Exam 2: School age/adolescent Growth and Development [11] Flashcards by Carla Blaney

Development for age 5 (Preschool)

Copies square
Can draw a person with 4 body parts

Can ride a bicycle
Likes to help adults (certain household chores)
Can dress and undress self

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Development for age 6 (kindergarten)

Copies a triangle
Ties shoes
Rides a bike

Well-developed vocabulary
Follows simple directions

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Approximately how much does a child grow and how much weight does a child gain each year?

Grows 2.5” per year

Gains about 5-7 pounds per year

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What age does head circumference increase to adult size?

By age 12

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Development for ages 7 and 8

7/8:

Copies a diamond

Able to solve word problems

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This Erikson’s stage occurs during school age:

Eager to develop skills and participate in meaningful work
Sense of personal competence and accomplishment
Growing sense of independence
Peer approval is a strong motivator
Relationships center around same-sex peers
Feeling some inferiority regarding skills they can’t master

Industry (competence) vs Inferiority
(School age 6-12)

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Cognitive Development:

Piaget’s Concrete Operations Stage
School ages 7-11

Cognitive Development:
Piaget’s Concrete Operations Stage
(School age 7-11)

Child becomes more stable
Thinks operationally and uses logical reasoning rather than intuitive thought
Able to make judgements based on reason
Understands relationships between things and ideas
Egocentricity decreases
Magical thinking fades, more grounded in reality
Develops empathy

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What are some red flags for school age and adolescent growth/development?

Red Flags:

Chronic illness
Accidents and frequent injuries
Vision and hearing problems
Sudden change in school performance
Difficult family situations at home
Identification of learning needs

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What are the tanner stages for girls?

Tanner stages for girls:

1: Prepuberty
2: Breast buds; after buds start menses begins within 1-2 years (puberty starts at this stage)
3: Breast and areola in one mound
4: Areola/nipples separate and form secondary mound
5: Adult pattern (puberty ends)

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What is the average age of menarche?

Average age of menarche is 12 years old in the U.S. (range 8-15 years)

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Most girls’ height is gained before menarche. Skeletal growth in girls is considered complete within ____ years after menarche.

2 years after menarche

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What are the tanner stages for boys?

Tanner stages for boys:

1: Prepuberty
2: Testes enlarge; increased rugation in scrotum (puberty starts at this stage)
3: Penis lengthens; scrotal color starts to darken
4: Penis thickens and increases in size; testes larger
5: Adult pattern (puberty ends)

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What are the pubic hair stages (both genders)?

Pubic Hair (Both genders):

1: None
2: Few straight, fine hairs, sparse, easily counted
3: Darker, coarse, starts to curl
4: Hair is curly but not medial thigh; hair is coarser
5: Adult pattern; hair spreads to medial thigh and lower abdomen

**Note: Do not need to memorize pubic hair changes for either gender for the boards

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What is precocious puberty in girls and boys?

Precocious puberty is when puberty begins before age:

8 in girls
9 in boys

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Puberty is delayed in girls and boys if:

Puberty is delayed in:

Girls if no breast development (Tanner 2) by age 12
Boys if no testicular/scrotal growth (Tanner 2) by age 14

So,
Boys start puberty between the ages of 9 and 14
Girls start puberty between the ages of 8 and 12

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When do boys and girls get their growth spurts?

Growth spurts:

Girls: Start growth spurt 1 year earlier than boys
Boys: Start growth spurt 1 year later than girls (ages 11-15)

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What is spermarche and what is the average age?

Spermarche is the beginning of development of sperm in boys’ testicles at puberty. It is the counterpart of menarche in girls. Typically occurs around age 13.

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What defines adolescence?

Adolescence is defined as the onset of puberty until sexual maturity.

In terms of communication, what does HEADSS mean?

Home (what’s going on at home?)
Education, employment (How’s school? Are you working?)
Activities (What do you do outside of school, sports, music, hobbies?)
Drugs
Sexuality
Suicide

** Can be good to ask what their friends are up to in the HEADSS; non-judgmental approach

What are factors that increase risky behaviors?

Increase risky behaviors?

Poor academics
Impulsivity
ADHD/ADD
Lack of role models
Low self-esteem
Poverty
Abuse
Lack of support

What are common dangers for adolescents?

