Perspectives from Typical Child Development



Perspectives from Typical Child Development





INTRODUCTION

Development occurs throughout the life cycle, and although we frequently focus on some particular aspect of development (cognitive, motor, and so on), in reality developmental processes are fundamentally interrelated. The term maturation is often used to describe the sequential pattern of growth but both experience (nurture) and endowment (nature) interact in complex ways. As described in Chapter 1, various approaches, methods, and theories have been used to understand development. For many investigators, the development of the embryo and fetus has served as a model for subsequent development with the various processes interacting reciprocally. One of the observations consistent with this view is the awareness that early development of motor skills move in top-down (cephalocaudal or head to toe) and center-out (proximodistal) fashion so that, for example, head control is achieved before trunk control before leg control and arm control is achieved before hand control.

Clearly, while the human genome gives considerable developmental potential, it also sets certain limits. Depending on the particular skill being studied, the relative dominance of genetic or experiential factors may shift so that even if a baby has good genetic potential its placement in a severely depriving environment will result in developmental delays; conversely, a child born having suffered the effects of some insult in utero such as fetal alcohol exposure may not be able to achieve normative levels of functioning no matter what environment is provided, although even here, high optimal development would be more likely in a supportive environment. It is appropriate to begin any consideration of development with a discussion of development prior to birth.


PRENATAL DEVELOPMENT

Development starts at conception as the zygote begins to develop actively once the egg is fertilized. Within a few days, it will have reached the uterus and implanted and may be 0.1 inches in length. Within 2 weeks, the menstrual period may be missed and may alert the mother to the pregnancy. Over the next 6 weeks, major organs and structures develop primarily following the cephalocaudal and proximodistal pattern. By about 8 weeks, the embryo is recognizably human. After this time, the fetus grows rapidly with increased differentiation. The head initially grows more actively than other parts of the body and gradually slows
during fetal life, so that at birth the head is about one fourth the length of the entire body but in adulthood only about one sixth. Conversely, at birth the legs are about one third of body length, but this increases to half by adulthood.

By about the third month in utero, the fetus can swallow, make a fist, and wiggle its toes; by the fourth month, it can respond to light; and by the fifth month, loud sounds may elicit movement. Similarly, more organized behaviors, like the sucking reflex develop before birth; this is also a time when the processes like breathing, body temperature regulation, and swallowing are sufficiently organized to make life possible outside the uterus. By around 8 months, fetal fat stores accumulate rapidly. Antibodies from the mother help prevent infection postpartum.

Even before the child is born, parents begin to experience the child and are impacted by it. This happens in various ways. For the mother, the experience of fetal movement (“quickening”) provokes a series of responses as the mother observes that the child may be soothed by her speech or movement. Similarly, the mother’s impact on the child begins as soon as fertilization has occurred. Although intrauterine life is relatively homeostatic, it can be influenced by the mother’s health (both physical and psychological) as well as by other factors. Mothers typically gain 25-30 pounds and this weight gain is important for fetal growth; mothers who do not gain appropriate weight or who are undernourished may increase the likelihood that their baby will be small. Other factors that may adversely impact the development of the child in utero include exposure to radiation, maternal infection, or exposure to drugs.

The effects of teratogens depend on several factors. These include the timing of the exposure (e.g., in some cases, these may even antedate the pregnancy). Timing of exposure and the dose also are important depending on the agent. The route of the teratogen may also be important. The effects of teratogens can be more generalized or more specific; for example, thalidomide exposure is associated with limb defects whereas alcohol exposure in utero produces a range of problems.

The adverse effects of alcohol on the developing fetus have been recognized since ancient times. Although reports on potential adverse effects on the fetus began to appear in medical literature in the 1700s, Jones and Smith in 1973 brought new attention to the significant teratogenic effects of alcohol exposure in utero. Fetal alcohol syndrome (FAS) is associated with growth deficiency, usually mild intellectual deficiency, a characteristic “flattened” face, motor problems, and other morphologic features. A number of learning difficulties are noted as are language difficulties and continued growth problems. In the United States, alcohol continues to be the most frequently used teratogen and is one of the more common causes of intellectual deficiency. Chronic alcohol abuse is associated with greater risk, and, unfortunately, mothers who drink are also likely to smoke and the latter is also a risk factor. Stopping smoking at any point in the pregnancy is beneficial but is particularly so in the first trimester. Similarly, the potentially adverse role of prescription and street drugs has been recognized. The effects of these agents vary. Phenytoin is associated with increased risk for heart defects whereas tetracycline can cause staining of teeth and interfere with bone growth. Use of drugs like cocaine is associated with increased newborn irritability and sometimes with growth retardation. Agents like heroin and methadone can result in a withdrawal syndrome in the infant.

