4 Why study normal development? Need to know what is normal to be able to diagnose pathology.How to “use” these slides: Some topics are discussed to help you understand key concepts (Work of Ainsworth, Thomas and Chess, etc.) you don’t need to “memorize this”! I will tell you which slides are “key”. (slides with * = supplemental information)The objectives DON’T include pathology/disorders. I may mention some disorders to help you understand why and how , in the practice of medicine, understanding child development is important.
5 ObjectivesDescribe the normal development of children from infancy to adolescence (5273) Explain the major theories of development including the work of Sigmund Freud, Erik Erikson and Jean Piaget (5274) Describe the theory of attachment described by Bowlby (5277 )
6 Game planPresent normal development chronologically i.e. infancy, pre-school, latency/school age, and adolescenceWill discuss in infancy the concepts of major developmental theories which will be reviewed for specific stage of developmentWill have short video after each stage of development and 2 video at the end on attachment, emotions
7 Child Development “normative” child Development is a dynamic process Nature (genes) interacts with nurture (environment) continuallyComplex process (impact of risk/protective factors)
8 Developmental Phases (Erickson) InfancyBirth to 24 months, Basic Trust: I trust my parents and othersPre-school2 to 5 (6) years, Autonomy: I like to explore, but sometimes I get afraid when I can’t see my mom or dad.School-age/latency6 years-12 years, Industry: I like to show my friends what I can do.Adolescence12 years to 19 (24) years, Identity: I know who I am, and I’m not exactly like my parents.
9 Infancy (0 – 2y) Prenatal Variables Perinatal Variables Physical abilitiesCognitive abilitiesTemperamentEmotions (Erikson: Basic Trust vs Mistrust, Autonomy vs Shame and Doubt)
11 Infancy 0 – 2y Motor skills 4 wks: tonic neck reflex 16 wks: rolls to prone, hands engage in midline28 wks: sits unsupported40 wks: pulls to stand, cruises52 wks: picks up objects, walks several steps15 mo: walks aloneAdaptive skills4 wks: responds to sounds, follow moving object to midline16 wks: looks at object in hand28 wks: one hand reach and grasp of toy, transfer toy52 wks: releases toy, imitates scribble
12 Infancy Language skills 8 wks: vocalized in response to social stimulation;16 wks: laughs and squeals, “talks to people”;40 wks: “mama, “dada”, responds to “no-no”;15 mo: words, knows body partSocial skills4 wks: regards face;8 wks: follows moving person, smiles responsively;16 wks: initiates social smiles;40 wks: initiates “peek-a-boo”;52 wks: points for wants
13 Attachment (Bowlby)Attachment is primary drive for survival (evolutionary advantage).It is an emotional relationship (connection) with mutual affection, desire to maintain proximity. Specific to the person.Sensitive period in the first 3 yearsAttachment behaviors promote proximity to caregiver (crying, following, smiling, clinging).
16 Bowlby’s theory of Attachment* Pre-attachment:0 to 12 weeksAttachment making:12 weeks – 6 mo. With appropriate care giving, infants are able to prefer one particular person and begin attachment making phaseClear cut attachment:6 mo – 2 y. Has learned trust, people can be counted on to be thereReciprocal relationship:2 y on. Reciprocity: people take turns interacting. Effectance: their behavior produces some kind of result in the parenting person. Partnership, internal working models
17 Mary Ainsworth* Expanded on Bowlby’s observations. Confirmed that attachment serves the purpose to decrease anxiety.: for 9 months, observed 28 children aged 1 to 24 mo.Secure attachment N = 16Child cries little, happy to be with mother, can explore environment in mother’s presenceInsecure attachment N = 7Cry often, even in mother’s arms, little exploration of environmentAvoidant attachment N = 5Not yet attached, respond the same to mother and other adults
18 M. Ainsworth Strange Situation* For child 12 mo with mother observed in the lab.Note the reaction of the child over 8 episodes of 3 min. involving separation and reunion between mother and child, introduction of a stranger.B. Secure attachment 65% (best)A. Insecure avoidant 21%C. Insecure ambivalent 14% (“cranky”)D. Insecure-Disorganized (5% but 80% of abused children) Main & Solomon 1990
19 Temperament Development* Definition: “an individual’s character, disposition, and tendencies as revealed in his reactions.” Collins Dict.Affective tone, responsivity, motivation, “personality”Chess and Thomas conceptualized temperament as representing the HOW, or style of behavior, as contrasted to the WHY, or motivations and goals of behavior, and the WHAT, or perceptions abilities, and talents of the individual.
