Development Across the Lifespan (Test #4)

oral stage

(birth to 1 year of age): During infancy, the major source of pleasure seeking is centered on oral activities, such as sucking, biting, chewing, and vocalizing. Children may prefer one of these over the others, and the preferred method of oral gratification can provide some indication of the personality they develop.

Autonomy versus shame and doubt

(1 to 3 years of age): Corresponding to Freud's anal stage, the problem of autonomy can be symbolized by the holding on and letting go of the sphincter muscles. The development of autonomy during the toddler period is centered on children's increasing ability to control their bodies, themselves, and their environment. They want to do things for themselves using their newly acquired motor skills of walking, climbing, and manipulating and their mental powers of selecting and decision making. Much of their learning is acquired by imitating the activities and behavior of others. Negative feelings of doubt and shame arise when children are made to feel small and self-conscious, when their choices are disastrous, when others shame them, or when they are forced to be dependent in areas in which they are capable of assuming control. The favorable outcomes are self-control and willpower.

anal stage

(1 to 3 years of age): Interest during the second year of life centers in the anal region as sphincter muscles develop and children are able to withhold or expel fecal material at will. At this stage, the climate surrounding toilet training can have lasting effects on children's personalities.

Identity versus role confusion

(12 to 18 years of age): Corresponding to Freud's genital period, the development of identity is characterized by rapid and marked physical changes. Previous trust in their bodies is shaken, and children become overly preoccupied with the way they appear in the eyes of others compared with their own self-concept. Adolescents struggle to fit the roles they have played and those they hope to play with the current roles and fashions adopted by their peers, to integrate their concepts and values with those of society, and to come to a decision regarding an occupation. An inability to solve the core conflict results in role confusion. The outcome of successful mastery is devotion and fidelity to others and to values and ideologies.

genital stage

(12 years of age and older): The last significant stage begins at puberty with maturation of the reproductive system and production of sex hormones. The genital organs become the major source of sexual tensions and pleasures, but energies are also invested in forming friendships and preparing for marriage.

phallic stage

(3 to 6 years of age): During the phallic stage, the genitalia become an interesting and sensitive area of the body. Children recognize differences between the sexes and become curious about the dissimilarities. This is the period around which the controversial issues of the Oedipus and Electra complexes, penis envy, and castration anxiety are centered.

latency period

(6 to 12 years of age): During the latency period, children elaborate on previously acquired traits and skills. Physical and psychic energy are channeled into acquisition of knowledge and vigorous play.

Industry versus inferiority

(6 to 12 years of age): The stage of industry is the latency period of Freud. Having achieved the more crucial stages in personality development, children are ready to be workers and producers. They want to engage in tasks and activities that they can carry through to completion; they need and want real achievement. Children learn to compete and cooperate with others, and they learn the rules. It is a decisive period in their social relationships with others. Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. The ego quality developed from a sense of industry is competence.

Trust versus mistrust

(birth to 1 year of age): The first and most important attribute to develop for a healthy personality is basic trust. Establishment of basic trust dominates the first year of life and describes all of the child's satisfying experiences at this age. Corresponding to Freud's oral stage, it is a time of "getting" and "taking in" through all the senses. It exists only in relation to something or someone; therefore, consistent, loving care by a mothering person is essential for development of trust. Mistrust develops when trust-promoting experiences are deficient or lacking or when basic needs are inconsistently or inadequately met. Although shreds of mistrust are sprinkled throughout the personality, from a basic trust in parents stems trust in the world, other people, and oneself. The result is faith and optimism.

Initiative versus guilt

3 to 6 years of age): The stage of initiative corresponds to Freud's phallic stage and is characterized by vigorous, intrusive behavior; enterprise; and a strong imagination. Children explore the physical world with all their senses and powers (Fig. 28.4). They develop a conscience. No longer guided only by outsiders, they have an inner voice that warns and threatens. Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made to feel that their activities or imaginings are bad produces a sense of guilt. Children must learn to retain a sense of initiative without impinging on the rights and privileges of others. The lasting outcomes are direction and purpose.

Psychosexual Development (Freud)

According to Freud, all human behavior is energized by psychodynamic forces, and this psychic energy is divided among three components of personality: the id, ego, and superego (Freud, 1933). The id, the unconscious mind, is the inborn component that is driven by instincts. The id obeys the pleasure principle of immediate gratification of needs, regardless of whether the object or action can actually do so. The ego, the conscious mind, serves the reality principle. It functions as the conscious or controlling self that is able to find realistic means for gratifying the instincts while blocking the irrational thinking of the id. The superego, the conscience, functions as the moral arbitrator and represents the ideal. It is the mechanism that prevents individuals from expressing undesirable instincts that might threaten the social order.

