COUC502 human growth & dev

Maternal Nutrition: A well-balanced diet is critical to the development of a healthy baby. Two conditions that may lead to problems with maternal nutrition are undernutrition and malnutrition. Undernutrition occurs when all the nutrients are available in the mother's diet, but the mother does not ingest enough of them. In addition to eating a healthy diet, expectant mothers must also add certain vitamins, minerals, and other nutrients to their diets for optimal fetal development. Doctors often prescribe specific prenatal vitamins to address the needs of both the mother and unborn child. Malnutrition occurs when one or more of the essential nutrients is missing or when nutrients that are needed for healthy development are present but in the wrong proportions. Malnutrition is a global problem that affects millions of unborn babies and can lead to behavioral abnormalities, altered cognitive functioning, and disturbances in learning and memory. Ensuring that pregnant women understand various resources that may be available to them is critical in helping both the mother and the child get the nutrition that is needed for them to be healthy. Maternal Stress: Maternal stress is another factor that directly impacts fetal development. When a mother is emotionally aroused, her body produces hormones that can cross the placental barrier and enter the fetus's bloodstream. If these hormones cross the placenta often enough, then the fetus gets used to feeling chronically stressed, which prepares its system to overreact to stimuli. Thus, the baby may exhibit more emotional disturbances and gastrointestinal upsets, which may lead the baby to be colicky. While studies indicate that short-term emotional upsets that occur in all pregnancies do not harm the baby, major emotional disturbances and unresolved stresses may lead to emotionally troubled children and can result in spontaneous abortion, preeclampsia, preterm labor, reduced birth weight, and reduced head circumference. Therefore, it is important for mothers to seek out support and reduce their stress levels as much as possible during pregnancy. Counselors can work with pregnant mothers to reduce their stress and anxiety and to focus more on positive thinking and solutions. Counselors can also help reduce stress by assisting mothers with understanding each step of the pregnancy. Teratogens: Teratogens include any disease, drug, or another environmental agent that can harm a developing fetus. These include certain medications, chemicals, and infections. The effects of teratogens often depend on when the exposure occurred, how long the exposure lasted, and how much of the teratogen was present in the body. The effects of a teratogen are worst on fetal development if introduced when the fetal structure is forming and growing most rapidly, which is during the first trimester. Unfortunately, this is also the time when many women do not realize they are pregnant. Counselors, working in consultation with the mother's doctor, can play a critical role in helping pregnant mothers to reduce or eliminate their exposure to teratogens. Smoking while pregnant is especially dangerous to the developing fetus, as harmful chemicals, such as tar, nicotine, and carbon monoxide, are introduced into the placenta. These chemicals lower the amount of oxygen and nutrition that the fetus receives. Smoking during pregnancy can also lead to an improperly attached placenta, ectopic pregnancy, vaginal bleeding, stillbirth, and low birth weight. Alcohol can also be detrimental to the health of a developing fetus. Drinking at any time during pregnancy can have harmful effects—the same amount of alcohol that the mother consumes transfers to the fetus. While the adult's liver can break down the alcohol, the fetus's liver is not yet developed enough to do this; therefore, alcohol is much more damaging to the fetus. Alcohol increases the chance of having a miscarriage or preterm baby and is the leading cause of intellectual disability. Using illegal drugs during pregnancy can also cause long-term problems for the developing fetus. There is no safe time during pregnancy to use drugs. Maternal drug use during the first trimester can significantly impact the development of the baby's organs, while drug use during the second and third trimesters affects fetal brain growth. Maternal drug use at the end of the third trimester can stunt fetal growth and lead to preterm labor. Prescribed and over-the-counter medications can also negatively impact the developing fetus. Certain medications have been found to cross the placenta and enter the baby's bloodstream. However, some medications are safe. With ongoing research on the risks of medications on developing babies, an expectant mother needs to discuss any potential risks with a doctor and pharmacist before taking any prescribed or over-the-counter medication, including supplements. Counselors can contribute to the health of mothers and fetuses by offering proactive preventive education programs as well as offering empirically supported intervention for those struggling with drug and alcohol addictions. Domestic Violence: According to the World Health Organization (2017), violence against women is a major public health problem and a violation of women's human rights. Approximately 35% of women worldwide have experienced physical and sexual violence in their lifetime. As many as 38% of murders of women are committed by an intimate male partner. On a typical day in the United States, there are almost 20,000 calls placed to domestic violence hotlines. According to the Centers for Disease Control and Prevention, almost half (47.5%) of American Indian/Alaska Native women, 45.1% of Black women, 37.3% of White women, 34.4% of Hispanic women, and 18.3% of Asian-Pacific Islander women will experience sexual violence, physical violence, and/or stalking by an intimate partner. While both men and women experience domestic abuse, the most severe violence is committed by male partners against their female partners. Approximately 1 in 5 women, compared with 1 in 7 men, will be victims of severe physical violence by an intimate partner. Domestic abuse is also of concern worldwide, with an estimated 30% of women experiencing intimate partner violence. As many as 38% of murders of women worldwide were committed by an intimate male partner. Prevalence rates of intimate partner violence vary, with 37.7% in the Southeast Asia region, 37% in the Eastern Mediterranean region, 24.6% in the Western Pacific region, and 23.2% in high-income countries. According to a meta-analysis conducted by Hawcroft and colleagues (2019), over 70% of women in Arab countries experienced domestic violence. As you can see, domestic abuse and violence is clearly a worldwide concern. Researchers disagree about whether the prevalence of domestic abuse and violence decreases, increases, or remains the same during pregnancy. However, according to the American College of Obstetricians and Gynecologists, approximately 324,000 women who are pregnant are abused each year. As high as this number is, it is important to note that the actual prevalence of domestic violence experienced by pregnant women may be much higher because many women are reluctant to report abuse, especially during pregnancy. Many times, women believe that becoming pregnant will end domestic violence; however, abuse often begins or worsens during pregnancy, and both the baby and mother are at risk. Dangers include risk of miscarriage, vaginal bleeding, low birth weight, and fetal injury. Working with pregnant mothers to leave an abusive situation can be critical to the health of the mother and infant; however, leaving the relationship may be especially hard since many mothers are worried about financially supporting their children. Counselors can work with pregnant mothers to develop a plan for leaving that includes identifying a safe place to go, making a list of items to take, obtaining a prepaid cellular phone, getting a court order of protection, creating a code word for friends and family when in danger, obtaining an extra set of car keys, keeping evidence of abuse, and identifying financial supports. Mental and emotional needs will also need to be addressed in counseling regardless of whether the mother leaves the abusive environment. Counseling Issues: Now that you have read about healthy prenatal development and risks to healthy development, we turn our attention to other concerns that you may see as a counselor. While this discussion is not all-inclusive, we hope that this section will help you to understand the numerous concerns that soon-to-be parents may have. Having a child can be one of the most joyous events in a person's life, but it can also be one of the most stressful events. Having a child can sometimes strain relationships and trigger confusing emotions. If complications occur, then health issues and financial difficulties may arise. Unplanned pregnancies can create significant strain, and unrealistic parenting expectations can lead to struggles. Prior relationship struggles are likely to get worse. However, when both parents desire a child and have a basic agreement concerning parenting and behavior expectations, then a baby can bring a renewed sense of connection between intimate partners. Although all pregnancies have specific similarities, each pregnancy is also very different. Changes in body image, hormones, and attitude toward cultural pressures and expectations all contribute to how a woman feels about her pregnancy. Like fetal development, a woman's psychological concerns and issues change throughout each trimester of the pregnancy. For example, during the first trimester, a woman may feel heightened emotionality. While the woman may not physically look any different for several more weeks, her emotions are rapidly changing. Typical emotional highs and lows are magnified, which may lead to confusion and frustration. Additionally, if a woman has an increased risk of miscarriage, then this may be a time of heightened anxiety and stress since the risk of miscarriage approaches 20% in the first trimester. Thankfully, a general sense of well-being typically develops during the second trimester; however, a woman may begin to feel increased dependence on her partner and increased anxiety over her body image. The third trimester is typically filled with anticipation. First-time mothers are usually concerned with labor and delivery; however, this is also quite common with other mothers. Body image concerns may also arise again during this time, especially if the mother's sex drive has diminished. Fathers also experience psychological changes throughout pregnancy, which tends to follow the trimester schedule. For many men, the first trimester is filled with a sense of disbelief that the pregnancy is real. Because physical differences in the mother are not typically seen during this time, the father may wonder if the pregnancy is real and may have similar fears to the mother of whether the pregnancy will be successful. A man may find it difficult to express his feelings about his partner's pregnancy, and most men experience fear, concern, or even ambivalence toward the pregnancy. Participating in prenatal visits can be helpful to the father, making him feel more involved and connected to the pregnancy. During the second trimester, pregnancy becomes more apparent as physical changes begin to occur in the mother. During this time, if not before, the father may begin reflecting on his own childhood and the way he was fathered. This can bring up many emotions, depending on his experiences. During the final trimester, men may get to feel the growing child as he or she moves within the womb. This may be the first time that the father really envisions a growing child inside the mother. Additionally, pregnancy can produce profound changes in a relationship. Feelings about the mother's changing body, emotional instability, and shifting sex drives can cause strain on the relationship. Therefore, it is important for both partners to openly communicate during this time. While most women will experience some form of anxiety during pregnancy, van de Loo and colleagues (2019) found that mothers who had a low level of education, were pregnant with twins or more, had a history of depression, experienced severe nausea or extreme fatigue, did not exercise, and had negative life events often experienced anxiety at a higher level. Using literature, DVDs, and other materials is a great way to help educate parents about healthy child development and healthy parental development. Counselors may offer workshops designed to address anxieties of parents and include information related to the importance of prenatal care, the prevention of the mother's exposure to teratogens, and strategies for reducing the chance of premature and low birth weight babies. Workshops can also highlight the importance of breast-feeding, father involvement, available community resources, and cultural variations in parenting styles. Many of these activities may be held in conjunction with hospital-sponsored workshops. Another important area for counselor assistance is in helping parents consider the support that older siblings may need with the arrival of the new baby. Many parents assume that children will not struggle with the addition of a new family member. However, it is critical to help them realize that children may be excited or worried about the upcoming birth. Families undergo tremendous changes during this time, and children can be very susceptible to the stress associated with the changes. Letting a child know that he or she will not be replaced by the new sibling helps establish his or her security within the family. Reading books about siblings, as well as discussing the importance of being a big brother or sister, can foster a closer relationship to the sibling once born. It is also important for the child to receive special attention once the new baby is born. For example, Dad may want to take the child out for a special day, or Mom may spend an afternoon with the child. With all the busyness that comes with a new baby, it is important to emphasize that the older child is still an important part of the family. Grief: Pregnancies do not always go as planned. Many soon-to-be parents are devastated when they experience a miscarriage, stillbirth, or termination of the pregnancy. After any of these losses, many women and their partners experience grief. Unfortunately, this grief is often exacerbated by the lack of recognition of the loss by others, hormonal changes that occur during the postpartum recovery period, and any previous pregnancy-related losses that they may have experienced. It is important for parents, as well as other family members, to work through their grief. Elisabeth Kübler-Ross (1969) proposed five stages of normal grief that people tend to experience. It is important to note, though, that not everyone goes through every stage and that there is no order of stages. However, for many people, the first reaction is typically denial. This stage helps us through the initial shock of the loss. Once this stage wears off, anger typically follows. The anger may be directed toward others, even complete strangers. Families seek out someone to blame—the doctor, God, or so on. Bargaining is another stage that a family may go through (if we had only . . . if the doctor had only . . . ). Parents may even try to bargain with God (or their higher power). Feelings of depression may begin to emerge. During this time, thoughts are dominated by sadness and regret. Acceptance is the final stage of normal grief; however, not everyone may experience this stage. Coping with a loss is a very personal experience and will look different for every family member. As counselors, we can help our clients to work through the grief process healthily. Children often have a hard time grieving and need special attention through counseling services. Many well-meaning family members try to shield children from grief by distracting them, telling them partial truths, or even lying to them about the death of a loved one. Additionally, the parents may also be so deep in their grief about the loss of their child that they have a hard time focusing on a living child's needs. Often, adults simply do not understand when a child can understand death. During the preschool years (about 2 to 4 years old), children may not comprehend death, but they do experience a sense of sadness and loss. They often do not have the vocabulary to express their grief, so they act it out. During this age, parents may see a heightened sense of insecurity and clingy behavior, which is normal. It is also important to note that children this age are very literal in their understanding, so adults must be careful about how they explain death. For example, if an adult were to say that the deceased sibling went to sleep for a very long time, then the child may fear to go to sleep. During the elementary school years, most children begin to experience the full range of emotions like an adult. However, they may not fully understand what it is going on simply due to their lack of experience. Children often assume that they are to blame or may worry about who will care for them, particularly if their parents are strongly grieving. It is important that the child's grief can be expressed and supported by an attentive adult. It is also important for adults to recognize that grief experienced by a child may look very different than that experienced by adults. For example, children may appear disinterested. This behavior does not mean that they are not grieving; it simply means that they have taken in what they can now. When they are ready, children will reach out for more information. Children need creative outlets, such as art, music, puppets, and so on, to help work through their grief. Mental Health Disorders During Pregnancy: While depression and anxiety are the most common mental health issues during pregnancy, with approximately 10% to 15% of pregnant women being diagnosed, some mothers may also experience other mental health issues. Mental health during pregnancy depends on several factors, including the history of mental illness, the current treatment of mental illness, recent stressful events, and how the mother feels about the pregnancy. Symptoms of mental illness during pregnancy are like those experienced by those not pregnant, although the focus of concerns may be on the pregnancy. For example, anxiety may be specifically related to the health of the unborn child, becoming a mother, or so on. Additionally, if a mother previously had a mental illness, such as an eating disorder, then concerns related to body image may begin to arise again. It is important for the counselor to note that sometimes, pregnancy-related issues can be confused with symptoms of mental health illness. For example, lack of sleep or increased sleep is common in both pregnancy and depression. Anxiety is also normal during pregnancy; most women worry about becoming a mother, being a good parent, difficulties with the pregnancy, and childbirth. However, it is when these fears become overwhelming and interfere with the mother's life that anxiety becomes a diagnosable concern. According to worldwide estimates, approximately 10% of pregnant women and 13% of new mothers suffer from mental health disorders, especially depression (World Health Organization, 2019). Women who previously had a mental illness are at an increased risk of relapsing during pregnancy or after giving birth. Of concern are those women who stop using psychotropic medications during pregnancy. According to the American College of Obstetricians and Gynecologists and the American Psychiatric Association (2019a), approximately 14% to 23% of pregnant women suffer depressive symptoms. Because many psychotropic medications have either not been determined to be safe during pregnancy or have been determined as unsafe, pregnant women who have mental illness are left in a quandary. Should they take medication to help themselves but possibly cause harm to the unborn child? This decision must reflect an understanding of the risks associated with untreated psychiatric illness and the risks associated with fetal exposure. Because mental illness may cause significant struggles for both the mother and the child, discontinuing or withholding medication during pregnancy may not always be the safest option. It is important for the counselor to work closely with the medical doctor in treating mental illness among pregnant clients to ensure that both the mother and the unborn child remain safe. Depression can affect mothers and fathers both during pregnancy and after the birth of a child. Numerous studies have indicated high levels of depressive symptoms during pregnancy in the mother worldwide. However, studies have also indicated high levels of depressive symptoms for their partners as well. Parents may be particularly at risk of depression during the first trimester of pregnancy, as reported symptoms of depression tend to be higher during this time but then decline as the pregnancy progresses. As a counselor, it may be important to work with parents during the first trimester, discussing such topics as what the pregnancy means to them, what changes may need to be made, and how the upcoming birth could impact their current relationships. Helping soon-to-be parents work through these issues at the beginning of pregnancy can help set the stage for healthier prenatal development of the unborn child and can increase positive parenting after the birth of the child. Additionally, if clients have demonstrated symptoms of depression before pregnancy, then there is a greater risk of having a depressive episode during pregnancy and postpartum. Studies have indicated that individuals who have a previous psychiatric illness, stressful life events, poor marital relationship, negative attitude toward pregnancy, minimal social support, and low socioeconomic status have an increased chance of developing postpartum depression. These are multiple areas that counselors can begin focusing on during pregnancy. While depression, especially postpartum depression, receives primary attention in the literature, it is important for counselors to understand that women may also experience other emotional issues. Sometimes anxiety and stress during delivery can trigger past traumas (such as abuse) or be traumatic. Symptoms of post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) may be seen in some mothers. Again, concerns become diagnosable when they are severe. It is important for health care providers to recognize the warning signs of emotional distress and make appropriate referrals. Our job, as counselors, is to facilitate that understanding and provide resources and treatment when needed. Healthy parents lead to healthy children. Spirituality During Pregnancy: There is increasing discussion in the literature about how spirituality develops and the impact that it has on our decisions. While spirituality historically was integral to health care, technological advances have come to the forefront; however, spirituality is becoming a rapidly expanding area of research once again. While spirituality during pregnancy has limited research thus far, a few studies indicate that it is indeed important to many who are expecting a baby. How couples view the emergence of unexpected illnesses or complications during pregnancy, the birthing process itself, and the role of the upcoming parents in the child's spiritual development are all areas of concern mentioned in these studies. Counselors can explore the role of spirituality with their clients as another means to help them throughout their pregnancy.

