Human Growth and Development Hill Country Community MHMR Center

Children must pass through several stages, or take specific steps on their road to becoming adults.

How do children develop? Children grow and change in four ways: Physically Intellectually Emotionally Socially

Physical development is the way a child’s body grows Physical development is the way a child’s body grows. It is normal for children to grow at different rates. For example, some might walk at 11 months and some might walk at 16 months.

Intellectual development involves a child’s thinking Intellectual development involves a child’s thinking. Children learn to think by undertaking challenging tasks. Reasoning their way through different tasks helps children learn.

Emotional growth involves the development of a child’s feelings Emotional growth involves the development of a child’s feelings. A child learns what it feels like to be sad, angry, hurt, confident, excited, and happy.

Social development is the way a child learns to work, play, and interact with other people.

Early Childhood During early childhood, ages 1-4, children make enormous gains in the development of their concepts of self and the ways they interact with family and friends. For the 1-year old, mobility is a goal to be mastered. By age 4, mobility has become the means for exploration and increasing independence.

The 1-year old, imitates sounds and gestures; the 4-year old has mastered most of the complex rules of spoken language and can communicate thoughts and ideas. The 1-year old learns from what he can see, hear, feel, and manipulate physically; the 4-year old integrates the use of mental symbols and the development of fantasy.

The 1-year old is on the threshold of developing a sense of self, separate from his parents and other caregivers; the 4 year-old begins to pursue relationships outside the family as an individual in his own right.

Middle Childhood Middle childhood (ages 5-10) is a time of major cognitive development and mastery of cognitive and physical skills. Children in middle childhood significantly increase their vocabulary; enhance their imagination, creativity, and self-care skills; make advances in motor skills development; and improve their ability to cooperate, play fairly follow social rules, think morally, and use humor. Concrete operational thinking predominates, with concern mainly for the present and limited ability for abstract or future-oriented thinking, or for placing their experiences into a historical context.

Children frequently compare themselves with others and are initially “me” centered, or egocentric, but increasingly they recognize other people’s feelings. Children in middle childhood continue the progression from dependence on parents and other caregivers to increasing independence, which includes learning new skills and making new friends at school.

Adolescence Adolescents are in transition from the dependency of childhood to the independence and responsibility of early adulthood. As adolescents progress through early, middle, and late adolescence, self-esteem, mood, body image, cognitive development, family relationships, interactions at school and with peers, and participation in health-risk behaviors are critical developmental considerations.

Developmental Focus in Early, Middle, and Late Adolescence Stages of Adolescence Developmental Focus Early Adolescence (females 11-13 years; males 12-14) Independence Abstract thought Body image Same - sex peer groups Middle Adolescence (females 14-16 years; males 15 – 16 years) Peer groups, teams Morality Opposite – sex peers Sexual drives Sexual identity Late Adolescence (females/males 17 – 21 years Vocational plans Intimacy

Developmental Stages for Children/Youth Physical Development Intellectual Development Emotional Social Moral 0-6 months Needs to be touched and held physically Caregiver feeds child Feeding pattern is established Has sucking and grasping reflexes Reaches toward objects and grasps them Makes large muscle movements (arms and legs) Is able to follow objects and focus Rolls over Supports head Sleeps a lot No bladder or bowel control Rapid physical growth change Vocalizes (makes cooing sounds and chuckles) Vocalizes spontaneously Discovers s/he has impact on environment (e.g., if s/he cries, caregiver will come) Establishes attachment/bonding with caregivers (caregiver and child get to know each other – learn to read each other’s cues and become emotionally attached to one another) Crying and smiling Comforts self with thumb or pacifier Learns to truss that basic needs will be met Concerned with satisfaction of needs Distinguishes between physical self and physical other Recognizes caregivers Very dependent upon caregivers for fulfillment of needs Initiates social contact (e.g., smiles when caregiver appears) Sees him/herself as the center of the world Has no sense of right or wrong

