Personality of children with accident-related injuries

European Journal of Personality

Eur. J. Pers. 17: 299–307 (2003)

Published online 20 February 2003 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/per.479

Personality of Children with Accident-Related Injuries

MARGARETE VOLLRATH1*, MARKUS A. LANDOLT2

and KARIN RIBI2

1Institute of Psychology, University of Oslo, Norway, POB 1094 Blindern, NO-0317 Oslo, Norway2University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland

Abstract

Previous studies based on a variety of behaviour, temperament, and personality measures

identified a pattern of over-activity, impulsiveness, emotional instability, and aggressive-

ness in children who are prone to accidents. The present study is the first to study accident-

prone children by means of a comprehensive test for the assessment of the Five Factor

model (Hierarchical Personality Inventory for Children (HiPIC) (Mervielde & De Fruyt,

1999). 118 children, aged 6–15 years, who were hospitalized due to an accident-related

injury, were contrasted with 184 school-children of the same age. Lower socio-economic

status was under-represented in both groups. Children who were exposed to accidents had

higher scores on the facets of energy, optimism, and non-shyness (Extraversion domain),

and lower scores on the facets of concentration and achievement striving (Conscientious-

ness domain). There was no indication of higher aggressiveness, impulsiveness, or

emotional instability in the group exposed to accidents, and there were no gender-by-

accident interactions. Results suggest that there is a relatively benign pattern of

personality traits that is related to greater accident hazard in children. Copyright# 2003

John Wiley & Sons, Ltd.

INTRODUCTION

Accidents are the main causes of death and serious injury affecting children and

adolescents (Pless, Taylor, & Arsenault, 1995). Social and environmental factors such as

low socio-economic status and living in an urban environment contribute to increasing

exposure of children to accidents. For children, parental low socio-economic status may

entail living in poorly built and unsafe houses, in places with high traffic density or lacking

playgrounds, having only one parent, and lacking adult supervision (Bagley, 1992;

Pulkkinen, 1995).

Received 20 June 2002

Copyright # 2003 John Wiley & Sons, Ltd. Accepted 7 December 2002

*Correspondence to: Margarete Vollrath, Institute of Psychology, University of Oslo, Norway, POB 1094Blindern, NO-0317 Oslo, Norway. E-mail: [email protected]

Contract/grant sponsors: Swiss Research Foundation for Child and Cancer; Gebert Ruef Foundation; Hugo andElsa Isler Foundation; Anna Mueller-Grocholski Foundation; Bayer Diagnostics.

However, environmental factors do not suffice to explain increased accident liability.

Some children living in unsafe environments never fall victim to an accident, whereas

others living in optimal circumstances are exposed to accidents repeatedly (Manheimer &

Mellinger, 1967). Among individual differences, gender plays an important role as a

predictor for accident proneness. Among both children and adolescents, boys are more

likely to be involved in accidents than girls. In addition, it has been more difficult to find

consistent temperament or behavioural predictors of accident liability in girls than in boys

(Bagley, 1992; Bijur, Golding, Haslum, & Kurzon, 1988; Manheimer & Mellinger, 1967;

Matheny, 1987; Pulkkinen, 1995).

Moreover, temperament or personality dispositions of the child or adolescent

discriminate between those who are exposed to accidents and those who are not. Among

behaviours and traits identified in accident-prone children are (over)activity (Bagley,

1992; Bijur et al., 1988; Manheimer & Mellinger, 1967; Matheny, 1987; Pless et al., 1995),

extraversion (Manheimer & Mellinger, 1967; Schwebel & Plumert, 1999), aggression,

(Bagley, 1992; Bijur et al., 1988; Manheimer & Mellinger, 1967; Pulkkinen, 1995), low

rhythmicity, distractability, or vigilance deficits (Matheny, 1987; Pless et al., 1995),

impulsiveness and poor self-control (Matheny, 1987; Pless et al., 1995; Schwebel &

Plumert, 1999), disobedience and non-compliance (Pulkkinen, 1995), sensation seeking

(Potts, Martinez, & Dedmon, 1995), and negative emotionality or mood instability

(Bagley, 1992; Manheimer & Mellinger, 1967; Matheny, 1987).

