Fostering Self-Esteem through the Ages
MICHAEL S. JELLINEK, M.D.
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DR. JELLINEK is chief of child psychiatry at Massachusetts General Hospital and professor of psychiatry and pediatrics at Harvard Medical School, both in Boston. Write to Dr. Jellinek at pdnews@elsevier.com.
An individual's core sense of self-esteem is cultivated from birth, as a baby receives the attention and affection provided by the caretaker. When an infant's cry is comforted, her hunger nourished, her smiles met with smiles, the message is conveyed: You are valued.
This very early communication of worth can be insufficiently conveyed or disrupted when parents are overwhelmed by poverty, mental illness, or substance abuse and thus cannot anticipate or empathetically provide for their child's emotional or physical needs.
Although the building blocks of self-esteem are constructed throughout a lifetime, children in certain developmental periods may be especially vulnerable.
Kindergarten or first grade is often a key time. The 5- or 6-year-old first encounters the “real” world with hierarchical clusters of friends, gold stars handed out (or withheld) by the teacher, and birthday party invitations distributed to some, but not all. This is the age when the child is likely to begin comparing himself with others, or is first compared with others by an adult outside the family.
A second important stage for the development of self-esteem is during preadolescence, at about 9 years of age. The child's growing competence spurs competition on the Little League field, in the school orchestra, and in ability-ranked reading groups at school. Children, especially girls, begin to form cliques that invite or reject unofficial members.
I think the greatest challenge to self-esteem comes during grades 7, 8, and 9 when children are beginning to form their own identities and become acutely attuned to peer approval. This stage marks a time of tremendous individual variation in pubertal development and maturity, both physical and emotional. Look around a middle school and you'll see huge variations in height and weight, acne, voice pitch, perspiration, and breast development.
The comparisons hardly end there. Suddenly it seems to be crucially important who was chosen to play on the A team versus the B team; who earned the A, B, or D- grades; who will be going to the dance with an acceptable date; and whose art was selected for district-wide competition. Being in the “popular” group and having a positive identity as “an athlete” or “a good student” support the teenager's emerging identity and the transition toward autonomy and young adulthood.
Children are very vulnerable to self-deprecation during this time, even more so if their parents are setting high expectations, failing to recognize strengths, or simply not paying attention. Although parent's voices (and those of pediatricians) hold less sway for adolescents than for younger children, their input is still invaluable.
The same truths hold as children grow into late adolescence and face new challenges to self-esteem when they feel the sting of rejection from potential romantic partners, elite sports teams, musical ensembles, or college admissions offices.
Throughout childhood, pediatricians can help to foster the child's self-esteem by asking parents, right from the start, what their children do best. Encouraging parents to further these gifts and abilities will integrate a strong sense of self worth in the growing child.
I often ask parents which kind of skill they themselves spend the most time and effort on: one at which they excel, or one in which they struggle.
The answer is easy. Adults cultivate the things they do best.
Of course, every person should be helped to perform–at an average level–the tasks necessary for life. By the time they're ready to leave school, students should have enough math acumen to plan and live within a budget and manage their financial life; enough writing ability to file professional paperwork and handle correspondence; and enough athletic prowess to find and maintain an exercise activity to promote health for life.
But when I see a child who loves to write stories, then I think the best avenue to self-esteem might be a creative-writing summer camp, rather than a depressing summer of struggle at math camp in an attempt to turn those Cs into B-minuses.
You also can help by talking with parents and children about the reality of disappointment, a part of everyone's life. Parents can be encouraged to frame failures by providing context: Did the child try hard? Could something else be done differently next time? What failures have the parents experienced, and how did they deal with them? What were the long-term effects of these failures? Were they as serious as initially imagined?
Regrets are useful only when they are valid, and when change arises from them. Children who become excessively self-deprecating may need extra time and attention as they learn to review events realistically and highlight their positive interactions or accomplishments.
Discussions of strengths and weaknesses are particularly important in families with siblings, as different children will have differing needs and expectations. The family resources of time, money, and special efforts are best customized. Making note of specific customized efforts should help counter sibling accusations of “It's not fair!”
For example, one child may be able to sit calmly at church or synagogue at a very young age, whereas another has to work extremely hard to sit calmly for half an hour. One child can easily earn As in academic subjects, but another must put forth tremendous effort to earn Cs. One child may run a 7-minute mile–no sweat–in high school, and another may have to train long and hard to finish a mile's run.
I like to talk with parents and children about reasonable, individualized goals, so that the overweight child who works out every night and finally makes the junior varsity team isn't held to the same standard as the excellent athlete who makes the varsity team with little or no effort.
By the time a child is in junior high, I think parents and children can engage in shared discussions about what is “reasonable.” How well does the child do in this subject or this activity? How much success is the result of the child's innate ability, and how much can be added by willpower and effort? What should the goal be?
Ultimately, you want the child to set his or her own expectations and goals, with realistic self-appraisal and a positive spirit of adventure.
At the other end of the spectrum are the children who have been burdened with unrealistic expectations for so long that their initiative has been lost along the way. They suffer from chronically low self-esteem. For these children, the road ahead feels insurmountably steep, and each step is inscribed with a message of mediocrity: Why even try?
Changing the trajectory of chronically low self-esteem is difficult at any age, and is best attempted in younger rather than older children.
Psychotherapy, the identification of any elements of depression, and a carefully managed plan of expectations are required over an extended period of time to give these children the tools they need to believe in themselves.


PII: S0031-398X(08)70312-6
doi:10.1016/S0031-398X(08)70312-6
© 2008 Elsevier Inc. All rights reserved.

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