LC Unit 3 Flashcards
critical period vs sensitive period in development
critical period:
- when development is especially responsive to influence
- vulnerable to injury
- rapid growth
sensitive period:
- when development is more amenable to the aquisition of certain abilities (ex. language during 1st yr)
- more sensitive to certain stimuli
- more readily influenced by environmental factors that have a long term impact on development
- exposure to such thins suffices in teaching rather thane spending conscious effort to learn (ex. foreign language)
factors common to numerous developmental theories
Biological: -physical -nervous -endocrine Motor Cognitive Social/emotional and personality Language (expressive and receptive)
basic ideas behind the developmental theories of Freud, Piaget, Erikson, Bowlby, Bronfenbrenner, and Kohlberg
Freud:
-Ideas:
—Psychoanalysis
—The Oedipal Complex
—Freudian Slips
-Stages of Development:
—oral: birth to 18-24mo; sensually seeking through oral exploration
—anal: 18mo-3yo; control over toiling and masturbation; “anal traits”– compulsive, neat, retentive, stubborn
—Phallic: 3-6yo; Oedipal complex; castration anxiety or penis envy
—Latency: 5yo-puberty; temporary freedom from sexual instincts and anxieties through repression
—Genital: puberty-adult; sexual impulses no longer repressed; urges change to acceptable fulfillment of desires through loving another person
-Key terms:
—psychic apparatus parts:
===Id- underlying desires, uncoordinated trends
===Ego- organized and realistic part of your psyche
===Superego- critical and moralizing
—the unconscious
—dream interpretation
Piaget:
-Ideas:
—Cognitive development through interactions with the environment
-Stages of Development:
—Sensorimotor:
===Birth to 18-24mo
===dependence on exploration of perceptual stimuli through sensory modalities
===development of object permanence!!!
—Pre-operational:
===18mo-7yo
===understand pretend symbols
===magical explanations
===single perceptual attribute
===language development
===causality based on temporal or spatial nearness
===limited attention span and memory
===imaginary friends
===egocentrism
===can attribute 1 property to things: tall = older
—Concrete operations:
===7-12yo
===conserve volume and quantity
===reversibility of events
===causal sequences: pouring water from thin cup to fat cup = same vol
—formal operations:
===12yo-adult
===manipulation of ideas and concepts
===expansion of formal fund of knowledge
===abstract reasoning and metarecognition (allows understanding of divergent perspectives)
-Key terms:
—Assimilation: integration of new experiences w/ past experiences and problem solving based on past experiences
—Accommodation: reorganization of mind based on discordance between new experience and old experience to make sense of new experience
—Decalage: unevenness in developmental progress across different cognitive abilities (not everything develops at same rate)
—Object permanence: object is still there even if you can’t see it
—Egocentrism: toddlerhood. Adolescents- why is everyone always attention to me?
Bowlby:
-Ideas:
—Attachment Theory
===babies are evolutionarily programmed to have relationships with primary caregivers
-Stages of Development:
—Attachment
===2-7mo
===discrimination/limited preference
===differentiates among interactive partners
===may seem more comfortable with primary caregiver
===social with everyone and preferences not strongly expressed
—7-12mo
===preferred attachment becomes evident
===stranger anxiety
===separation anxiety
===development of “felt security”
===development of trust (vs mistrust)
===hierarchy of preferred caregivers
—12-20mo:
===use of attachment figure as a secure base from which to venture out and explore
===use of attachment figure as a safe haven to which to return if distressed or frightened
===proximity to caregiver promotes an internal feeling of security in infant
-Key terms:
—Secure base
===relationship w/ a person who provides comfort and safety and enables the infant/young child to explore the environment
—Strange situation
===experimental paradigm developed by Mary Ainsworth to determine attachment status
Erikson:
-Ideas:
—Identity development
—Conflicts at each stage results in formation of identity
-Stages of Development:
—Trust vs mistrust:
===infancy
===conflict resolves via relationship with loving, responsive parents
—Autonomy vs shame:
===early child/toddlerhood
===resolved through opportunities to exercise free choice and self-control with appropriate supervision
===learning rules and self-control
===willpower
—Initiative vs guilt
===preschool
===resolution leads to feelings of purpose and control
—Industry vs inferiority
===school age
===resolution leads to feelings of competency
—Identity vs role confusion