However, the empirical basis for conclusions about temperamental or personality

predictors of accident proneness in children is far from consistent. One of the most

important problems is related to the way personality has been assessed in previous studies.

Measures were very heterogeneous, partly not standardized (Manheimer & Mellinger,

1967), did not comprise the whole scope of personality, or were biased towards

maladjusted aspects of personality (Bagley, 1992; Bijur et al., 1988). Only a few studies,

for example, included measures of extraversion and emotional stability. Other studies did

not include measures of aggression. Hence, the comparability of the above studies in

relation to a common frame of temperament or personality constructs is limited, and the

relative weight of specific traits for predicting accident proneness is difficult to determine.

Another problem is related to the fact that, in some studies, personality was assessed up to

several years after the accident(s) had occurred. This raises the possibility that the child’s

personality may have been affected by physical changes resulting from the accident (e.g.

poor concentration as a consequence of head injuries).

To date, no study on children’s accident proneness has been based on the most

comprehensive and accepted modern personality model, the Five-Factor model (McCrae

& John, 1992). The Five-Factor personality model maps the entire personality domain

onto five basic, independent factors. These factors, in turn, are composed of facets or sub-

traits that allow a more fine-grained and detailed description of personality. For children,

the first Five-Factor personality instruments have only recently been developed, which

accounts for the fact that no previous studies on accident-prone children have used a Five-

Factor measure to date.

The goal of the present study is to provide a first contribution to fill this gap. The

personality of children who have suffered from an accident-related injury will be exami-

ned by means of a recently developed hierarchical Five-Factor questionnaire, the

Hierarchical Personality Inventory for Children (HiPIC) (Mervielde & De Fruyt, 1999).

This instrument not only provides scores for the five personality domains of Extraversion,

Benevolence (Agreeableness), Conscientiousness, Emotional Stability, and Imagination,

300 M. Vollrath et al.

Copyright # 2003 John Wiley & Sons, Ltd. Eur. J. Pers. 17: 299–307 (2003)

but also scores for 18 facets that are hierarchically organized under the primary domains.

In contrast to most previous studies, our sample will focus on accident-related injuries that

are severe enough to require hospitalization. In trying to translate the findings of previous

studies into the Five Factor model, we hypothesize that injured children will show higher

scores in the Extraversion domain, and lower scores in the domains of Benevolence,

Conscientiousness, and Emotional Stability.

METHOD

Participants and procedure

The study compares the personality of 118 children (cases) who were treated for an

accident-related injury with that of 184 non-injured primary-school children (controls).

Cases were consecutively recruited over a period of 30 months at four different

children’s hospitals in the German-speaking part of Switzerland. Inclusion criteria were (i)

an accident-related injury (except severe head trauma) that led to hospitalization for at

least one night, (ii) an age range of 6–14.9 years, (iii) sufficient command of the Swiss

German language by the child and by his or her mother, (iv) informed written consent to

the study given by the parents, and (v) no evidence of mental retardation in the child. The

118 cases (67 boys, 38 girls, aged 6–15 years (M¼ 9.8 years, SD¼ 2.3)) had been

hospitalized for a period of between 1 and 31 days (M¼ 8.08, SD¼ 8.23). Accidents

happened in the context of traffic situations, where the children were either pedestrians or

bicyclists (58.5%), or in recreational situations, which were mostly related to physical

activity indoors or outdoors (41.5%). Injuries comprised minor head injuries (49.2%),

lower-extremity fractures (16.9%), upper-extremity fractures (10.1%), non-extremity

fractures (27.9%), internal injuries (11.9%), or burns (10.5%). Thirty-seven per cent of

these children had combined injuries. The severity of the injury was rated by a physician

by means of the Modified Injury Severity Scale (MISS) (Mayer et al., 1980). Five dif-

ferent areas of the body are rated in relation to severity of the injury. The MISS is a

highly reliable, and widely accepted, rating scale for the severity rating of paediatric

patients’ injuries.