Maternal infections can be associated with various adverse effects. Congenital rubella can lead to severe mental retardation, visual and sensory problems, as well as cardiac difficulties. AIDS is associated with a number of congenital malformations, although, fortunately, work on prevention has advanced dramatically in the more developed countries. Similarly cytomegalovirus (CMV) and toxoplasmosis may be associated with significant learning difficulties, intellectual deficiency, and a range of other problems.

Heavy metals and other environmental toxins can have teratogenic effects as can exposure to radiation. Other risks arise with both very young (teenage) or comparatively older (>35) maternal age. For older mothers, the risk for Down syndrome begins to increase substantially. Similarly, malnutrition in the mother can be associated with growth retardation and behavioral difficulties in the newborn. Other maternal health issues, for example, diabetes, can be associated with risk to the developing child.



Perinatal Variables

Prematurity is an important risk factor for subsequent developmental problems. Premature infants also present challenges for parenting and are more likely to be abused or neglected. Both preterm babies (born before the 37th week of pregnancy) and low birth weight babies (born at or near term but who are small for gestational age) have increased risk. Although babies born as early as 24 weeks now survive, lack of development of important organ systems, particularly the respiratory system, presents major challenges. Although strides have been made in supporting preterm infants, prevention continues to be a significant public health challenge.

Premature preterm infants are at increased risk for various problems including neurologic problems, retinopathy, and developmental disabilities. Cardiovascular and respiratory problems are also common. Risks increase with the degree of prematurity. Even when babies are born on time, as many as 3% of all infants exhibit significant malformations or birth defects whereas another 7% or so may exhibit less serious problems. Babies born with severe developmental difficulties often have difficulties that started even before the labor and delivery, although sometimes a traumatic birth can result in major neurologic damage.

Parents of a premature baby or one with a birth defect face a challenge. All parents worry about their baby prior to birth but the experience of having a baby with a problem can bring up a host of unpleasant feelings—anger, anxiety, even guilt. The sense of loss of the anticipated, perfect, baby can be a shock and a source of depression. The child’s continued presence serves as a constant reminder of this. Reactions of the parents are a function of their own histories and personality as well as the visibility and location of the birth defect.


Responses of Parents and Family of the Newborn

Various factors shape the parents’ attitudes toward the fetus and neonate. The first is their relationships with their own parents. There are several views of the ways pregnancy is experienced; these range from the idea that pregnancy is inherently a crisis to the other extreme that views pregnancy as a normal part of development. With advances in technology, mothers (and often fathers) are aware of the pregnancy at a very early stage. Often, the first picture of the fetus during ultrasound concretizes this knowledge for both parents. Fathers sometimes experience some of the symptoms of pregnancy along with their partners (in some cultures fathers may experience feelings at the time of childbirth—couvade syndrome). Some fathers will sense, and resent, the preoccupation of the mother with the pregnancy. As with mothers, the fathers’ experience of being parented can play a major role, although even fathers who have had difficult parental experiences can be loving and affectionate fathers. Sometimes, prospective fathers become more anxious, for example, owing to a sense of greater responsibility or unresolved issues with their parents. Sometimes, the couple’s expectations of each other are changed by the pregnancy.

In addition to the parents, other members of the family also play important roles. Around the world, probably the bulk of child rearing (apart from breastfeeding) is done by other children—usually siblings. In developed countries, grandparents, aunts, and uncles often play a major role. Parents may find this helpful or intrusive. Preparation of the sibling for the arrival of a new brother or sister varies depending on the child’s age. Significant sibling conflict/rivalry is more likely in the context of a problematic parent-child relationship particularly because the mother’s attention to the older child decreases.


INFANCY AND TODDLERHOOD

In the first weeks after birth, infants quickly become active in learning about the world. They begin to explore the environment through multiple modalities, can track moving objects, screen out irrelevant stimuli, and become active players in the “social game.” For the typically
developing infant, the face/voice of the parent is the most engaging thing in the environment and this early social interest sets the stage for many subsequent skills in multiple areas. Tables 2.1 and 2.2 summarize some of the landmarks of development in the first year of life.

