Intellectual development in childhood and adolescence (Human Behaviour) Flashcards
Describe how children’s reasoning skills develop with age
Piaget’s stage model of intellectual development
1) Sensorimotor (0-2 yo)
- Experiences the world through basic reflexes, senses and motor responses (movement and sensation)
- Learning through basic actions: sucking, looking, grasping, listening
- Learn object permanence (things can exist if not visible)
- Begin to ‘separate’ self from other people
- Learn that their actions cause things to happen, other people to react
2) Preoperational (2-7 yo)
- Emergence of language
- Beginnings of symbolic thinking: using words and pictures to represent objects
- Egocentricity: seeing their actions as key to making things happen; struggle to understand other people’s perspectives
- Concrete thinking
- Lack of concept of conservation (thinking one glass has more water if it is taller)
3) Concrete operational (7-11 yo)
- Learns to experiment with and manipulate (operate) real (concrete) objects
- Conservation of number, reversibility
- Classification of objects; organised thinking
- Inductive logic from specific information and general principles
- Still struggle with abstract and hypothetical concepts, still concrete in thinking (magical thinking)
- Less egocentric: think about how others may think and feel
- Recognise that their thoughts are unique
Formal Operation (11 upwards)
- Learns complex abstract reasoning about hypothetical questions
- Begins to think about moral, philosophical, ethical, social and political issues using abstract reasoning
- Can begin to use deductive logic, and reasoning from general principles
- Considers a range of possible outcomes to things
Sociocultural theory
- Stresses that human learning is a social process
- Mentors and peers influence individual learning
- Cultural beliefs and attitudes affect how learning takes place
- Learning from others is integrated on an individual level
- Each culture provides ‘tools of intellectual adaptation’. Tools may be different and culturally appropriate (e.g. music, story, rote learning)
- Stages of development are fluid
- Stresses the importance of play in learning
- Cognitive reasoning is limited at any given age
- Full cognitive development requires social interaction and is culturally dependent
- Children learn best through problem-solving shared with someone else (e.g. parent, peer)
- Egocentric speech: self-talking eventually becomes ‘inner speech’
Zone of proximal development:
- the distance between the child’s independent problem solving capacity and the potential capacity under guidance or collaboration.
- Scaffolding: learning is supported and take existing skills and knowledge, instills confidence to progress
- Language: age appropriate and reciprocal, learning partnerships
Differences between Vygotsky and Piaget
Vygotsky:
- Social factors influence development
- Development differs between cultures
- Parent’s should be more hands on, provide more scaffolding
Piaget:
- Interaction and exploration of the environment influences development
- Development stages are discrete and universal
- Allow kids to explore and take risks
Explain why the concept of “theory of mind” is relevant to medicine
Human attribute wishes, feelings, and beliefs to other people to explain their behaviour
- Theory of Mind continues to develop throughout childhood and adolescence becoming more sophisticated with age and experience.
- Impairments in Theory of Mind may be signs of neurodiversity or reflect developmental delay.
- Chimpanzee’s follow the Theory of Mind
Clinical Relevance
Children younger than 7 may not have a well-developed Theory of Mind. What might be the implications of this for medical consultation?
- Understanding their own feelings and sensations and being able to describe them to someone who does not know how they are feeling.
- Understanding the roles and perspectives of people present in a consultation/assessment. Theory of mind development is an active process. Children can learn to communicate their feelings to others more accurately
Attachment Theory
- The primary (evolutionary) function of these bonds is safety and the giving and receiving of essential care.
- Secure attachment is vital to the development of cognitive abilities: socialising, speech and communication, emotional regulation, physical health, a sense of self and other people (mentalising and empathising).
- A secure attachment provides a ‘Secure Base’ from which the child begins to explore the world. (Howe, 2011).
Describe how children’s understanding of illness develops with age
Children’s explanation of illness becomes increasingly sophisticated with age (Bibace & Walsh, 1980)
- 2-4 yo: Phenomenism ~ particular objects are believed to cause illness but with no sense of mechanisms involved
- 4-7: Contagion ~ Illness is caused by proximity to ill people or to particular objects
- 7-9: Contamination ~ illness is caused by physical contact with an ill person. It may be viewed as a punishment for misbehaviour.