Parents were asked by the responsible physician whether they were willing to

participate in this study, which involved an interview with the child, and filling in

questionnaires by the parents. If parents consented, the assessment was carried out four to

six weeks after the accident, i.e. after the beginning of hospitalization. Specially trained

psychology students carried out an interview with the child, and delivered the HiPIC to

the mothers. Mothers were asked to describe their child’s personality as observed

during the year prior to the accident. Mothers returned the questionnaire by mail. Of 180

patients hospitalized because of an accident during this time period, 42 did not parti-

cipate because their parents declined permission. The two main reasons given for non-

participation were that the study was considered too time consuming or of too little

relevance. Of the remaining 138 children completing the interview, personality

questionnaires were not returned by 20 mothers. This results in a response rate of 65%.

Lower socio-economic status was under-represented in this sample due to the language

requirements, which excludes exactly those groups (foreigners with poor education,

recently arrived refugees) that constitute the major part of the lowest socio-economic class

in Switzerland.

Personality of children with accidents 301


Controls were 184 primary school-children from three small and middle-sized cities in

the German speaking part of Switzerland whose addresses were provided by school

counsels. Eligible parents of a child attending primary school were selected from a larger

address pool according to presumed language skills (Swiss/German/Italian last name).

Parents received a questionnaire by mail and were asked to assess their child’s personality.

Response rate was around 33%. In the present study, mothers’ assessments were used.

Children who had been hospitalized for any reason during the year prior to the

investigation were excluded from the control sample. The control group (N¼ 184)

comprised 85 boys and 99 girls, aged 6.4–13.1 years (M¼ 9.7 years, SD¼ 1.8). Again, due

to the language requirements, lower socio-economic status was under-represented in

controls.

Cases and controls did not differ in mean age (F¼ 0.13, p¼ 0.72), but boys were clearly

over-represented among cases (�2¼ 8.32, p¼ 0.004).

INSTRUMENTS

Hierarchical Personality Inventory for Children (HiPIC)

The HiPIC was developed by Mervielde and De Fruyt (1999) on the basis of free parental

descriptions of their child’s personality. The 144-item inventory assesses the five trait

domains of Extraversion, Benevolence (roughly corresponding to Agreeableness in the

Five-Factor model), Emotional Stability (roughly corresponding to the opposite pole of

Neuroticism), Conscientiousness, and Imagination (roughly corresponding to Openness to

Experience). Eighteen facets are hierarchically organized under the five trait domains (see

Table 1). The HiPIC is an observer-based measure of personality, and usually the parents

(often the mothers) are the informants for the description of their child’s personality. The

HiPIC is suited for the personality assessment of 4–12 year old children, but can be used to

rate older children’s personality up to age 14 (Mervielde, personal communication). All

HiPIC items refer to a particular overt behaviour, excluding adjectives normally used to

describe personality. The items have a similar grammatical format, i.e. they are formulated

in the third person singular without negations. Each item is rated on a five-point Likert

scale ranging from 1 (uncharacteristic) to 5 (very characteristic). The factor structure

proved highly replicable across informant groups in previous studies, with Cronbach’s

alphas for domain scales and facet scales all exceeding 0.80 (De Fruyt & Mervielde, 1998;

Mervielde & Asendorpf, 2000). The present study used a German translation of the HiPIC

(Nieuwenboom and Vollrath), which was approved by the HiPIC’s original authors. Mean

scores for the scales were computed if no more than two items per scale were missing.

Internal consistency coefficients of the facets in this sample varied between 0.75 (ES2:

self-confidence) and 0.90 (B1: altruism).

Statistics

Data distribution was inspected for boys and girls separately. As strongly recommended by

McClelland (2000) and Stevens (2002) in the case of ANOVA, non-normally distributed

data was transformed by means of different procedures, according to the shape of the

distributions: natural logarithm (scales E4, shyness, B1, altruism, B2, dominance, B3,

egocentrism, B5, irritability, and C1, concentration), and square root (S1, anxiety, S2, self-

confidence). In all cases, the KS-Lillefors (Norusis, 2000) test indicated normal



Tab

le1

.H

iPIC

face

tsc

ale

mea

ns

by

case

nes

san

dg

end

er.

and

MA

NO

VA

par

amet

ers

per

do

mai

n(f

acto

rsca

sen

ess

and

gen

der

,n

oin

tera

ctio

n)