21 Temperamental Constellations* Easy Temperament 40%Biological regularity, approach tendencies to the new, quick adaptability to change, a predominantly positive mood of mild or moderate intensityDifficult Temperament 10%Biological irregularity, withdrawal tendencies to the new, slow adaptability to change, frequent negative emotional expressions of high intensitySlow to warm up temperament 15%Withdrawal tendencies to the new, slow adaptability to change, frequent negative emotional reaction of low intensity, “shy”Other 35%
22 Goodness of FitThe compatibility of traits between children and their parents = Goodness of fitGood fit: results in parents behaving with more sensitivity and positive interactions with their childrenTherapy: work to improve fit
23 Developmental Theories Psychoanalytical: Sigmund FreudCognitive development: Jean PiagetSocial development: Erik Erikson
24 Psychoanalytical (Freud) Psychoanalytical (the sexual aim of young infant is to obtain pleasure and relief from discomfort by the most immediate means possible. The infant draws pleasure from visual, tactile, kinesthetic and auditory stimuli). (conscious and unconscious emotions and defense mechanisms can contribute to the development of negative emotional/cognitive states)Stages:Oral phase (birth – 18 mo) (Infancy)Anal phase (12 – 18 mo – 3 y) (Toddlerhood)Phallic-Oedipal phase (3 – 5 y) (Pre-school)Latency phase (5 – 6 – 11 y) (School-age)Adolescent Genital Phase (11 – 12 y on)
25 Psychoanalytical (Freud) Oral Stage: mouth, most sensitive and greatest source of pleasure. Mouthing, sucking and biting.Anal Stage:. Control, Action, controllable pleasure.Phallic-Oedipal Phase: Child is aware of anatomical differences between sexes, experience of intense sexual and aggressive urges toward both parents. Understanding of the relationship between parents, a wish to remain the center of their lives, while realizing the gender/sexual roles of the same sex-parent.Oedipus complex: the child’s desire for intimacy with the opposite sex parent. Resolution: identify with same-sex parent while retaining affection of opposite-sex parent. Consolidation of gender identity formation.
26 Psychoanalytical (Freud) Latency Stage: relative quiescence of libidinal drives. Sexual drives are channeled into socially appropriate activities (school, sports). Development of ego, superego.Adolescent Genital Stage: Final stage of psychosexual development, separation from family, identity formation and psychological capacity for true intimacy
27 Cognitive Development (Piaget)* A child needs to find ways to understand, to remember, to solve problems, and to organize their environment.“making and using knowledge”: includes attention, information processing, thinking, intuition, memory, etc.Constructivism, stage-based theoryThe child is a scientist trying to develop mature scientific thought processesExplains cognitive maturation by use of a biological model that focuses upon schemes (i.e. organized ways for children’s developing brains to make sense of their experiences or internalized frame of reference)No focus on social and emotional development
28 Cognitive Development (Piaget)* To structure such schemes, children use 2 complementary processes:Assimilation: integration of external element (take new experience into existing schema)Accommodation: modify existing schema to adapt to new experienceEquilibrium (balance) = creation of new knowledgeCognitive growth occurs in structural stagesCognitive maturity is defined by a child’s increasingly refined ability to conceptualize space, both internally and externally.