- 9-11: Internalization ~ illness is located within the body but may be caused by external factors e.g. catching a cold because you are cold
- 11-16: Physiological ~ illness is caused by malfunctions in organs or systems which may be due to infections
- 16+: Psychophysiological ~ psychological factors like stress and fatigue can affect physiological processes, rather than just being an outcome.
Children’s understanding of illness
A child’s understanding of illness depends on multiple factors:
- Age and stage of development
- Language/communication style and ability
- Cultural background
- Personal experience (some children with long standing medical conditions have more detailed knowledge
- Systemic & family factors (children with disabilities often have peers with medical conditions)
Outline strategies to help children understand illness and medical procedures
Stage 1: What can the child tell you?
- What can the child tell you about their symptoms?
- How does the child experience their symptoms and make sense of them?
- What level of language is the child able to use?
- Does the child understand what is happening to them?
Stage 2: how do you communicate information to the child?
- How might you assess the developmental stage of the child?
- Make the explanation match the age and experience of the child
- Use appropriate creative and age-appropriate means of communication
- Consider the language and the concepts you use and what this means to the child
- Pay attention to the child in the moment and in the room; are they ready and able to understand
Explaining illness to children
- Take into account their developmental stage
- Acknowledge wider experience not just age/appearance
- Include peers and family members to educate those who care for the child.
- There are a range of resources available: easy reads, picture resources, websites etc.
- Specialist nursing and care services, specialist organisations have resources.
Experience of pain in childhood
(Kortesluoma & Nikkonen, 2004)
- Context dependent: e.g. other experiences of illness, seeing blood, restriction in movement or function (unable to do their usual activities)
- Fear and anticipation: previous experience of surgery, medical procedures that have been painful.
- Systemic fears: how parents/carers are reacting (calmly, fearfully etc.)
- Social concepts of ‘fighting’ illness, ‘being brave’.
(Carney et al., 2003; Tates & Meeuwesen, 2001)
Measuring children’s pain - self-report
- How measure child’s pain: ask them!
Pain is inherently subjective – self-report is the ‘gold standard’ measure - Children can report pain consistently and reliably
- Basic pain vocabulary (e.g. “ow”, “boo-boo”)
emerges as early as 18 months (Stanford et al., 2005) - Numerical or visual analogue scales
commonly used to measure pain intensity
in older children/adolescents - Face pain scales commonly used with
younger children - Note – subject to biases, past experience & scale anchors
- Gold standard
Communication
- Getting alongside the child and using creative communication that is stage appropriate
- Considering the system around the child, how parents, carers are communicating anxiety or confidence
- Taking appropriate time, don’t rush it (unless medical urgency dictates).
Describe social and environmental factors that affect pubertal timing
- Gonadarche: biological process beginning with activation of the hypothalamic-pituitary-gonadal axis and ending with the attainment of reproductive competence
- Adrenarche: activation of the hypothalamic- pituitary- adrenal axis, often begins earlier than gonadarche.
- Activation of the growth axis: resulting in a linear growth spurt at around age 12 in girls (precedes secondary sexual development) and age 14 in boys (after genitals have begun to grow), as well as changes in body size and composition
Pubertal timing
Age at puberty has fallen over last few hundred years
- 7-year range for onset of puberty
- Begins 1-2 years earlier for girls than boys
Menarche (woman’s first period) mean age
- Norway 1840: 17 now: 13 (Santrock, 1998)
- UK now = 12.9 (Whincup et al. 2001)
Causes:
- improved standard of living
- health and nutrition
- body mass - girls ~ 17% body fat
- boys ~ > 2sd
Physical development during puberty
Sexual maturation of the body: The gonads begin to secrete hormones (testosterone and oestradiol) at ~11-14 yrs
- Rapid increase in height and weight (up to 4in/10cm per year)
- Weight gain = mainly muscles for boys, fat for girls
- Pubic and underarm hair growth
- Facial hair growth and voice changes for boys
- Breasts grow and hips widen for girls
- Increased production of oil, sweat glands, acne
- Changes in bio rhythms- frequently sleep longer - 9 1/2 hours
Brain Development
- Synaptic Pruning (of excess grey matter): frequently used connections are strengthened, infrequently used connections are eliminated
- White matter: control actions e.g. regulate body temp, heart rate, release hormones.