Developmental Pace

Although development has a fixed, precise order, it does not progress at the same rate or pace. There are periods of accelerated growth and periods of decelerated growth in both total body growth and the growth of subsystems. Not all areas of development progress at the same pace. When a spurt occurs in one area (e.g., gross motor), minimal advances may take place in language, fine motor, or social skills. After the gross motor skill has been achieved, the focus will shift to another area of development. The rapid growth before and after birth gradually levels off throughout early childhood. Growth is relatively slow during middle childhood, markedly increases at the beginning of adolescence, and levels off in early adulthood. Each child grows at his or her own pace. Distinct differences are observed among children as they reach developmental milestones. Nursing Alert Research suggests that normal growth, particularly height in infants, may occur in brief (possibly even 24-hour) bursts that punctuate long periods in which no measurable growth takes place. The researchers noted sex differences, with girls growing in length during the week they gained weight and boys growing in the week after a significant weight gain. Sex-specific growth hormone pulse patterns may coordinate body composition, weight gain, and linear growth (Lampl, Johnson, & Frongillo, 2001; 2005). Furthermore, findings indicate a stuttering or saltatory pattern of growth that follows no regular cycle and can occur after "quiet" periods that last as long as 4 weeks.

Temperature

Body temperature, reflecting metabolism, decreases over the course of development. Thermoregulation is one of the most important adaptation responses of infants during the transition from intrauterine to extrauterine life. In healthy neonates, hypothermia can result in several negative metabolic consequences, such as hypoglycemia, elevated bilirubin levels, and metabolic acidosis. Skin-to-skin care, also referred to as kangaroo care, is an effective way to prevent neonatal hypothermia in infants. Unclothed, diapered infants are placed on the parent's bare chest after birth, promoting thermoregulation and attachment (Galligan, 2006). After the unstable regulatory ability in the neonatal period, heat production steadily declines as the infant grows into childhood. Individual differences of 0.5° F to 1° F are normal, and occasionally a child normally displays an unusually high or low temperature. Beginning at approximately 12 years of age, girls display a temperature that remains relatively stable, but the temperature in boys continues to fall for a few more years. Females maintain a temperature slightly above that of males throughout life. Even with improved temperature regulation, infants and young children are highly susceptible to temperature fluctuations. Body temperature responds to changes in environmental temperature and is increased with active exercise, crying, and emotional stress. Infections can cause a higher and more rapid temperature increase in infants and young children than in older children. In relation to body weight, an infant produces more heat per unit than adolescents. Consequently, during active play or when heavily clothed, an infant or small child is likely to become overheated.

Psychosocial Development (Erikson)

Each psychosocial stage has two components—the favorable and the unfavorable aspects of the core conflict—and progress to the next stage depends on resolution of this conflict. No core conflict is ever mastered completely but remains a recurrent problem throughout life. No life situation is ever secure. Each new situation presents the conflict in a new form. For example, when children who have satisfactorily achieved a sense of trust encounter a new experience (e.g., hospitalization), they must again develop a sense of trust in those responsible for their care in order to master the situation. Erikson's life-span approach to personality development consists of eight stages; however, only the first five relating to childhood are included here:

Cognitive Development (Piaget)