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Parent Education-Discipline for the Infant: Parental beliefs about discipline have been linked to parenting practices, which in turn have been linked to child outcomes. These beliefs are often rooted in cultural and personal beliefs concerning what parents should do to promote their children's development. For example, many African American mothers express stronger beliefs about the use of punishment for infants and have greater concerns about spoiling infants as young as 6 months of age as compared to European American mothers (Burchinal, Skinner, & Reznick, 2010). Therefore, it is critical to explore parental beliefs and cultures surrounding child discipline before suggesting discipline strategies. Many parents believe that infants, younger than 1 year of age, can be spoiled, and that spoiled infants will later exhibit conduct problems or other negative outcomes if they are not taught to respect authority. These parents are also less likely to demonstrate responsive and stimulating parenting practices with their infants and believe that their infants act in intentionally negative ways. Mothers who use more direct or punitive parenting styles with infants often justify their approach as a way of teaching the infant to respect authority and to avoid spoiling the child. These efforts are an attempt to reduce behavior problems in the future, yet the opposite is true. Providing loving responses to an infant's cries and behaviors leads to an increase in independent behaviors when the child is older. Counselors can focus on helping parents eliminate the use of physical punishment with children, especially with infants. For parents of very young children, the focus of counseling efforts should be on determining the extent to which parents believe that infants can intentionally misbehave and should focus on removing the negative connotation of spoiling. This focus in counseling has been demonstrated to be successful in helping parents understand that infants do not intentionally misbehave, nor can they be spoiled. By educating parents about typical infant behavior and expectations, counselors can be at the forefront of preventing future child abuse. Attachment Parenting: Secure attachment, fostered by consistent, predictable relationships, is the foundation for healthy childhood development. Developing a secure attachment has numerous benefits and can be fostered by attachment parenting, a parenting philosophy based on the principles of the attachment theory. Attachment parenting promotes autonomy and independence. Studies demonstrate that securely attached children are more likely to explore their environment, possess a more developed conscience, and exhibit more empathy and prosocial behaviors. Secure attachments also promote emotional availability, better moods and emotional regulation, reduced levels of stress, and fewer behavior difficulties. Finally, attachment parenting practices are associated with higher intelligence and academic performance. Sometimes challenges may arise that interfere with bonding experiences. If either the parent/caregiver or the child is dealing with a problem that interferes with his or her ability to relax, then attachment may be difficult. For example, babies with physical problems, such as compromised nervous systems or other serious health problems, as well as babies with environmental concerns, such as being separated from the primary caretaker at birth or experiencing a series of caretakers, may struggle to bond. Parents may also have issues that interfere with attachment. Parents who are, themselves, products of an insecure attachment, who grew up in abusive or unsafe homes, or who have primarily negative memories of their own childhoods may struggle with bonding. Parents who have emotional problems such as depression or anxiety, who have drug or alcohol problems, or who experience high levels of stress may also struggle to offer the nurturing support infants need. Counselors can play a critical role in helping new parents to foster a positive attachment. Parents often believe that they may spoil the baby if they are always available. However, it is important to note that the more responsive a parent is to an infant's needs, the less spoiled the baby is as he or she grows. Children with secure attachments tend to be more independent than children who are insecurely attached. Helping parents set up daily routines, encouraging them to respond to baby's cries, and teaching them to follow baby's cues can foster the development of positive attachment. Attachment parenting encourages reciprocity, cooperativeness, and being more sensitive, and it helps infants manage difficult feelings. Mothers of securely attached infants are more consistent, sensitive, and accepting of their babies compared to mothers of insecurely attached infants. There are also criticisms of attachment parenting. The cover and article in the May 2012 Time magazine, "Are You Mom Enough?", raised much debate over the attachment parenting philosophy (Pickert, 2012). The arguments that arose were that this parenting philosophy causes mothers to subjugate themselves to their children and to sacrifice everything (working, sex, etc.). However, the other side of the argument is that attachment parenting is the best choice for the development of their children. Some critics are concerned with bed sharing, which has been linked to SIDS; however, Attachment Parenting International tries to address this risk with guidelines for safe bed sharing. Other critics point out that the ability to form healthy attachments is also impacted by peer pressure and relationships during school, dating, and marriage; therefore, early childhood experiences are not the sole indicators of positive attachment. Some believe that attachment parenting can lead to overdependent children or highly stressed parents. However, proponents of attachment parenting disagree with these claims. In the end, most parents try to make the best decisions that they can with their children; however, it is important that counselors remain aware of various parenting philosophies, as well as their benefits and limitations. Even the best philosophy will not be successful if the parent is not able to implement it.

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Piaget's Theory of Cognitive Development: Jean Piaget's theory of cognitive development describes how humans gather and organize information and how this process changes developmentally (Inhelder & Piaget, 1958). He believed that children are born with a very basic mental structure on which all subsequent learning and knowledge is based. For Piaget, the focus was on how mental structures and processes evolved to help individuals make meaning out of their experience and adapt to their changing environments. To understand this process of adaptation, he employed the constructs of schema, assimilation, accommodation, and equilibration. For Piaget, a schema (or the plural schemata) referred to the cognitive structures by which an individual organizes his or her experience and environment. For example, upon encountering a dog for the first time, an infant will experience visual, auditory, and olfactory input. These data, according to Piaget, will be linked in a neural pathway, a schema that will eventually be used as a mental template to represent dog each time these stimuli are encountered. However, as we know, not all dogs will be like the first one experienced, and other animals (for example, a fox or wolf) may possess some of the characteristics of our dog but will be different. These subtle differences will force an individual to develop new schemata to reflect and organize these categories of stimulation. Stages: Birth to 18 to 24 months: Infants adapt and organize experiences by way of sensory and motor actions. Initially, simple reflexes (for example, sucking) help them know their world. Later, within this stage, infants differentiate themselves from the external world, and objects take on their existence. This is the time when object permanence occurs, with the infant able to symbolize the object and realize that objects exist even if they are out of the infant's sensory experience. Preoperational stage 2 to 7 years: While the child at this stage lacks logical operations, he or she is no longer tied to sensorimotor input but is tied to and operates via representational and conceptual frameworks. The child can employ symbols to recreate or present experiences. In this stage, the child believes that everyone sees the world the same way that he or she does. This is called egocentrism. Conservation, another achievement of this stage, is the ability to understand that quantity does not change if the shape changes. Concrete operational stage 7 to 11 years: In this stage, the child can employ logic, however, only to concrete problems and objects. Formal operational stage ≥11 years At this point, children's abstract thinking leads to reasoning with more complex symbols. They can think logically about abstract propositions and test hypotheses systematically. They become concerned with the hypothetical, the future, and ideological problems. Although many think Piaget's cognitive theory is too narrow to explain human lifespan development, he is credited with discovering that thoughts, not just experience, contribute to human development. The advancement of medical research, particularly brain research, has allowed scientists to study how humans process information and react to various stimulations and will ultimately allow researchers to understand human cognition development at every age shortly (Atherton, 2011).

