Disability and Self: Critical Factors in Positive Adjustment After the Onset of Disability in Emerging Adulthood

adjustment following the onset of chronic disability. The presence or


O
ver 1 billion people live with some form of disability and that number is increasing (World Health Organization, 2021).Some reports suggest that 15% of adults ages 60 and older report at least one functional limitation (Infurna & Wiest, 2016), while an estimated 5% of working Americans experience a short-term disability each year (Council for Disability Awareness, 2021).Research indicates the life stage in which one develops a disability discussed by Lachman (2004), in emerging adulthood, individuals are generally healthy and therefore focused on milestones related to their career and personal life.Emerging adulthood is characterized as a time when young adults explore their newfound freedom and solidify their identities (Arnett, 2000).Developing a physical disability during emerging adulthood disrupts normative developmental trajectories and creates a stark contrast between life experiences gathered as an able-bodied person and life experiences following the onset of disability.
themselves, but also impacts their interactions with others and with society at large.Ableism is a tangible experience for many people with disabilities who may experience judgment and marginalization.Experiences of ableism can vary depending on the severity of symptoms, the individual's own attitudes and perceptions, and the visibility of an individual's disability.People with visible disability symptoms may be more likely to experience overt ableism, as their by recurring-remitting symptomatology, such as Multiple Sclerosis (MS), an incurable neurodegenerative disease in which the body's immune system attacks the myelin sheath, resulting in diverse and unpredictable manifestations of symptoms.An individual may be able to pass as able-bodied at times, depending on where they happen to be on the spectrum at that time.The choice to disclose or conceal disability person's daily experiences (Nario-Redmond, 2020).
Studies by Fong et al. (2006) and Dalmonte et al. (2004) found that a "positive outlook, maintenance of social relationships, and an ability to adapt to the environment are critical to maintaining wellbeing" (Ploughman et al., 2012, p. 7).The purpose of this study is to thrive and achieve their goals after the onset of a physical disability.

LITERATURE REVIEW ABLEISM
reactions, behavioral actions or practices, and cognitive beliefs and stereotypes that go beyond general negativity.There are nuances and degrees to which these three forms can manifest, and ableism exists at the internal, interpersonal, and institutional levels.
Internalized ableism incorporates ableist attitudes, beliefs, and practices in the minds of individuals who identify as disabled.This form of internalized oppression has been found to contribute to mental health concerns, including anxiety, depression, isolation, and feelings of inferiority (Jóhannsdóttir et al., 2022).

RESILIENCY AND MULTIPLE SCLEROSIS
After experiencing stress or trauma, some people adjust positively and establish a stable developmental trajectory; others respond maladaptively (Herrman et al., 2011).An individual's ability to recover regain a level of physical or emotional health after illness or loss, which is associated with successful coping and 'bouncing back' in spite of substantial adversity" (2020, p. 2769).Studies on the ability to maintain independence, adaptive lifestyle habits, social participation, and overall resilience promotes healthy aging with MS (Ploughman et al., 2020).
Higher psychological resilience is associated with better physical function in people with MS and with fewer neurological symptoms (Jakimovksi et al., 2022).Studies report a lifetime prevalence of depression in people with MS of up to 50%, and the development of depression is closely linked to coping style, positive adjustment, and resilience factors (Ploughman et al., 2020).Social connection closely associated with greater resiliency and more adaptive coping strategies in people with MS (Jakimovksi et al., 2022).

SELF-EFFICACY
achievements and their capacity to respond to challenges and meet their disability to achieve their goals (Amtmann et al., 2012).There are the actions an individual chooses to take, as most opt for behaviors that result in feelings of competency and accomplishment.These beliefs their outlook and adjustment to life following a diagnosis (Tan-Kristanto & Kiropoulos, 2015).life events.People with an external locus of control attribute events and while those with an internal locus of control feel that their actions are the catalysts for events.A health locus of control (HLC) refers to the perception individuals have of their options for symptom management and disease control (Wilski et al., 2019).The degree to which an choose to cope with the limitations they experience.

SOCIAL SUPPORT
Social support is associated with better psychological well-being, reduced stress levels, and improved emotional well-being and perception of happiness and success (King et al., 2000).Jensen et al. (2014) found that perceived social support is associated with subjective well-being in people with physical disabilities.The corollary is that there is a strong association between lack of social support and depression.Individuals with physical disabilities are at a higher risk of lacking perceived social support, as their mobility may be impaired and, as a result, their ability to engage with a broader community is limited.The type of social support people receive, whether from friends, family, or support plays the largest role (Jensen et al., 2014).The importance of on perceptions of self and happiness, demonstrating how essential having a diverse support system is to positive adjustment after an adverse life event.

METHODS
D is a 56-year-old heterosexual, cisgender, white female from New York developing a disability in emerging adulthood has on an individual's perception of themselves and their ability to live a fully-realized life and portion of her early life, as well as having experienced periods of diagnosis and into middle adulthood.

