answers to an aid. In math, she
had to verbally explain every step of the math
problem, requiring her to calculate all of her com-
putations in her head. Consequently, teachers
often denied her the opportunity to take their
classes because they did not think she would fit
in. She stated, ‘‘I didn’t feel mistreated by my peers
so much as I always felt like the teachers and adults
. . . that I had to prove my right to be in certain situa-
tions.’’ In spite of the obstacles she encountered,
she graduated from high school with a 3.67 grade
point average (GPA).
Positive experiences. However, three partici-
pants described positive interactions with teach-
ers. For example, one student had a fifth-grade
teacher who tutored her on his own time so she
could catch up with the other students. Another
participant believed she was not as good as the
other students, had given up the idea of college,
and was just putting in her time to finish high
school. However, one teacher changed her views:
He handed the report card to me, saying ‘‘Very good,
Dorothy.’’ He turned to the class. ‘‘Class, Dorothy
here got the highest test scores of anyone in all of my
classes.’’ I was so stunned; I dropped all of my papers.
I remember this teacher because he reached out to me
and took me from where I was and helped me to dream
of unreachable stars. I started thinking, ‘‘Hey, I’m not
so dumb. I can even beat all of the smart kids if I want
to.’’ From then on, I started striving for ‘‘A’s’’ because I
started believing ‘‘A’s’’ were possible for me to achieve.
Consequently, Dorothy graduated from high
school with high enough grades to attend a major
university where she not only obtained her bache-
lor’s degree but earned a master’s degree as well.
Experiences With Peers
A third major theme regarding educational
experiences revolved around the participants’
experiences with peers. This theme was divided

into two subthemes: negative experiences and
positive experiences. A discussion of each follows.
Negative experiences. Many participants had
difficult experiences with peers during elementary
school. These experiences included teasing, being
mimicked because of their awkward gait or
unusual speech, and actual physical mistreatment
where they were tripped or shoved. However, for
most participants, the teasing diminished as they
got older. For example, one participant explained.
‘‘As I got into junior high and high school, those things
became less of an issue . . . and I saw less of those peo-
ple that had been teasing me and making fun of me.’’
However, this mistreatment never went away
completely, and participants continued to have
experiences with peers who did not accept them.
Social rejection was another negative experi-
ence participants had with peers and often cited
as the hardest part of their school experiences.
One participant stated, ‘‘I still didn’t have any
friends my own age I could talk to.’’ The lack of a
social life was particularly difficult during high
school. In fact, one participant went to her senior
prom with her brother because none of her peers
asked her and her parents did not want her to miss
out on the experience.
Positive experiences. Conversely, four partici-
pants had positive experiences with peers. For
example, when one participant was able to trans-
fer from a self-contained classroom into a regular
fifth-grade classroom, she met a girl who became
her best friend. Their friendship continued
through school and they even attended college
together.
Another participant described how she made
friends:
Well, ironically enough, in high school, I’m obviously
not an athlete because of my physical limitations, but
our fellowship of Christian athletes at school was open
to pretty much everybody and I knew a lot of those
people. So I met a lot of friends there and I found a
lot of commonalities, like common interests outside
of school. I don’t know that I met a wide variety of peo-
ple but I was able to pick the people that would accept
me and I would accept them.
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Vol. 26 No. 4, August 2010 315
In addition, all participants said they had to
learn how to discern who was accepting of their
disability and who was not. For example, they
described difficult situations in which they
thought they were accepted but were later
rejected. In fact, one participant never had a
friend until she was 10 years old and was ecstatic
to have a friend until her friend rejected her: ‘‘I was
so deeply hurt when she rejected me. I don’t even
remember what it was she said. I just remember the
searing pain it gave me.’’ However, as participants
got older, they learned to be more discerning
about people and were more easily able to make
friends.
Coping Mechanisms
A final theme regarding educational experi-
ences revolved around coping mechanisms partici-
pants used when faced with negative experiences.
This theme was divided into two subthemes: neg-
ative coping mechanisms and positive coping
mechanisms. Evaluation disclosed more positive
than negative coping mechanisms. A discussion
of each follows.
Negative. As participants faced negative
experiences from both teachers and peers, some
coped in negative ways. For example, one partici-
pant stated, ‘‘I didn’t care if I wasn’t popular,’’ and
she spent most of her time alone in her bedroom.