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Social and Emotional Development: Toddlerhood is a wondrous time but can also be challenging for parents and caregivers. A major theme running through this period of development is the increasing movement toward the child's establishment of autonomy, including mastery and control over oneself and one's environment. This push toward independence is both exciting and challenging for children and parents, alike (Erikson, 1963). See Table 2.2 in Chapter 2 (Erikson's Stages of Psychosocial Development) to review the stage of autonomy versus shame and doubt. Autonomy is the source of parental laments about the terrible 2s as well as the parental joy of potty training and various forms of self-care (e.g., feeding). Counselors can help parents and caregivers understand that this drive for independence is to be seen as a wonderful event rather than a child misbehaving. A child needs to develop himself or herself as separate from the parent, as someone who has individual emotions and thoughts. When parents reframe challenging behaviors into efforts to learn independence, then many misbehaviors are no longer seen as such. During this time, children develop a basic self-concept, which includes experiencing pride for displaying good behavior and embarrassment or distress at displaying bad behavior. Children's social development begins with an affectionate and trusting relationship with other family members and adults outside of the family, but by the age of 3, children begin to develop relationships with other children. However, children do not begin to actively play with other children until later. At this time, children engage in parallel play, which is played in the presence of, rather than in interaction with, other children. Therefore, it is a good idea to have plenty of toys that children can play with so that they do not fight over one toy in particular. By the age of 1 year, many children will engage in imitative play, most often by imitating the caregiver. Children will often choose toys such as a play cell phone, purses, vacuums, pots/pans, and so on to imitate behaviors that they observe mom or dad doing. Baby dolls are important for both boys and girls at this age since they pretend that they are either the mommy or daddy and will engage in caretaking behaviors, such as feeding, washing, and reprimanding them. These actions help the brain develop. During imitative play, children learn adult behaviors by taking on the role of a caregiver, develop empathy and emotional intelligence by caring for the baby doll, and create connections within the brain from imaginative thought. Play is critical to the healthy development of a child. Risks to Healthy Toddler Development Unfortunately, not all toddlers experience healthy development. Genetics and the environment play a critical role in the development of the human species. This section will describe a few circumstances that can put a child at risk for unhealthy development. Child Maltreatment: While child maltreatment can occur throughout childhood and adolescence, it most often begins during this stage of development as toddlers begin to assert their independence. Each state supplies its own definitions of child abuse and neglect based on minimum standards set by federal law. The federal Child Abuse Prevention and Treatment Act (CAPTA), reauthorized in 2016, defines child abuse as, at minimum (a) any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation; or (b) an act or failure to act that presents an imminent risk of serious harm. Most states recognize four major types of maltreatment: physical abuse, neglect, sexual abuse, and emotional abuse. Multiple forms of child maltreatment are often seen in combination, although in some cases they are found separately. Keeping in mind that state definitions vary, the following are examples of what most states consider child maltreatment. Physical abuse is commonly associated as a nonaccidental physical injury inflicted by a parent, caregiver, or another person who is responsible for the child. Injuries range from minor bruises to severe fractures or death as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, hitting, burning, or otherwise harming a child. Hitting can be identified through the use of a stick, strap, hand, or other objects. Such physical discipline as spanking and paddling is not considered abuse as long as it is supported as reasonable and does not cause bodily harm to the child. Any injury, as stated previously, is considered abuse regardless of whether the caregiver intended to harm the child. Neglect is often defined as the failure of a parent, guardian, or other caregivers to provide for a child's basic needs. It can be in the form of physical neglect, medical neglect, educational neglect, or emotional neglect. Physical neglect is most commonly constituted as failure to provide necessary food or shelter or a lack of appropriate supervision. Medical neglect is the failure to provide necessary medical or mental health treatment. Failure to educate a child or attend to special educational needs is known as educational neglect. Emotional neglect is considered as the absence of attention to a child's emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs. Many states have now begun to recognize abandonment and parental substance abuse as forms of neglect. Abandonment is identified when the child has been left alone in circumstances when he or she suffers serious harm, the parent has failed to maintain contact with the child or provide reasonable support for a specified period of time, or if the parent's identity or whereabouts are unknown. In some states, parental substance abuse can also be regarded as maltreatment when a child is prenatally exposed to substances that cause harm to the child. Other instances involving substance abuse as a form of maltreatment include using a controlled substance when supervising a child; manufacturing controlled substances, such as methamphetamines, in the presence of a child; or selling, distributing, or giving illegal drugs or alcohol to a child. Sexual abuse is defined by CAPTA as the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children or incest with children. In more general terms, sexual abuse includes activities such as fondling a child's genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials by a parent or caregiver. Emotional abuse, also known as psychological abuse, is determined as a pattern of behavior that impairs a child's emotional development or sense of self-worth. This form of maltreatment is most always present when other forms are identified, although it is difficult to prove. It may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. As a counselor, you will most certainly come into contact with victims of child maltreatment or their families. It is imperative that you have knowledge about the signs and symptoms of the various types of maltreatment and procedures for reporting concerns. Early identification and reporting of abuse reduce further harm to the victim. Children who are abused can suffer a multitude of behavioral and emotional struggles, including depression, anxiety, low self-esteem, substance abuse, eating disorders, and the repetition of the cycle of abuse. As a counselor, you are mandated to report any reasonable suspicion of child abuse. Developmental Delays and Learning Disabilities: Unfortunately, some children struggle with developmental milestones and may experience developmental delays, which can lead to learning disabilities later in life. While not all developmental delays and disabilities can be prevented, some conditions can be treated or eliminated with early detection and treatment. Learning ways to recognize, treat, and prevent developmental delays in babies and young children is vital in working with parents to help their children be successful. Counselors can work with local public health agencies to provide educational programs for women who are pregnant or are considering becoming pregnant. These workshops can provide screening services to determine risk levels and offer information to help a mother improve her health to give the child the best possible start in life. Counselors can work with pregnant mothers to eliminate poor lifestyle habits, including smoking and substance abuse. If taken before and during pregnancy, folic acid can also help prevent neural tube defects or spina bifida. After birth, counselors can encourage parents to have their child's hearing and vision examined if it was not examined in the hospital after birth. Early treatment and intervention for hearing problems can lessen their impact on language development, while early intervention with visual problems may sometimes reverse the problem altogether. Immunizations are also important to discuss with parents. Many may be concerned about the potential side effects, so counselors should encourage them to seek out information and discuss the risks and benefits with their pediatrician. Another issue that parents may want to discuss is metabolic blood screening. The March of Dimes (2016) recommends at least 35 screenings and provides public information about each of them, which can be helpful for parents. While learning disabilities are often not diagnosed until a child has been in school for a few years, there are often early signs that parents may notice, which can also lead to earlier interventions. It is important to note that while the presence of these early risk factors does not cause a child to have a learning disability, it does indicate a need to monitor the child for possible early intervention. Prenatal Risk Factor: Environmental Risk Factors: Developmental Risk Factor Family history of learning disabilities Poverty Developmental delay with gross motor skills, such as crawling, walking, or jumping Prenatal injuries affecting neurological development Injuries or long-term illnesses affecting neurological development. In the United States, the Individuals with Disabilities Education Act (IDEA) is a federal law that requires appropriate services to be provided for children with disabilities. Infants and toddlers, from birth to 25 months, receive early intervention services under IDEA Part C, while children ages 3 to 21 receive services under IDEA Part B (IDEA, n.d.). Public school districts provide screening and assessment for developmental delays so that early intervention can begin. Furthermore, programs such as Zero to Three (2019), a national nonprofit organization, provide parents, professionals, and policy makers with the knowledge and skills to nurture early child development. This program provides information related to early childhood development, behavior, maltreatment, and public policy. The program also provides information specifically related to military families. Early Head Start (2011) is another program offered in the United States that focuses on healthy early childhood development. This program is available for low-income families and provides services such as home visits, family center activities, center-based childcare, and referrals to other community resources. This program also offers prenatal services to encourage a healthy pregnancy and birth. It is important for counselors to be aware of the services that are provided for parents and their young children. These services can offer additional support to parents who are struggling, can provide answers to parenting questions, and can calm fears related to child development. Remaining vigilant and staying up to date on early childhood laws and regulations and these additional resources is critical if we truly want to help parents nurture healthy toddlers. Counseling Issues As noted above, toddlerhood is often characterized as the "terrible 2s" because of the child's struggle for independence. It is often a prime time when families seek out the help of a counselor or a health care provider. This section will provide examples of various concerns that parents may have in regard to rearing healthy toddlers. Anxiety During Toddlerhood: Anxiety disorders are the most common form of psychopathology in children, and separation anxiety is a common issue for most children and is developmentally normal until the ages of 3 to 4. However, a child with clinical separation anxiety experiences recurrent excessive distress or worry beyond that expected for the child's developmental level. This anxiety results from separation or impending separation from the child's attachment figure. Characteristic features of separation anxiety include severe distress, worry, or fear leading to impairment of functioning. It is also frequently accompanied by somatic symptoms such as headaches, stomachaches, nausea, and vomiting. While the prevalence rate of all anxiety disorders in children is approximately 7% (Centers for Disease Control and Prevention, 2019), the prevalence rate for separation anxiety is 4% (Psychology Today, 2019). Separation anxiety has also been linked with other disorders such as conduct disorder and depression, therefore making these disorders frequent comorbid conditions of separation anxiety disorder. Risk factors for developing separation anxiety disorder include life stresses or losses (illness or death of a loved one, loss of a pet, moving), the temperament of the child, family history of anxiety, and environmental issues such a natural disaster that resulted in separation. As counselors, it is important for us to be aware of the characteristics of separation anxiety as well as different intervention strategies to address the issue. Infants experience numerous emotions. In normal development, infants become familiar with their home environment and feel comfortable when parents or their caregivers are around. When infants are put in situations where something unusual is going on or are unfamiliar with a particular place, then they will become fearful. From 8 to 14 months, children become frightened when they meet new people or visit new places. They believe familiar faces and places are safe; therefore, they feel uneasy or threatened when they are separated from their parents, caregivers, or home. Separation anxiety, in general, is a normal stage that infants go through and usually ends when the child is around 2 years old. Some toddlers may understand that their parents or caregivers are out of sight but will return later. However, some toddlers may display behaviors that signify higher levels of distress due to separation. There are many symptoms that result from separation anxiety in children; some of these include excessive distress when separated from the primary caregiver, nightmares, reluctance to go to school or other places, reluctance to sleep without the caregiver nearby, repeated physical complaints (stomachaches, dizziness, muscle aches), homesickness, worrying about losing the caregiver, and worrying about harm toward the caregiver. There are no tests for separation anxiety because it is normal; however, if severe separation anxiety persists after age 2, then an evaluation by a counselor may be needed to see if the child has an anxiety disorder or other condition. Young children with symptoms that improve after age 2 are considered normal even if some anxiety comes back later in life in stressful situations. Counselors can work with parents to ease separation anxiety before it becomes a major problem by encouraging parents to help their child feel safe in the home, to trust people other than his or her parents or caregivers, and to trust that his or her parents will return. The separation process can be difficult for all persons involved, and it is a process that requires open communication and self-awareness for the parent. Counselors can help parents examine their own thoughts and feelings about the separation process and ask their child about his or her thoughts and feelings. Parents should not ignore their own feelings on separation or their child's feelings. It is important for parents to take baby steps, especially if separation anxiety is a problem. Parents can begin by separating for just a few minutes at a time. For example, by placing the toddler in a safe room or play pen and giving the child a hug or kiss while promising to return, then leaving for a few minutes and giving the child another hug or kiss after returning. Parents can practice this technique multiple times throughout the day until they can build up for longer periods. Another strategy parents can try is talking about the anxieties. For example, toddlers may struggle with separation anxiety when starting preschool for the first time. Parents should talk to their child about what the child likes about school and his or her worries. For example, find out if the child is worried that the parent will not come back. Parents should help their children understand that they plan on returning and tell them the time they expect to be back. Some children may even be worried that something will happen to their parents while they are gone. Even though parents cannot promise complete safety, they can promise the child they will be extra careful. Parents can also try encouraging a transitional object. A transitional object could be anything the child cherishes such as a favorite stuffed animal or a blanket. Parents can allow their children to take their favorite object with them in order to support feelings of comfort and safety. It is also important for parents to remember that some children struggle more with anxiety caused by separation than others. Some children may have experienced a loss such as a divorce or the death of a loved one or pet, which can cause them to fear that someone or something else will leave them. Other children who struggle with separation anxiety may have attachment issues that last for years. In these types of situations, it is important for parents to seek professional help. Counselors use many different strategies to help children who are already struggling with separation anxiety issues. The treatment of choice is usually counseling over medications; however, medication may be necessary for severe situations. Most children who have not improved from counseling alone usually have other emotional problems in addition to separation anxiety disorder. One technique counselors can use for separation anxiety is behavior modification therapy. This intervention directly addresses the symptoms of separation anxiety and is more effective if the behaviors are addressed positively. The child is also rewarded for small accomplishments. For example, this therapy can be used when a child is having issues sleeping in his or her own bed. Instead of withholding dessert from a preschooler who does not want to sleep in his or her own room, give hugs and praises when the child can go near the room. Praises should be continued when the child is able to stay in the room for 5, 10, or 15 minutes alone. This will allow the child to feel some type of success rather than failure. Cognitive therapy is another technique counselors use to help with separation anxiety. This therapy is used to help children learn how they think. It also allows them to increase their ability to solve problems and focus on positive thoughts. When children focus on more positive feelings, they become open to learning about different ways to deal with anxiety. Some of these include playing games, coloring, listening to music, and so on. Toddlers can even be taught relaxation techniques such as taking deep breaths and counting slowly to 10. Stranger anxiety is another common childhood anxiety. Typically peaking at 6 to 7 months, stranger anxiety also tends to reappear between the ages of 12 and 24 months. Children often become quiet, verbally protest (crying), or may hide behind a parent when a stranger approaches. It is important to note that children should be somewhat wary of strangers simply because of safety concerns. A child should not willingly walk away with a complete stranger. However, children during this age may also act this way toward people who are not really strangers, such as grandparents, aunts and uncles, and so on. This type of anxiety is very typical and actually indicates a strong bond with the caregiver. To help a child during this phase, parents can prepare the child for a meeting with a stranger by talking about the person, holding the child during moments of distress or staying within arm's length of the child, and making sure that the child is comfortable before leaving him or her with a new babysitter. Counselors can encourage parents to remain calm and show the toddler that he or she is safe. This stage typically only lasts a few months and will pass. However, if a child is displaying more severe discomfort, such as being extremely agitated with a stranger and avoiding all strangers, then the child may be exhibiting signs of stranger terror. Behaviors such as hiding when any unfamiliar person enters the home (even if the person is not trying to interact with the child), being extremely upset in the presence of a stranger even while in a familiar environment, loud screaming and back arching when a stranger attempts to hold or comfort the child, or long periods of extreme stillness and wariness while in the presence of a stranger indicate that the child needs additional help from a pediatrician and counselor. This behavior is not typical of early childhood development and is most often seen in foster children (due to earlier maltreatment) and neglected children. Many of the interventions noted earlier can also be used with stranger terror. Because anxiety disorders are the most common disorders in children, counselors and parents should be aware of the symptoms as well as prevention and intervention strategies for helping a child. Counselors can work with children, parents, and preschool educators to help alleviate struggles with anxiety for those who suffer. Case Illustration 5.1 can further help you explore how you might respond to parents with a child struggling with separation anxiety. Case Illustration 5.1 Responding to Separation Anxiety Karen recently weaned her 18-month-old child, Elizabeth, so she planned a special night out for herself and her husband, Justin. However, when the babysitter arrived, Elizabeth cried and cried, and the babysitter had to pull the child off of Karen. The entire time during dinner, Karen could not relax and kept thinking about her child. Finally, she and Justin decided to end the night early and go home. Once they arrived home, the babysitter told them that Elizabeth cried for almost an hour and then fell asleep. Justin and Karen were both disappointed that their plans for a night out did not go as they had hoped, so they planned a night out the following week. The scenario repeated itself. Karen and Justin both feel as though they may not ever get to enjoy an evening out together if this continues. Practice Exercise It is important for Karen and Justin to continue to build their relationship with each other as well as take care of the needs of Elizabeth. Because Karen recently weaned Elizabeth, the child, as well as the mom, may already be experiencing some anxiety over the end of the nursing relationship. Therefore, they may want to wait a few weeks before leaving Elizabeth with a babysitter until this anxiety has eased. It may also be important for Karen to be mindful of the time spent with Elizabeth. Is she still holding the child as much? Does Elizabeth get moments of undivided attention from her? These things occurred during nursing, so the counselor may want to encourage Karen to continue fostering this close relationship without nursing. Karen and Justin can also seek out a familiar person to babysit during this time of transition, such as a grandparent. Leaving the child with a trusted, familiar adult may help calm Elizabeth's fears. Additionally, explaining to Elizabeth a day in advance that her grandmother will be coming to play while Mommy and Daddy go out for a little while can also help her prepare for the transition. When the moment arrives for Karen and Justin to depart, they should do so fairly quickly. They should not sneak out of the house, as this fosters mistrust, but rather calmly tell Elizabeth that Mommy and Daddy will be back soon, give her kisses and hugs, and walk away. This will help Elizabeth see that there is nothing to worry about. The grandmother can then quickly distract Elizabeth with a fun toy or game. Photo 5.2 To be able to express yourself emotionally at an early age is part of healthy identity development. Source: Ryan McVay/Digital Vision/Thinkstock. Gender Identity Development Gender identity refers to a child's personal sense of his or her own gender, being either male or female, and typically develops between 18 and 30 months of age. However, gender identity often is encouraged even before a baby is born. Families who know the biological sex of a child before a baby is born to tend to begin tailoring their parental planning, such as choosing gender-specific names, picking out clothing, painting the baby's room, and so on. Therefore, people in a child's life have already begun to set up expected gender behaviors. Upon birth, these behaviors typically either begin, for those parents who did not know the sex of the child prior to birth, or continue. During this time, theories of social learning describe different types of parental and environmental influences that help shape the child's gender identity. However, gender development progresses through childhood and is not necessarily set during these early months of life. Evidence suggests that gender identity typically takes place by the ages of 2 to 3; however, it may not be well defined until 6 years of age (see Table 5.3). While this age range has been accepted for several decades, a final point of gender identity development has still been unproven and may continue throughout life. Table 5.3 Stages of Gender Identity Development Table 5.3 Stages of Gender Identity Development Age Stage Description 8 to 10 months Child's awareness Discovers his or her genitals 1 to 2 years Physical difference Knows the difference between genitals 3 years Sense of self Identifies self by gender 4 years Child identity Understands he or she will always be a boy or girl 4 to 5 years Gender stability Understands gender remains the same across time 6 to 7 years Gender constancy Understands gender is independent of external features Social learning theory argues that parental behaviors help to shape a child's gender identity. Parents often begin this influence by simply pointing out the differences in genitalia and labeling the body parts correctly (vagina and penis). Clothing, toys, and expectations of play behavior are also encouraged or discouraged according to a child's sex. For example, girls are often encouraged to play more quietly with dolls or stuffed animals, while boys are encouraged to play rough with trucks or blocks. However, it is important to recognize that both boys and girls should be encouraged to cross these gender expectations in play. It is important for girls to play rougher by climbing trees or playing ball and for boys to assume a nurturing role by playing with dolls. Both types of play encourage behaviors that all of our children need. Gender schema theory was formally introduced by Sandra Bem (1981) as a cognitive theory explaining how individuals become gendered in society and how sex-linked characteristics are maintained by culture. Information related to gender is predominately transmitted through society by schemata that outline a group of beliefs that are feminine and masculine according to the culture. Bem purports that gender identity is influenced by the sex typing that an individual undergoes. She outlines four categories in which an individual may fall: sex-typed, cross-sex typed, androgynous, and undifferentiated. Sex-typed individuals integrate information in accordance with their own gender. For example, a female integrates feminine behaviors and assumes a strong female gender identity. Cross-sex typed individuals may integrate information that is aligned with the opposite gender (female adopting strong masculine behaviors). Androgynous individuals integrate information from both genders, and undifferentiated individuals do not show processing of any sex type. While all of the behaviors discussed above are typical of toddlers, some children may demonstrate consistent behaviors that are opposite of their sex, which may lead to the diagnosis of gender identity disorder (GID). GID can be defined as an internal conflict where the individual desires to be the opposite sex. Cross-gender behavior in children is very common, but GID is a relatively rare disorder. GID is characterized by powerful and persisting cross-gender identification, with the desire or belief that one is the opposite sex. Individuals diagnosed with GID also prefer stereotypical cross-gender clothing, activities, and playmates and will typically assume the role of the opposite gender in fantasy or make-believe play. Persons with GID also display an explicit aversion to their own genital or sex-typed behavior, activities, or clothing. Early treatment of GID can help increase the self-esteem of a child as well as peer relationships; however, it is imperative for the counselor to help families understand that gender expression is very fluid during this age period. Generally, the younger the child, the more flexible the gender expression is. However, if a child truly exhibits GID, the counselor can help the family explore possibilities, develop coping strategies, and learn supportive roles that may be needed as the child ages. Treatment for children with GID often focuses on treating secondary problems such as depression and anxiety and improving self-esteem. Treatment may also focus on instilling positive identifications with the child's biological gender (Turban & Ehrensaft, 2018). Sexual Development and Abuse Prevention Toddlers love to be naked, yet often times parents shy away from discussing sexual development. However, this is actually a very important topic to begin for children as young as toddlers. Parents can begin by providing correct labels for body parts (including vagina and penis), discussing basic bodily functions, and allowing children to explore all of their body parts. Masturbation in young children is normal and should not be punished, but a parent may wish to redirect the child to masturbate in a private setting. A parent's reaction (including voice, word choice, and facial expressions) is the child's greatest lesson regarding sexuality. By not responding with anger, surprise, or disapproving words, the parent can teach the child that this curiosity about his or her body is a normal part of life. Toddlers also tend to be curious not only about their own bodies but about others' bodies as well. Often this is demonstrated through a child's game of playing doctor. Instead of overreacting, parents can ask their child to get dressed and distract him or her with a toy or game. Later the parent may wish to help the child learn more about his or her body (and the bodies of others) through a children's book geared toward toddlers. Completing the Guided Practice Exercise 5.2 can help you begin to identify resources to assist parents with discussing this topic with their young ones. Guided Practice Exercise 5.2 Sexual development seems to be a hard subject for many parents to discuss with their children. The use of books may help them to feel more comfortable with this topic. Locate and bring to class two books related to sexual development that would be appropriate for parents to read with their children. Discuss why you think these would be good books and strategies for helping parents discuss this topic with their children. Because of the child's natural curiosity regarding genitalia, it is imperative that parents discuss sexual abuse with their child. However, children must first learn about body parts and functions before they can learn to protect themselves from abuse. Parents can explain that even though touching genitalia may feel good, no one, not even family members or other people they trust, should ever touch the child in these areas. However, the best prevention of sexual abuse at this age is close adult supervision at all times. Discipline During Toddlerhood Parents want their children to find happiness, good health, purpose, and confidence once they are grown adults. However, many parents struggle with how to help their children achieve these goals. By the time infants are 12 months old, discipline is a frequent occurrence in many families. While there is a multitude of research suggesting disciplinary options that have proven effective, many parents are rarely guided by them because there are multiple other factors influencing their parenting behaviors. Not only are parents forming their own ideas and values about family discipline, but individuals such as early childhood educators and counselors are also following this trend. Unfortunately, at times, early childhood educators tend to reflect more on their own upbringing, rather than reflecting on up-to-date research on their training. It is critical that those working in the early childhood field, especially counselors, remain current on the research basis for effective parental discipline in order to enhance and maintain a supportive role for families. Ideally, counselors will work closely with families and develop warm, trusting, and open reciprocal relationships with them. Because of these relationships, early childhood counselors become important agents of change for children and families. When parents are struggling with teaching their young ones the rules on how to communicate and interact with people, places, and things in their physical and social worlds, early childhood counselors can provide a supportive and welcoming environment for parents to turn to and seek assistance. In order to effectively provide discipline, counselors and parents need to understand the functions of the behavior itself. Figure 5.1 demonstrates typical functions of behavior. Description Figure 5.1 Functions of Behavior It is also important for the counselor to discuss the meaning of discipline with parents and the different options that research suggests for parents to use when disciplining their children. Discipline is the process of teaching children the values and typical behaviors of society. By guiding children's moral, emotional, and physical development, parents will enable their children to take ownership and responsibility for themselves when they are older. There are clear boundaries of what is acceptable and unacceptable behavior, as well as what is right and wrong. Children need to become aware of these boundaries and be able to distinguish among them properly. Many parents use a form of punishment when trying to discipline their children. However, discipline is different from punishment in that discipline places emphasis on teaching and making children aware of the consequences of their actions. When an adult uses positive discipline with a child, the parent helps the child understand why a certain behavior is unacceptable and another behavior is acceptable. If negative discipline is used, the child is usually focused on simple obedience and the avoidance of punishment. Many parents use physical punishment as their way of disciplining their children. Physical punishment is the use of force to cause pain, but not injury, for the purpose of correction or control. Some individuals may associate physical punishment with abuse, but most authors distinguish physical or corporal punishment from abuse. The primary difference between abusive and nonabusive parents is the frequency and intensity with which parents direct negative behavior toward their child. Depending greatly on cultural values, the line dividing the two concepts may be drawn at different levels and intensities. The use of corporal punishment by parents is very controversial even though research has clearly demonstrated negative effects on children. While acceptance of physical punishment has declined in America since the 1960s, two-thirds of Americans still approve of spanking (Gillespie, 2018). Internationally, physical punishment is viewed as a violation of human rights and is banned in more than 50 countries (Global Initiative to End All Corporal Punishment of Children, 2017). The United Nations Committee on the Rights of the Child issued a directive in 2006 to eliminate legalized violence against children. It has been supported by 193 countries, with only the United States failing to ratify it. Fifty-four countries have banned physical punishment of children in all settings, including the home. It is important for parents and early childhood educators to be aware of some long-term negative developmental outcomes linked with parental use of physical punishment, as well as what effective discipline looks like. Corporal punishment used by parents may cause disrupted social behavior, delayed cognitive development, poor quality of parent-child relationships, poorer moral internalization including parental values and rules, and increased chances for mental health problems such as depression, anxiety, suicidal ideation, and psychiatric disorders (American Psychological Association, 2018). So what is effective discipline? This is a question many parents ask when they have young children. Being an effective parental discipliner, unfortunately, has no magic universal recipe, but there are research findings that are useful in showing parents practices that are linked with positive outcomes (see Table 5.4). Table 5.4 Effective Discipline Table 5.4 Effective Discipline Principle of Effective Discipline Description Parental warmth and involvement Parents are responsive to children, demonstrating attention, care, and affection while fostering a reciprocal relationship. Clear communication and expectations Parents set clear, achievable goals for behavioral expectations. Induction and explanation Parents explain why behaviors are appropriate or inappropriate and set up logical consequences for inappropriate behaviors. Rules, boundaries, and demands Parents design rules that are easy to understand and are fair and equitable for the child's developmental level. Consistency and consequences Parents are consistent with reinforcement. Positive consequences can strengthen appropriate behaviors, while mild punishment (time-out or privilege withdrawal) can discourage inappropriate behaviors. Context and structure Parents model appropriate behavior. Additional forms of maintaining appropriate behavior can also include using behavior charts and time-out. However, these must be implemented appropriately in order to be effective, and parents may sometimes struggle with being consistent. See Tables 5.5 and 5.6 for directions for using time-out and behavior charts. Table 5.5 Effective Time-Out Strategies Table 5.5 Effective Time-Out Strategies Prior to the initial use of time-out for discipline, role play what time-out will look like so that the child understands. Parents might consider using a doll, stuffed animal, or puppet for demonstrating what time-out looks like. Demonstrate that time-out includes being quiet and sitting in one spot. Decide on a specific length of time (the general rule is 1 minute times the child's age; therefore, a 2-year-old would sit in time-out for 2 minutes maximum); use a timer if needed. The time-out area should be in a boring place with limited entertainment (as much as possible). The child should be directed to time-out immediately after inappropriate behavior occurs. Do not interact with the child while they are in time-out. If the child gets up, then place the child back in the spot, but do not look at or talk to the child. When the time-out is over, discuss the inappropriate behavior with the child, emphasize the appropriate behavior that you would like to see, and give the child a hug to express unconditional love. If inappropriate behavior continues, then place the child back in time-out. Consistency is a major issue and is often why parents struggle with this intervention. Table 5.6 Responding to Toddler Biting Behavior Taming Temper Tantrums. Toddlerhood is often known for the terrible 2s and the terrifying 3s. The presence of temper tantrums is frequently exhibited after the child is attempting to say, express, understand, react, or convey something that another person does not understand. When children tend to fall short of adequate communication with others in their environment, signs of frustration might be exhibited in the form of temper tantrums. Children have their own unique understanding of the world around them, and adults in their lives can help them to learn to handle disappointments, fear, and irritants with healthy and effective communication. Understanding that children see the world in extreme intensities can assist caregivers with empathy and endurance when handling tantrums. Teaching children to verbalize frustrations can aid in prevention of further tantrums. If the child does not have adequate pragmatics, teaching sign language or an alternate form of communication to convey a message may help the child to feel secure and in control. However, some temper tantrums are inevitable and parents may struggle with how to respond appropriately. Table 5.7 provides strategies to assist parents with preventing temper tantrums as well as for responding to a temper tantrum. Table 5.7 Temper Tantrums Table 5.7 Temper Tantrums Temper Tantrum Behavior Prevention Be consistent with rules and expectations. Do not compromise on rules or expectations for behavior. When you change these, a child becomes confused and does not know when the rules apply. Identify any specific triggers that are preliminary to tantrums, and try to reduce or avoid them as much as possible. Triggers may include being hungry or sleepy, having to sit still for prolonged periods of time, or excitement in the environment around the child. Provide opportunities throughout the day to help the child express his or her thoughts and feelings. Help the child learn feeling words (happy, mad, sad, etc.) as well as appropriate methods for displaying emotions. Provide positive reinforcement when the child is following rules or displaying appropriate behaviors. Positive reinforcement should be consistent and ongoing. Develop a plan for how you handle temper tantrums in a variety of situations and environments. Consider different scenarios, and develop a plan for how you will react. Having a plan will help you remain calm during the temper tantrum. Intervention Consider the reason for the tantrum. Reasons could be seeking attention, inability to communicate, emotional frustration, exhaustion, or fear. Get down on the child's eye level and convey unconditional support for his or her emotions. Bend down and look the child in the eye. Convey that you understand how he or she is feeling, but that this behavior is not acceptable. Clarify rules, and stay calm. Explain rules and consequences to the child in a calm voice. Do not give in. Keep in mind that tantrums are scary for the child. Learning to experience emotions is uncharted territory for toddlers. Biting. While not all toddlers bite, biting is a typical normal behavior for many toddlers. Toddlers bite as a small form of aggression that is typically displayed when the child is feeling frustrated. When parents or caregivers use the biting opportunity to teach self-control, the behavior tends to diminish more quickly. Biting also seems to decrease as a toddler matures and can better express himself or herself. As counselors, it is important to remind parents that a child who begins to bite is attempting to communicate in some way, and he or she is not just exhibiting bad behavior. Figure 5.2 provides some precautions or preventions to take if this behavior does arise. Description Figure 5.2 Responding to Toddler Biting Behavior Source: Sparrow (2008). Parenting is a very difficult task and can sometimes seem overwhelming to many individuals. Spending time getting to know a child and what they need as an individual is a great place to begin. Once a parent has an idea of how their specific child reacts to certain situations or experiences, the parent can move forward in discovering the best discipline method to use. Reviewing the example case provided in Case Illustration 5.2 can give you a clearer idea of the behavioral struggles that parents may experience and how a counselor can assist. Case Illustration 5.2 Toddler Biting After staying home for 2 years with her son, Michael, Kim decides to go back to work. During the first week Michael is in day care, Kim receives a phone call from the day care saying that Michael is having a problem biting other children in the class. She has never seen her child bite another child, so she does not believe the worker. The next week, she receives another phone call saying that parents were complaining about Michael biting their children. The worker stated that if he does not stop the biting, he will be expelled from the day care so that the other children are not in danger. Finally, Kim realizes that her son is biting other children, but she does not know what to do about it. Practice Exercise Toddlers typically begin biting because they cannot adequately express their frustrations. The key to helping Kim will be determining what is frustrating Michael and then helping him to express these frustrations in a more positive manner. The counselor may wish to observe Michael in the day care setting so the counselor can clearly see the events leading up to the biting behavior. Once the antecedent events are determined, then the counselor can work with Michael and the day care employees to eliminate or reduce the frustrating events (if possible) and help him express his frustrations in a healthier manner. Sleep During Toddlerhood Circadian rhythms, or the sleep-wake cycle, begin to develop at about 6 weeks of age. The sleep-wake cycle is regulated by light and darkness and is the primary activity of the brain during early development. These rhythms take time to develop, resulting in irregular sleep schedules of newborns; but, by 3 to 6 months, most infants have a regular sleep-wake cycle. Sleep is especially important for children because it directly impacts mental and physical development. By age 2, most children have spent more time asleep than awake and approximately 40% of childhood is spent sleeping. Toddlers need about 12 to 14 hours of sleep per 24-hour period. However, the increase in toddlers' motor, cognitive, and social abilities can interfere with sleep. A drive for independence and need for autonomy may also inhibit a proper daily sleep routine. In addition to sleep disturbances, their ability to get out of bed, separation anxiety, and development of their imagination are also factors that can lead to sleep problems. Daytime sleepiness and behavior problems may signal poor sleep habits. Around 18 months, a child's nap time is typically once a day and lasts only about 1 to 3 hours. Parents should not allow naps too close to bedtime as this may delay sleep at night. A consistent bedtime routine and maintenance of a daily sleep schedule could help prevent sleep problems in toddlers. Limits should be consistent, communicated, and enforced. Toddlers may also be encouraged with the use of a security object such as a blanket or stuffed animal. The bedroom environment should be the same every night, as well as throughout the night. For parents who are attempting to transition their toddler to sleep alone, TVs, computers, and any other electronic devices should be removed from the child's room to create an environment that is conducive to sleep. Light from these devices as well as their stimuli make it much more difficult to fall asleep. Establishing a bedtime routine psychologically prepares toddlers for sleep and also reduces their nighttime anxiety. Parents may encourage a schedule such as taking a warm bath at a designated time every evening, followed by dressing in pajamas, then teeth brushing, and reading good-night stories. This consistent routine will lower stress levels and create steps that are anticipated by the toddler and are associated with bedtime. Parents are also responsible for creating a sense of security during sleep and should be prepared to calm fears and ease the transition from sleep to waking to make the event as stress-free as possible. Digital Media While the American Academy of Pediatrics (AAP) does not recommend any digital media for children under the age of 2 (with the exception of video chatting), surveys demonstrate that 92.2% of 1-year-olds have already used a mobile device (Hill, 2016). The AAP reports that there is no proof that media for children under the age of 2, even media marketed as educational, is beneficial. In fact, studies actually suggest that media use, even background television exposure, harms children's language development (AAP, 2017; Lapierre, Piotrowski, & Linebarger, 2012; Lillard, Li, & Boguszewski, 2015). Guidelines in North America, Canada, and Australia urge parents to limit screen time, including other technology tools such as iPads, Kindles, cell phones, and so on. Parents should also encourage no screen time in the bedroom. Infants' and toddlers' vocabulary growth is directly related to how much time parents spend talking to them rather than hearing a person on television speak. Additionally, television viewing for children under the age of 3 has been associated with irregular sleep schedules, which can affect a child's mood, behavior, and concentration. As can be expected, children who live in homes with high media use are likely to spend less time being read to and looking at books. This could result in more time needed to be able to learn how to read in comparison with children who live in households with low media use. Table 5.8 includes recommendations for media exposure for toddlers. Additionally, Guided Practice Exercise 5.3 provides an opportunity for you to develop a proactive counseling tool for use in your own community. We encourage you to further explore how tools like this one can be used. Table 5.8 Media Viewing for Toddlers Table 5.8 Media Viewing for Toddlers Avoid media use for children under age 2. If media is viewed by toddlers, then parents should be present to watch with the children and use the opportunity to increase conversation. Adult content should be avoided, even if the toddler is not actively watching, because it distracts both the parent and child from engaging with each other. When parents are consumed with household duties and cannot actively play with their child, they can encourage free play instead of relying on television to keep the toddler occupied. Independent play allows children to think creatively, solve problems, and accomplish new tasks. Guided Practice Exercise 5.3 Pediatrician offices often have television monitors in the waiting rooms to entertain both the parents and children. These monitors can also be used to disseminate important parenting and health-related information to families. Design a PowerPoint presentation or a video that could be displayed on a monitor to educate parents about the dangers of screen time for children. Be sure to include recommended guidelines as well as practical strategies for parents to use for limiting the screen time that their child is exposed to. Social Skills It is very important for toddlers to develop good social skills because the skills they develop at this age will influence how they interact with peers and adults later in life. When children are between the ages of 2 and 3 years old, they are able to make friends and initiate play themselves. However, some toddlers struggle with social development. About 17% of toddlers have social development problems that are serious enough to cause distress. While reasons vary, many toddlers struggle with social skills due to autism, speech problems, temperament, or a nonsupportive caregiver, as well as many other factors. There are several strategies for counselors to use when working with toddlers on social skills. Symbols, such as gesturing and speaking, can be early predictors of how toddlers' social skills will develop. Counselors can ask the toddler's parent(s) how often the child points or speaks. Toddlers who have a higher frequency of pointing at objects will have better development of social-emotional concepts later, such as being talkative or having a bigger vocabulary. If the child is not gesturing or trying to speak a lot, then the counselor will have a good idea that the toddler is having trouble with social skills. At this age, it is important for counselors to involve play in a session with a toddler. Mathieson and Banerjee (2010) found that peer play between the ages of 2 and 3 is critical in developing social skills in children. When children engage in play at this age, they learn basic social skills like compromise and mutual support. Also, if the counselor and toddler play with toys, the counselor can see how well the child shares. Manners can also be taught when playing is involved. For example, if the toddler wants to play with a certain toy, the toddler must ask nicely to play with it. Another tool for counselors to use with toddlers is children's music. If the counselor plays a song that the toddler knows, or is familiar with, then the toddler may start to dance and sing. Music can help with social skills in toddlers because it gives children a chance to express themselves through dancing and singing. Singing is also a way for the child to develop or improve their language skills. Playing age-appropriate music in the home or in the car is an easy way parents can get their toddler to start dancing and singing, which can help improve his or her language. Photo 5.3 Playtime and sharing toys are the first steps to gaining positive social skills. Source: Jupiterimages/liquidlibrary/Thinkstock. Helping a child feed himself or herself is also a way to build social skills in toddlers. If the parent and toddler have an enjoyable experience while the parent is feeding the child, this can increase social skills, because the parent is interacting with the child. In order for this to work, the parent must be responsive to the child and interact in a cooperative way with the child. If this is successful, then the child will eventually learn to feed himself or herself and gain other social skills, such as knowing how to properly interact with another person. Some easy things parents can do in the home to promote social development can be as simple as letting the toddler play dress-up. This will allow the toddler to pretend to be someone else. Another easy thing that parents can do to promote social skills in toddlers is to use manners with the child every day. If the child wants a cookie, then the child should be able to ask nicely for a cookie. This will also help promote language development. Taking turns with a toddler is also important in developing social skills. A parent could ask to use a crayon the child has and then explain why it is important to share and take turns. Parents really have the control as to how well their toddler's social skills develop. Parents are able to praise good social skills, such as sharing, or offer alternatives for not using good social skills, such as hitting. The hope is that the toddler will enjoy the praise and continue to develop those good social skills. Toddlers and other children will often model what they see their parents do, so it is important for the parents to be the model for good social skills. If a toddler sees mom and dad hitting each other, then the toddler will just assume it is okay for that kind of behavior to occur. If a child sees the parents asking nicely for something, then the child is more likely to ask nicely the next time he or she wants something. Photo 5.4 Even very young children can communicate with each other. Source: iStockphoto.com/kate_sept2004. Toilet Training Some parents look forward to the day of no more diapers but find that toilet training is more difficult than they anticipated. The key to successful toilet training is to know when the child is both physically and socially ready and to take it in stride. Parents who push their toddler to be toilet trained too early only set themselves up for struggles. Physical Development. A child should be able to get his or her pants up and down quickly before potty training. This skill is difficult, so have the toddler practice dressing and undressing. Playing dress-up is a fun way to encourage this skill. Additionally, children must be able to physically hold their urine or bowel movements. If a child is not physically able to do this, then he or she is not ready to be toilet trained. Social Readiness. Be supportive throughout the toilet-training stage. Do not punish a child for accidents and encourage him or her to seek out your help when needed. Bowel movements and urinating should not be referred to as gross or dirty because this could lead to a feeling of shame. Instead, parents should focus on this as being a normal part of life. Additionally, both the ability and the desire to imitate others will speed toilet training. Many children learn by watching peers, siblings, parents, or a doll go through the process. Encourage parents to allow children into the bathroom so that the parent can model appropriate methods for using the toilet. Sometimes children can develop fears during toilet training. Do not discount these fears! The loud flushing sound of the toilet, automatic toilets, and falling into a toilet can all be very frightening to a toddler. Some toddlers even struggle when watching their bowel movement disappear down the toilet, as if it is part of them. Encourage parents to be empathetic and understanding when responding to these fears. The toilet-training process should be fun for the toddler. Parents can encourage appropriate toileting behaviors by offering enthusiastic praise and modeling appropriate behaviors. If a child is struggling, then perhaps the process was started too early. In this case, simply step back and wait a little longer before trying again. Case Illustration 5.3 provides an example of how toilet-training struggles can be addressed by a counselor. Case Illustration 5.3 Issues With Toilet Training Aniya is 2½ years old and goes to day care while her parents are working. In order to move to the 3-year-old class, Aniya must be potty trained. While both the day care teacher and her parents are working on this, Aniya refuses to use the toilet and continuously has accidents in her clothes. Practice Exercise As a counselor, the first priority is to determine if Aniya is physically capable of holding her urine and bowel movements. By asking the parents questions about her developmental history, the counselor may be able to determine whether this is an issue or not. If Aniya seems to be physically able to hold her urine and bowel movements, then the next step is to determine a positive approach for potty training. At this point, Aniya may already have negative thoughts about using the toilet since both her parents and teachers have already been trying to potty train her. It will be important to ensure that negative comments and actions are not part of the potty-training plan and that Aniya is not made to feel guilty about her accidents. It may be necessary to put toilet training on hold for a few weeks so that Aniya's negative perception can wane. During this time, the parents should allow Aniya into the restroom with them so that they can model appropriate bathroom behavior. Once a few weeks have passed, the counselor may design a behavior chart to encourage potty training. Depending on Aniya's interests, a reward chart can be designed for both home and day care. Additionally, asking Aniya throughout the day to use the toilet and reminding her of the reward chart may help her get into the habit of using the toilet. Summary Children learn best through one-on-one playful interactions with a loving and caring adult. The primary developmental task between ages 1 and 3 involves the development of autonomy. Child maltreatment most often begins during this stage of development as toddlers begin to assert their independence. At this time, children engage in parallel play, which is play in the presence of, rather than in interaction with, other children. Learning ways to recognize, treat, and prevent developmental delays in babies and young children can be vital in working with parents to help their children be successful. Separation anxiety is a common issue for most children and is developmentally normal until the ages of 3 to 4. Gender identity typically develops between 18 and 30 months of age. Sexual development and abuse prevention is an important topic to begin discussing with toddlers. It is critical that counselors remain current on the research basis for effective parental discipline in order to enhance and maintain a supportive role for families. Toddlers need about 12 to 14 hours of sleep per 24-hour period. The AAP does not recommend any screen viewing for children under the age of 2. It is very important for toddlers to develop good social skills because the skills they develop at this age will influence how they interact with peers and adults later in life. The key to successful toilet training is to know when the child is both physically and socially ready and to take any setbacks in stride. Additional Resources Websites Association for Play Therapy (APT) https://www.a4pt.org/ Child Mind Institute: Media Guidelines for Kids of All Ages https://childmind.org/article/media-guidelines-for-kids-of-all-ages/ Healthy Children: Gender Identity Development in Children https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Identity-and-Gender-Confusion-In-Children.aspx Mayo Clinic: Infant and Toddler Health http://www.mayoclinic.com/health/potty-training/CC00060 Parents: Social Development Milestones: Ages 1 to 4 https://www.parents.com/toddlers-preschoolers/development/social/social-development-milestones-ages-1-to-4/ PsychCentral: Is Your Toddler Struggling With Anxiety? What You Need to Know https://psychcentral.com/blog/is-your-toddler-struggling-with-anxiety-what-you-need-to-know/ Sleep.org: Solving Common Toddler Sleep Problems https://www.sleep.org/articles/solving-common-toddler-sleep-problems/ WebMD 7 Secrets of Toddler Discipline https://www.webmd.com/parenting/guide/7-secrets-of