- Grey matter: muscle control, sensory perception, speech
- Decrease in grey matter over time, increase in white matter
- Reorganisation: Connections become more specialised and efficient
- Parts of brain controlling physical movement, vision and senses mature first
- Areas involving memory and attention mature later
Prefrontal cortex starts to develop early in life and into the young person’s 20s.
- Responsible for rational, executive brain functions
- planning, organising thoughts
- problem solving
- weighing consequences
- assuming responsibility
- interpreting & controlling emotions
- inhibitory control
Describe the psychological aspects of puberty
Mental and physical health risks
Eating Disorders:
- 1.5 % of females, 0.1 % males anorexic. Mean age of onset 15-25 years
- 1.9 % of females, 0.3% males bulimic. More often identified in males and at an older age range
Schizophrenia:
- Typical onset late teens-early 20s. Not fully understood why.
Overweight:
- ages 12-19
- Boys 6.1% - 16.7%; Girls 6.2% - 15.4%
- Physical activity level drops dramatically during adolescence
Outline how changes in cognition during adolescence affect decision-making and risk-taking
Theory of Adolescent Egocentricism: David Elkind
Theory of Psychosocial development: Erik Erikson
Theory of Moral development: Lawrence Kohlberg
Adolescent Egocentrism
- Adolescent preoccupied with what other people think of them, feeling of being at the centre of attention
- Go to extreme lengths to avoid being embarrassed e.g. conforming in clothes, behaviour
- Associated with measurable drop in self-esteem as the young person’s egocentrism makes him ‘hyper-aware’ of others’ opinions
- Need for privacy – relax more when removed from imaginary audience
- Personal fable: believe own beliefs and feelings unique, never before experienced by anyone
Psychosocial Development
Identity versus role-confusion stage of development:
- “Who am I” – forging an identity
- Description of adolescent’s pursuit of a coherent sense of self during the adolescent years.
- Role confusion can occur when the adolescent is unable to put together aspects of him or herself
Limitations:
- Age norms were overly optimistic, complete identity by 20 years
Moral Development
- Build on Piaget’s stage model
- Six stage theory of moral development with an invariant sequence
- Invariant: because each stage depends on the development of certain cognitive abilities
- Each succeeding stage evolves from and replaces its predecessor
- Level 1: Preconventional Morality
- Level 2: Conventional Morality
- Level 3: Postconventional (or Principled) Morality
Impact of Peers
Increased importance of friendships
- Gender identity intensifies
- Spending more time with friends than with family
- By age 13, 90% of adolescents report having a same-sex best friend
- Romantic relationships become important
Friends in adolescence highly influential, can have both positive and negative influence
- Share fears and secrets with friends rather than parents
- Mental health issues & vulnerability
- Group conformity & risk-taking behaviour
Decision Making
Improved decision-making skills
- identify alternatives and consequences of alternatives
- evaluate desirability of consequences
- assess likelihood of consequences
- make rational decision
But adolescents appear to be good at making bad decisions
- accidents are leading cause of death (Heron, 2007)
- sexual risk taking (James et al. 2012)
- unhealthy behaviours (de Visser et al., 2006)
Changing patterns of risk taking
(Patalay & Gage, 2019)
Significance decline in rates of reported
- Substance use (smoking and alcohol)
- Antisocial behaviour (graffiti)
- Sexual activity and teenage pregnancies
Has been replaced by an increase in
- Mental health problems
- Self-harm and suicide rates
- Conduct disorders & attention issues
Prevalence of reported mental health issues has doubled in last 10 years
Risk taking: Now
Risk factors thought to be correlating with findings:
- Austerity
- Academic pressure
- Digital age “environment”
- COVID pandemic
(Patalay, 2019; Strasburger et al., 2014)
- Children and adolescents spend >7h on entertainment media a day2
Identify important issues for medical consultations with adolescents
Adolescents might be dissatisfied with medical interactions (e.g. Rutishauser et al., 2003;)
- concerns about privacy and confidentiality
- embarrassment about sensitive issues
- up to 52% (up to 15-year-olds) said that seeing the doctor alone was important but only 20% were given the opportunity to do so
What is Adolescence?
The developmental process of maturation between childhood and adulthood where the person adjusts mentally to:
- physical changes in body development
- changes in relationships and friendships
- greater independence of thought and social freedoms
- complex emotional development
decisions about their future path
Adolescence is influenced by multiple physical, social, cultural and environmental factors.