30 Sensorimotor stage (birth – 2 y) Infant use body senses and activity to explore their environment.Reflexive, presymbolic:- imitation, smiles, playful- looks for objects partially hidden (interactions with the external world)- peek-a-boo, finds hidden objects (complex intentional behavior)explores properties and drops objects
31 Sensorymotor (1 – 2y)18 mo – 2 y: mental representation, make believe play, memory of objectsObject permanence: i.e. the ability to remember an object once it is out of sight (12 – 18 mo) (can manipulate images, words internally)
32 AgeSigmund FreudJean PiagetErik EricksonInfancy 0-2yOral stage (mouth: frustration/gratification)Anal stage (1-3y): toilet trainingSensory motor stage: reflexes, uses senses to interact with environment, motor activitiesObject permanenceOnset languageBasic Trust: weaning, separation from parent, need to trust and feel loved by caregiversAutonomy vs Shame/Doubt (1-3y): toilet training, independence, need to be supported by parent, need to be able to try things without fear of being punished/judged if fails
33 Video 2 weeks, primitive reflexes (#6) Primitive reflexes shown in this clip: toe grasp, clonus, tone, incurvation, crawling, walking, weight-bearing. Note head control. – Some reflexes extinguish with development (only returning in pathological states), others persist.Video boy 11.5 mo and girl 10.5 mo (#7)Social communication, aggression, frustration, competition, negotiation, conflict resolution btwn infantsVideo Ainsworth strange situation (#10)
34 Social Development – Attachment Theory* 4 phases in the social maturation process:Period of attachment, child develop a sense of selfPeriod of self-understanding: allows children to analyze their own make upPeriod of perspective taking: child apply self-knowledge to adults and peersPeriod of true friendship and peer orientation
35 Social Development Erik Erikson Basic Trust vs Mistrust (0 – 1 y)Autonomy vs Shame/Doubt (1 – 3 y)Initiative vs Guilt (3 – 5 y)Industry vs Inferiority (6 – 11 y)Identity vs Role Confusion (11 – 20 y)Intimacy vs Isolation (21 – 40 y)Generativity vs Stagnation (40 – 65 y)Integrity vs Despair (65+)
36 Pre-school (2 – 5 y) Tasks: Role of Environment: Autonomous identity: separate individuals who can be autonomous despite wish to be dependent at times on parents/othersGender identity: I am a boy/girl.Role of Environment:Protect child in his assertive explorations from experiencing too many episodes of over/under-stimulation.Teach child to gratify his needs/wishes within the family/social environment while respecting limits/rules of parents.Provide emphatically attuned encouragements support/admiration for growing autonomy while teaching that autonomy has limits/restrictions.
37 Preschool Physical development: Cognitive development: Can walk, run, control of sphincters (21/2 for day urination, night: 4 y, bowel: 4 y) Sleep: 12 h (naps)Cognitive development:Sense of themselves as separateCan appreciate right, wrong, good, bad, valued/not valued.Can infer the emotional state of another person, they usually project their own feelings onto others and they identify with the projected feelings.Use verbal language to identify actions.Ability to understand concepts expressed in verbal language: can store explicit memories (information encoded in verbal form)
38 Preschool Cognitive Development: Ability to form fantasies Ability to form beliefs: a conception that establishes the relationship between 2 or more inanimate objects, aspects of nature’s law or people. The sun makes the earth warm, the earth moves.Ability to form categories.Ability to use primary (magical, absence of logical connections) and secondary process (reality based, logical) thinking.Cannot understand conservation (pie cut in 4 and 8 pieces not equal, want the one cut in 8)
39 PreschoolPlay: primary means by which children teach themselves Pretend games, imaginary friend commonFunction of play:Act out playful fantasy, a pleasurable life experience using toys, other adults, children as symbols for the real experience, acquiring new knowledge in the process.To practice delaying the behavioral or verbal expression of skills and feelings that are causing developmental conflicts with parents.To unconsciously attempt to reconstruct a pathogenic belief, especially one resulting from a traumatic experience
40 Preschool Child has an autonomous and valued identity Child has a gender identity as male or femaleChild speaks in sentences, thinking is egocentric, empathy is not presentPreoperational phase: begins to think symbolicallyEmotional and Social Development:Erikson: autonomy vs shame/doubt; initiative vs guiltFreud: anal stage of development; phallic/Oedipal stageGender identity
41 Piaget Preoperational Phase (2 – 7 y) Children become intuitive, anticipating experiences with consequences.Think symbolically but illogicallyConcepts*:Egocentric, unable to perceive self from others in their environment.Animistic “I’m afraid of the moon”Lack of hierarchy “where do these blocks go”Centration “I want it now, not after dinner”Irreversibility: “I don’t know how to go back to that room”Transductive reasoning “We have to go this way because that’s the way Daddy goes”
42 PreschoolTheory of mind or mentalisation: Child has an awareness that others have internal states and mental representations. (decentering, perspective taking: children become aware that 2 children looking at the same display from different side of a table will see two different view of the display. Later they can incorporate thoughts and feelings of others as different from their own).
