Overview of Development



Overview of Development







Whoever touches the life of the child touches the most sensitive point of a whole which has roots in the most distant past and climbs toward the infinite future.

–Maria Montessori


Developmental Stages

What development is not is consistent and unalterable. The normal range of development is broad, and one stage does not neatly finish before the next can begin. However, recalling these stages is much more useful than merely studying for Board examinations. It keeps in mind the need to think developmentally, to consider the areas of development in which a child is doing well, and the areas in which he or she needs intervention. Although seeing hundreds of children (both typical and impaired) is the best way to begin to differentiate normal variations in temperament and fantasy from more concerning symptoms of psychiatric disorder, the tried and true developmental models, particularly that of Erikson, may be useful for the ongoing assessment of a child’s ability to meet and master the developmental tasks at each age. Each time I assess a child or adolescent, I review in my own mind the developmental tasks for the age, and how the child is faring with respect to these. For children and adolescents, treatment is not merely focused on a specific diagnostic disorder, but
on providing interventions that address areas of developmental concern, and helping the child gain the skills and support needed to get on a healthier developmental trajectory.

A basic understanding of human development is fundamental to the psychiatric evaluation in general and most essential in the assessment of children and adolescents. An appreciation for the wide variability among children in terms of development will assist in identifying and targeting areas of developmental concern while minimizing the risk of overdiagnosis and overpathologizing. Normal reactions of one developmental period (such as stranger anxiety in a 1-year-old) when it occurs in another stage (such as similar severe fears in a 5-year-old) may suggest a disorder.




Prenatal Development

Each person has 23 double helix strands of the genetic code for all physical characteristics and organ capacities in the body. Traits such as temperament and activity level also have a genetic basis. Although some genes have strong penetrance and express themselves in virtually all environments (such as eye color), much of development is the product of complex gene-environment interactions. Family history of development may give an indication of the genetic makeup and potential vulnerabilities of the fetus. Understanding the nurturing environment assists in gaining an appreciation for the unfolding of the genetic potential in a given individual.

The second trimester of gestation is when neurological and brain development occurs most rapidly. Thus, insults during this time may result in obvious or more subtle functional deficits for the baby. The clinician should inquire about the prenatal period. Exposure to substances (alcohol, substances of abuse, or medications), trauma, or severe stress during pregnancy may be significant to the developing fetus and be a source of vulnerability when the baby is born.


Infancy (Birth to 1 Year)

Sigmund Freud characterized infancy as the Oral Stage of development, during which time the mouth and eating were of dominant importance. This stage is marked by extreme dependency, urgency of needs, low frustration tolerance, and no consideration of others. Erik Erikson, in his psychosocial stages of development, postulated the normative crisis of infancy as



that of Basic Trust vs. Mistrust. The capacity for basic trust is achieved when the infant feels safe and well cared for by his or her caregivers. Infants gain a sense of security by having their physical needs cared for in a sensitive manner, according to John Bowlby. This caring and mutual bonding is the key to secure attachment.








Table 1.1. Comparison of Developmental Theorists





































Age Sigmund Freud Erik Erikson Jean Piaget
  Psychoanalytic drive theory
Psychosexual stages
Psychoanalytic theory
Psychosocial stages
Cognitive stages of development
0–1 Oral Stage (birth to 12–18 mo)
Primary site of gratification and tension in oral area (mouth, lips, tongue)
Sucking and biting
Trust vs. Mistrust (birth to 12–18 mo)
Trust depends on reliability of care provided by caretaker
Frustration associated with weaning
Optimism and hope derive from basic trust
Sensorimotor Phase (birth–2 yr)
Modification of reflexes; cross modal fluency
Association between means and ends
Object permanence; objects still exist even if obscured from view
Mastery motivation (10–12 mo); child seeks to master challenges
1–3 Anal Phase (12–18 to 36 mo)
Primary site of tension and gratification is anal area
Toilet training
Autonomy vs. Shame (12–18 to 36 mo)
Increased capacities (motor, sphincter, language, etc.)
Need for consistent limits from caretaker
Shame occurs with lack of self-control
Self-doubt evolves from parental shaming
Can infer cause and effect (1–2 yr)
Schemas (units or categories of cognition)
Assimilation (incorporation of new knowledge) and accommodation (modification of schema to adapt to new stimuli)
3–5 Phallic-Oedipal Phase (3–5 yr)
Primary site of tension and gratification–genitals
Castration anxiety, fear of genital loss or injury (interest in Band-Aids)
Oedipus complex: Child desires intimacy with parent of opposite sex; to be rid of same-sex parent
Initiative vs. Guilt (3–5 yr)
Initiative, enjoyment of activity and accomplishments
Guilt over aggressive urges
Resolution of oedipal conflict via role identification
Sibling rivalry common
Preoperational Phase (2–6 yr)
Language acquisition and symbolic reasoning
Egocentrism; see world exclusively from own perspective
Thinking is transductive (causality inferred from temporal or spatial proximity)
Magic thinking (prelogical)
6–11 Latency Stage (6–11 yr)
Relative quiescence of libidinal drives
Sexual drives channeled into socially appropriate activities (i.e., school work, sports)
Further development of ego functions
Formation of superego
Focus on same-sex relationships
Industry vs. inferiority (6–11 yr)
School is important Child is busy creating, building, accomplishing
Danger of sense of inferiority and inadequacy of child; feels unable to compete with regard to skills (e.g., academic, sports) and status among peers
Socially decisive age
Concrete Operations (6–11 yr)
Emergence of logical, cause and effect thinking
Reversibility of events and ideas
Switch from egocentric to social speech
Ability to see another’s point of view
Conservation of volume and quantity
Rigid interpretation of rules
11 + Adolescent Genital Phase (11 or 12 yr and beyond)
Final stage of psychosexual development
Recapitulates earlier phases
Separation from family
Identify formation
Biological capacity for orgasm and psychological capacity for true intimacy develop
Identity vs. Role Confusion (11–18 yr)
Group identity (peers) primary
Developing ego identity (sense of inner sameness)
Preoccupation with appearance
Moodiness and reactivity
Danger of role confusion; uncertainty about sexual and vocational identity
Formal Operations (11 yr+)
Hypothetical/deductive abstract reasoning
Elaboration of information processing
Metacognitive capacity; can think about thinking
Ability to grasp concept of probabilities

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jul 5, 2016 | Posted by in PSYCHIATRY | Comments Off on Overview of Development

Full access? Get Clinical Tree

Get Clinical Tree app for offline access