She explained, ‘‘I liked being at home or in my room
with my things.’’ Even though she denied she was
negatively affected by her experiences, her
description of her life as a child was filled with
sadness:
I wasn’t invited to other people’s houses to do things. I
was excluded a lot. It’s kind of like you just sit back
and you learn to be the watcher and you listen to what
people are saying. And you’re not really the one . . .
you’re not the life of the party. It’s like you become
more comfortable listening to people’s conversations
like in the classroom or in the lunchroom or in the hall-
way. But you’re the one who’s the quiet one, but you
know what everybody else is saying. You’re not
communicating. You just observe and you listen.
Her childhood coping mechanisms continued
into adulthood.
316 THE JOURNAL OF SCHOOL NURSING
Another participant also described self-
isolation as her means of coping, ‘‘I shut everything
out . . . I’m quiet; very quiet. I shut myself in my bed-
room and didn’t come out.’’ She also described anger
about the way she was treated.
Positive. However, other participants found
positive ways to cope with mistreatment or social
rejection. For example, two participants who did
not have friends as children spent their free time
in the school library, where they gained a love of
books and reading. In both cases, the librarians
took an interest in the participants and let them
do some librarian tasks.
Other participants found different positive
ways to cope with negative experiences. For exam-
ple, several focused on getting good grades, one
developed a sense of humor about herself and her
situation, and another found a love of dogs. As an
example, this participant described her lifetime
love of dogs.
Dogs were always my friends because, when I’m with a
person, the person can see my handicap. They can’t
help but pass some kind of judgment based upon my
handicap. But, to a dog, I’m not anymore handi-
capped than you are. So I just love dogs. They’ve
always been my friends, you know.
Another participant described how she coped
with her lack of participation in extracurricular
activities by focusing on studying.
I didn’t do a lot of—I guess you could say—extracur-
ricular activities. I spent a lot of time studying, I think
that’s one of the ways that I sort of tried to compensate
for maybe some of the things that I felt like I couldn’t
do. I put my energies into studying a lot and making
the grades. I graduated high school with a 3.67 GPA.
A third participant shared a humorous device
she used when someone kept staring at her:
And this guy was just staring at me and somehow, in
my head I was like, ‘‘OK, he’s not staring because
I’m in a walker, he’s staring at me because I’m devas-
tatingly beautiful and he can’t take his eyes off me.’’
And so, I kind of . . . like I said, I have no idea how
that came to me, but I have remembered it since then
and just kind of twisted things that way.
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She continued to explain that she often twisted
negative situations around in a funny way to make
them feel more positive.
Participants described both negative and posi-
tive educational experiences that shaped their pri-
mary and secondary school years. Although they
were frustrated with how difficult it had been for
them during these years, they were more emo-
tional as they described interactions with teachers
and peers. Even though for some participants,
school experiences occurred over 40 years ago,
they were remembered in vivid detail.
DISCUSSION
Understanding the primary and secondary
educational experiences of women with CP can
be helpful to teachers, school nurses, and parents.
Although the educational system may have chan-
ged since participants were in elementary or high
school, the importance of their experiences over
their lifetimes is clear. There were more differ-
ences between participants based on whether they
had positive rather than negative academic experi-
ences, their age, and how recently they were in
school. For example, participants with positive
academic experiences and positive interactions
with teachers and peers were able to develop
better ways of dealing with the negative experi-
ences they encountered in education. They also
were able to attain higher levels of education,
because half of the participants received
bachelor’s or master’s degrees. In addition, two
participants younger than 25 years of age are still
in their higher education years and may also
receive bachelor’s degrees. However, participants
who primarily had poorer educational experiences
and no significant positive experiences developed
negative coping mechanisms that continued to
affect their lives and did not believe they were
capable of advanced education. For the partici-
pants who developed positive coping methods,
attaining educational success often occurred in
spite of resistance from school personnel to allow
them to be educated in regular classes with their
peers. Unfortunately, due to speech difficulties
and physical impairments, school personnel
assumed there was also a cognitive impairment
in these women—even though the prevalence of

cognitive impairment for CP without epilepsy is
18–50% (Odding, Roebroeck, & Stam, 2006).
Therefore, school personnel need to understand
that cognitive ability is often not affected by phys-
ical disability, and students with CP should
receive an education based on their cognitive
abilities rather than their physical impairments.
‘‘Understanding the primary and secondary
educational experiences of women with CP can be
helpful to teachers, school nurses, and parents.’’