43 Phallic stage: Oedipal complex Sigmund FreudJean PiagetErik EricksonPreschool 2 – 6yPhallic stage: Oedipal complexPreoperational phase: Think symbolically, egocentric, magical thinkingInitiative vs guilt: imitate adults, do things independently, has goals
44 Video age 3y 8mo (# 18)Pretends to be a pink elephant animal (special blanket), fantasy vs reality, transitional objectVideo age 2 1/2y (#106)Ability to role play, and relive daily events by creating small reenactments. – Some gender role rehearsing is involved (she is pretending to be Mommy, not Daddy). – Use of 2nd person pronouns.Video age 4y 2mo (#132)Piaget: conservation of length; knows categories but lacks flexibility to shift concepts. Pre-operational thought
45 School-age (6 – 12 y) Language and cognitive development Can express complex ideasLogic is very importantPiaget: concrete operations: conceptual skills develop and thinking become organized and logical.Improved gross motor development: sports, arts
46 School-age Emotional and social behavior Freud: latency period. Superego developmentMoral development startsIdentification with other adultsIdealize same parentPeer interactions are more importantEmpathy startsErikson: Industry versus Inferiority
47 Piaget: Concrete Operational Stage Ability to think logically, in an organized fashionConcepts*:Hierarchical classifications: arranges cars by typesReversibility: can play games backward and forwardConservation: lose 2 dimes can look for sameDecentration: worry about small details, obsessiveSpatial operations: likes models for directions
49 Latency, ego and superego development AgeSigmund FreudJean PiagetErik EricksonLatency/school age 6-12yLatency, ego and superego developmentConcrete operational phase: ongoing learning and consolidation of knowledge: thinks logically.Concepts; classification (hierarchy), reversibility, conservation, decentrationIndustry vs inferiority.Task: going to school, doing things and creation to discover interests talents, learn their strengths,.Competence
50 Video age 6y 8 mo (# 23)“don’t hope for things : they will come true, and vice-versa”. God (or her conscience) punishes her for disobeying her father, by causing a flat tire.Magical thinking, egocentricity, religion, moral development, development of conscienceTrying to make sense of the world, searching for cause and effect.
51 Video 11 y (#32)Time management will be a crucial life skill, affecting his future success in academics, his career, and his ability to juggle work and home life. This is a good time to learn how to prioritize, plan, and not leave things to the last minute. –Rather than not allowing Brian to go to the pick-up game, Mom lets Brian make his own decisions, then encourages him to learn from his experience and change future choices accordingly. –Effort is highly dependent on the degree to which one is inspired by the task at hand (soccer versus clarinet, for example). Mom never had to remind Brian to get ready to go to his soccer games, or push him to practice his athletic skills.
52 Adolescence (12 – 19y)Profound biological, social and psychological changesBiological: rapid acceleration of skeletal growth; physical sexual developmentPsychological: acceleration of cognitive development; consolidation of personality formation; thinking becomes abstract, conceptual, future orientedSocial: preparation for role of young adult; development of morals (conformity to shared standards, rights and duties)Variable: age of onset, length, rate of growth etc. Rite of passageAdolescent turmoil is NOT common, NOT normalAbout 20% of adolescents will have a diagnosable mental disorder: Adjustment disorder, anxiety disorder, depressive disorder.
