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Child Self-Efficacy Scale (CSES)
Please visit this website for more information about the instrument: Child Self-Efficacy Scale  
Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
The Child Self-Efficacy Scale (CSES) is a self-report tool that examines self-efficacy despite pain to assess normal functioning and well behavior. The CSES is a 7-item form asking how sure a child is that they can perform certain activities while in pain. The CSES-Parent version is also a 7-item measure developed to mirror the child measure and was designed to measure how sure parents are of their child's ability to function when in pain (Bursch et al., 2006).
Comments/Special Instructions
CP-specific Pain Categories: Self-efficacy and Pain Interference
CP-specific ICF Domain: Activity and Participation (World Health Organization, 2001).
Scoring and Psychometric Properties
Scoring: The CSES requests the responder rate their confidence in performing certain activities when in pain on a 5-point scale. The items are scored from 1 to 5 with 1 being "very sure" an activity can be done while a child is in pain to 5 being "very unsure" an activity can be done while a child is in pain. Scores range from 7 to 35, with lower scores indicating higher child pain self-efficacy (Bursch et al., 2006; Tomlinson et al., 2021).
The CSES-Parent version also has 7 items measuring how sure parents are of their child's ability to function when in pain using the same 1 to 5 Likert scaling as the children's version (Bursch et al., 2006).
Psychometric Properties: The scale was initially developed in an unpublished thesis and has since undergone sufficient psychometric testing resulting in good internal consistency and validity with a sample of children aged 9-18 years (Stahlschmidt et al., 2019; Bursch et al., 2006).
Overall, the CSES showed excellent internal consistency. The Cronbach's alpha was 0.89 for the 7 child items and 0.90 for the 7 parent items (Bursch et al., 2006).
Test construct validity for the CSES was established for 23 of the 27 hypothesized correlations within the parent and child measures and between parent and child measures. Child report of self-esteem, somatic, and emotional symptoms did not correlate with parental report of self-efficacy. Emotional symptoms also did not correlate with the child measures of self-efficacy (Bursch et al., 2006).  
Strengths: The CSES demonstrated excellent initial reliability and validity. This measure along with the CSES-Parent can assess parent and child self-efficacy beliefs for the child functioning normally when in pain (Bursch, et al., 2006). The rating scale has been used to evaluate self-efficacy with pain in children and adolescents with both acute and chronic pain including abdominal pain, headaches, and athletic injuries (Tomlinson et al., 2021; Carpino et al., 2014; Kalapurakkel et al., 2015; Oosterhoff et al., 2018). A modified version of the scale has been used to evaluate self-efficacy with pain in adolescent girls and young women with intellectual disabilities (McManus et al., 2014; Kennedy et al., 2014).
Weaknesses: Potential weaknesses of the CSES include sample composition, sample size, and the research design of the studies validating the scale. The CSES might not be generalizable to children and adolescents with less severe chronic pain, or with less extensive experience with the health care system (Bursch et al., 2006). The focus of the scale is on self-efficacy despite pain versus a direct measurement of pain. For children with cerebral palsy, it may be difficult to discern impact of pain versus the physical disability with regards to questions that involve physical functioning.  This scale may not be as useful for children with more severe cerebral palsy.  Thus, rating of self-efficacy to perform tasks while in pain may be confounded by other motor and nonmotor impairments.
Key References:
Bursch B, Tsao JC, Meldrum M, Zeltzer LK. Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions). Pain. 2006 Nov;125(1-2):35-42.
Stahlschmidt L, Hübner-MÖhler B, Dogan M, Wager J. Pain Self-Efficacy Measures for Children and Adolescents: A Systematic Review. J Pediatr Psychol. 2019 Jun 1;44(5):530-541.
Additional References:
Bursch B, Schwankovsky L, Gilbert J, Zeiger R. Construction and validation of four childhood asthma self-management scales: parent barriers, child and parent self-efficacy, and parent belief in treatment efficacy. J Asthma. 1999;36(1):115-28.
Carpino E, Segal S, Logan D, Lebel A, Simons LE. The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache. J Pain. 2014 May;15(5):527-34.
Kalapurakkel S, Carpino EA, Lebel A, Simons LE. "Pain Can't Stop Me": Examining Pain Self-Efficacy and Acceptance as Resilience Processes Among Youth with Chronic Headache. J Pediatr Psychol. 2015 Oct;40(9):926-33.
Kennedy S, O'Higgins S, Sarma K, Willig C, McGuire BE. Evaluation of a group based cognitive behavioural therapy programme for menstrual pain management in young women with intellectual disabilities: protocol for a mixed methods controlled clinical trial. BMC Womens Health. 2014 Sep 8;14:107.
McManus S, Treacy M, McGuire BE. Cognitive behavioural therapy for chronic pain in people with an intellectual disability: a case series using components of the Feeling Better programme. J Intellect Disabil Res. 2014 Mar;58(3):296-306.
Oosterhoff JHF, Bexkens R, Vranceanu AM, Oh LS. Do Injured Adolescent Athletes and Their Parents Agree on the Athletes' Level of Psychologic and Physical Functioning? Clin Orthop Relat Res. 2018 Apr;476(4):767-775.
Tomlinson RM, Bax KC, Ashok D, McMurtry CM. Health-related quality of life in youth with abdominal pain: An examination of optimism and pain self-efficacy. J Psychosom Res. 2021 Aug;147:110531.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Document last updated August 2022