Participants were often placed in special
education settings without appropriate academic
testing. Within these settings, expectations were
low and participants were not taught age-
appropriate subjects. The failure of schools to
meet the academic needs of females with CP may
be limiting, or even preventing, their educational
achievements and options. For instance, the only
participant who did not graduate from high school
was not taught to read or write until adulthood.
Now, as an adult, she writes poems and short stor-
ies. It is impossible to know what her potential
might have been had she received an appropriate
education as a child and had she received cogni-
tive supports during her early school years. Inter-
estingly, Schenker, Coster, and Parush (2006)
found students with CP were provided with signif-
icantly more physical task supports than cognitive
supports, probably similar to some of these study
participants. Although providing physical support
and/or adaptations may be important for the aca-
demic success of students with CP, their academic
and cognitive needs must also be addressed.
Most participants talked about negative experi-
ences they had with both teachers and peers.
These experiences often centered on their exclu-
sion from social activities. Being socially accepted
by peers can improve quality of life (Davis et al.,
2009), and yet research shows adolescent girls
with CP are not well accepted by peers (Nadeau
& Tessier, 2009). This finding is similar to the
experiences of these participants. However, if
school personnel can influence peers’ social accep-
tance of adolescents with CP by their own willing-
ness to accept them and include them in activities,
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Vol. 26 No. 4, August 2010 317
negative educational experiences may decrease
(Asbjornslett & Hemmingsson, 2008).
Lack of experience with or understanding of
people with CP was acknowledged by several par-
ticipants as a major reason for being mistreated by
teachers and peers. Therefore, it would be impor-
tant for teachers to know the abilities children
with CP have and make adjustments accordingly.
For examples, Tripp and Rizzo (2006) discovered
when physical education teachers were informed
that they were to have a student with CP in their
elementary school physical education class, their
willingness to teach the student was significantly
lower than the teachers who only knew the child
had a physical disability. However, physical edu-
cation teachers with years of experience teaching
children with CP or other physical disabilities
were not reluctant to teach any child.
It is important to help children with CP cope
positively with their educational experiences, even
though some study participants coped negatively
because most patterns of coping began in child-
hood. Those participants who found positive ways
to cope with their experiences of social rejection
continued to identify positive coping mechanisms
as adults. However, those who coped negatively
by using self-isolation continued to cope in
unhealthy ways as adults. Ideally, assisting chil-
dren and adolescents with CP to find positive
ways to cope with the negative aspects of CP will
promote healthier adult coping mechanisms and
resilience (Collishaw et al., 2007; Rutter, 2006).
SCHOOL NURSING IMPLICATIONS
Indeed, school nurses have a unique role in the
educational system and can help both students
with CP and teachers. They are advocates for stu-
dents and are expected to ‘‘facilitate positive
responses to normal development, promote health and
safety, intervene with actual and potential health
problems, provide case management services, and
actively collaborate with others to build student and
family capacity for adaptation, self-management,
self-advocacy, and learning’’ (Council on School
Health, 2008). This role, as a member of the
Individualized Education Program (IEP) team,
therefore, requires that school nurses understand
the unique challenges of students with disabilities
318 THE JOURNAL OF SCHOOL NURSING
such as CP. This understanding will enable them
to facilitate academic experiences that promote
their students’ adaptation and learning. Specifi-
cally it would be important for them to foster pos-
itive interactions between students with CP and
both teachers and peers, facilitate mainstreaming,
educate school personnel that CP does not always
result in cognitive delays, and encourage a com-
plete evaluation of a student’s abilities prior to pla-
cement in special education classes. As an
advocate for students with CP, school nurses need
to also have regular interactions with these stu-
dents. These interactions should explore how the
students perceive their treatment by teachers and
peers and ways in which they cope with negative
situations. When necessary, school nurses ought
to provide in-service training for teachers and edu-
cational modules for other students that promote
positive interactions and academic experiences for
their students with CP. They should also assist
students develop positive coping methods. Just
as the women in this study had their own educa-
tional experiences, students with disabilities today
have their own experiences. The school nurse who
listens to students’ stories can be a positive force
in the educational lives of students with CP.
ACKNOWLEDGMENTS
I sincerely appreciate the help and support of
Kathleen A. Knafl, who served as my dissertation
advisor, Mary Ann Curry, Catherine Coverston,
and also the women who so graciously shared their
time and experiences for this research.
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