Developmental Stages for Children/Youth Physical Development Intellectual Development Emotional Social Moral 6 months to 1 ½ years Feeds self with a spoon Stands and walks “dances” to music Sits by him/herself Has precise thumb and finger grasp Can stack 2 or more blocks Uses one or two words to name things or actions Says words like “Mama” and “Dada” Point to familiar things Points to at least one body part Curious about everything (explores his/her world) Realizes an object can exist when out of sight and will look for it (e.g. drops things from high chair and looks for it) Hugs caregiver Does not like separation from caregiver Expresses several emotions clearly but is unable to identify them Trusts caregivers Sees him/herself as permanent with enduring qualities (e.g., male versus female) Plays simple games (e.g. peek-a-boo, patty cake) Extends attachment to people other than caregivers Developing some independence from caregivers (can meet some of his/her own needs e.g., can feed him/herself and reach for objects) Sees him/herself as the center of the world Has no sense of right or wrong

Developmental Stages for Children/Youth Physical Development Intellectual Development Emotional Social Moral 1 ½ years To 3 years Walks up and down stairs (one step at a time) Rides a tricycle Throws and kicks a ball Can put on a simple garment Can hold a crayon with fingers Increased eye-hand coordination (e.g., simple puzzles) Can draw a complete circle Handles small toys skillfully Bladder and bowel control Can draw a partial person (e.g., head and body) Talks in sentences Speech is understandable half of the time Uses pronouns for self and others (e.g., I, you) Can express feelings verbally Shows sympathy Refers to self as “I” or “me” Can be separate from caregivers Recognizes people outside of immediate environment Role of caregivers is crucial to the development of self (e.g., will imitate adults behavior) Plays with children (e.g., plays cooperatively sometimes) Washes and dries own hands Toilet trained Tests boundaries and limitations (e.g., learns to say “no”) Learns to consider needs and feeling of others World expands beyond home to the “outside world” Beginning to learn about right and wrong

Children ages 0-3 with social and emotional delays are treated through the Early Childhood Intervention programs. ECI

Developmental Stages for Children/Youth Physical Development Intellectual Development Emotional Social Moral 3 to 6 years Hops on one foot repeatedly Skips and dances well Good balance and coordination Has refined motor skills (e.g., can draw a square with good corners) Prints a few letters Can draw a complete person Can complete a puzzle Talks in sentences Is completely understandable Defines familiar words Has developed certain likes and dislikes Understands cause and effect relationships only in relation to his/her own needs, wants or experiences (e.g., hot stove hurts me) Expresses ideas, asks questions, and engages in discussions Can identify pictures of happy and sad people appropriately Identifies with caregivers and likes to imitate them Forms images of self Can be further away (physically) from caregivers Frequently overwhelmed by feelings (s/he can experience feelings of doubt and shame) Dresses and undresses without help except for tying shoes Plays role in “make-believe” play Follows simple game rules Needs choices and s/he wants more independence Can share and take turns Often has “best friends” Likes to show off skills to adults Will test authority Can identify differences in self and others (e.g., gender, color of eyes and hair) Protects self and stands up for his/her rights Is concerned with what behavior works to bring about reward or punishment Still needs outside controls and his/her conscience relatively unformed

Developmental Stages for Children/Youth Physical Development Intellectual Development Emotional Social Moral 6 years to 12 years Can play sports and develop new skills Energetic Has a large appetite Height and weight increasing at a steady rate Increased coordination and strength Body proportions becoming similar to an adult's Fine motor coordination well-developed (e.g., writing and drawing skills) Highly verbal (e.g. tells jokes, makes puns) Asks fact-oriented questions (e.g. wants to know “how”, “why” and “when”) Can deal with abstract ideas Judges success based on ability to read, write and do arithmetic Wants to develop skills and become competent Enjoys projects that are task oriented (e.g. sewing, woodwork) Learns to think systematically and generally about concrete objects Learns the concept of “past”, “present”, and “future” Acts very independent and self-assured but can be childish and silly at times Self is partly defined by school environment (personality is more defined) Likes affection from adults More independent but wants caregivers to be present to help Can identify what s/he is feeling Can distinguish between wishes, motives, and actions Participates in community activities Enjoys working and playing with others Has friends Plays mostly with same sex peers Can be alone Strong group identity (e.g., Brownies) Learns to achieve and compete Imitates and identifies with same-sex adult Begins to experience conflict between parents’ values and those of peers Has strong sense of fairness Rules are important and must be followed (I.e., breaking rules is bad)