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Healthy Infant Development: Healthy nutrition and a supportive environment are critical to the development of the infant once born. Breast-feeding is highly recommended, as is delaying solid foods until after 4 to 6 months. According to the American Academy of Pediatrics (AAP, 2019a), breast milk should be the only nutrient fed to infants until 4 to 6 months of age. For those mothers who are unable to or choose not to breast-feed, a prepared infant formula can be used. However, human breast milk is ideal for infants because it contains lactose, a sugar that provides energy and lipids, which are healthy fats. The AAP recommends breast-feeding for at least 1 year, and the World Health Organization (2019) recommends breast-feeding for at least 2 years. Infants who are breast-fed have less diarrhea, fewer cases of ear and urinary tract infections, fewer infectious diseases, and lower obesity rates (AAP, 2019a). The AAP also states that breast-fed babies have lower incidences of sudden infant death syndrome (SIDS) in the first year of life. In addition to the benefits of breast-feeding for infants, mothers also experience decreased postpartum bleeding, more rapid uterine involution, and decreased menstrual blood during monthly cycles. Many parents mistakenly give their infants juice, thinking it will provide them with necessary vitamins. However, fruit juice offers no nutritional benefits to an infant under 1 year of age, and new studies reveal that juice should not be introduced before 12 months of age. Once introduced, the amount should be limited to 4 ounces per day for children younger than 4 years, 4 to 6 ounces per day for ages 4 to 6, and 8 ounces per day after that. Consuming the whole fruit is preferred over giving children juice. An excessive consumption of juice can lead to malnutrition, short stature, and dental cavities in children. If juice is given, it should be offered in a cup not a bottle. According to the AAP (2019c), solids should not be introduced to an infant until he or she is 6 months old, able to sit alone, and can grab for items to put into his or her mouth. Simple basic foods should be introduced one at a time. A popular first food is infant cereal mixed with warm breast milk or formula. The AAP also recommends infant cereals that are enriched with iron because the natural stores of iron become depleted around 6 months of age. New foods should then be introduced one at a time, every 2 to 3 days, so that any food sensitivity or allergy can be easily identified. Within 2 to 3 months of beginning solid foods, the infant's daily diet can consist of breast milk (or formula), cereal, vegetables, fruits, and meats; however, these need to be spread throughout the course of the day rather than offering the infant all of these food groups at one sitting. Around 8 to 9 months old, the infant can begin eating finger foods. The AAP states, however, that raisins, nuts, popcorn, or other small or hard foods should be avoided as infants can easily aspirate on them. The Advisory Committee on Immunization Practices (Centers for Disease Control and Prevention, 2019), the AAP (2019b), the American Academy of Family Physicians (2019), and the American College of Obstetricians and Gynecologists (2019) also recommend that an immunization schedule be followed to deter illnesses and diseases that have been problematic in the past. However, immunizations have recently been a source of suspicion regarding their link to physical and mental disorders. A 1998 study by Wakefield et al. claimed to find a link between the measles, mumps, and rubella (MMR) vaccine and autism, which led to the refusal of many parents to get their children vaccinated. However, the study has since been deemed flawed and was retracted by the journal that published it. Many studies have now found no scientific evidence of a link between autism and vaccination (Astuti, Salimo, & Pamungkasari, 2018; Goin-Kochel et al., 2016; Hviid, Hansen, Frisch, & Melbye, 2019; Wu et al., 2018). Another scare in the vaccination world occurred when thimerosal, which was used as a preservative in several vaccines, was linked to autism; indeed, several studies indicate a possible link (Dorea, 2017; Geier, Kern, Homme, & Geier, 2017; Kern et al., 2017; Namvarpour, Nasehi, Amini, & Zarrindast, 2018). However, the Centers for Disease Control and Prevention (2019) maintains that thimerosal in vaccines does not show a connection between thimerosal and autism; however, thimerosal was taken out of childhood vaccines in 2001. Another concern that has been noted in the literature is the link between the DTaP (diphtheria, tetanus, pertussis) vaccine and SIDS. The root of this concern is that a moderate proportion of children who died of SIDS had recently been vaccinated with DTaP; however, most SIDS deaths occur during the age range when three shots of DTaP are given. Therefore, it may simply be a coincidence. A number of controlled studies conducted during the 1980s indicated that there was no association between SIDS and the DTaP vaccine, and studies today continue to find the same (Huang, Chen, Hsu, Glasser, & Rhodes, 2017; Moro et al., 2018). It is important to realize that all vaccines can have side effects. However, for most, these side effects are minor and may only include a low-grade fever or a sore arm. But other, more severe side effects have been noted as previously described. However, the effects of various diseases can also be devastating. It is important for counselors who work with parents of young children to realize the benefits and risks of vaccinations and to be vigilant about staying on top of the current research. Providing a supportive environment is also vital to the healthy development of the infant. Parents and caregivers should create an environment that is safe and conducive for child exploration. Because infants are natural explorers, safety is a primary concern. All electrical outlet plugs should be covered; breakable items should be put away for the time being, and movable, top-heavy furniture should be secured or made stationary. Parents and caregivers should also provide a nurturing environment, including activities to encourage large motor development, such as small steps and stools, as well as provide a variety of materials and toys for children to develop their fine motor skills, such as items that require grasping and carrying. While there is nothing shocking about any of the above, and in fact, it may appear as simply intuitively logical, the conditions of safety and nurturance are not automatic, and for some living in poverty or experiencing daily threats to their well-being, these provisions may not be possible. It is our responsibility, as counselors, to advocate for those whose life conditions challenge their abilities to provide for such safe and nurturing environments.