53 Piaget: Formal Operational (11 +) Concepts:Hypothetic-deductive reasoningImaginary audience, everyone is looking at themPersonal fable: inflated opinion of themselvesPropositional thinking, logicCapacity to think abstractly (can think about thoughts)
54 AdolescenceDevelopment of identity, sense of self (self-concept, self- image) is more negative and less stable early than later adolescenceSocial Development: expansion of relationships beyond the family: peer group; shift from parents to peers as providers of companionship, intimacy; need peer approval and advice; development of empathyRisk taking: 40% of all teenage death due to MVA survey: 40% of HS students used THC, 85% alcohol (32% binge drinking), 3% cigarettes
55 Adolescence Pressures: to succeed academically to make vocational choices earlyAutonomy from familyAccept growing/changing body
57 Genital stage: ability to have intimate relationships Sigmund FreudJean PiagetErik EricksonAdolescence 12 – 24yGenital stage: ability to have intimate relationshipsFormal operational phase.Concept: hypothetic-deductive reasoning, logic, capacity to think abstractly,Identity vs role confusion.Task: social identity, need to define and clarify personal and professional interests. Importance of appearance, role models, belonging to a groupStrength: Fidelity
58 Video age 13.5 (#8)Cheated on an exam.Morality, parental expectation, observation of peers behavior (tolerating it)
59 Question 1Theories of development formulated by Freud, Erikson, and Piaget share which of the following characteristics?A. They postulate a genetically determined capacity for the development of patterns or systems of behavior by the child.B. They propose that the overall behavior patterns that emerge are qualitatively similar to one another.C. They are all structural theories of development that imply that reorganizations within the child is unnecessary.D. They postulate that the child reacts in particular ways to environmental stimuli.E. None of the above.
60 Question 1Theories of development formulated by Freud, Erikson, and Piaget share which of the following characteristics?A. They postulate a genetically determined capacity for the development of patterns or systems of behavior by the child.B. They propose that the overall behavior patterns that emerge are qualitatively similar to one another.C. They are all structural theories of development that imply that reorganizations within the child is unnecessary.D. They postulate that the child reacts in particular ways to environmental stimuli.E. None of the above.
61 Question 2By age 5 years, a child will have attained all of the following motor developmental milestones except:A. Can stand on one foot.B. Can dance and jump.C. Manifests firmly established legs, eye and ear dominance.D. Can copy a square.E. Can build a tower of 10 cubes.
62 Question 2By age 5 years, a child will have attained all of the following motor developmental milestones except:A. Can stand on one foot.B. Can dance and jump.C. Manifests firmly established legs, eye and ear dominance. (starts age 2-3, well developed age 5)D. Can copy a square.E. Can build a tower of 10 cubes.Dominance: foot: 7y, eye 8y, ear 9y
63 Question 3Piaget conceptualized 4 major stages of cognitive development. Which of the following states the correct sequence in which these stages normally occur, from birth to adolescence?A. Preoperational, sensorimotor, concrete operational, formal operational.B. Concrete operational, sensorimotor, preoperational, formal operational.C. Sensorimotor, concrete operational, formal porational, preoperational.D. Formal operational, concrete operational, sensorimotor, preoperational.E. Sensorimotor, preoperational, concrete operational, formal operational.
64 Question 3Piaget conceptualized 4 major stages of cognitive development. Which of the following states the correct sequence in which these stages normally occur, from birth to adolescence?A. Preoperational, sensorimotor, concrete operational, formal operational.B. Concrete operational, sensorimotor, preoperational, formal operational.C. Sensorimotor, concrete operational, formal porational, preoperational.D. Formal operational, concrete operational, sensorimotor, preoperational.E. Sensorimotor, preoperational, concrete operational, formal operational.