Common dangers:

MVA
Homicide, suicide
Depression
Drugs
Risky sexual behavior

Review of early adolescence (11-14 years)

Physiological
Psychological
Social
Potential problems

Early adolescence (11-14 years)

Physiological:
Onset of puberty
Growth spurt
Menarche (females)

Psychological:
Concrete thought
Preoccupation with rapid body changes
Sexual identity
Questioning independence
Parental controls remain strong

Social:
Search for same-sex peer affiliation
Good parental relationships
Other adults as role models
Transition to middle school
Involvement in extracurricular activities
Sensitivity to differences between home culture and culture of others

Potential problems:
Delayed puberty
Acne
Orthopedic problems
Psychosomatic concerns
Depression
Unintended pregnancy
Initiation of tobacco, ETOH, other drugs

Review of middle adolescence (15-17 years)

Physiological
Psychological
Social
Potential problems

Middle adolescence (15-17 years)

Physiological:
Ovulation (females)
Growth spurt (males)

Psychological:
Competence in abstract and future thought, idealism
Sense of invincibility or narcissism
Sexual identity
Beginning of cognitive capacity to provide legal consent

Social: 
Beginning emotional emancipation
Increased power of peer group
Conflicts over parental control
Interest in sexual relationships
Start of driving
Risky behavior
Transition to high school
Reduced involvement in extracurricular activities
Possible cultural conflict between family's and peers' culture

Potential problems:
Experiment with risky behaviors (sex, drinking, smoking, drugs)
Motor vehicle crashes
Menstrual disorders, unintended pregnancy
Acne, overweight, short stature (males)
Conflicts with parents
Eating disorders and poor eating habits

Review of late adolescence (18-21 years)

Physiological
Psychological
Social
Potential problems

Late adolescence (18-21 years)

Physiological:
Growth completed

Psychological:
Future orientation
Emotional independence
Unmasking of psychiatric disorders
Capacity for empathy
Intimacy, reciprocity with interpersonal relationships
Self identity
Recognized as legally capable of providing consent
Attainment of legal age for (voting) but not (drinking ETOH)

Social:
Individual of peer relationships
Transition in parent-child relationship
Transition out of home
May begin preparation for further education, career, marriage, parenting

Potential problems:
Eating disorders
Depression, suicide
Auto crashes
Unintended pregnancy
Acne
ETOH, smoking, drug dependence

Erikson's ___ versus ____is when the infant's needs are consistently met or unmet

"Trust vs Mistrust" Depends on care given or not given by caregivers, especially the mother

This phase of cognitive development has four stages in infancy and includes reflexive, repetitive, and imitative.

Piaget's Sensorimotor Phase; learn through trial and error

Erikson's _______ occurs in toddlerhood (12-36 months) where the major task is acquiring a sense of autonomy. The child uses "no" and right and wrong are determined by the consequences of their action. Toilet training is most important in this stage. Wants to choose own clothes and dress self.

"Autonomy vs Shame and Doubt" Erikson's Autonomy versus shame and doubt applies to early childhood (ages 1-3) Toddler strives for autonomy Most important in this stage: Toilet training "No" "Me do it" stage Wants to choose own clothes and dress self Children who experience too much doubt in this stage will lack confidence throughout life

This phase occurs between 12-24 months. There is an awareness of casual relationships between 2 events (cause and effect or trial and error). Learn spatial relationships and through imitation. As the child gets closer to age 2 he/she is able to perform more complex mental operations and has a limited awareness of time.

Piaget's Sensorimotor phase (trial and error learning)

In this cognitive stage 2, children from ages 3-7 develop language, memory, intuitive intelligence through make believe play. Magical thinking occurs in this stage around ages 3-5.

Piaget's Preoperational Phase

``` Erikson's initiative versus guilt applies to: A. Early childhood B. Preschool C. School age D. Adolescence ```

Answer: B Erikson's "initiative versus guilt" applies to preschool (ages 3-6) Most important in this stage: independence Eager for responsibility and likes to help with chores Hero worship Pretend play like house (pretend to be the mommy or daddy)

Piaget's ______ occurs in school-age children (6-12) and includes: Developing an understanding of relationships between things and ideas Use thought processes to experience events and actions Able to make judgments based on reason and logic

Piaget's Concrete Operational Phase Occurs in school-age children (6-12) and includes: Developing an understanding of relationships between things and ideas Use thought processes to experience events and actions Able to make judgments based on reason and logic

This psychosocial stage occurs from onset of puberty (ages 12-18) and includes: Social relationships Develop sense of self and personal identity Sex role identity Failure leads to role confusion and a weak sense of self

Erikson's "Identity vs Role Confusion" This stage occurs from onset of puberty (age 12-18) and includes: Social relationships Develop sense of self and personal identity Sex role identity Failure leads to role confusion and a weak sense of self

This 4th and final cognitive stage starts around age 12 and goes into adulthood. The use of deductive reasoning, abstract thinking, and theoretical concepts can be used to find creative answers to problems. Concerned about others thoughts and needs.

Piaget's Formal Operational Phase

What are Piaget's 4 Stages of cognitive development and at what ages do they occur?

Piaget's 4 Stages of Cognitive Development: Sensory-motor: 0-2 Pre-operational: 2-7 Concrete operations: 7-12 Formal operations: 12 and up

``` What change in boys indicates the onset of puberty? A. Voice changes B. Testicular enlargement C. Growth of dark pubic hair D. An increasing penis size ```