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Day Care: Quality Matters: Many parents often struggle with the decision of whether to place their newborn into a day care setting, while many parents simply do not have a choice. Often, this decision can lead to stress and anxiety as parents try to determine the best setting for their newborn. Counselors can help parents navigate these decisions by being aware of childcare opportunities in the area, understanding the advantages and disadvantages of childcare settings, and providing support as parents try to make this decision. Understandably, the need for day care for infants and children has risen in the past few decades due to the growing number of parents/guardians, especially mothers, entering the workforce. Childcare settings may include a day care center or care from a relative or nonrelative in a private home. Whatever the setting, parents need to explore the advantages and disadvantages of each option. Studies have shown that the overall quality of childcare settings is critical to the development of the child. Children placed in high-quality settings demonstrated high achievement and development through middle childhood regardless of their SES, as well as increased cognitive and psychosocial skills, because they were exposed to more advanced material. On the other hand, children placed in poor-quality settings developed psychosocial and emotional problems. Children in these settings may experience extreme separation anxiety, social struggles with peers, poor nutrition, and poor caretaker skills. Therefore, it is critical that counselors work with parents to properly assess various childcare options and help them determine the best placement for their child. Counselors and parents should consider the characteristics of the caregiver, staffing ratios and turnovers, environment of the setting, services provided, and personal interactions with the caregiver. The characteristics of the child caregiver are the most important aspect to consider. Caregivers should be warm, caring, and attentive to the individual needs of each child. Discipline should be positively focused and not punitive. The caregiver should actively communicate and play with children. Good staffing ratios with a low turnover rate are also important, as are low caregiver-student ratios. The smaller the number of children per adult in the setting, generally the better the childcare. At a minimum, the childcare setting should have at least one adult for every three to four infants, and one adult for every three to six children under the age of 3. Additionally, finding a caregiver with specialized training in early childhood development is extremely beneficial. The overall environment of the setting should also be assessed. The most frequently noted disadvantages to childcare settings are health concerns and the risk of infection. While children are much more susceptible to infectious diseases in a day care center as opposed to a private home setting, all settings should be checked for signs of mold, water leakage, and damage to floors and walls, as these problems could exacerbate respiratory infections in children. The number of children in the environment should also be assessed, since crowding and lack of hygiene also lead to health problems. A quality environment should not only be clean but should also be welcoming for children to explore and learn. Parents should search for a setting that is neat, clean, orderly, and organized into child activity centers. For parents of newborns, you will want to search for an environment that includes a rocking chair, cribs that are free from blankets and other suffocation hazards, bouncy seats, a tummy time area, and plenty of toys and books. Additionally, when visiting a setting, parents should make sure that babies are individually fed by the caretaker, bottles are not being propped up on the babies, and babies are put to sleep on their backs. For older children, parents should make sure that there are enough developmentally appropriate toys and materials for all the children to use to discourage aggressive behaviors related to not sharing. Parents of older children should also ask the caregiver about activities planned throughout the day. Parents should search for a setting that encourages imaginative play that enhances a child's social, emotional, physical, and cognitive development. Safety is also of utmost importance. Parents should determine whether the caregiver will always be vigilant in his or her supervision of children. Additionally, parents should determine if a caregiver has been trained in child cardiopulmonary resuscitation (CPR) and first aid, as well as if basic sanitary procedures (e.g., washing hands) are being followed. Adequate lighting, temperature, and noise control are also important to assess. Many quality childcare programs also provide comprehensive services for families, such as healthy nutrition, preventative health care, child development monitoring, consultation opportunities with outside specialists, provision of services for children with disabilities, parent programs, and continual staff development opportunities. Finding a setting that also provides these services can greatly enhance the overall wellness of the child. Finally, forming a positive relationship between the caregiver and parent, as well as the caregiver and child, is critical for high-quality care. A parent should feel free to visit the setting at any given time and should visit at random times throughout the year. Parents should be notified immediately of any problems or concerns that the caregiver has and should feel comfortable discussing any parental concerns with the caregiver. Finding a caregiver who can give daily reports of the child's behaviors and activities during the day is very helpful. Children in a high-quality day care setting should exhibit happiness and comfort within the setting. This is one of the best indicators of the environment. High-quality childcare environments have the capability of promoting trust, autonomy, and positive well-being in children. Finding the best setting for a child can lead to positive physical, cognitive, and social-emotional growth and development. Counselors can assist with this process by working with parents to assess childcare options, which can minimize the amount of stress and anxiety that many parents experience. Sleep Concerns: Clinical research has found that there is an interaction between sleep and physical, emotional, and behavioral well-being for individuals. Infants require longer sleep periods than adults do. Therefore, it is important that normal sleep patterns are established early on after birth for both infants and caregivers to have appropriate sleep cycles. There are several factors that affect sleep (normal sleep cycles as well as sleep disturbances): infant temperament, attachment, physiological states, caregiver presence during the sleep routine, sleeping arrangements, and the continuity of sleep disorders. Maintaining sleeping and waking periods throughout the day is a major developmental milestone for infants. Though normal sleep cycles may be difficult to achieve instantly, there are methods to obtain normal patterns as the infant develops. Infant sleep has been broken down into four kinds of sleep patterns: awake (eyes opening or opening and closing), active sleep (movements of arms and legs, irregular breathing, and eye movement), quiet sleep (regular breathing patterns, no limb or eye movement), and transitional sleep (anything that does not fall into the previous categories). As infants age, their duration of active sleep compared to quiet sleep increases. .Wakefulness may be due to the need to nurse or feed, being overtired, soiled diapers, or attachment issues. Though these are not all the factors that can contribute to wakefulness, they are probably the most common. Wakefulness, especially at night, can affect caregiver sleep cycles as well. Caregivers may experience fatigue, poor maternal and paternal health, distress, depression, feeding difficulties, and problems in family life. Often crying is associated with wakefulness, which causes sleep disturbances in both infants and caregivers. Sleep disturbances have been found to increase with age only if appropriate interventions and sleep management methods are not used. In addition, as children age, they are inclined to participate in problematic behaviors such as watching television, playing video games, using cell phones, or using the internet, which make them alert at night and influence sleep patterns and bedtime behavior. For caregivers, sleep is important, not only for their mental well-being but for their ability to care for their child or children. Infants with bedtime resistance and daytime sleepiness are associated with parental stress. Therefore, it is imperative that caregivers learn appropriate sleep management methods and interventions in order to allow themselves and their child or children restful sleep. There are several methods that have been found to be useful when managing sleep in infants. Researchers recommend providing education about infant sleep cycles through parent consultation to promote healthy sleep management for infants. Caregivers were more likely to have positive results when using these methods than without the use of consultation and education about sleep cycles. Behavioral approaches have been found to be an appropriate choice for providing sleep management techniques. Extinction, the Ferber method, and self-soothing are common strategies for sleep in infants. Extinction is described as extinguishing a behavior (such as infant crying) by removing reinforcing stimulus (such as caregiver attention) in order to gain the desired behavior. There are several different kinds of extinction methods. Unmodified extinction, also known as the "cry-it-out" method, involves the caregiver putting the infant to bed and not attending to him or her until the next day. Self-soothing is the process of a child learning how to calm themselves down when they are placed in their crib, or when they wake up in the middle of the night, in order to fall back asleep. The process is called "self"-soothing because it is done by the child themselves, without the help of parents except for the possibility of illness or danger. However, recent studies have associated this method with increased levels of toxic stress in the infant and it is no longer encouraged. The modified/graduated extinction or the use of the Ferber method is more commonly used and involves brief caregiver comfort when the infant is distressed and slowly reducing caregiver attention by waiting longer periods of time before coming into the room to comfort the infant. Another extinction approach is called extinction with parental presence. In this method, the caregiver stays in the room with the child, preferably in a different bed, until the child falls asleep. The child is aware of his or her caregiver's presence and may be comforted by this fact. Though there have been some criticisms of the latter two sleep strategies, there has not been a significant number of empirical studies that show they affect an infant's mental or emotional well-being. Another method of sleep management involves immediate responding. Though there are similarities between extinction and immediate responding, the latter requires caregivers to respond quickly to their infants if they show distress and rocking or nursing their infant until they become drowsy. This method does not bring about success as quickly as the extinction methods, the modified extinction method; however, studies have indicated that it is just as successful as the behavioral strategies and may be a gentler approach for helping an infant sleep. Positive bedtime routines can also be used when establishing normal sleep patterns. Caregivers reinforce appropriate sleep behavior by establishing relaxing activities intermingled with praise and encouragement. Once a routine is established with reinforcing behaviors from caregivers, the infant will fall asleep faster because of cues given by caregivers.