Developmental Stages for Children/Youth Physical Development Intellectual Development Emotional Social Moral 12 to 18 years Growth spurts Develops sexual characteristics and has sexual drives New needs in personal hygiene, menstrual products, razors) Achieves impressive changes in cognitive development (I.e., able to think and reason) Able to reason, generate general principles and test them out against evidence Capable of introspection and of perceiving differences between how things are and how they may be Begins to consider and sometimes make career choices Growth in ability to think abstractly and utilize imagination in solving problems Identifies with significant others outside of home Develops sexual identity Part child, part adult (e.g., “Go away, come closer” message Develops independence (e.g., “I dare you to tell me what to do!) Likely to show extreme mood swings Less dependent on family for affection and emotional support Strives to define self as separate individual Often feels misunderstood May engage in part-time work Enjoys many social activities (e.g., at school) Relies heavily on peers (e.g., tries to conform to peer group norms) Has close friendships and emotional involvements Experiences conflict with parents (e.g., expectations) Experiments with sex-role expectations and standards Challenges values of home Develops personal morality code What becomes important is whether the behavior conforms to the behavior of others, not its inherent rightness or wrongness Belief that good behavior is maintained by some presence of authority

Areas of Concern that may or may not be indicators of future mental health issues in Early Childhood Bedtime Struggles Difficult Behavior at Mealtime Gorging, Begging for Food, Refusing Food Parents Who Limit Independence in Self-Care Temper Tantrums Critical or Detached Parents Vulnerable Child Syndrome Difficulty Forming Friendships Chronically Aggressive Children

Bedtime Struggles When a child refuses to go to or stay in bed, consider the following: The child may not be tired because of irregular schedules Parents may believe their child needs more sleep than is necessary The child may need more adult assistance in going to bed Consistent behavioral limits are not being maintained during the day Fears may be causing the child to resist going to bed Parents may be having trouble separating from their child at bedtime, which could be creating a sleep problem

Difficult Behavior at Mealtime If a child demonstrates difficult behavior at mealtime, ask about parental expectations regarding behavior and eating, what else is going on during mealtimes (e.g., whether the TV is on, whether children are included in conversations), and general behavioral problems.

Gorging, Begging for Food, Refusing Food Gorging, begging for food, and refusing food can be signs of underlying family conflict or other psychosocial, developmental, or neurological problems.

Parents Who Limit Independence in Self Care Parents who are having trouble allowing their child to mature may be underestimating the child’s abilities. Parenting groups or classes, play groups that parents attend, and other opportunities to talk with parents of children of similar age can help parents develop realistic goals. Discuss the risk of oppositional behavior resulting from parental interference in self – care.

Excessive Temper Tantrums Excessive temper tantrums may reflect problems with social, self-care or verbal skills. Disruptions in sleeping, eating, and care-giving routines can intensify tantrums.

Critical or Detached Parents Parents who have low involvement or negative interactions with their child may be exhausted or overly stressed, or may be repeating patterns form their own childhood. They may have a mental disorder such as depression or substance abuse.

Vulnerable Child Syndrome Explore parents’ feelings if they perceive their child as special or vulnerable, or if they have trouble tolerating their child’s negative emotions. Ask parents, “How does your child’s behavior make you feel? What does it make you worry about? What does your child’s behavior remind you of in your past?” A traumatic past (e.g., infertility, fetal or newborn loss) may interfere with a parent’s ability to allow the child to feel frustrated. Parents may need a referral to a mental health professional for therapy.

Difficulty Forming Friendships For shy children or children who have difficulty making friends, suggest low-stress, structured play dates such as inviting a friend over to watch a movie, make cookies, etc. Help parents reinforce appropriate social behaviors to help build children’s social group. A short, successful play date is better than one that lasts too long.

Chronically Aggressive Children For chronically aggressive children who do not respond to appropriate parental strategies, assess potential contributing factors: life stresses; neglect or abuse at home or in child care, inadequate sleep; disruptions in routines; exposure to aggression (including family violence), skill deficits, especially in expressive language or fine motor areas; hearing loss; and signs of hyperactivity/impulsivity or depression. Evaluate families for overt and covert encouragement of aggression (ignoring, speak of it as a sign of strength, suggest using it as a problem-solving strategy).

If these issues remain persistent and problematic it may be indicative of underlying psychological, neurological or medical concerns that require further evaluation.

Areas of Concern that may or may not be indicators of future mental health issues in Middle Childhood Inhibited children Enuresis (bed-wetting) Aggression Bullying Difficult Adjustment to School Substance Abuse

Inhibited Children If children avoid new or challenging activities, help them evaluate the possible consequences, both good and bad, of participating in these activities. A stepping stone approach toward new activities can make them less frightening or intimidating to children. If children’s progress toward age-appropriate friendships and activities stops or their anxiety becomes overwhelming, hey should be evaluated by a mental health professional.

