Sense of mastery: helping children feel they have a say in their own recovery

Our article on resilience introduced the Resiliency Scales for Children and Adolescents (RSCA), and one finding stood out: children with acquired brain injury (ABI) scored significantly lower than their peers on a factor called sense of mastery, and lower mastery was, in turn, linked to poorer family functioning. This article looks more closely at what mastery means, why it matters, and why giving children a voice in their own rehabilitation is not just good practice, but may be part of how mastery is rebuilt.

What we mean by ‘sense of mastery’

Within the RSCA, sense of mastery describes a child’s belief that they can influence what happens to them, together with their optimism, self-efficacy and adaptability (Prince-Embury, 2008). In plain terms, it is the difference between a child feeling that things simply happen to them and a child feeling that they have some say in what happens next, even when circumstances are difficult. It is not the same as being in control of everything, which nobody is, but it reflects a child’s sense that their own actions, choices and efforts make a difference.

What the research found

In my MSc dissertation, children with ABI scored significantly lower than healthy controls on both Mastery and Resourcefulness, and significantly higher on Emotional Reactivity and Vulnerability. Mastery was also one of the resilience scales most strongly linked to family functioning: across the whole sample, poorer family functioning was significantly correlated with lower mastery. Tonks et al. (2011), whose dataset this dissertation drew on, suggested that a child’s sense of mastery may be protective following ABI, helping them engage with rehabilitation and adjust to changes in their own abilities.

Taken together, this points to mastery as something worth paying close attention to after a childhood brain injury: it tends to be lower than it would otherwise be, it is connected to how the family around a child is functioning, and it may help shape how well a child engages with the rehabilitation process itself.

Why children’s voice matters

If sense of mastery is about a child believing their actions and choices make a difference, then how rehabilitation itself is delivered is not separate from that belief, it can either support it or work against it. Jenkin et al. (2020) interviewed clinicians working in paediatric neurorehabilitation about goal setting with children, adolescents and their families. Clinicians described their role as that of an active collaborator, working alongside children and families to generate goals that were meaningful to them, rather than simply handing down a treatment plan. The themes that emerged, collaboration, flexibility, and navigating the challenges of involving children and families in this process, point to goal setting itself as something that can either build a child’s sense of mastery or quietly erode it.

This is part of why my current doctoral research takes a mixed-methods approach, designed to give proper weight to the lived experiences and perspectives of children with ABI themselves, alongside more traditional measures. Children’s own accounts of what recovery feels like, and what helps or hinders it, are not simply a nice addition to the data. If a child’s sense of control over their own life is part of how they recover, then asking them what that feels like, and what would help, is part of the evidence base too.

What this means in practice

At Hawkley Rehab, this is one of the reasons our approach to case management is person-centred. Children and young people are involved in setting their own goals wherever possible, in a way that fits their age and stage, and plans are built around what matters to them and their family, not just around what has been lost. This sits alongside the work described in our other articles: a child’s sense of mastery is connected to how their family is functioning, to their parents’ own coping and wellbeing, and to the everyday balance of warmth and structure at home. Giving a child a voice in their own rehabilitation is one more thread in the same picture.

If you would like to talk about what this might mean for your family, please get in touch.

References

Jenkin, T., Anderson, V., D’Cruz, K., Collins, A., Muscara, F., Scheinberg, A. and Knight, S. (2020) ‘Engaging children and adolescents with acquired brain injury and their families in goal setting: the clinician perspective’, Neuropsychological Rehabilitation, 32(1), pp. 104–130. doi: 10.1080/09602011.2020.1801470.

Prince-Embury, S. (2008) ‘The Resiliency Scales for Children and Adolescents, psychological symptoms, and clinical status in adolescents’, Canadian Journal of School Psychology, 23(1), pp. 41–56.

Tonks, J., Yates, P., Frampton, I., Williams, W. H., Harris, D. and Slater, A. (2011) ‘Resilience and the mediating effects of executive dysfunction after childhood brain injury: a comparison between children aged 9–15 years with brain injury and non-injured controls’, Brain Injury, 25(10), pp. 870–881. doi: 10.3109/02699052.2011.581641.