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Ecological Systems Theory: Theories of development classified as ecological theories emphasize environmental factors. Urie Bronfenbrenner (1917 to 2005) created one ecological theory that has important implications for understanding lifespan development. Bronfenbrenner, a Russian American, developed the ecological systems theory of human development, which posits that a child's development occurs within a complex system of relationships, including parent-child interactions (the microsystem); the extended family, school, and neighborhood (the mesosystem); and the general society and culture (the exosystem). All in all, the theory posited five environmental systems significant for understanding human development: microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Table 2.4 provides descriptions of these systems, and Figure 2.1 highlights their dynamic interactive nature. Microsystem: The microsystem refers to the immediate surroundings of the individual and consists of the interactions in his or her immediate surroundings. It is the setting in which a person lives; family, peer groups, neighborhood, and school life are all included in the microsystem. It is in the microsystem that the most direct interactions with social agents take place, with parents, peers, and teachers, for example. The individual is not merely a passive recipient of experiences in these settings but someone who helps to construct the social settings. Mesosystem: The mesosystem connects with the structure of the microsystem. The relationship can be seen between school life, the neighborhood, and the family. The child's environment links the child with his or her immediate surroundings. Some common examples are the connections between family experiences and school experiences, school experiences and church experiences, and family experiences and peer experiences. A result of mesosystem interactions could be that children whose parents have rejected them may have difficulty developing positive relations with their friends or peers. Exosystem: The exosystem is the outer shell surrounding both the mesosystem and the microsystem. The inner level of the exosystem is affected by the support of the macrosystem. Bronfenbrenner describes the exosystem as being made up of social settings that do not contain the developing person but affect experiences in his or her immediate settings (Berk, 2007). The exosystem includes other people and places that the child may not interact with often but still have a large effect on the child, such as parents' workplaces, extended family members, neighborhoods, and so on. For example, a wife or child's experience at home may be influenced by the husband's experiences at work. The father might receive a promotion that requires more travel, which might increase conflict with the wife and affect patterns of interaction with the child. Macrosystem: The macrosystem influences the individual directly, but the individual has less influence in determining settings. The macrosystem includes aspects of culture and the relative freedoms permitted by the national government, cultural values, the economy, wars, and so on. The macrosystem also describes the culture in which individuals live, including socioeconomic status, poverty, and ethnicity. Chronosystem: The chronosystem refers to the patterning of environmental events and transitions over the life of an individual as well as sociohistorical circumstances. For example, divorce is one transition. Researchers have found that the negative effects of divorce on children often peak in the first year after the divorce. Two years after the divorce, family interaction is less chaotic and more stable. An example of sociohistorical circumstances would be the increasing opportunities in the last decades for women to pursue a career. -This theory is illustrated by a big circle with arrows pointing everywhere.

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Research Design: The Experiment According to Campbell and Stanley (1963), "By experiment, we refer to that portion of research in which variables are manipulated, and their effects upon other variables observed" (p. 1.). Thus, the experiment would be one in which the researcher manipulates one or more independent variables, controls any other relevant extraneous variables, and observes the effect of the manipulations on the dependent variable(s). The independent variable is the variable being manipulated by the researcher, and the dependent variable is the change in behavior measured by the researcher. The independent variable, the variable predicted from, is the presumed cause. The dependent variable, the variable predicted to, is the presumed effect. All other variables that might affect the results, and therefore produce a false set of results, are called confounding variables (also called random variables) and these must be eliminated, in some way, from influencing the outcome. Since an experiment is a study of cause and effect, it differs from nonexperimental methods in that it involves the deliberate manipulation of one variable while trying to keep all other variables constant. When applied to the study of human development, pure experimentation is difficult at best and impossible for certain research questions. Humans do not generally lend themselves to isolation, laboratory conditions, and manipulation of factors. For example, if a researcher is interested in understanding how best to affect children's reading abilities, he or she may gather two groups of children matched on variables that could affect reading abilities but are not the variables under study (for example, intelligence, current reading level, visual acuity, motivation, etc.). Once these variables have been accounted for (i.e., controlled), the method of teaching, which is the focus of the study (i.e., independent variable), will be introduced to one of the groups. The dependent measure might be a reading score or measure of grade-level performance. The hypothesis under investigation would be that the group receiving the test variable (the reading program) would do significantly better than those who did not. Strengths and Weaknesses of Laboratory Research: Strengths: 1. Experiments are the only means by which cause and effect can be established, and true experimental design can deliberately and systematically introduce changes and then observe their consequences. 2. Experiments allow the researcher to control the variables; the purpose of control is to enable the researcher to isolate the one key independent variable to observe its effect on the dependent variable. To control the variables allows the researcher to conclude that it is the independent variable, and nothing else, that is influencing the dependent variable. 3. Experiments can be replicated. The experimental method consists of standardized procedures and measures, which allow it to be easily repeated. 4. The data generated by experimental research are normally quantitative and can be analyzed using inferential statistical tests. The results of the tested data permit statements to be made about how likely the results are to have occurred through chance. Weaknesses: 1. The experiment is not typical of real-life situations, and the unnatural environment may generate the distortion of behaviors because the experimental setting is not ecologically valid (not a real-life setting). The range of behavior to be observed in the laboratory is relatively narrow. By controlling the situation so precisely, the observation and measurement of the behavior may be very limited. 2. A psychological experiment is a social situation in which neither the subjects nor the experimenters are passive; they are active, thinking human beings. The Hawthorne effect has demonstrated that regardless of the experimental manipulation employed, the workers' production seems to be improved, and the logical conclusion is that the workers are pleased to receive attention from the researchers who expressed an interest in them. Thus, the results do not necessarily reflect how the workers would behave in the same situation if experimenters were not present. 3. Often, the experimental method, as it operates in psychology, has a history of using biased or unrepresentative sampling. For instance, the participants in this type of research are often psychology students who are required to partake in research as a course requirement. 4. The strength of the experimental method is the amount of control that the researcher has over variables. However, it is not possible to completely control all the variables. There may be other variables at work of which the experimenter is unaware of, and it is extremely difficult to control the mental world of the research participants. 5. The ethical practice in experimental research is a major concern since experiments nearly always involve deceiving participants to some extent. The very term subject implies that the participant is being treated as something less than a person. Researchers need to understand that many areas of human life cannot be studied using the experimental method because it would be too unethical to conduct this type of research in those areas. 6. Some behavioral researchers consider normative data to have very limited usage because such data tend to describe, rather than explain, phenomena. Also, grouping people together, many argue, limits researchers' ability to look at individuals' specificities.

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Social and Emotional Development: Identity is a person's self-definition that focuses on enduring traits of the self. Infants learn who they are and how they are perceived by how they are treated. Loving, caring relationships with caregivers are critical to healthy social-emotional development. Early experiences in childhood shape the development of skills to form friendships, communicate emotions, and respond positively to challenges. Supportive relationships help children to develop trust, compassion, and empathy. The following section describes several aspects of identity development that begins in infancy. Emotional development refers to a child's ability to recognize, express, and regulate his or her emotions. Although all infants express universal emotions, the frequency and use of these emotions is influenced by the child's culture, adult-child interactions, and context. Researchers and practitioners consider social referencing, temperament, self-regulation, and attachment as constructs of emotional development. Social referencing refers to the ability to observe and understand emotional cues of others and then to use those cues to guide personal behavior. For example, a child may see his or her mother smiling at a toy, so he or she responds by crawling toward it. However, if the mother looks fearful, then the child stops. The baby is using the emotional cue from his or her mother to determine if he or she should crawl toward the object. Most research indicates that social referencing begins around 7 months of age. Temperament refers to an individual's personality, disposition, and tendencies. Each child has a unique personality; some are more relaxed, some are more energetic, and some are more irritable. Some infants enjoy being around a lot people, while others want to be around only a few. Originally discussed by Thomas, Chess, Birch, Hertzig, and Korn (1963), temperament includes nine dimensions: activity level, biological rhythms, approach/withdrawal, mood, intensity of reaction, sensitivity, adaptability, distractibility, and persistence. These nine dimensions are then divided into three temperament types, including easy, difficult, and slow to warm. While some babies may have varying levels of intensity on different temperament dimensions, one type usually dominates. Children with easy temperaments are typically more cheerful, recover quickly from changes in routine, have regular biological rhythms, and are moderately active. Conversely, children with difficult temperaments tend to be fussy, have intense emotional reactions, and are fearful of new situations. Slow to warm children are passive, need time to adjust to new situations, and withdraw from or negatively react to new situations. While temperament describes a child's basic personality, the most important factor in the child's future outcome is the goodness of fit between the caregiver's temperament and the child's temperament. Goodness of fit cannot only be how well the caregiver's temperament matches that of the child but also how well the caregiver understands, accepts, and works with the child's temperament. For example, the way a caregiver views the temperament of the child can impact parenting behaviors and thus the caregiver-child relationship. A child with a difficult temperament who experiences intense emotions may be viewed as overly emotional and demanding or vivacious. The viewpoint of the caregiver directs his or her responses to the child and thus encourages or discourages the parent-child bond. Self-regulation refers to the ability to regulate and attend to emotions and behaviors. While this development begins as early as the occurrence of the first reciprocal, sensitive interaction between adult and child, self-regulation continues to develop throughout the lifespan. Children who are provided with positive, empathetic support regarding emotions are able to learn how to express their emotions in culturally acceptable ways. However, children who are mistreated, abused, or neglected have a difficult time controlling their emotions and behavior. These children may resort to aggression and other maladaptive behaviors in an effort to control their intense emotions. The emotional bond between the child and caregivers is referred to as attachment. According to Bowlby (1979) and Ainsworth, Blehar, Waters, and Wall (1978), attachment is an affectional bond between two individuals that is persistent and emotionally significant. The attachment produces a desire to maintain closeness as well as to seek security and comfort and results in distress when the two individuals are involuntarily separated. Children are typically described as being securely attached, insecurely attached-anxious resistant, insecurely attached-avoidant, or insecurely attached-disorganized disoriented. Children who are securely attached seem to feel safe and protected by their caregivers. They seek the parent after separation and go to the parent for comfort. They feel safe to explore their environment and are more socially competent. In contrast, children who are identified as anxious resistant are fearful to explore the environment and often stay close to their caregiver because of the adult's inconsistent responses to the child's distress. This leads to a limited exploration of the environment, which may then lead to feelings of incompetence, especially if parents are intrusive and negatively controlling. Children who are avoidant attached see their caregivers as being unavailable, so they learn to suppress their negative emotions of distress. Therefore, they avoid the adult (e.g., look away, arch their backs). These children often struggle socially because they seem to prefer playing with objects rather than with people. Finally, children identified as disorganized disoriented often appear dazed and confused when with the caregiver. This behavior typically is a result of abuse or neglect. Keeping in mind that social referencing, temperament, self-regulation, and attachment are all constructs of emotional development, Erik Erikson, a neo-Freudian psychologist, developed eight stages for his theory of psychosocial development in 1959. Like Freud, Erikson was primarily concerned with how personality and behavior were influenced after birth. Erikson's theory basically asserts that a person experiences internal struggles that he or she must then negotiate in order to grow and develop (see Figure 4.1). Each stage involves two opposing emotions. Successfully passing through each stage involves achieving a healthy balance between the two opposing emotions. For example, in Stage 1, which primarily occurs between infancy and 18 months of age, infants need to develop a healthy level of trust but they also need to understand when it is helpful not to trust. According to Erikson (1959), the first stage of psychosocial development, trust versus mistrust, is the most critical. During this stage, infants learn whether they can trust the people around them. In fact, because of their complete dependence on caregivers, the quality of care that an infant receives is vital to the successful resolution of this stage. When the child cries, does the caregiver consistently respond? When the child is scared, does the caregiver consistently provide comfort? If these needs are consistently met, then an infant develops a healthy balance between trust and mistrust. However, if these needs are not met or are inconsistently met, then mistrust develops, and children may believe the world is inconsistent and unpredictable. Infants who develop trust feel safe and secure and develop into adults who can hope. Other stages will be discussed in future chapters, as appropriate. Helping parents and caregivers understand the critical role that they play in a child's social-emotional development is critical in creating a nurturing, supportive environment to allow children to thrive. While the descriptions above have provided some guidelines to typical infant development, there are individual differences associated with both hereditary and environmental factors. For example, children who have tall parents tend to be taller than the typical child. Environmentally, health and nutrition also play an important role in the differences in infant development. For example, children in more developed areas of the world tend to be taller than children in regions where food is scarce and infectious diseases are more prevalent. Similarly, children who experience chronic poverty are also more likely to experience slower growth. Ethnic differences can also be found in development. For example, in the United States, African American children typically grow faster and taller than their Caucasian peers, and American Caucasian children tend to be taller and bigger framed than Asian American children.

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Survey Interviews: Often the research question being investigated is best understood by way of direct response from those within the study. For example, in wishing to learn more about peoples' attitudes or beliefs about an issue, asking them directly may be the most effective strategy for gaining understanding. The use of the direct interview or the application of a survey or questionnaire can be very effective in gathering this type of self-reported information, especially when seeking it from large groups of people. In a good survey, the questions are clear and unbiased, allowing respondents to answer unambiguously. As is true for all research methodology, survey research has both strengths and weaknesses as a vehicle for gathering insight and understanding. Strengths and Weaknesses of Survey Research: STRENGTHS: 1. Surveys are relatively inexpensive. 2. Surveys are useful in describing the characteristics of a large population. 3. Surveys can be administered from remote locations using a website, mail, email, or telephone. 4. Collecting large samples is feasible in a survey, making the results statistically significant even when analyzing multiple variables. 5. Multiple questions can be asked about a specific topic, giving considerable flexibility to the analysis. 6. There is flexibility at the creation phase in deciding how the questions will be administered: face-to-face interviews, by telephone, as a group-administered written or oral survey, or by electronic means. 7. Standardized questions make measurement more precise by enforcing uniform definitions upon the participants. 8. The between-group study can be standardized to ensure that similar data can be collected from groups, then interpreted comparatively. 9. High reliability is not difficult to obtain by presenting all subjects with a standardized stimulus. 10. This medium of research greatly eliminates observer subjectivity. WEAKNESSES: 1. A methodology relying on standardization forces the researcher to develop questions general enough to be minimally appropriate for all respondents, possibly compromising what is most appropriate to many respondents. 2. The initial study design, including the method and the tool, must remain unchanged throughout the data collection, and this makes the design inflexible. 3. To get a good-sized sample, the researcher must ensure that many the selected samples will respond to the survey. 4. In the conclusion of the survey, it may be hard for participants to recall information or to tell the truth about a controversial question. 5. The survey is a widely used research method for gathering data from samples ranging from health concerns and political viewpoints to attitudes and opinions. Surveys tend to be weak on validity (except face validity) and strong on reliability. Also, survey answers are influenced by the wording and sequence of the questions. The selective memory of the respondents may also contribute to how they answer the questions. 6. The artificiality of the survey format has compromised its validity, and participants are more inclined to respond to questions they perceive to be relevant and meaningful rather than those questions they cannot comprehend. Survey data must have reliability if they are to be useful since survey research presents all subjects with a standardized stimulus and potentially eliminates the unreliability issue in the process of data collection.