Enuresis Bed-wetting is common, affecting 40 % of all 3-year olds. It is less common in school-age children, occurring in 20% of 5 year-olds, 10% of 6 year-olds, and 3% of 12 year-olds (Schmitt, 1992). Most children who wet the bed overcome the problem between ages of 6-10 if there is no underlying medical cause. Medical causes are present in fewer than 1% of children with enuresis. Emotional difficulties may contribute to bed-wetting. In cases of abuse, the bed-wetting may be a strategy for keeping the abuser away.

Aggression Children may exhibit aggressive behaviors during the course of their development. For some children, aggressive behavior may interfere with functioning at home, school, or with friends. Helping children recognize feelings of anger and helping them find ways to manage their anger can prevent the development of significant aggressive behavior problems.

Bullying Approximately 1 out of 7 school children is either a bully or a victim of bullying. (Batsche and Moore, 2000) Bullying is generally learned and can be effectively addressed, particularly if interventions occur when children are young. Children who are bullied may have low self esteem, be overly anxious, or have trouble expressing themselves.

Difficult Adjustment to School While helping parents understand that their child will adjust to school at his own rate, assist them in determining whether the child’s adjustment is too difficult (e.g., as evidenced by mood problems, anxiety symptoms, an increase in somatic complaints, and school refusal

Substance Abuse During middle childhood, some children begin to use alcohol, tobacco, or other drugs. The rate of substance use among children increases significantly between the 4th and 6th grades. The transition from elementary to middle school/junior high school increases the child’s risk for substance use (Gleaton, 1999).

If these issues remain persistent and problematic it may be indicative of underlying psychological, neurological or medical concerns that require further evaluation.

Areas of Concern that may or may not be indicators of future mental health issues in Adolescence Academic Difficulties and Low Self-Esteem Mood Problems Eating Disorders Pregnancy, Parenting, and Abortion Sexual Abuse and Sexual Assault STD’s Excessive Influence of Peers Absenteeism and Dropping Out Adolescent Substance Abuse

Academic Difficulties and Low Self Esteem Adolescents who experienced academic difficulties in the early grades are at particular risk for self-esteem problems. Encourage parents to talk to the teacher, counselor, principal if they are concerned about performance and low self-esteem. Encourage parents to support their adolescent in developing other skills or talents (e.g., artistic, athletic) to enhance self-esteem. Persistent low self esteem may indicate depression or emerging personality disorders.

Mood Problems Parental complaints about their adolescent’s moodiness or mood swings are common. Sometimes parents are simply describing parent-adolescent conflict, with the adolescent making angry responses to things the parent says or does. Help them learn to negotiate conflicts and disagreements. If the adolescent reports feeling sad or bored most of the time or having frequent bad moods or marked mood swings, the possibility of a mood disorder should be considered. Some adolescents complain primarily of physical symptoms. Insomnia, excessive worry, academic and social difficulties, and significant risk-taking behaviors are other symptoms of mood problems.

Eating Disorders Eating problems can result from excessive concerns about body shape, size, and weight and from an unhealthy body image. Eating disorders are more common in females. In high risk groups (e.g. adolescents who are dieting, adolescents who participate in sports that encourage leanness), special efforts should be directed toward increasing knowledge about healthy and regular physical activity and promoting a healthy body image.

Pregnancy, Parenting, and Abortion The U. S. has one of the highest rates of adolescent pregnancy among developed countries (Singh and Darroch, 2000). Parenting during adolescence can disrupt social and emotion growth. Adolescent parents are at risk for poor educational, vocational, and financial outcomes.

Sexual Abuse and Sexual Assault In one study, 8% of all women and 16% of women whose first episode of sexual intercourse occurred at age 15 or younger reported that their first sexual encounter was not voluntary (Abma et al., 1997). Retrospective studies indicate that the most likely age for children and adolescents to experience sexual abuse is between 7 and 13 years (Bachman et al., 1988). The mental health professional should be aware of the broad range of consequences of sexual abuse and sexual assault, both physical and psychological (e.g., psychosomatic complaints, depressive symptoms, acting-out behaviors, acute stress disorder, PTSD, eating disorders, dissociative disorders)

STDs According to a report from the Institute of Medicine, adolescents are disproportionately affected by STDs. Approximately 3 million adolescents acquire an STD each year, and many have long-term health problems as a result (Eng and Butler, 1997). According to the Youth Risk Behavior Survey about 42% of sexually active adolescents reported not using a condom during their last sexual intercourse (Kann et al., 2000).