===adolescence
===resolution leads to an integrated sense of self
—Intimacy vs isolation
===early adulthood
===resolution enables feeling of love towards others
—Generativity vs stagnation
===middle adulthood
===marked by caring for others and productivity in society
—Ego integrity vs despair
===late adulthood
===wisdom
===integrity and selfhood that withstands physical deterioration
Kohlberg:
-Ideas:
—Stages of Moral Development
—(Heinz Dilemma)
-Stages of Development:
—Naive moral realism:
===action based on rules
===motivation is to avoid punishment
—Pragmatic morality:
===action based on desire to maximize reward/benefit and minimize negative consequences for self
—Socially-shared perspectives:
===action based on beliefs about approval / disapproval of others and feelings of guilt
—Social system morality:
===action based on formal dishonor and guilt about harm done to others
—Human rights and social welfare morality:
===action based on maintaining respect for community and self-respect; social values and rights
—Universal ethical principles:
===action determined by equity, fairness, and concern about maintaining personal moral principles
Bronfenbrenner: -Ideas: ---Human ecology theory -Stages of Development: ---Development involves interaction between individual and the environment -Key terms: ---microsystem: ===immediate context for an individual (ex family, classroom) ---mesosystem: ===2 microsystems in interaction ---exosystem: ===external environment that directly influences development (ex parental workplace) ---macrosystem: ===broader social context ---chronosystem: ===evolution of external systems over time
3 levels of the mind as outlined by Freud
Id:
- set of uncoordinated instinctual trends
- primal urges, food, sex, aggression
- indistinct
- entirely subconscious
- “I want it”
Ego:
- organized, realistic part
- mediator between primal urges and behavior accepted in reality
- “take it and you will get in trouble”
Superego:
- plays the critical and moralizing role
- moral values
- conscience
- can lead to self-blame and attacks on ego
- “You know you can’t have it. Taking it is wrong”
defense mechanisms as defined by Freud
Ego defenses:
-unconscious and mental processes used to resolve conflict and prevent undesirable feelings (anxiety, depression, etc)
Repression:
hiding away wishes in the unconscious
Displacement:
symptoms (wishes/impulses) that are hidden in one area appear in another
Sublimation:
using energy from unfulfilled wishes/impulses in a constructive way
Denial:
failure to acknowledge a truth that produces anxiety
Rationalization:
actions based on one motive justified by a more acceptable motive
Reaction formation:
displaying a trait that is the opposite of a repressed one
Projection:
Attributing your own unacceptable impulses to another
Regression:
reverting to behaviors seen in earlier stages of development to obtain care/resources that alleviate anxiety
types of behavior used to classify an infant’s attachment to his or her primary caregiver
Secure infants:
- seek proximity, contact, and interaction w/ caregiver
- distress at separation but are happy to see caregiver upon return
- more readily comforted by caregiver than stranger
- 55-65% in low risk
Avoidant infants:
- avoid proximity to caregivers at reunion
- treat mother the same as a stranger
- 15-20% in low risk
Resistant infants:
- seek proximity then reject it
- anger toward caregiver and stranger; passivity
- 5-10% in low risk
Disorganized/disoriented:
- no coherent strategy
- strange behaviors
4 developmental domains which are tracked across the lifespan
Motor
Cognitive
Social
Emotional
motor, cognitive, and social/emotional developmental abilities associated with each of the following age groups: newborns, infants, toddlers, preschoolers, school aged children, and adolescents
Newborns: -Motor: ===feeding, sleeping, movement -Social: ===social interaction -Emotional: ===ability to calm themselves
Infant: 0-6mo -Motor: ===Primary reflexes (moro, Babinski, Rooting, Sucking) ===Resolve and become increasingly purposeful ===Habituation after repeated exposure ===Reaching (3mo), rolling (4mo), sitting up (6mo) -Cognitive: ===visual and auditory tracking ===imitation ===object/action patterns ===means-ends association -Social: ===social smile (6weeks) ===unintentional babbling/cooing --> purposeful vocalization ===stranger anxiety (6mo) -Emotional: ===surprise, sadness, fear, distress
Older babies: 6-12mo -Motor: ===banging/shaking ===crawling ===pulling up ===standing ===walking (12mo) ===complex action patterns w/ objects ===increase fine manipulation -Cognitive: ===sensory-motor stage: ===play games ===cause and effect ===object permanence ===language development ===can remember things/people and anticipate future events ===experience the world through their senses (Piaget's sensory-motor stage) -Social: ===stranger anxiety peaks ===separation anxiety (8mo) -Emotional: ===express different moods ===joint attention ===increase use of social referencing and secure base behavior ===usually a time of very positive mood
