Child Development

• Attachment basics: attachment is critical for child to meet survival needs (new born can crawl to mother's breast and attach, can also distinguish infants own mother’s milk from milk of other mother’s in delivery ward)
• also critical for psychological developmental needs; infants attach to fathers at the same time they attach to mothers
• mirroring is vital for successful attachment
• specific attachment to a person by the infant does not occur until 6-8 months
• infant can distinguish parents: father tends to be more unpredictable and mothers more soothing. Consequence is that children want their mothers when they are hurt or in trouble and their daddies when they want to play
• Mothers tend to be purely empathetic as where fathers have empathy but can also set limits. These are gender specific traits that are critical for child development. Children unattached to fathers are at developmental risk due to lack of limits; these children are stressed, but not damaged
• Temperament basics: an inborn aspect of personality (calm, vocal, picky, out going, reserved) and affects ability to attach.
• is exacerbated or exaggerated in pre-term and crack babies
• Developmental Milestones - use Denver Developmental Screening Test to determine if child is developmentally on tract in terms of Gross motor, Language development, fine motor, and personal/social skills
• If child has not reached a landmark by the time 90% of other children do, this must be investigated.
• Gross Motor: walks by 1 year
• Fine Motor: reach grasp by 8 months; pincer grasp by 10 months
• Language: says mama and dada by 10-11 months; 2 word by 2 years
• Social: smile at 3-4 months; peek-a-boo at 6 months
• Theories of development - these are the most important theories on infant development
• Erikson: "Trust vs mistrust" - child in stable functional family tends to experience the world as a safe place to explore
• children shuttled between relatives, foster homes, or abused have trouble attaching. They develop the notion that the world is not a safe place and exploring it is risky; this negatively impacts remainder of all development
• Freud: "Oral stage" is characteristic of infancy. Child learns that feeding is pleasurable.
• Teen-age anorexics are dealing with problems associated with allowing them selves to feel worthy of pleasure
• Piaget: Noted a progression from concrete means of "Sensorimotor" learning to the abstractions of "Object Permanence"
• Sensorimotor: children learn by interacting with environment directly; so passive learning is ineffective
• Object Permanence: an understanding of the notion that just because something is not seen at a given moment, it can still exist. The lack of this ability is why peek-a-boo is so much fun to a 6 month old and the development of it is why it is so boring to a 1 year old.

• The main thing happening at this stage is the development of concept of self as separate (Separation) resulting in Individuation and Independence. Process exemplified by the frequent use of the word "No" to exert control.
• Developmental Milestones
• Fine motor: build with blocks
• Language: they ask questions to build vocabulary
• Social: Separation anxiety is an issue that develops from the child’s thought that if a parent is not present they may not be thinking about the child. This is the beginning of a process by which a child ultimately develops an image of the parent within itself. This is a fundamental developmental process that leads to personality disorders if interrupted by divorce, death of a parent or abuse.
• Abuse at this stage results in personality splitting due to child’s inability to reconcile the dichotomy of a nurturing parent who meets their needs being the same person who also becomes monstrous and hurts them.
• Theories of development - contrary to the impression created by emphasis on toileting among the developmental theorist, this is not the only important thing happening during Toddlerhood
• Erikson: "Autonomy vs Shame and Doubt" - child is struggling with sense "I want to do for myself" vs fact that parent needs to consistently set limits on impulsive behavior for socialization; shame and doubt result from overcontrol by parents
• the psychosocial strength that comes from a sense of self-control (autonomy), without the loss of self-esteem or development of shame and doubt, results in a sense of will power.
• once autonomy is developed, the child enjoys learning and helping
• Freud: "Anal Phase" - child is struggling with issue of "am I going to do what Mommy wants me to do or am I going to have control by holding back."
• if child does not develop a sense of "doing for one’s own self" as their primary motivation, then they have developmental issue that later manifest. An example is the child who procrastinates with homework because like toilet training; it is something they do to make others happy (Mom), not something they do for a sense of personal satisfaction
• from this perspective, healthy parenting involves admiring the child as they do for themselves and progress from dependent to independent functioning
• by contrast, unhealthy parenting might be exemplified by parents who themselves depend on their child’s neediness and discourage acts of self-reliance. Guess what this neurosis looks like
• Movie showed a Toddler in Britain during the 1950’s separating from parents for minor surgery. Child essentially goes through a Grieving process; becomes more withdrawn, shows symptoms of depression, eats more, sucks fingers, etc.
• Piaget: Pre-Operational (2-7) - "Symbolic Thought": this is a significant development at this stage because once a child starts using language they are really using symbols
• current thinking is that the cognitive development of a child is dependent on his/her emotional attachment to the primary caregiver. This is in large part due to the fact that interactive communication (using language) is very critical for the child to develop this symbolic thought. Passively watching TV won’t do this and is actually counter productive to it
• a good screening question is," How many TVs do you have in your house?"