Each stage of cognitive development is derived from and builds on the accomplishments of the previous stage in a continuous, orderly process. This course of development is both maturational and invariant and is divided into the following four stages (ages are approximate): Sensorimotor (birth to 2 years of age): The sensorimotor stage of intellectual development consists of six substages that are governed by sensations in which simple learning takes place. Children progress from reflex activity through simple repetitive behaviors to imitative behavior. They develop a sense of cause and effect as they direct behavior toward objects. Problem solving is primarily by trial and error. They display a high level of curiosity, experimentation, and enjoyment of novelty and begin to develop a sense of self as they are able to differentiate themselves from their environment. They become aware that objects have permanence—that an object exists even though it is no longer visible. Toward the end of the sensorimotor period, children begin to use language and representational thought. Preoperational (2 to 7 years of age): The predominant characteristic of the preoperational stage of intellectual development is egocentrism, which in this sense does not mean selfishness or self-centeredness but the inability to put oneself in the place of another. Children interpret objects and events not in terms of general properties but in terms of their relationships or their use to them. They are unable to see things from any perspective other than their own; they cannot see another's point of view, nor can they see any reason to do so. Preoperational thinking is concrete and tangible. Children cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Thought is dominated by what they see, hear, or otherwise experience. However, they are increasingly able to use language and symbols to represent objects in their environment. Through imaginative play, questioning, and other interactions, they begin to elaborate concepts and to make simple associations between ideas. In the latter stage of this period, their reasoning is intuitive (e.g., the stars have to go to bed just as they do), and they are only beginning to deal with problems of weight, length, size, and time. Reasoning is also transductive; because two events occur together, they cause each other, or knowledge of one characteristic is transferred to another (e.g., all women with big bellies have babies). Concrete operations (7 to 11 years of age): At this age, thought becomes increasingly logical and coherent. Children are able to classify, sort, order, and otherwise organize facts about the world to use in problem solving. They develop a new concept of permanence: conservation; that is, they realize that physical factors (such as, volume, weight, and number) remain the same even though outward appearances are changed. They are able to deal with a number of different aspects of a situation simultaneously. They do not have the capacity to deal in abstraction; they solve problems in a concrete, systematic fashion based on what they can perceive. Reasoning is inductive. Through progressive changes in thought processes and relationships with others, thought becomes less self-centered. They can consider points of view other than their own. Thinking has become socialized. Formal operations (11 to 15 years of age): Formal operational thought is characterized by adaptability and flexibility. Adolescents can think in abstract terms, use abstract symbols, and draw logical conclusions from a set of observations. For example, they can solve the following question: If A is larger than B and B is larger than C, which symbol is the largest? (The answer is A.) They can make hypotheses and test them; they can consider abstract, theoretic, and philosophic matters. Although they may confuse the ideal with the practical, most contradictions in the world can be dealt with and resolved.

Patterns of Growth and Development Directional Trends

Growth and development proceed in regular, related directions or gradients and reflect the physical development and maturation of neuromuscular functions (Fig. 28.1). The first pattern is the cephalocaudal, or head-to-tail, direction. The head end of the organism develops first and is large and complex, whereas the lower end is small and simple and takes shape at a later period. The physical evidence of this trend is most apparent during the period before birth, but it also applies to postnatal behavior development. Infants achieve control of the heads before they have control of their trunks and extremities, hold their backs erect before they stand, use their eyes before their hands, and gain control of their hands before they have control of their feet. Second, the proximodistal, or near-to-far, trend applies to the midline-to-peripheral concept. A conspicuous illustration is the early embryonic development of limb buds, which is followed by rudimentary fingers and toes. In infants, shoulder control precedes mastery of the hands, the whole hand is used as a unit before the fingers can be manipulated, and the central nervous system develops more rapidly than the peripheral nervous system.

Sequential Trends

In all dimensions of growth and development, there is a definite, predictable sequence, with each child passing through every stage. For example, children crawl before they creep, creep before they stand, and stand before they walk. Later facets of the personality are built on the early foundation of trust. The child babbles, then forms words, and finally sentences; writing emerges from scribbling.

Moral Development (Kohlberg)

Moral development, as described by Kohlberg (1968), is based on cognitive developmental theory and consists of three major levels, each of which has two stages: Preconventional level: The preconventional level of moral development parallels the preoperational level of cognitive development and intuitive thought. Culturally oriented to the labels of good/bad and right/wrong, children integrate these in terms of the physical or pleasurable consequences of their actions. At first, children determine the goodness or badness of an action in terms of its consequences. They avoid punishment and obey without question those who have the power to determine and enforce the rules and labels. They have no concept of the basic moral order that supports these consequences. Later, children determine that the right behavior consists of that which satisfies their own needs (and sometimes the needs of others). Although elements of fairness, give and take, and equal sharing are evident, they are interpreted in a practical, concrete manner without loyalty, gratitude, or justice. Conventional level: At the conventional stage, children are concerned with conformity and loyalty. They value the maintenance of family, group, or national expectations regardless of consequences. Behavior that meets with approval and pleases or helps others is considered good. One earns approval by being "nice." Obeying the rules, doing one's duty, showing respect for authority, and maintaining the social order are the correct behaviors. This level is correlated with the stage of concrete operations in cognitive development. Postconventional, autonomous, or principled level: At the postconventional level, the individual has reached the cognitive stage of formal operations. Correct behavior tends to be defined in terms of general individual rights and standards that have been examined and agreed on by the entire society. Although procedural rules for reaching consensus become important, with emphasis on the legal point of view, there is also emphasis on the possibility for changing law in terms of societal needs and rational considerations. The most advanced level of moral development is one in which self-chosen ethical principles guide decisions of conscience. These are abstract and ethical but universal principles of justice and human rights with respect for the dignity of people as individuals. It is believed that few people reach this stage of moral reasoning.