Toddler: 12-36mo -Motor: ===Walking ===Climbing ===Running ===Hitting / Biting ===Fine motor skills ↑, use of tools -Cognitive: ===Best way to learn is through play and social interaction. ===“No” emerges ===↑ Symbolic capacity ===Imitate novel events ===Single words and brief phrases ===Number concepts ===When/Then logic -Social: ===Separation anxiety peaks (13mo) ===Tantrums and passions ===Low frustration tolerance ===↑ independence ===↑ ability to follow rules ===Peer play and friends ===Emotions felt 1 at a time ===Empathy and theory of mind -Emotional: ===Routines and rituals are important. ===Toddlers are masters at detecting differences. ===Don’t initiate a routine you’re not willing to repeat
Preschooler: 3-6yo -Motor: ===Jump ===Walk up stairs ===Alternating feet ===Jungle gym ===Ride a bike ===String beads ===Button/unbutton ===Scissors ===Draw a person -Cognitive: ===Pre-operational thinking: ===Best way to learn is through play and social interaction. ===Vocab ↑ from 1000-8000 words ===Retelling/inventing stories ===Number and letter recognition ===Time telling -Social: ===Peer relationships ===Taking turns / negotiation ===Play, gender segregation ===Imaginary friends ===Self help skills ===Ability to follow rules ↑ and participate in groups -Emotional: ===Fears are very common ===Gender identity solidifies ===Sense of self as constant
School aged children: 6-12yo -Motor: ===Complex gross motor tasks - sports ===↑ Fine motor skills ===Sewing, typing, pottery -Cognitive: ===Concrete cognition: ===Logical thinking ===Deductive reasoning ===Advanced classification into hierarchies ===Seriation ===Conservation of mass, length, wt, volume ===Written expression matches verbal expression -Social: ===Social groups ===Relationships with adults outside the family ===Rule bound behaviors -Emotional: ===Complex emotions are experienced and described ===Perspective
Adolescents: -Motor: ===↑ strength + endurance, higher skill levels ===Fine motor skills -Cognitive: ===Flexible and abstract thinking ===Mental hypothesis testing ===Multiple alternatives ===Complex reasoning and problem solving ===Logical rules ===Consider combinations of factors that affect solutions -Social: ===Peer pressure ===Dating ===Pecking orders ===Parental influence ↓ and peer influence ↑ -Emotional: ===Issues with peer rejection ===Sense of self is in flux ===Ask them: “What do you do with your friends?” ===With regards to sexual activity + substance use “What have you tried”
characterize adulthood from a developmental and milestone perspective
Continued development:
- Myelinization of the central nervous system until the 5th decade
- Complex social skills continue to improve until about age 30
- Delay of gratification peaks at age 40
- Physical abilities vary by age (sprinters hold records in their 20s while distance runners hold records in their 30s)
- Cognitive abilities vary by age
- Better driving records at age 50 than age 20
- Suicide is a greater risk with age
Sensory:
- Vision: declines after age 65; changes in ability to see things up close in the mid-40s
- Hearing: loss in the 70’s with decreased perception of high frequency sounds
- Decline in reaction time, strength and coordination
- Taste/smell: declines, especially in men
Memory:
- Substantial decline in recent-long term memory;
- less impact on remote long-term memory - questionable based on future lectures where only processing time should increase and memory should stay the same.
- Working memory decreases
- Little change in memory span
Intelligence:
- Crystallized intelligence (fund of knowledge) increases
- Fluid intelligence (processing speed, reasoning speed) decreases
cardiopulmonary changes at birth which allow the switch from placental-based to pulmonary-based gas exchange
Pulmonary adaptation to extrauterine life is determined by 3 factors:
- Lung growth & development
- Respiratory drive
- Physiologic maturation
Lung Growth & Development
- Canalicular Phase:
- –17-27 weeks.
- –Type II cells begin to differentiate and capillary network begins to form.
- Saccular Phase:
- –26-36 weeks.
- –Thinning of interstitial space allowing closer association of capillaries to air spaces and type I cells.
- Alveolar Phase:
- –36 weeks to 3 or more years.
- –True alveoli present.
Take home message:
Prior to 24 weeks the capacity for ventilation is limited by lack of true air spaces and the distance of capillaries from rudimentary air spaces.
This is the limit of viability for a fetus.
