Childhood Development

by Helen Farrell, MD

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    00:01 Now we're gonna talk about development and starting with this fact, each age group is associated with physical, social, sexual, and cognitive changes.

    00:12 So a lot of changes occur in the early childhood in developmental process so we're gonna go through this in a little bit of detail. So at in infancy, the major emotional milestone is attachment. During preschool years, a few things are happening here so the child's emotional and cognitive development includes this idea of egocentricity, the child's perspective that all life events are revolving only around them. They also have during this time, magical thinking, the creative weaving of reality and fantasy to explain how things occur in the world.

    00:50 And they have body image anxiety during preschool years due to the child's immature body integrity.

    00:57 And then during the latency period, about 6-12 years of age, this is characterized by a child's mastery of skills. School and peer groups play a fundamental role and status really depends on the child's ability and how they compare against their peers.

    01:15 Children tend to develop best friends during this time and they often can start to now use logical thinking and appreciate other people's points of view. During adolescent years, the emphasis really becomes on creating a sense of autonomy for the child.

    01:32 They struggle to create a sense of identity separate from their parents.

    01:36 They are seeing themselves now as individuals and attractiveness becomes a key component of their self esteem.

    01:43 So let's walk through a few theories of development. So we're gonna go through a few different theorists and what they thought. So Bowlby is one and he had the attachment theory which is a reciprocal process of bonding that is based on the care and relationship that develops between the infant and primary caregiver, usually the mother. The result of this attachment behavior is an infant who feels protected and here are a few different stages that child goes through.

    02:12 First theory is the protest where the mother leaves the room and the infant is separated and cries.

    02:18 Then there's despair, the infant will give up hope that the mother's ever going to return and then there is detachment. The infant has emotionally separated now from the mother but has some security that he's gonna be okay and he is no longer crying.

    02:36 Mary Ainsworth created a model to determine the quality and strength of the attachment between mother and infant. So she actually developed the stranger situation to observe the infant in increasingly stressful situations and see how they respond.

    02:53 So the first step of the situation is the mother in the room with the child, then a stranger enters the room. The mom leaves and then the child can be observed in terms how stressed they become, later the mom will reenter and then the child's response to that is observed as the primary caregiver is now back in the comfort zone. Mahler had the separation-individuation process where separation-individuation occurs between a mother and a child and it begins at approximately 5 months of age and is followed through the first 3 years of life.

    03:30 So there is a differentiation in which physical movement of the child away from the mother.

    03:37 Then practicing which is physical distance through walking and separation anxiety that starts to occur. Next, there's something called rapprochement which is a self-awareness in the child that begins to develop. The child wants to stay close to the mother but also during this time starts to want to explore too. And finally, something called consolidation or object constancy, this is when the child can maintain an internal representation of the mother even when she's no longer there whether the mother left or the child wandered away and got separated from the mom. There is an internal sense that the mother is still somehow available and that's object constancy.

    04:22 Freud had a psychosexual model of development and he believed that in each stage the goal is to drive pleasure and relieve the pain. So based on child's development of sexual drives, body maturation and nervous system development, here's his theory: At first there is the oral phase of development. Here the infant is focused on sucking at the breast and all of the satisfaction and frustration is derived from that source.

    04:53 Then they enter the anal phase, about 1-3 years old, here the child's urges are centered around their bowel functioning. And then the phallic phase or genital phase which is where the child becomes really focused on their genitals for pleasure and satisfaction.

    05:10 This is where the oedipal complex comes in and the child falls in love with parent of the opposite sex and wants to have an exclusive, possessive relationship with that parent and eliminate the other one. Then the latency phase occurs during 6-11 years old and this is where sexual development is actually relatively stagnant and then in adolescence the sexuality develops and really then proceeds on into adulthood.

    05:40 Erik Erikson had an epigenetic model for development. At birth to 1 year, children grappled with this idea of trust versus mistrust, then autonomy versus shame and doubt as they started to become individuals and realize they are separate entities from the parents, then they go on to have initiative versus guilt for their actions, a sense of industry versus inferiority, and the identity versus role confusion during these preteen years.