65 Question 4 Best description of motor behavior in a 1 y old child: A. Sits steadily on the floorB. Pulls self to standingC. Walks with one hand heldD. RunsE. Rides a tricycle
67 Question 4 Best description of motor behavior in a 1 y old child: A. Sits steadily on the floorB. Pulls self to standingC. Walks with one hand heldD. RunsE. Rides a tricycle
68 Question 5Erickson’s basic trust vs mistrust stage corresponds to Freud’s ……. Stage:A. OralB. AnalC. PhallicD. Latency
69 Question 5Erickson’s basic trust vs mistrust stage corresponds to Freud’s ……. Stage:A. OralB. AnalC. PhallicD. Latency
70 Question 6 Development task Age Social smile Reach for/grasp toy Stand out without supportRides a tricycleSay 2-3 wordsPick up a small object with thumb/index
71 Question 6 Development task Age Social smile 2 mo (4-8 wks) Reach for/grasp toy moStand out without support moRides a tricycle ySay 2-3 words yPick up a small object with thumb/index 10 mo
72 Question 7 Preschoolers struggle to deal with separation because: Their repertoire of coping abilities is still developingThey have increased cognitive abilitiesThey are able to reassure themselves easilyThey have never experienced a successful separationThey are emotionally stable
73 Question 7 Preschoolers struggle to deal with separation because: Their repertoire of coping abilities is still developingThey have increased cognitive abilitiesThey are able to reassure themselves easilyThey have never experienced a successful separationThey are emotionally stable
74 Question 8True or False: most preschool children do not recognize that their imaginary friends are not really visible.TrueFalse
75 Question 8True or False: most preschool children do not recognize that their imaginary friends are not really visible.TrueFalse
76 Question 9True or False: infant assessments are not only a measure of the child’s functional or developmental status, but also a measure of the child’s environment.TrueFalse
77 Question 9True or False: infant assessments are not only a measure of the child’s functional or developmental status, but also a measure of the child’s environment.TrueFalse
78 Question 10Infant are able to respond differently to their fathers and mothers by what age?8 months6 months4 months2 months
79 Question 10Infant are able to respond differently to their fathers and mothers by what age?8 months6 months4 months2 months
80 Question 11In Psychoanalytic theory, the anal phase of psychosexual development is characterized byA. The child’s focus on autorerotic activities.B. The child’s experience of intense sexual and aggressive urges toward both parents.C. The child’s development of concepts of inevitability regarding birth, death, and sex differences.D. The child’s experience of feelings of separateness and worth.E. the child’s sequential development of play.
81 Question 11In Psychoanalytic theory, the anal phase of psychosexual development is characterized byA. The child’s focus on autorerotic activities.B. The child’s experience of intense sexual and aggressive urges toward both parents.C. The child’s development of concepts of inevitability regarding birth, death, and sex differences.D. The child’s experience of feelings of separateness and worth.E. the child’s sequential development of play.
82 Question 12 True statements about enuresis include A. The majority of enuretic children wet intentionallyB. There is a correlation between enuresis and psychological disturbance that increases with ageC. Children with enuresis are more likely to have developmental delays than other childrenD. There is no evidence for a genetic component to enuresisE. Children living in socially disadvantaged environments do not have an increased incidence of enuresis
83 Question 12 True statements about enuresis include A. The majority of enuretic children wet intentionallyB. There is a correlation between enuresis and psychological disturbance that increases with ageC. Children with enuresis are more likely to have developmental delays than other childrenD. There is no evidence for a genetic component to enuresisE. Children living in socially disadvantaged environments do not have an increased incidence of enuresis
84 Question 13 A two year old child will most likely be able to: A. Build a tower of 2 or 3 cubesB. Draw a circleC. RunD. Copy a squareE. Copy a triangle
85 Question 13 A two year old child will most likely be able to: A. Build a tower of 2 or 3 cubesB. Draw a circleC. RunD. Copy a squareE. Copy a triangle
86 ReferencesEssentials of Lewis’s Child and Adolescent Psychiatry Volkmar & Martin, 2011Normal Development in the First ten years of Life, Geri Fox (DVD)Normal Development in Middle childhood and Adolescence, Geri Fox (DVD)Video: A simple gift: Comforting your baby (10 min) and Helping Young children cope with Emotions (17 min ) Infant Mental Health Promotion project, The Hospital for Sick Children, 1998
87 References*html (Development of the Young BrainFor more than twenty years, National Institute of Mental Health neuroscientist Dr. Jay Giedd has studied the development of the adolescent brain. Decades of imaging work have led to remarkable insight and a more than a few surprises.)Many other videos on brain development, including adolescents.