HiP

ICfa

cet

scal

es

E1

E2

E3

E4

B1

B2

B3

B4

B5

C1

C2

C3

C4

S1

S2

I1I2

I3

Cas

esM

3.6

63

.45

3.8

12

.27

3.7

52

.93

2.4

93

.36

2.6

93

.39

3.1

53

.11

3.4

22

.61

3.6

03

.90

3.9

23

.84

SD

0.6

60

.68

0.6

00

.66

0.6

20

.62

0.6

20

.58

0.7

10

.71

0.6

10

.66

0.6

80

.75

0.5

80

.61

0.6

60

.65

Co

ntr

ols

M3

.41

3.5

43

.54

2.4

23

.73

3.0

42

.50

3.3

32

.76

3.6

33

.28

3.1

63

.61

2.7

43

.57

4.0

74

.05

3.9

1S

D0

.60

0.6

90

.59

0.6

30

.67

0.7

10

.60

0.5

30

.70

0.7

10

.66

0.7

60

.68

0.7

00

.60

0.6

40

.67

0.6

0B

oy

sM

3.6

63

.41

3.6

32

.36

3.6

42

.94

2.5

03

.28

2.8

03

.41

3.1

43

.01

3.4

72

.64

3.5

63

.89

3.9

33

.88

SD

0.7

20

.69

0.5

90

.65

0.6

70

.71

0.6

00

.53

0.7

00

.71

0.6

60

.76

0.6

80

.70

0.6

00

.64

0.6

70

.60

Gir

ls M3

.32

3.6

23

.66

2.3

63

.85

3.0

72

.50

3.4

12

.64

3.6

93

.34

3.2

93

.61

2.7

43

.61

4.1

54

.08

3.8

8S

D0

.76

0.6

60

.63

0.6

70

.66

0.6

70

.61

0.5

00

.64

0.7

10

.63

0.7

40

.68

0.7

10

.62

0.5

80

.66

0.6

1M

ult

iv.

effe

ctF

(4,2

93

)¼

6.3

5p¼

0.0

00

F(5

,29

2)¼

0.8

0p¼

0.5

5F

(4,2

93

)¼

2.6

4p¼

0.0

3F

(2,2

97

)¼

1.0

1F

(3,2

96

)¼

1.0

7p¼

0.3

6ca

sen

ess

"2¼

0.0

8"2¼

0.0

14

"2¼

0.0

35

p¼

0.3

7"2¼

0.0

07

"2¼

0.0

33

Un

ivar

iate

F4

.42

15

.94

5.3

44

.91

3.9

3p

0.0

40

.00

00

.02

0.0

30

.05

Mu

ltiv

.ef

fect

F(4

,29

3)¼

9.1

6F

(5,2

92

)¼

5.7

0p¼

0.0

00

F(4

,29

3)¼

2.9

8p¼

0.0

2F

(2,2

97

)¼

1.8

3F

(3,2

96

)¼

6.1

7p¼

0.0

00

gen

der

p¼

0.0

00"2¼

0.1

1"2¼

0.0

9"2¼

0.0

4p¼

0.1

6"2¼

0.0

6"2¼

0.0

1U

niv

aria

teF

12

.78

6.4

78

.91

5.0

93

.86

8.5

35

.64

11

.05

11

.15

p0

.00

00

.01

0.0

03

0.0

20

.05

0.0

04

0.0

2�

0.0

01

0.0

01

E1:E

ner

gy.

E2:E

xpre

ssiv

enes

s.E

3:O

pti

mis

m.E

4:S

hynes

s.B

1:A

ltru

ism

.B2:D

om

inan

ce.B

3:E

goce

ntr

ism

.B4:C

om

pli

ance

.B5:Ir

rita

bil

ity.

C1:C

once

ntr

atio

n.C

2:P

erse

ver

ance

.

C3:

Ord

er.

C4:

Ach

ievem

ent

stri

vin

g.

S1:

Anxie

ty.

S2:

Sel

f-co

nfi

den

ce.

I1:

Cre

ativ

ity.

I2:

Inte

llec

t.I3

:C

uri

osi

ty.

F¼

Wil

k’sF

.



distribution after transformation for both boys and girls. After normalization, univariate

homogeneity of variance was present for 17 of the 18 HiPIC facets when comparing boys

and girls. This is important when group sizes are fairly unequal (Stevens, 2002). Three

outliers were removed from the data because of extreme values on more than four HiPIC

facet scales.