DISABILITY AND SELF
The student researcher arranged to interview D in person at her home.The student researcher made it clear before and throughout the interview that the participant could stop at any time and that D was comfortable.The interview lasted approximately two hours and was recorded and transcribed via the Otter app on the researcher's phone.completion of the research paper.She was informed of her rights and signed an informed consent document indicating that she understood interview were organized using thematic analysis into topics related to self-perception, perception by others, resiliency, and social support.This study received IRB approval prior to publication.

IMPACT OF DISABILITY ON SOCIAL SUPPORT
Numerous protective factors were present in D's childhood, including a strong sense of community, growing up in a middle-class family, conservative town.Concurrently, she experienced certain risk factors, particularly within her family dynamics.D shared that her role in the family, even as a child, was the peacemaker and "perfect child" who her sibling's maladaptive behaviors.Growing up with a brother who struggled with substance abuse and undiagnosed bipolar disorder, she When discussing her parents' devastation over her diagnosis, she heartache into their life."She experienced a transition from being an independent emerging adult to an emerging adult who relied heavily on the support of others.This sense of guilt carried over to other important relationships in D's life, including that with her husband.She recalled her fears of becoming dependent on her husband at only 24, thinking at the time, "Oh no, he's going to have to take care of me, like I'm an old woman."Despite fears of being a burden, D shared that her husband became even more devoted.He looked out for every detail, every detail that would make my life better and easier." Relocating far from home as an emerging adult, D found herself away situations as transplants to the area.I had just gotten married here in New York and immediately moved social support system.She explained that her friends in California became skilled at adapting to her needs to the point that she experienced very few perceived limitations during that period.Her disability became integrated into the especially clear as she described how her friends responded to her new limitations.
Despite acknowledging the crucial role social support played in D's perception of her limitations, she was highly resistant to becoming that she felt the disability community represented a "pity party" she out of mind."D expressed that she felt no need to be involved with the community because she could get any information about her condition from her doctor or online, without hearing about other people's problems.Coming from a family that believed highly in taking responsibility for one's problems without outside help may have helped shape this attitude toward her disability.

SELF-PERCEPTION AND DISABILITY
perceived herself and her abilities, roles, and goals.Due to the relapsing-remitting nature of her MS, there were periods when she could live life essentially as an abled person and disconnect from her very real limitations that she was experiencing.She was also frustrated with herself for not having the capacity to do everything she wanted.in internalized ableist thoughts; D felt she was being denied the full experience of emerging adulthood.However, these attitudes would shift as she developed adaptive coping mechanisms and began to accept life as it was.D expressed that as a young adult, she struggled with comparing her experiences with those of her peers.Watching her with her health challenges.When D lost her job due to her symptoms, it with myself because I worked so hard to get where I was, and I had to leave it because of this stupid disease… I felt badly about myself because of that."D expressed that she was also forced to confront the reality of her mom.At this point, she had to reassess her goals and aspirations and recognize that she could not do everything.She cited this as another turning point in her acceptance that the real limitations imposed upon her by MS restricted some life paths.However, D took this as an opportunity to reevaluate her priorities and recognize that she valued starting a family over having a career.After the birth of her daughter, D had to again come to terms with her capabilities as she initially struggled to reconcile her new role as a mother with her physical limitations.a baby.Like I could never give her a bath by myself.Those kinds of things…got to me, but then I hired a nurse to come and take her for a couple hours here and there.And she did all the things could do other things… So that made it not so bad.It was just part of how we lived.themselves.While D's chronological age is 56, it is important to consider her biological age when discussing her perception of self.As physical deterioration, and D expressed concerns over both physical and cognitive decline as she ages and the disease progresses.When asked about considerations when planning for the future, she explained that she is much more practical about her capabilities now.
Well, now I have to absolutely face that if I stay in the physical condition I am in right now, there are things I won't be able to do.For example, we are most likely taking the retirement cruise of planned on doing, but you know what?I might not be able to do situation has been an empowering coping mechanism from the onset of her MS.From the day they gave her her diagnosis, not a positive word passed her lips.Everything was miserable.Everything was terrible.Everything was awful.Even good things that happened…I never wanted that, and I thought, 'I got through all these years with the disease without becoming bitter.'At a critical turning point in her life, D adopted a mindset that deliberately looked for the positive aspects of life because she viewed it as a decision within her control, demonstrating her strong sense of by her father as he managed her brother's struggles and family responsibilities, came to play a crucial role in how she tackled the challenges she faced as an emerging adult.

RESILIENCY AND DISABILITY
and resiliency that characterizes her experience with MS from her diagnosis up to the present day.Throughout the interview, D made many comments about refusing to let her diagnosis "ruin [her] attitude."I saw when my mother was so depressed and negative, what it did to the people around her, and I never wanted to do that to attitude, and people want to make themselves miserable by seeing only the negative.D's experience watching her mother battle cancer strengthened her already existing resiliency.Some of D's response may be rooted in the interpersonal role that she took on within her family from a young age, that of the dependable child who rose to meet challenges headcharacteristics that informed her perspective on disability and adversity.be practical.How can I make this better?You try it.Does it make it better?Maybe, maybe not.But you tried to make it better.And if D's resilience manifests through a strong sense of practicality.Her ability to bounce back after setbacks and challenges is integral to who she is, shaped in part by her self-determination.