    06:12 As they move in to their 20's and 40's they start to grapple with intimacy versus isolation, and then as careers become more important to individuals they move into the stage of generativity versus stagnation, and finally there's integrity versus despair as one enters the later years of their life. Piaget has a cognitive developmental model.

    06:36 Here the child follows a continuous pattern of behavior of adapting and responding to various stimuli in the environment. This was described as a schema, a pattern or a loop of behavior driven by stimulus-response-awareness.

    06:54 In terms of assessing a child and practice, what you want to do is keep in mind that children tend to report information in very concrete terms.

    07:04 They're usually not very abstract yet. They'll give accurate details about emotional states.

    07:09 Parents are an excellent source of collateral information when it comes to the child and it's important because they can reliably report to you about the child's conduct, do you wanna ask them about the child's school performance, and whether or not there are any legal or oppositional issues at home. Ask about the child's developmental history with particular attention to whether or not they met their milestones on time.

    07:34 And you wanna ask about family history of psychiatric disorders and going beyond that you wanna know who had what, whether or not they got treatment for it, how that family member responded to treatment, if there are any bad reactions.

    07:47 You also can rely on teachers as a good collateral source of information when it comes to assessing a child. They often can tell you about the child's conduct, peer relationships, academic performance. You may have to consider whether or not you need to touch based with welfare system, whether or not child protective services has ever been involved in a patient. And if they have been involved with a child, you probably wanna seek them out for some collateral source of information as well.

    08:16 A couple of things to review now are some developmental disorders that can happen in childhood.

    08:22 So mental retardation or intellectual disability, this is when there is a significant drop in the IQ for example when somebody has an IQ below 70. And also of concern are when there are deficits in adaptive skills appropriate for the age. When it comes to hearing and visual and learning disorders, it's really important that before diagnosing a child with a learning disorder that you first have them assessed for hearing and visual problems.

    08:55 It's a very important part of information to keep in mind. Certain learning disorders can be reading, math, or written expression disorders. And there are different causes of mental retardation and intellectual disabilities so let's keep this in mind, genetic causes can be Down's syndrome or Fragile X, prenatal infections such as this list you see here can also cause developmental delays and disabilities. There can be perinatal problems such as anoxia, prematurity, or birth trauma and in postnatal traumas or postnatal problems like a hypothyroid issue, malnutrition or trauma. So this summarizes a little bit about the theory behind development and is an important consideration to keep in mind as you are evaluating a child or adolescent in your practice.

    About the Lecture

    The lecture Childhood Development by Helen Farrell, MD is from the course Mild and Major Neurocognitive Disorders. It contains the following chapters:

    • Childhood Development
    • Theories of Development
    • Mental Retadation/Intellectual Disability

    Included Quiz Questions

    1. Pre-school
    2. Infancy
    3. Latency
    4. Adolescence
    5. Pre-adolescence
    1. Adolescence
    2. Preschool
    3. Infancy
    4. Latency
    5. Post-school
    1. Bowlby’s attachment theory
    2. Mary Ainsworth theory
    3. Mahler’s separation-individuation process
    4. Freud’s psychosexual model
    5. Erikson’s epigenetic model
    1. Mahler’s separation-individuation process
    2. Freud’s psychosexual model
    3. Mary Ainsworth theory
    4. Piaget-cognitive development
    5. Erikson’s epigenetic model
    1. 3-5 years
    2. Birth-1 year
    3. 1-3 years
    4. 6-11 years
    5. 12-18 years
    1. Piaget's cognitive development model
    2. Erikson’s epigenetic model
    3. Freud’s psychosexual model
    4. Mary Ainsworth theory
    5. Bowlby’s attachment theory
    1. <70
    2. <50
    3. <40
    4. <90
    5. <20

    Author of lecture Childhood Development

     Helen Farrell, MD

    Helen Farrell, MD

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