Group comparisons were carried out by means of separate two-factor MANOVAs for

each domain. Factors were group and gender. Because case-by-gender interactions did not

reach significance in any of the analyses, the interaction term was excluded from the final

design. In addition, a two-factor MANOVA without interaction term was computed for the

entire set of the 18 HiPIC scales, after interaction proved to be non-significant in the first

analysis.

RESULTS

In a first step, the injury severity score was correlated with child gender and child

personality. Injury severity did not correlate significantly with 17 of the 18 per-

sonality scales. There was one significant negative correlation with the scale C4:

achievement striving (r¼�0.20, p¼ 0.05). This correlation, however, must be attributed

to chance. Injury severity according to the MISS was not related to gender (r¼ 0.06,

p¼ 0.49).

In Table 1, means, and standard deviations in cases and controls and boys and girls are

shown before transformations. There was a significant overall effect of case on the scales

of the Extraversion domain with an effect size of "2¼ 0.08. Cases showed higher scores

than controls on E1, energy, and E3, optimism, but lower scores on E4, shyness. There

were also significant overall differences between boys and girls. Boys scored higher on E1,

energy, and lower on E2, expressiveness, than girls.

Surprisingly, there was no significant overall effect of case on the scales of the

Benevolence domain. In other words, there was no indication whatsoever for higher

irritability, rebelliousness, or anger in cases compared to controls. There were significant

differences between boys and girls in the Benevolence domain, with girls achieving higher

scores on B1, altruism, and B4, compliance.

As expected, there was a significant, albeit moderately sized, overall effect of case on

the scales of the Conscientiousness domain ("2¼ 0.035). Cases scored lower than controls

on the C1, concentration, scale, and on the C4, achievement striving, scale. There was also

a significant effect of gender, with girls showing higher scores on concentration,

perseverance, and order.

There was no significant overall difference between cases and controls on the scales of

the Emotional stability domain. Gender showed a non-significant tendency for an overall

effect, but none of the univariate differences approached significance. Equally, cases and

controls did not differ significantly on the scales of the Imagination domain. However,

there was a highly significant effect of gender on the Imagination domain. Girls scored

markedly higher on the I1, creativity, scale than boys.

The overall MANOVA showed a significant effect of case versus control on personality

as well, with F(18, 279)¼ 2.38, p¼ 0.002, and "2¼ 0.13. Univariate effects were found on

exactly the same scales as in the domain-wise analyses. Equally, there was an overall

gender effect on personality, with F(18, 279)¼ 4.28, p¼ 0.000, and "2¼ 0.22.



DISCUSSION

To our knowledge, this is the first study to examine the personality of children with

accident-related injuries by means of an inventory for the assessment of the five

personality factors. We found that children with accident-related injuries scored higher on

the Extraversion domain and lower on the Conscientiousness domain, whereas their scores

on the domains of Benevolence, Emotional Stability, and Imagination did not deviate from

that of controls.

In relation to our hypotheses, the differences in the Extraversion and Conscientiousness

domains were expected. Those other studies that included measures for extraversion or

related constructs also reported higher scores in children with higher injury proneness

(Bagley, 1992; Manheimer & Mellinger, 1967; Matheny, 1987; Schwebel & Plumert,

1999). However, in our study, we were able to locate the extraversion differences on the

facets of energy, non-shyness, and optimism. Energy measures liveliness rather than over-

activity, hence high scores on all three facets represent personality features commonly

regarded as desirable.

Differences in the Conscientiousness domain correspond to those found in other studies

as well. Children with accident-related injuries showed lower scores on concentration in

this study, which roughly corresponds to earlier findings regarding higher distractibility

(Matheny, 1987) or lower attentiveness (Pless et al., 1995). The combination of higher

energy and optimism with lower concentration may be the key to explaining higher

accident-proneness in these children.

In contrast to previous studies (Bagley, 1992; Bijur et al., 1988; Manheimer &

Mellinger, 1967; Matheny, 1987; Pulkkinen, 1995), the accident-prone children in our

study were not more disobedient or aggressive: relevant scales from the Benevolence

domain, such as dominance, egocentrism, compliance, or irritability, did not show any

deviation. Neither was there any indication for lower emotional stability in our sample, in

contrast to what was found in some of the previous studies (Bagley, 1992; Manheimer &

Mellinger, 1967; Matheny, 1987). As regards the Imagination domain, we did not

formulate explicit hypotheses. However, it would not have been surprising if we had found

higher curiosity scores in children with accident-related injuries.