B. Testicular enlargement is the first change that signals puberty in boys. It usually occurs between the ages of 9-14 (Tanner Stage 2). Voice change occurs between Tanner stages 3-4. Fine pubic hair may occur at the base of the penis; darker hair and increasing penis size occurs during Tanner stage 3. ** Tanner staging very important for contact sports physicals **

``` Erikson's industry versus inferiority applies to: A. Early childhood B. Preschool C. School age D. Adolescence ```

Answer: C (school age 6-12) ``` Most important: school Eager to develop skills Do productive work on their own Develop increasing sense of independence Motivated by peer approval Relationship centered on same-sex peers Feel some inferiority regarding skills they can't master ```

``` Erikson's identity versus role confusion applies to: A. Early childhood B. Preschool C. School age D. Adolescence ```

Answer: D - Erikson's "identity versus role confusion" applies to adolescence (ages 12-20s) ``` Most important: Peer relationships Develop sense of self-worth Develop sense of identity Develop sex role identity Gain sense of belonging in valued group Acquire skills important to valued group Build reliable relationships with others See themselves as separate from their parents ```

The NP is performing a well child exam on an 8-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the NP recommend to the parents to improve speech and language skills: A. Provide educational videos that focus on language B. Read simple board books to the infant at bedtime C. Sing to the child and play lullabies in the baby's room D. Turn the television to Sesame Street during the day

B. Read simple board books to the infant at bedtime As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and TV are all passive media and do not involve this interaction.

The NP performs a developmental assessment of a 32-month-old child. The child's parents reports that about 70% of the child's speech is intelligible. The NP observes that the child has difficulty pronouncing "t," "d," "k," and "g" sounds. What is the correct action? A. Evaluate the child's cognitive abilities B. Obtain a hearing evaluation C. Reassure the parent this is normal D. Refer the child to a speech therapist

C. Reassure the parent this is normal Intelligibility of speech reaches about 75% by age 3. Tongue-contact sounds are more intelligible by age 5. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated since these finding are within normal limits.

During a well child exam on a 6-year-old, the NP assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child? A. Adherence to daily family routines and regular activities B. Having 2 older siblings who attend the same school C. Parental concerns about bullying in the school D. The child's ability to recognize 4 different colors

C. Parental concerns about bullying in the school Parental expectation is the strongest predictor of school success in children. Parents who are worried about what may happen in school can transmit this anxiety to the child. Children who have a secure family life with daily routines will do better in school. Having older siblings who attend school increases success. Children at this age are expected to know 4 colors so this is an indication of school readiness.

The NP is performing a well child assessment on a 13-year-old female whose mother asks when her daughter's periods may start. Which information with the NP use to help estimate the onset of menses? A. The age of mother's menarche B. The patient's age at thelarche C. When adrenarche occurred D. Whether linear growth has stopped

B. The patient's age at thelarche Thelarche, or the development of breast budding generally precedes menarche by 2.5 years so this should be determined when attempting to predict this milestone. The age of the mother at menarche is not a reliable indicator. Adrenarche is related to adrenal and not gonadal development and is less valid than other secondary sex characteristics in assessing sexual maturation. Rapid linear growth usually begins after thelarche and peaks about a year later but is not used to predict menarche.

The NP is performing an exam on an adolescent male who asks about sexual identity because of a concern that a friend is worried about being gay. What is the response? A. Provide the teen with a questionnaire to gain information about his sexuality B. Remind the adolescent that mandatory reporting requires disclosure to parents C. Suggest that the adolescent discuss sexual concerns with parents D. Tell the adolescent that unless he is at risk, what he says will be confidential

D. Tell the adolescent that unless he is at risk, what he says will be confidential Adolescents should be encouraged to divulge information about their sexuality to providers by assuring them that confidentiality will be maintained unless the health of the child or others is at risk. The patient may be trying to ask questions about himself in a manner that does not implicate his own sexuality so the NP needs to gain his trust

The parent of a 14-year-old tells the NP that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home and wants the family to eat vegetarian meals. What would the NP tell the parent? A. Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent B. Provide vegetarian options for the adolescent to preserve adequate nutrition and protein intake C. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals D. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home

C. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals Early adolescents begin to develop their own value system and may try value systems other than the one that they have learned from their family. The parent may allow expression of other values such as a vegetarian diet as long as nutritional needs are met and the adolescent takes responsibility for preparing the food. Adequate protein intake is not really a big problem in the US. If an illness occurs then you can address the protein/nutrition issue.

What is characteristic of the psychosocial development of school-age children? A. Peer approval is not yet a motivating factor B. Developing sense of initiative is very important C. Motivation comes from extrinsic rather than intrinsic sources D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment

The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well and the child must be prepared to accept some feelings of inferiority. Peer group formation is one of the major characteristics of this age group A developing sense of initiative is characteristic of preschoolers. School age children gain satisfaction from successful independent behaviors