After about 1 month of age, the infant’s ability to engage in voluntary motor movement begins to increase. The infant also begins to produce more sounds and becomes increasingly differentiated in their affective responses. Between 2 and 7 months, there is increased social interaction along with an increased awareness of the nonsocial world and greater coordination of sensation and motor action. By about 4 months, imitation becomes more striking (and further consolidates social interest and attachment). Shortly thereafter, the earliest aspects of object permanence are seen so that things exist to the baby even when not visible; at around this time, the infant’s awareness of cause-effect relationships also increases (see Chapter 1 for a discussion of Piaget’s model of cognitive development in infancy). Both discoveries are important building blocks in social-cognitive development, that is, as the infant appreciates its own ability to impact the world and the stability of people in that world. Object permanence
is an important foundation for symbolic thinking and language development and the appreciation of cause-effect helps the infant gain a new appreciation of intentionality. Socially, these skills are reflected in games like peek-a-boo.















Between 7 and 9 months, the infant develops an awareness that they can be understood by others, that is, that the mother or father can understand their feelings, wishes, and desires (a phenomenon termed intersubjectivity). The infant’s behavior also becomes more goal directed. Around this time, the infant develops more sophisticated strategies for obtaining desired ends by grouping behaviors together in a sequence. These phenomena also serve as a basis for communicative gesturing, for example, pointing at or reaching for an object while looking at the mother/father to request help in getting it. Advances in object permanence and in social skills development also help infants develop a strong sense of attachment to their caregiver (Box 2.1). This is expressed in various ways including phenomena like separation anxiety (often starting between 6 and 8 months and peaking sometime after the first birthday) and in the related phenomenon of stranger anxiety (often beginning around 8 months and peaking around age 12-18 months). Both phenomena speak to the infant’s strong awareness of essential caregivers and the ability to differentiate them from strangers.

Several new milestones are usually achieved by, or shortly after, the first birthday and mark major changes in the life of the infant and family. Motor and motor coordination skills advance (see Table 2.1) such that typically by about 12 months the infant begins to be able to walk independently. Similarly, with the onset of language (usually also around this time) and greater symbolic capacities, the infant is able to hold multiple bits of information in mind and is able to appreciate new ways to solve problems by trial and error. Important foundations for language are well established by 1 year of age and include the ability to engage in reciprocal interaction, differentiated babbling, and use of sounds and intonation (prosody) typical of their native tongue. Once language acquisition starts, knowledge of words usually dramatically increases (Figures 2.1 and 2.2). Usually by age 2, the toddler’s expressive vocabulary is between 50 and 75 words and increases over the next several months so that
by age 3, it is between 500 and 1000 words. By this age, the typical toddler will also be using sentences of three to four words. Increased ability to use language and think symbolically give the potential for advance planning rather than trial and error.



BOX 2.1 Attachment

Although the importance of emotional connections between infants and caregivers has been known (and discussed) for centuries, only starting in the 20th century was much attention paid to the centrality of these connections for normal child development. The idea of attachment (in the sense of psychological connectedness) has come to encompass many aspects of this process. Psychological attachment is the emotional connection one person has to another (over space and time). Attachments are very specific and can be of varying degrees of strength and typically are strongly positive.

From the first moments of life, the adult and infant embark on an emotionally intense social interaction that has strong biologic and psychological aspects. In some animals (birds and mammals), particularly those that can move and walk shortly after birth, the phenomenon of “imprinting” is observed (i.e., the young animal begins to follow around the apparent parental object, whether it is a mother goose or an ethologist such as Konrad Lorenz). For other species (including humans) in which a long period of care is required before the young can move away independently, a complex series of processes occurs and is referred to by the concept of attachment.

The awareness of this phenomenon in infants came through many individuals, but particularly the British psychiatrist and psychoanalyst John Bowlby, who noted the major difficulties children had when separated from their parents because of the child’s illness. He was aware of the many emerging studies on the negative effects of inappropriate early care (e.g., as in orphanages) and was not satisfied with earlier psychoanalytic views of parent-child relationships. In a very influential monograph for the World Health Organization, Bowlby suggested the critical importance of a supportive mother-child relationship, and his work and that of his student and colleague, Mary Ainsworth, stimulated considerable research on the topic over the next decades. Bowlby’s work extended into many areas, including ethology, developmental psychology, and evolutionary biology (among others). Workers such as Harry Harlow demonstrated the importance of a soft, cloth mother substitute for developing rhesus monkeys, and Ainsworth developed a specific psychological paradigm (the “strange situation”) that involved brief separations of young children and their mothers and observations of reunion behavior to estimate the quality of the attachment present. Bowlby’s work and that of others led to closing congregate care settings for young children in the developed world.