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Theories of human development: (Mature People Eat Bacon, Soup, Corn, Pies, Veggies, Bananas, Eggs). (Mat., Psycho, Erik Psy, Beh, Soc. L., Cog, Piag Cog., Vyg Soc., Biop, and Eco.) Maturationist Psychoanalytic Erikson Psychosocial development Behaviorism theories Social learning theory Cognitive theories Piaget's theory of Cognitive development Vygtotsky's Sociocultural perspective Biopsychosocial theory Ecological systems theory

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Cognitive Theory: Whereas behavioral theory targeted the process of developing behavior and psychoanalytic models emphasized the role of the unconscious, theorists expressing a cognitive theory of development emphasized the unfolding of conscious thought and the developing abilities to process, store, retrieve, and use information. Two major players in the realm of cognitive theory are Jean Piaget, a well-known Swiss psychologist, and Lev Vygotsky, an equally well-known Russian psychologist. Both men contributed significantly to our understanding of the nature of cognitive development.

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Vygotsky's Sociocultural Perspective: Like Piaget, Lev Vygotsky (1896 to 1934), a pioneer of sociocultural theory, maintained that children actively construct their knowledge. However, he disagreed with Piaget's proposal that progression through the identified cognitive stages was natural and invariant. Vygotsky emphasized the role of culture in promoting certain types of activities and emphasized that a child masters tasks that are deemed culturally important. Vygotsky believed that human development is the result of interactions between people and their social environment. He focused on the connections between people and the sociocultural context in which they act and interact in shared experiences and cultural artifacts such as written languages, number systems, various signs, and symbols.

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Seeking the Truth: Research Methodologies: A developmental theory is a systematic statement of general principles that provides a coherent framework for understanding how and why people change over time concerning their behaviors, attitudes, thoughts, philosophies, and physical and psychological capabilities. Theories in development are scientific theories and, as such, represent the systematic statement and integrated assumptions and hypotheses drawn from the observations and research conducted by developmental theorists. As scientific theories, theories of development propose explanations of phenomena that are tested for confirmation or falsification using scientific methodology. Through research, theories are modified to reflect and explain new data. However, when the subject is human development, the application of the scientific method is not always easy; as such, multiple methods of research are employed.

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Counseling Issues: As you reviewed the characteristics of infancy and the factors that contribute to healthy development as well as those that could inhibit healthy development, perhaps you began to conceptualize the unique contribution that a counselor could make in providing targeted interventions and prevention services. What follows is a nonexhaustive presentation of the role a counselor and counseling may provide in fostering healthy development. The counselor as educator and provider of support is emphasized throughout the following discussion. Postpartum Depression: Postpartum depression (PPD) is defined as moderate to severe depression after the birth of a child. Approximately 10% to 15% of women and 10% of men experience PPD (Garfield et al., 2014; Ko, Rockhill, Tong, Morrow, & Farr, 2017). Most parents experience PPD within the first 3 months after birth, but it can take up to 1 year before symptoms arise. Additionally, the risk for PPD peaks in the winter months. Unfortunately, after the first 42 postnatal days, suicide is the leading maternal cause of death during the first year after birth (Thornton, Schmied, Dennis, Barnett, & Dahlen, 2013). In developed countries, the risk of PPD based on place of residence (rural versus urban) is mixed, with some studies indicating that those in the rural setting are at higher risk and others stating that those in urban environments are at greater risk. However, most studies agree that the prevalence of PPD is even more prevalent among rural women in developing countries as compared to rural women from developed countries. Some common risk factors that have been identified for women in rural settings in general include low socioeconomic status (SES), being single, history of abuse, low social support, past psychiatric history, depression during pregnancy, and recent stressful events. Women in rural settings in developing countries have additional risk factors that have been identified. These include lack of knowledge of infant care, struggles with in-laws, having an unemployed or uneducated husband, psychopathology of the husband, years of marriage, gender of infant, having more than five children, and having two or more children under the age of 7 (Kim & Dee, 2018). Living in a rural area may decrease access to mental health services, resulting in fewer diagnoses of depression and lack of appropriate treatment opportunities. Women in these settings may also not seek out counseling services. Lack of knowledge about symptoms of PPD may also be a factor. . Screening for depression also occurs infrequently in rural communities. Counselors may want to develop improved screening tools and referral systems to assist primary health care providers in rural areas with identifying risk factors and detecting PPD earlier. Additionally, group therapy has been found to be an effective intervention for women in rural settings who suffer from PPD.

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Cultural Diversity and Human Development: From the cultural diversity perspective, the contributions of Bronfenbrenner and Vygotsky are significant to the study of human development because their theories focus on its socioecological and sociocultural contexts. Bronfenbrenner's theory focuses on the mutual accommodation and interaction between the developing individual and the physical environment; this ecological approach defines the development of the individual who interacts with the environment in the process of mutual accommodation. Vygotsky, in a similar theoretical approach, developed the theory of cognitive development to emphasize that human development is inseparable from social and cultural activities. His theory complements Bronfenbrenner's ecological systems theory of human development. According to Vygotsky, by interacting with the environment, society, and people with higher skill levels, children develop higher mental processes and learn to use the tools of culture such as language, mathematics, interpersonal skills, and so on. This interaction process is important because it allows children to become acculturated in the use of their intellectual tools. Most importantly, by interacting with a variety of cultural, ecological, and social contexts, children can understand and learn self-regulation.

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First Trimester: During the first trimester (weeks 1 to 12), the fetus develops in a cephalocaudal (head to toe) direction, meaning that the structures near the head develop faster than the structures near the feet. Weeks 2 to 8 are a critical period in our development. During this time, all the major organs and structures begin to form, such as bones, skin, and internal organs. All the major organs are formed by the end of the eighth week. The heart begins to beat, and blood begins to circulate. By the end of the first trimester, the head, face, eyes, ears, arms, fingers, legs, and toes have formed. The lungs have begun to develop, hair has started to grow, and buds for 20 temporary teeth have developed. Second Trimester. During the second trimester (weeks 13 to 27), the organs continue to develop further and begin to function within the body. The fetus can swallow, hear, pass urine, and suck its thumb. Genitals, eyebrows, eyelashes, and fingernails form. The skin is very wrinkled and is covered with vernix (a waxy coating) and lanugo (fine hair). The fetus moves, kicks, sleeps, and wakes. Third Trimester. During the third trimester (weeks 28 and beyond), the fetus still kicks and stretches; however, this activity may slow down a bit as the fetus grows and space in the uterus declines. The fetus gains most of its weight during this period, about one-half pound per week until the 37th week. During this time, the lanugo disappears, and the bones harden, but the skull remains soft for delivery.

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Social Learning Theory: A second behavioral approach to the explanation of the influence of environment on development was initially presented by Albert Bandura (1997, 2008) as a social learning theory. Bandura's social learning theory posits that people learn from one another via observation, imitation, and modeling. The theory has often been called a bridge between behaviorist and cognitive learning theories because it encompasses attention, memory, and motivation. Bandura's model expanded the classic behavioral theory to include cognitive elements. His work emphasized the importance of observational learning (also called imitation or modeling). According to Bandura, Barbaranelli, Caprara, and Pastorelli (2001), social learning is connected to perceptions and interpretations of the individual's experience. Self-efficacy, the belief that personal achievement depends on one's actions, teaches people to have high aspirations and to strive for notable accomplishments when they see others solve problems successfully.

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Healthy Toddler Development: While the first 12 months of life include profound changes in development, toddlerhood allows us to see the child's personality begin to develop. From an infant who could not lift his own head, the child has grown into a person who runs, responds to your words, and expresses his preferences. While toddlerhood is often referred to as the terrible 2s, it is actually a wondrous time to examine the establishment of independence and boundaries. Physical Development: Compared with infancy development, physical development seems to slow during the toddler years, as you can see in Table 5.1. By 2 years of age, the toddler perfects the gross and fine motor skills that emerged during infancy by further developing balance, coordination, and stability. Toys that stimulate a baby's walking and age-appropriate climbing will further develop his balance and coordination. The child is also much better at manipulating objects. By the age of 3 years old, the toddler increases body strength and is able to master challenges such as tricycles and appropriate playground equipment. Additionally, between the ages of 2 and 3, the child should be developmentally ready to begin toilet training, which we will discuss in more detail later in this chapter. Sensory and Perceptual Development:. At around 18 months of age, children begin to use their senses to change the way they interact with the environment. For example, a child may adjust his steps depending on the type of surface he is walking on, or he may choose to slide down a steep embankment instead of walking upright. By 36 months, children can more quickly use their senses to adjust their interaction with the environment. For example, a child may quickly realize that she needs to walk more slowly with an open cup of water compared to a lidded cup of water. Motor Development: Between the ages of 12 and 18 months, a child develops strength, balance, and coordination to walk. By age 2, she or he may be able to climb well, walk up and down stairs while holding on for support, kick a ball, and run short distances. Finally, by the age of 3, a child should be running, jumping, and climbing on age-appropriate playground equipment. Because a 2- to 3- year-old is so active, supervision is critical at this age to prevent accidents. A baby's fine motor skills also improve during this time. Between 12 and 18 months of age, a baby can pick up small objects and build a simple stack of blocks. By 24 months, a child can mold play-dough, put round and square pegs into holes, and turn rotating handles. At this age, a child may enjoy coloring with crayons and will begin to hold and drink from a cup. By the age of 3, a child should begin to show a preference for one hand over the other. Activities such as large-piece puzzles, big blocks, and musical toys can help further enhance fine motor development. The traditional playing in sand boxes with scoops, measuring cups, and toy trucks will also further develop fine motor muscles and develop early recognition of volume and size.

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Language Development: As newborns, babies can discriminate speech sounds. At birth, newborns prefer to hear their mother's voice over a stranger's voice, indicating that they have been listening to their mother's voice while in the womb. Infants begin with cooing and then progress to babbling around 5 months of age. Babbling increases to include well-formed syllables, which is required for later speech and language development. Therefore, it is important for parents and caregivers to encourage, imitate, and respond to babbling. By 9 months old, babies may begin to say "da-da" or "ma-ma" intentionally. While infants are born ready to learn any language, by 12 months old, they have lost the ability to discriminate the sounds in different languages. By 7 to 12 months of age, infants focus on and practice the sounds of the language that they most commonly hear. It is important to note, though, that language heard through television or radio is not internalized and will not develop language in infants (Linguistic Society of America, 2019). Therefore, it is important for parents and caregivers to constantly talk to their child because infants learn language best when adults talk directly to them. Cognitive Development: While the brain grows exponentially during prenatal development, it continues to develop at a rapid pace during the first 3 years of life. It is during this time that a young child's experiences literally shape the neural connections in the brain. Synapses are overproduced in the cerebral cortex and then pruned based on the experiences that the infant has. For example, as an event occurs and reoccurs, the synapses storing the information about the event become more active, thicker, and stronger. However, those synapses that are not exercised are deleted from the brain. This pruning enables the brain to become more finely tuned and functional. In fact, almost half of the neurons that are created during infant development survive to function in adults. A child's brain is immature at birth. Both physical maturation and experience play a role in positively influencing optimal brain development, with parents and caregivers playing a critical role. Being sensitive to an infant's distress, being emotionally available, and being responsive to a baby's cues are critical parenting skills to develop positive emotional and social development. Infants learn how to regulate their emotions and behaviors by watching the caregiver's attempts. Responding to infant cues, such as crying and cooing, leads to increased language and cognitive development.

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Lifespan Study: Researchers in lifespan development often have a special concern with studies that focus on the relation of age to some other variable. Methods that are sometimes employed to study the effect of age involve identifying groups of varying ages and comparing them on some dimension (i.e., cross-sectional research) or at other times following the same individuals across their lifespan and noting changes in the dimensions under investigation (i.e., longitudinal study). Cross-Sectional Research: A cross-sectional study is a descriptive study in which the characteristics under investigation are measured simultaneously in different age populations. Cross-sectional studies can be thought of as providing a snapshot of contrasting populations at a point in time. While the data collected may reveal differences, the actual cause for those differences cannot be isolated nor validly attributed to age alone. Longitudinal Research: A longitudinal study, like a cross-sectional one, is observational. So, once again, researchers do not interfere with their subjects. However, in a longitudinal study, researchers conduct several observations of the same subjects over some time, sometimes lasting many years. The benefit of a longitudinal study is that researchers can detect developments or changes in the characteristics of the target population at both the group and individual levels. The key here is that longitudinal studies extend beyond a single moment in time. As a result, they can establish sequences of events.

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Process of Case Study: In contrast to people typically included in survey research, a case study is an in-depth look at a single individual. The focus of the case study is to collect complete, detailed information about the individual in a situation or when exhibiting a set of behaviors. A case study is heavy in qualitative data, with extensive detailing of conditions and events and reliance on anecdotal accounts of those involved (Parsons & Brown, 2002). Typically, the process of a case study starts with a wide view of data collection. Researchers gather as much data as possible that describe the case, while at the same time formulating questions and refining data collection techniques. As the study progresses, attention may shift to gathering the information that explains the present situation and the factors contributing to what is observed. Data are collected using a wide variety of methods, such as observation, questionnaires, interviews, and so on. While the strength of a case study is that it can provide a rich, in-depth look at a single individual, a limitation is that the data collected are not easily generalizable to other individuals.

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Research Contributing to a Counselor's Identity: Research is not only a data source for ethical and effective practice but is a process in which all professional counselors should seek to contribute. Engaging with the research either as a knowledgeable consumer or contributor is essential not only to effective practice but to the development of one's professional identity. This also applies to the importance of studying human development through the lifespan, because one cannot deny the contribution of life experience to the well-being and quality of life of everyone in society. Counselors need to keep up with the current research being conducted. The more research studies that counselors read to improve understanding and can apply at work, the more they can optimize their abilities to improve counseling services for their clients. New studies can help counselors understand what is important for them to focus on in their work. Research can also teach them what is expected of a professional counselor at work. However, over the last 2 decades, the enthusiasm for research has declined. According to Reisetter et al. (2004), there is a need to inspire interest in research among counselor education students in training and practice. Although there has been a lot of research on the development of humans, there is much more to learn. Students in the counseling field, along with practicing counselors, need to read, understand, and participate in more counseling research activities. According to Nelson and Southern (2008), there are four areas counselors should consider when determining how scholarly they are on the job and how they can apply this knowledge to optimize their job performance. discovery, where a counselor researches and investigates. The second important area is integration, which occurs when a scholar takes isolated concepts and places them in a larger context that gives new meaning to an emerging perspective. The third area is application, which involves service-related activities geared toward applying knowledge/scholarship to solving individual and community problems. The last, and perhaps least valued, area is teaching with educators in the academic profession.

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Research Observation: The scientific observation approach in human development research requires the researcher to record human behavior objectively, methodically, and systematically. In employing scientific observations, researchers need to know what they are looking for, what they are observing, when and where they will be observing it, and how the observation will be made. This research approach can be applied to both qualitative and quantitative research methods. When a researcher wants to see and attempt to get a comprehensive picture of a specific situation by gathering notes and verbatim or narrative data, this research is considered qualitative. When the researcher uses independent measures such as scales and objective observational recording instruments, the data collected are quantitative (Berger, 2011). There are two possible settings for making scientific observations: (a) a laboratory, which is a controlled setting in which the researcher can manipulate the environment (removing the real-world experience) to optimize the research result, and (b) a real-world setting. Although conducting behavioral observations in a laboratory setting will provide researchers the ability to control certain factors that may influence behaviors not related to the study, this approach has drawbacks. First, because a laboratory is an artificial setting compared to that of typical human engagement, participants in the laboratory research study may perform differently (most work harder and perform better) since they are aware that they are being observed. This phenomenon is called the Hawthorne effect. Second, volunteers who are willing to come to the laboratory to participate may not represent the population the researchers intend to study. Last, due to its complex nature and the number of variables involved, the study of human development is difficult, if not impossible, to examine in the laboratory. Human development and lifespan studies often lend themselves to investigation within real-world settings. These naturalistic observations can be conducted in childcare centers, classrooms, work settings, shopping malls, sporting arenas, and so on. In conducting observations in natural settings, the researchers can observe people's real behaviors and interactions with one another. As with any other type of research method and data collection, the major concern regarding direct scientific observation is its validity and reliability. A well-defined behavior to be measured and a well-trained observer to make the observations will enhance the validity of the data to be collected. A well-trained observer must be aware of his or her own bias, world view, beliefs, and perceptions, which may influence the way he or she observes and interprets the situation. The observer effect, in which people being observed behave differently because they are being observed, may also compromise the research.