Nutrition

Nutrition is probably the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. During the rapid prenatal growth period, poor nutrition may influence development from the time of implantation of the ovum until birth. During infancy and childhood, the demand for calories is relatively great, as evidenced by the rapid increase in both height and weight. At this time, protein and caloric requirements are higher than at almost any period of postnatal development. As the growth rate slows, with its concomitant decrease in metabolism, there is a corresponding reduction in caloric and protein requirements. Growth is uneven during the periods of childhood between infancy and adolescence, when there are plateaus and small growth spurts. Children's appetites fluctuate in response to these variations until the turbulent growth spurt of adolescence, when adequate nutrition is extremely important but may be subjected to numerous emotional influences. Adequate nutrition is closely related to good health throughout life, and an overall improvement in nourishment is evidenced by the gradual increase in size and early maturation of children in this century

sleep and rest

Sleep, a protective function in all organisms, allows for repair and recovery of tissues after activity. As in most aspects of development, there is wide variation among individual children in the amount and distribution of sleep at various ages. As children mature, there is a change in the total time they spend in sleep and the amount of time they spend in deep sleep. Newborn infants sleep much of the time that is not occupied with feeding and other aspects of their care. As infants grow older, the total time spent sleeping gradually decreases, they remain awake for longer periods, and they sleep longer at night. For example, the length of a sleep cycle increases from approximately 50 to 60 minutes in newborn infants to approximately 90 minutes in adolescents (Anders, Sadeh, & Appareddy, 2005). During the latter part of the first year, most children sleep through the night and take one or two naps during the day. By the time they are 12 to 18 months of age, most children have eliminated the second nap. After 3 years of age, children have usually given up daytime naps except in cultures in which an afternoon nap or siesta is customary. Sleep time declines slightly from 4 to 10 years of age and then increases somewhat during the pubertal growth spurt. The quality of sleep changes as children mature. As children develop through adolescence, their need for sleep does not decline, but their opportunity for sleep may be affected by social, activity, and academic schedules.

Spiritual development (Fowler)

Stage 0: Undifferentiated Stage 1: Intuitive-projective Stage 2: Mythical-literal Stage 3: Synthetic-convention Stage 4: Individuating-reflexive

Metabolism

The rate of metabolism when the body is at rest (basal metabolic rate, or BMR) demonstrates a distinctive change throughout childhood. Highest in newborn infants, the BMR closely relates to the proportion of surface area to body mass, which changes as the body increases in size. In both sexes, the proportion decreases progressively to maturity. The BMR is slightly higher in boys at all ages and further increases during pubescence over that in girls. The rate of metabolism determines the caloric requirements of the child. The basal energy requirement of infants is about 108 kcal/kg of body weight and decreases to 40 to 45 kcal/kg at maturity. Water requirements throughout life remain at approximately 1.5 mL/calorie of energy expended. Children's energy needs vary considerably at different ages and with changing circumstances. The energy requirement to build tissue steadily decreases with age following the general growth curve; however, energy needs vary with the individual child and may be considerably higher. For short periods (e.g., during strenuous exercise) and more prolonged periods (e.g., illness), the needs can be very high. Nursing Alert Each degree of fever increases the basal metabolism 10%, with a correspondingly increased fluid requirement

Sensitive Periods

There are limited times during the process of growth when the organism interacts with a particular environment in a specific manner. Periods termed critical, sensitive, vulnerable,and optimal are the times in the lifetime of an organism when it is more susceptible to positive or negative influences. The quality of interactions during these sensitive periods determines whether the effects on the organism will be beneficial or harmful. For example, physiologic maturation of the central nervous system is influenced by the adequacy and timing of contributions from the environment, such as stimulation and nutrition. The first 3 months of prenatal life is a sensitive period in the physical growth of fetuses. Psychosocial development also appears to have sensitive periods when an environmental event has maximal influence on the developing personality. For example, primary socialization occurs during the first year when the infant makes the initial social attachments and establishes a basic trust in the world. A warm and consistently responsive relationship with a parent figure is fundamental to a healthy personality. The same concept might be applied to readiness for learning skills, such as toilet training or reading. In these instances, there appears to be an opportune time when the skill is best learned.