• Developmental Milestones:
• Cognitive growth is greatest during this period: i.e. vocabulary grows from 300 to 10,000 words
• Mastery of impulses: critical for development down the road. Child develops ability to delay gratification, control anger.
• Development of conscience: Child internalizes parent’s values.
• Preconventional morality does not include a sense of conscience: something is right if they can get away with it and wrong if they get caught and punished. There is no sense that the behavior is wrong. Children are in this stage before developing a conscience, and stuck here if they are sociopaths.
• Acceptance of triangular relationships: Oedipal complex is reflection of a child's desire to have a singular relationship with a particular adult. Normally a parent is the object of the child’s desire and can manifest in statements like, "Will you marry me when I grow up." The concurrent development of a conscience and ability to reality test enables the child to figure out this isn’t going to happen. In the process of figuring this out, the child may have a phase where they always leave someone out of a relationship (like the other parent is left out) = the triangular relationship. This is seen when children play games but refuse to allow one of the parents to join in.
• Theories of Development:
• Erikson: "Initiative vs Guilt": Builds on the previous stage of "Autonomy vs Shame and doubt". Initiative is the child exercising his/her will power to do what he/she wants to do. Guilt results from over restriction of the initiative that is the natural result of the autonomy developed in the previous stage.
• the psychosocial strength that develops from Initiative without a sense of guilt is a sense of purpose. Child’s developing conscience helps control the initiative (Freud’s Superego controlling the Id). Prepares child for competitive schooling.
• the meaningful work of this stage is socialization and is a function of cognitive ability because if all of one’s energy goes into performing cognitive type tasks (in school) then little energy is available for learning how to function socially.
• developmentally delayed children show aggressive initiative.
• Freud: "Phallic-oedipal stage" involves the same issue as Horney’s "Womb envy": which is basically whole body pride.
• Castration anxiety is more accurately understood as a generalized concern for body integrity.
• can lead to intense concern during illness or injury. They have a concept of their body as an oozing mass covered in skin. Consequently Band-Aids are very popular for nearly every ailment.
• children at this age notice the difference between their bodies and those of the opposite sex. Rather than envy of other’s body parts, they are more disappointed by the realization that they can not have everything. For example, some children do seem to go through a stage of rejecting their gender (i.e. tomboy.)
• Piaget: "Pre-operational Thinking": a characteristic of early stage Toddlerhood - children maintain relative egocentrism:
• personalize their observations and experiences; often via magical thinking "The moon followed me from pappy’s house"
• can show spontaneous empathy but can not be objective about why they feel that way.
• they are unable to reverse a thought process or rank things relatively.
• moral laws exist as indivisible parts of certain behavior; to obey adults is to be "good", to disobey is to be "bad" even if doing so is accidental or unavoidable
• Developmental Guidance (from physician)
• Preparation: Let a child know what is going to happen ahead of time, whether good or bad. Allowing the child to experience anticipatory anxiety will lead to questioning that will relieve anxiety. Ultimately the child will learn the value of worry and can respond appropriately when he/she is 16 ( to the designated driver puking up EtOH)
• Separation at school entry: It isn’t your father’s kindergarten any more. Kids are doing math and reading. So if they don’t have the basic developmental tasks under control (toileting, well-developed initiative, etc.), then they are not going to succeed at the cognitive tasks that they are going to be expected to perform. In other words, don’t push kids into preschool until they are ready.
• TV: American college of pediatrics think that no child under the age of 2 should be exposed to television.

• Developmental Tasks
• assimilation into the world of other kids. Children at this stage are able to accurately evaluate where they stand in the larger world. At this stage, children have to deal with the knowledge that they are not the best at most things and feel OK about being a "medium kid."
• this period gives rise to an evolution from a rigid morality based on following rules to one that is flexible based on an understanding of the rules (being able to reverse a thought process by deriving beginning step from the conclusion)
• development of flexible ethical and moral codes leads to empathy. For children to be able to do this, it is best to include acknowledgement that they are forgiven or provide opportunity to make wrong right in punishment situation
• developing a conscience is an important part of developing empathy. If a conscience is not developed in the earlier stages, there is nothing that can be done to put one there later. These people are then unable to empathize and often exhibit sociopathic behavior.
• Developmental Theories
• Freud "Latency": comes from the observation that children’s incestuous behavior subsides during this period. The idea is that the sexual energy spent competing within the family is sublimated outward
• it is not true that sexual energy is latent, children at this stage have a healthy interest in aspects of sexuality even though there is an obvious voluntary separation of the sexes
• Homophobia at this stage is more an expression of a fear of being different than of homosexuality.
• Erikson "industry vs inferiority": means what you might think. This stage of development is focused on converting the energy of earlier stages to the task of learning.
• if previous development is not complete, a sense of inferiority can develop from an inability to succeed at the even greater challenges at hand.
• Piaget "concrete operational": impressionistic and intuitive thinking augmented by using small logical steps in reasoning; results are more constant, reproducible and communicable. Change is from an inductive to a deductive world concept.
• magical thinking is replaced with scientific thinking
• they are capable of manipulating 2 or more variables at once, thus can perform long division, understand abstract literature, and their own art is frustrating in the sense that they can conceive of a product more complex than they can create. This is the stage where the talents of artists, architects, gymnast sprout and are cultivated. This is the tragedy of slashing funding for school music, art and gym programs; the talents of these individuals are lost to society.