Attachment processes are strongly developmental but are also lifelong. Various patterns of attachments in infants and toddlers have been identified along with many of the behavioral and developmental correlates of this process. Attachment can be disrupted by various factors, including a lack of an appropriate parent or parent substitute or unavailability of the parent (e.g., because of severe maternal depression). Children who have been abused may still form attachments, although the quality of the attachment may be unusual.

Reprinted with permission from Volkmar, F. R., & Martin, A. (2011). Essentials of Lewis’s child and adolescent psychiatry (1st ed., p. 18). Lippincott Williams & Wilkins/Wolters Kluwer.

The increased ability to use symbols also makes for a major reorganization of cognitive development after 18 months as Piaget realized. Increased cognitive abilities are also reflected
in phenomena like deferred (i.e., remembered) imitation. The young child begins to use symbols in play, and play begins to shift from simple functional use of materials to more abstract levels.






Various problems can negatively impact normative development. These are summarized in Table 2.3 and include problems in self-regulation (eating, sleeping, impulse control, aggression, and mood/anxiety difficulties). Given the centrality of social factors in early development, disturbances in relatedness are particularly important; these can arise as a result of environmental stress, deprivation, or with disorders like autism. Maternal/parental deprivation can arise because of problems in the parent or life circumstances. Risks arise owing to repeated changes in the primary caregiver as well as owing to abuse and neglect (see Chapter 24). The intersection of mental health and physical problems can be seen most dramatically at this age and disentangling cause-effect and relationship-individual issues can be difficult.














Developmental delays can occur in isolation or across multiple areas. Problems in some areas, for example, language, may be reflected in other areas as well. Risk is increased by factors like prematurity and parental substance abuse or nonavailability. Various models of early intervention have been developed and can be helpful. Typically, mild cognitive delays are not noted until later, but more severe delays, often associated with specific genetic and metabolic disorders, can be seen. These include conditions like Down syndrome, fragile X syndrome, Prader-Willi syndrome, and so on.


THE PRESCHOOL PERIOD

As emphasized by Piaget (see Chapter 1), major changes in cognitive, communicative, and social-affective development occur between 2 and 5 years of age. The nature of language and thinking changes dramatically. These capacities are intrinsically and fundamentally interrelated so that greater cognitive capacities are reflected in new and more complex language as well as
in increasingly sophisticated and nuanced social relationships. Children become more capable of understanding, and reflecting on, their own feelings and responses and can be highly verbal in indicating their wants and desires. They become much more active participants in dialogue with parents and caregivers making their thoughts, wishes, feelings, and opinions clear.

The preschool period is also a time when exposure to children other than siblings often occurs, for example, in childcare or early preschool programs. This is also a time when siblings are commonly born. Frequent behavioral-developmental difficulties in this age group can include problems with peers (particularly if the child is aggressive), anxiety problems (often around separation), and developmental delays of all types (but particularly speech-language delays). An increased awareness of the earliest manifestations of problems that come to later be diagnosed as disorders (e.g., anxiety and mood problems) has stimulated interest in the diagnosis and epidemiology of developmental and mental health problems in this age group (Egger, 2009). At the same time, there is also awareness of the potential for short- (or longer) term stresses to be reflected in behavioral and developmental change (Sosinsky et al., 2018).

During the time of explosion of words, the young child may learn about nine words each day. By the end of this time, children will have extensive vocabulary and a good sense of many aspects of correct language use including morphology, grammar, and syntax. Children at this age also have a marked capacity for learning other languages (an ability that begins to diminish, at least in terms of its ease, after about age 6). Some of the relevant milestones in development in the preschool period are summarized in Tables 2.4 and 2.5.
















The ability to think more abstractly and symbolically is expressed in many ways. Children begin to use drawings to represent the world (Figure 2.3 and Box 2.2). During this period, the young child also has a growing ability to organize and engage in forward planning (executive functions) that becomes important later for school success. There is a strong desire to learn, and often children take great pride in their learning and have a desire to “show off” as well as a sense of invulnerability (the latter can contribute to poor judgment and accidents). A major focus of early educational programs is the support of the child’s interest in learning and exploration. Sensitive programs (and parents) are careful to arrange opportunities for learning that are mildly challenging as well as stimulating, thus helping the child to be involved in a continuous process of learning. Self-care and other “adaptive” skills also increase. Games provide important insights into the idea of rules as well as some basic abilities in recognition and manipulation of symbols that will become relevant to later school performance.

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Jun 19, 2022 | Posted by in PSYCHOLOGY | Comments Off on Perspectives from Typical Child Development

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