HISTORICAL CHANGES AND SOCIAL INSTITUTIONS
treatment options for MS, and she jumped on the opportunity to be a accommodations and treatments for MS now, compared to when she was diagnosed, D expressed gratitude for the changes over the past decades.
I think in the last 20 or 30 years it has been an amazing period of time for disabled people, with the ADA rules being enforced and really wonderful.
It is evident that societal perceptions of people with disabilities have shifted positively since D's diagnosis, as have the accommodations and better" since her diagnosis.The increasing accommodations provided to her through her urban environment and the development of accessibility tools, such as her electronic gait stimulator and her portable wheelchair, have made it easier to maintain her current mobility and allow her more freedom.

EXPERIENCES WITH ABLEISM
The complex interactions between achievement and disability on the severity and visibility of her symptoms, meaning that at times she could "pass" as able-bodied even if it took a physical or mental toll to do so.Overall, D expressed that she is far less concerned with the perception of others than when she was younger and still coming to terms with her new reality.Having to constantly decide between disclosing her condition or maintaining an abled persona characterized much of D's early period with MS.
her diagnosis from her bosses and coworkers as she recognized there were potential repercussions to disclosing her disability status.D recounted how she was forced to share her diagnosis after deteriorating to the point that her symptoms became visible.When her MS caused her position.In this instance, the ableist perception of others directly resulted in limited career opportunities.D shared that as she has gotten older and her disease has progressed, strangers.D described feeling largely unbothered by the thought of how how they interact with her.Now, the choice to disclose her condition is no longer an option; symptoms such as a persistent limp provide visual indicators.Responses to her disability are often characterized by ableist attitudes, whether they manifest as pity, discomfort, or dismissal.She emphasized how frustrating it can be when someone reduces her to reactions now compared to when she was younger.
if someone says, 'Oh, what is that,' and they kind of push it, and matter to me what they say.What are you gonna do?
Rather than shying away from increasing visible indication of impairment over the years, D has embraced the realities of life with MS.Not only did she share her gratitude for mobility aids such as her walker and wheelchair, she also described her assortment of "fabulous canes, people are aware of her disability, it is up to her to decide how she responds to them.

DISCUSSION
Study of the factors that contribute to positive adjustment after the onset of disability is a crucial area of research that is only becoming more relevant, as more and more people are experiencing disability and living with their conditions for many years.As people with MS age, their expectations and priorities evolve with the progression of the disease.According to Ploughman et al. (2012), many people diagnosed with MS of agency and control over their condition and promote positive adjustment.D's inner strength and belief in her ability to live a fully realized life helped her positively adjust to life with a disability and maintain an interview, D expressed beliefs in resilience and resistance to despair.Without this sense of control over how she responded to adversity, D in the early stages.As Ploughman et al. (2012) proposed, D experienced a transition from denial to acceptance to self-advocacy.This transition was not always linear, as MS's relapsing-remitting nature caused her to vacillate between denial and acceptance even as she learned to advocate for herself.Individuals do not exist within a vacuum, and it is essential to look at the broader social contexts in which they exist.The development of lives of that individual and the people with whom they have relationships.D's diagnosis of MS had a profound impact on herself and on dynamics with her parents, husband, and larger social network.D relied on the support of friends and family members while navigating life skills, social life, sense of empowerment, and reduction in loneliness (Forouzan et al., 2013).The importance of this support is underscored by the numerous references D made throughout the interview to the network of friends and family that emerged to help her manage MS. identities and positionality.Multidisciplinary research has consistently ethnic minorities, with minority and socioeconomically disadvantaged populations up to three times as likely as other groups to experience disability at older ages (Schoeni et al., 2005).However, research has in income and education rather than biological distinctions (Fuller-Thomson et al., 2009).As a middle-class woman, D had access to her inability to work, she was at a lower risk of falling into poverty.She was fortunate enough to understand the healthcare options available involvement with novel treatments as they became available.

LIMITATIONS
It must be noted that the data provided through this interview may not accurately describe the experiences of other persons with disabilities, even those who also developed MS at a young age.Due to the subjective nature of disability, caution must be exercised when attempting to extrapolate one individual's experience to a broader may have led D in a particular direction, even though open-ended was made to ensure that conclusions regarding the roles of resiliency, rooted in evidence drawn from relevant, peer-reviewed research.

FUTURE RESEARCH DIRECTIONS
of social support on an individual's experience, investigating whether researchers may be interested in studying how positive internal interventions.Developing programs that encourage the adoption of health-promoting attitudes and behaviors may allow healthcare people with MS view themselves, their capabilities, and their life trajectory.

D
's experiences and decisions since she developed MS are either give into despair or forge ahead.D shared that after her mother DISABILITY AND SELF received a cancer diagnosis, her mother essentially decided life was over.