In comparison with earlier samples of children who were exposed to accidents (Bagley,

1992; Bijur et al., 1988; Manheimer & Mellinger, 1967; Pulkkinen, 1995), the present

sample was better adjusted. In support of our findings, several recently published articles

based on the Terman Life Cycle Study have pointed out that high scores on childhood

cheerfulness and low scores on childhood conscientiousness are related to shorter life

expectancy and poorer health (Friedman et al., 1995, 1993; Martin et al., 2002). In

particular, cheerfulness was related to higher engagement in risky hobbies.

It cannot be excluded that our study design and selection procedure has biased our

findings. Hospitalisation as a criterion for the selection of accident-related injuries does

have advantages and drawbacks. On the one hand, the outcome criterion is measured more

stringently and objectively than accidents selected on the basis of general practitioner

journals or retrospective reports by mothers. On the other hand, injuries treated in hospital

are usually more severe. One could speculate that severe accidents compared with minor

ones reflect to a greater extent other factors than child personality (for example, in traffic

accidents, the other party may be at fault). However, within our sample, which represented

a wide spectrum of accident severity, we did not find that severity proper was related to

personality in either direction.



The fact that we did not find maladjusted personality patterns in children who were

injured in an accident may reflect that our sample under-represented the lower socio-

economic strata of society, where risk-enhancing conditions such as poor living conditions

and neighbourhood or child neglect may interact with child maladjustment (Robins &

Robertson, 1998). Moreover, we did not assess accident history. Child personality effects

will stand stronger if more data about accidents and near-accidents are being aggregated

over time. In addition, being designed for the assessment of normal personality, the HiPIC

may not pick up severe adjustment problems equally well as some other behavioural

screening questionnaires. The fact that we did not find different personality patterns for

boys with accident-related injuries in comparison with girls may be due to the relatively

low number of injured girls in our sample.

Still, our findings suggest that there may be several pathways leading to a common

outcome, the accident. Not only severely maladjusted, difficult children appear to be at

higher risk, but there appears to be another high-risk group as well: lively, non-shy,

optimistic children who show just so much thoughtlessness. In terms of accident

prevention, this group would certainly be easier to reach and influence than maladjusted,

difficult children. However, further research on children involved in accidents, based on

the Five Factor model, is essential before final conclusions can be drawn.

ACKNOWLEDGEMENTS

The study was carried out while Margarete Vollrath was affiliated with the Institute of

Psychology, University of Zurich, Switzerland. This research was funded by grants from

the Swiss Research Foundation for Child and Cancer, the Gebert Ruef Foundation, the

Hugo and Elsa Isler Foundation, the Anna Mueller-Grocholski Foundation, and Bayer

Diagnostics. We are grateful to the families that participated in this project, as well as to all

the physicians involved. We also thank Felix H. Sennhauser and Hanspeter E. Gnehm for

their continuous support and contribution to this research.

REFERENCES

Bagley, C. (1992). The urban environment and child pedestrian and bicycle injuries: interaction ofecological and personality characteristics. Journal of Community and Applied Social Psychology,2(4), 281–289.

Bijur, P., Golding, J., Haslum, M., & Kurzon, M. (1988). Behavioral predictors of injury in school-aged children. American Journal of Diseases of Children, 142, 1307–1312.

De Fruyt, F., & Mervielde, I. (1998). The assessment of the Big Five in the Dutch language domain.Psychologica Belgica, 38, 1–22.

Friedman, H. S., Tucker, J. S., Schwartz, J. E., Martin, L. R., Tomlinson-Keasey, C., Wingard, D. L.,& Criqui, M. H. (1995). Childhood conscientiousness and longevity: health behaviors and cause ofdeath. Journal of Personality and Social Psychology, 68, 696–703.

Friedman, H. S., Tucker, J. S., Tomlinson-Keasey, C., Schwartz, J. E., Wingard, D. L., & Criqui,M. H. (1993). Does childhood personality predict longevity? Journal of Personality and SocialPsychology, 65, 176–185.

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Personality of children with accident-related injuries