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Rules Governing Human Subjects Research: World Opinion: Rules governing research on human subjects has been embedded not just in the parameters of our professional ethics but also within the rules and regulations established by governments. For example, as a result of the atrocities revealed during the Nuremberg trial following World War II, the Nuremberg Code was established in 1947. This code articulated the basic requirements for researching in a way that respects the fundamental rights of research subjects. The World Medical Association met in Helsinki, Finland, in 1964 to draft the Declaration of Helsinki, a document that built on the Nuremberg Code to outline the standards of ethical research involving human subjects. This declaration was revised in 2000. Additional rules of study were developed in 1962 after the tragedy with thalidomide. Prior to 1962, researchers were not required to obtain informed consent from participants before prescribing investigational drugs. After significant numbers of pregnant women who had received thalidomide gave birth to infants with deformities, public outrage over this practice led to an amendment to the Federal Food, Drug, and Cosmetic Act that required investigators and researchers to obtain informed consent from potential subjects before giving them investigational medications. Other events have also had a significant effect on how we regulate research conduct today. Additionally, the National Research Act of 1974 established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The goal of this commission was to clarify the ethical guidelines to apply to research involving human subjects in all research disciplines. The commission conducted a series of meetings at the Belmont Conference Center near Baltimore, Maryland, and generated a report to address and explain the fundamental ethical principles that should guide research conduct involving human subjects. This became known as the Belmont Report and was published in 1978. The three major ethical principles of the Belmont Report are as follows: Principle 1: Respect for persons. . Principle 2: Beneficence. Principle 3: Justice.

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Sensory and Perceptual Development: During the first few months of life, the sensory system seems to function at a higher level than the motor system. With regard to perceptual development, vision, hearing, taste, smell, and touch are more developed at birth. When first born, a baby can see about 8 inches in front of his or her face, which is the approximate distance of a parent's face when holding the baby. Babies also see the world in black and white, but by 3 months of age, they can see blue, green, yellow, and red. Babies also prefer to look at faces and can distinguish between genders and different races. Hearing begins early during the gestational period. At around 20 weeks prenatally, fetuses turn toward the source of a sound. In fact, very loud noises can cause an infant to increase his or her movements for approximately 30 minutes after hearing the sound. At birth, an infant can distinguish the difference between the voice of the mother and that of a stranger, and the infant will calm down when hearing their mother's voice. By 6 months of age, an infant follows sounds with his or her eyes and will babble when excited. By 12 months of age, a child will listen when spoken to and can respond to requests, such as "Come here." The National Institute on Deafness and Other Communication Disorders (NIDCD) offers a checklist to assess the development of hearing and communication up to the age of 5 (see https://www.nidcd.nih.gov/health/your-babys-hearing-and-communicative-development-checklist). Taste and smell are also well formed before birth. At 12 weeks prenatally, taste buds form. Newborns have shown preferences regarding smells, which indicates that infants' sense of smell is highly developed at birth (Adam-Darque et al., 2018; Loos et al., 2017). Specifically, the scent of breast milk has a calming, painkilling effect on newborns. Newborns can distinguish between flavors and prefer sweet, savory, and salty flavors, while they reject bitter and sour substances. Studies also suggest that the infant's preference in taste is influenced by the mother's diet during pregnancy and breast-feeding. Touch is a profoundly powerful sense that is often forgotten. Numerous studies highlight the importance of touch in infant development. A parent or caregiver's touch can reverse effects of stress and protect at-risk infants. Babies who receive lots of touch tend to show less emotional negativity as they get older and develop fewer symptoms of anxiety and depression. Studies have indicated that premature and high-risk newborns gain more weight when their parents hold them skin-to-skin against their chests. Massage is also effective in nurturing healthy development and increasing weight gain.

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The Field Experiment: Sometimes an experiment can be conducted in a more natural setting, that is, in the field. As an example, the television series entitled What Would You Do? has been a part of the Primetime series, an American news magazine broadcast on ABC since 2008 (ABC, 2013). The show stages events that people do not experience or expect in everyday life, and these events, as staged, are usually injustices or illegal activity. The producers set up hidden cameras to view the reactions of ordinary people when they encounter these staged injustices or illegal acts as performed by actors. They want to see whether the individuals are compelled to act or mind their own business. In these field experiments, the series looks at how ordinary people react to everyday dilemmas that test their character and values. One of the scenarios involves three teenagers (actors) who beat and taunt a homeless man in front of a passer-by on the sidewalk. As with the laboratory experiment, the independent variable of this type of field experiment is still deliberately manipulated by the researcher. Regardless, it still has the advantage of being less artificial than the laboratory experiment.

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Toddlers: Language Development. While physical growth may seem to slow, language development flourishes during this time. Between the ages of 12 and 18 months, in particular, most children dramatically increase their use of language. The baby develops a greater understanding of words spoken to him or her, but the inability to use expressive language skills may lead to crying, tantrums, and biting, which we will discuss later. Caregivers should listen carefully and allow the child time to express himself or herself. Waiting for approximately 10 seconds may encourage the child to speak more. Caregivers can also model language for the child by describing in simple words what the child is doing as he or she is doing it. Narrating daily activities helps the child associate words with what he or she is doing. By the age of 24 months, a child may have a familiar vocabulary of about 50 words and may speak in short sentences of one to three words. While the child may not be able to say all of the words that he or she has learned, he or she can often point to objects when you say the word. By the age of 3, a child may have a vocabulary of between 50 and 250 words. The child will begin to ask "why" a lot. This may become increasingly frustrating for caregivers, but we strongly encourage patiently answering these questions to encourage language development. Cognitive Development: Toddlers become aware of cause and effect and will often throw objects to see the caregiver's response. This typically becomes a game and will continue as long as the caregiver provides a response. Children become interested in objects that move and begin to prefer action toys. Hide-and-seek is also a wonderful game that toddlers thoroughly enjoy. They become interested in hiding themselves as well as hiding toys. Children also begin their first imitative play activities, often by imitating adult tasks such as caretaking and housekeeping. By 18 months, children respond to directions, begin to use objects as tools, and can solve simple problems such as using one object to reach another. By 24 months, children become more aware of themselves as individuals. They will begin to identify with their toys and will not want to share them. They will also begin showing preferences. While they may show frustration when they cannot do what they want, they can also be easily redirected. Offering choices, rather than saying "no," can help to minimize tantrums and give them a sense of control. By the age of 3, children begin to develop memories.

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Cognitive Development: The brain is the first organ to begin developing (at 18 days of fertilization) in a fetus. Initially, the brain begins as a layer of cells on the neural plate, which folds to form the neural tube. This tube then closes, beginning in its middle and progressing outward. Failure of the plate to properly fold and create a tube by the end of the fourth week results in neural tube defects, which lead to disorders such as spina bifida or anencephaly. The wall of the tube then thickens and forms the brain and spinal cord. During the fourth week, the neural tube begins to form the hindbrain, the midbrain, and the forebrain. The hindbrain divides into the myelencephalon and metencephalon. The myelencephalon then forms the medulla oblongata, which regulates respiration and heartbeat, while the metencephalon forms the pons and cerebellum. The pons connects the cerebral cortex with the medulla oblongata and serves as a communications center between the two hemispheres of the brain. The cerebellum controls motor movement coordination, balance, equilibrium, and muscle tone. The midbrain forms the inferior and superior colliculi, which control auditory and visual responses; the tegmentum, which controls motor functions, regulates awareness and attention, and regulates some autonomic functions; and, finally, the substantia nigra, which controls voluntary movement, produces dopamine, and regulates mood. The forebrain further divides into the diencephalon and telencephalon. The diencephalon forms the thalamus and the hypothalamus, which control and regulate many areas, including body temperature, sleep, emotions, hunger, and thirst, and the pineal body that produces melatonin. The telencephalon develops into the rhinencephalon (the olfactory center) and the neocortex. The neocortex forms most of the mass of the brain. As the bilateral telencephalic vesicles grow, the cerebral hemispheres begin to develop. Initially, these expand outward, but as growth continues, the vesicles develop to the midline of the brain and cover the diencephalon and mesencephalon. The hemispheres initially appear smooth, but as growth continues, the surface folds begin to form sulci (grooves) and gyri (convolutions), which increase the surface area of the brain without increasing the size of the brain cavity. Growth in the brain is particularly noticeable during weeks 28 and 30 of development.

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Healthy Prenatal Development: In discussing prenatal development, it is common practice to break this period of development into three phases or trimesters. The first trimester includes the first 13 weeks of prenatal development, the second trimester includes weeks 14 to 27, and the third trimester includes weeks 28 and beyond. Within each of these trimesters, critical developments occur across physical, cognitive, and social-emotional domains. Physical Development As can be seen in Figure 3.1, the developing fetus undergoes dramatic physical changes while in utero. From the union of a microscopic sperm and egg, a fully developed baby forms after only 9 months in the womb. Physically, a fetus undergoes the most dramatic changes in the first 8 weeks of life, but critical growth and development occur throughout the full 9 months of pregnancy.

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Physical Development: Physical growth during infancy is very rapid. Many parents voice that their infant seems to have grown overnight. In fact, infants and toddlers grow in spurts, meaning they grow for several days, often at night, and then rest. The World Health Organization released growth charts (see https://www.who.int/growthref/en/) that describe optimal growth for children up to the age of 19, while the Centers for Disease Control and Prevention provides growth charts for children up to the age of 20 living in the United States (see https://www.cdc.gov/growthcharts/index.htm).

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Natural Experiments: In a natural experiment, behavioral scientists and psychologists can use a natural situation to conduct a research study that they cannot themselves manipulate. For example, a psychologist may use a one-way mirror or a hidden camera or observe from a distance to study aggressive behavior among children. In conducting this type of experiment, the researcher must not allow the children to notice him or her. This is not a true experiment because the psychologist is unable to manipulate or control variables. For this reason, a natural experiment is sometimes referred to as a quasi-experiment (Kazdin, 1980).

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ACA Guidelines for Ethical Research: According to the American Counseling Association (2014), "Counselors who conduct research are encouraged to contribute to the knowledge base of the profession and promote a clearer understanding of the conditions that lead to a healthy and just society. Counselors support efforts of researchers by participating fully and willingly whenever possible. Counselors minimize bias and respect diversity in designing and implementing research programs" (p. 16). The ACA Code of Ethics addresses many areas related to conducting counseling research and provides the following guidelines: Researchers have responsibilities when using human research participants. They should seek consultation if the research suggests a deviation from standard practices, consult the institutional review board (IRB) procedures, and use precaution to avoid injury to participants. Also, the principal researcher should be mindful of ethical obligations and responsibilities and have minimal interference in the lives of research participants. Finally, researchers should consider multicultural and diversity issues. Rights of research participants include informed consent—counselors may not conduct research that involves deception. There are policies on student/supervisee participation, client participation, the confidentiality of information, persons not capable of giving informed consent, commitments to participants, explanations after data collection, informing sponsors, and disposal of research documents and records. Nonprofessional relationships with research participants should be avoided. Researchers do not condone or subject research participants to sexual harassment or potentially beneficial interactions. Researchers must report accurate results and are obligated to report unfavorable results and errors while protecting the identity of participants and allowing replications of the study. The publication includes recognizing the contributions of others. Counselors may not plagiarize; they must review republished data or ideas, acknowledge contributors appropriately, and establish agreements in advance of the publication. Students are listed as principal authors if they are the primary contributors, and submissions should not be duplicated.

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The noted developmental psychologist, Lawrence Kohlberg, believed that counseling is important for the development of both the counselor and the client. Kohlberg's explanation for this relationship was established in his MORAL development theory, originating from his earlier work and writings on moral development and moral education that was applied to the process of schooling, particularly as it relates to teaching and not counseling. After studying Jean Piaget's views on the cognitive development of children's thinking about the physical world, Kohlberg asserted that all the basic processes involved in physical cognition in stimulating developmental changes are fundamental to social development. He further asserted that the counseling process between a counselor and a client is a fundamental social activity, and thus, this process should be considered a developmental process of social interaction. Kohlberg also believed that the skill of listening requires the empathy and role-taking that are important for both moral and psychological growth between the counselor and the client. Kohlberg offered the view of progressivism, which encourages the nourishment of the individual's natural interaction with a developing society or environment and cognitive-developmental psychology as compared to other theories offered.

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Biopsychosocial Theory: it is important to highlight that the biopsychosocial model focuses on the integration and reciprocal effect that the biological, psychological, and social systems have on our development. This theory helps to highlight the fact that mental and psychological states are influenced by many interacting processes, including internal and external variables and factors such as bodily processes, personality dispositions, and life events.

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Behaviorism Theory: Whereas Erikson introduced the importance of social context to development, the behavioral theory (at least in its classical form) placed nearly sole emphasis on the impact of environment, experience, and learning about the unfolding development of the human condition. John B. Watson deemed the father of American behaviorism, emphasized the role of environment in the shaping of human development, as reflected in the following statement: "Give me a dozen healthy infants, well-formed, and my specified world to bring them up in and I will guarantee to take anyone at random and train him to become any specialist I might select . . . doctor, lawyer, artist, merchant-chief . . . and, yes, even beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors."

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Social and Emotional Development: Prenatal researchers believe that there is a connection between a mother's emotions and how her baby feels in the womb. Emotional involvement and expression are seen as early as 10 weeks in utero. Around 6 months, the unborn baby can share the mother's emotions. This is important to note because if mothers experience a significant amount of emotional distress, the child's emotional development can be affected. Mothers who are anxious or depressed during pregnancy tend to produce children who suffer from many social, emotional, or behavioral disorders such as anxiety, attention-deficit/hyperactivity disorder, and depression (Betts, Williams, Najman, & Alati, 2015). Additionally, mothers who resented being pregnant and felt no attachment to their unborn children had children who later suffered from emotional problems. On the contrary, mothers who were less anxious and wanted their children generally tended to have emotionally healthy children. Therefore, it is critical that mothers receive counseling services as needed to manage significant emotional distress. Risks to Healthy Prenatal Development Throughout the pregnancy, the fetus is vulnerable to many factors. However, during the first trimester, the fetus is especially at risk. Some factors that may impede healthy prenatal development include maternal nutrition, maternal stress, teratogens, and domestic violence.

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Erik Erikson's Psychosocial Development Theory: Erikson presented a model emphasizing the challenges and tasks presented across one's lifespan as key to understanding human development. Further, unlike Freud, Erickson emphasized development from within a social context. Erickson's theory is an epigenetic theory, which means it focuses on both the biological and genetic origins of behaviors as interacting with the direct influence of environmental forces over time. He suggested that this biological unfolding about our sociocultural settings takes place in stages of psychosocial development, where progress through each stage is in part determined by our success, or lack thereof, in all the previous stages. Erickson theorized that humans pass through eight stages of development, with each presenting the individual with a unique developmental task or what he termed a "crisis". Erickson felt that these psychosocial crises were based on physiological development interacting with the demands put on the individual by parents and society. Infant: trust versus mistrust toddler: autonomy vs. shame/doubt preschool: initiative vs/ guilt school age: industry vs. inferiority adolescent: identity vs. role confusion young adult: intimacy vs. isolation adulthood: generativity vs. stagnation mature adult: integrity vs. despair

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Maturationist Theory: Granville Stanley Hall was a pioneering American psychologist and educator. Hall was a firm believer in the scientific method and its application to the study of human nature. He supported empirical research in the then-emerging area of child development, developing both theories of psychological development and its application to children's education. Although Hall's understanding was incomplete and his theories were not fully accepted, his work was significant in laying the foundation for the field. His maturationist theory emphasized the importance of genetics and evolution and was based on the premise that growing children would recapitulate evolutionary stages of species development as they grew up. Hall concluded that it would be counterproductive to push children ahead of their developmental stage since each stage laid the foundation for what was to follow. In simple terms, his position was that everyone would need to crawl before learning to walk.

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