Excessive Influence of Peers In general, adolescents choose friends who are similar to themselves (e.g., an adolescent with anti-social inclination is more likely to join a peer group with these tendencies, an adolescent who values high academic performance is more likely to choose academically oriented friends. If parents are concerned that their adolescent is unduly influenced by his peers the following problems may exist: Parents demonstrate “passive neglect” The adolescent lacks self confidence and has a poor self image.

Absenteeism and Dropping Out Many adolescents feel disconnected from school. This feeling can be caused by many factors (e.g., poor academic skills, school failure and resulting feelings of incompetence, negative friendships, problems with teachers/peers, problems at home, emotional or behavioral problems). For many adolescents, a key to connecting them to school is enhancing their involvement in activities that lead to feelings of competence and that offer a connections with peers and adults who have a positive influence on them.

Adolescent Substance Abuse Several factors increase the risk of adolescent substance abuse. These include psychiatric disorders (e.g., depression) and family problems (e.g., parental substance abuse, family violence, abuse, neglect). Be on the lookout for substance abuse especially when the following are present: Aggressive behavior Smoking or alcohol experimentation Sexual activity starting in early or middle adolescence Psychiatric disorder(s) Suicidal intent or history of suicide attempt Physical or sexual victimization Delinquency or school failure Family history of school failure

If these issues remain persistent and problematic it may be indicative of underlying psychological, neurological or medical concerns that require further evaluation.

Parenting A Circle of Life

We spend the first 12 months of our children’s lives teaching them to walk and talk, and then the next 24 years telling them to sit down and shut up! (Anonymous)

Parenting falls into roughly three recognizable stages. Early Stage: families with young children (under ages 10-12) Middle Stage: families with teenagers (13-18) Late Stage: parents are sending their adult children to college, careers, or marriage (the launching stage) (18 and older)

Early Stage The birth of a first child requires a tremendous emotional and physical investment for the couple. A man commonly feels a loss of companionship from his mate, but his self-concept is enhanced by the birth of the child. He focus his energy on the establishment of his career with a strong sense of being the family provider. A woman’s dominant role becomes that of parent, usually perceiving career as a secondary role. In this stage, balancing the parents’ needs with the child’s fosters a child’s health self-concept.

Sources of Conflict in the Early Stage Marital expectations are reinforced, adjusted or changed. In-law relationships may be strained as parents relinquish emotional care-taking to their child’s spouse. Division of labor between the couple comes into focus more clearly, often creating friction. (Men’s willingness to accept their share of the work greatly reduces the conflict.)

Middle Stage Caring for teen children requires patience and energy. Studies show that teens involved with sports and other extra-curricular activities are much less likely to abuse drugs and alcohol. Consequently, parents with active teens find themselves spending a good deal of time shuttling children and attending competitive events. The stress of balancing work and family, though present in all stages, peaks late in the middle stage.

Sources of Conflict in the Middle Stage Parents are defining marital expectations to the stresses of children. Teen years put the most stress on families. Teens test boundaries and demand their independence. As the parent sees their care-giving role diminishing, they struggle emotionally one minute looking forward to the launching stage, the next minute hoping to postpone the launching. Parents may disagree on appropriate boundaries for their ½ child ½ adult.

Late Stage Late stage couples face changing health, both theirs and their parents. Occasionally, middle or early stage couples find themselves caring for elderly parents, too. The daughter or daughter in-law is generally the main caregiver for the elderly parent. Another late-stage concern is sending the child on to college, career, or marriage. Parents need to give conscious and unconscious permission for the adult child to leave. Giving mixed messages invites indecision, uncertainty, and even failure for the adult child. The parents must make the transition from caregivers to friends or advisors, generally not an easy task.

Sources of Conflict in the Late Stage Couples examine retirement and resources available for old age. Adult children may request financial assistance, creating a strain on the late-stage budget.

These stages are viewed as the “normal” way families develop and relationships unfold. Family, personal, and societal expectations make deviating from the norm stressful.