Respiratory Drive:
- Fetal “breathing” movements are inconsistent, no net movement of fluid into lungs
- Fetal gasping occurs with asphyxia, can result in fluid aspiration (e.g. meconium aspiration) prior to birth
- At birth, onset of regular, consistent respirations occurs in response to:
- –Sensory stimulation: cold, light, touch, noise
- –Mild asphyxia and hypercarbia as the blood flow to the baby is not great during contractions
Failure to Breathe
- Primary apnea:
- –Apnea is brief in duration
- –Stimulation initiates cry
- –Followed by gasping respirations
- –HR and BP relatively maintained
- Secondary apnea:
- –When original gasping ceases, secondary apnea ensues;
- –Requires positive pressure ventilation to establish lung inflation and begin regular respirations
- –Stimulation alone is ineffective
- –HR and BP fall quickly
- –Death occurs without rescue ventilation
- –Therefore, if the infant is apneic at birth, we assume it’s secondary apnea and intervene quickly
Physiologic Maturation:
Surfactant is a phospholipid-protein complex that coats the inside of air sacs and allows air to remain in the air sac on expiration called the functional residual capacity.
-Lower surface tension within air spaces.
-Prevent alveolar closure at the end of expiration.
-Composition:
—90% lipid: phosphatidylcholine + phosphatidylglycerol.
—10% protein: Proteins A, B, C, D and phospholipids are important for spreading surfactant as a mono-multilayer film and fighting infection.
—The surfactant mono-multilayer enables the formation of the Functional Residual capacity, FRC, and the ΔV / ΔP, which is the optimal compliance.
—Macrophages recycle 90%.
-Secreted by Type II alveolar cells.
—Stored as lamellar bodies.
—Extruded as tubular myelin into the airspace after fusing with cell membrane.
factors that modulate pulmonary vascular resistance around the time of birth
Normally following birth, lung expansion causes PVR to fall
Additionally, ↑ PO2, ↑ pH, ↓ PCO2, ↑ NO, ↑ Prostacyclin all contribute to a lower PVR.
The opposite factors cause the PVR to remain high, for example:
- Lung disease, and inadequate lung inflation
- –Surfactant deficiency
- –Retained fetal lung fluid
- –Inadequate inflation at birth
- Chronic intrauterine hypoxemia which leads to vascular remodeling
- Acidosis, sepsis, other stressors which cause pulmonary vasoconstriction
basic transitional events in glucose metabolism
signs of and risk factors for hypoglycemia in the immediate newborn period
The fetus receives a continuous intravenous glucose supply in utero, via umbilical circulation, which is abruptly cut off at birth
- Insulin does not cross placenta, but glucose does (from mother to fetus)
- Insulin production by the infant should cease quickly as glucose falls
- The production of insulin, however, is excessive and prolonged in infants of diabetic mothers (IDM), due to islet cell hyperplasia in the fetus in response to chronic hyperglycemia
Glucose is initially maintained by mobilization of hepatic glycogen stores
- Premature or IUGR babies have no glycogen stores
- Asphyxia, stress: stores used up quickly
Thereafter, glucose is provided by gluconeogenesis from protein, glycerol (fat) and lactate
-These substrates are also limited in premature and IUGR infants
Risk infants should be screened during first hours of life
- Intrauterine growth restricted (IUGR)
- Premature
- IDM
- Polycythemia
Signs:
- Jittery!!! (tremulous)
- Irritable
- Lethargic
- Apnea
- Seizures
Diagnosis:
- Blood glucose < 45 mg with symptoms/signs
- Blood glucose < 35-40 mg with risk factors, but asymptomatic (intervention level a little controversial)
- Lowest glucose is within 2-4 hours of birth
Treatment:
- Feed (formula) if baby able and willing to do so
- IV glucose if baby not able to feed, or if the glucose is not improved after feeding, or if the glucose is very low (< 25-30 mg), or if life-threatening symptoms (apnea, seizures) are present
physiologic signs expected during normal transition and the clinical signs of an abnormal transition
Risk Factors for an Abnormal Transition:
- Impaired fetal growth (IUGR), which implies chronic poor placental function
- –Poor nutrition and poor O2 delivery during pregnancy
- –Sets the stage for abnormal transition, delayed fall in PVR, poor glucose and temperature homeostasis
- Maternal diabetes, hypertension, premature rupture of membranes, bleeding, or chorioamnionitis
- Delayed or no prenatal care
- Preterm (< 37 weeks gestation) → could be cocaine or methamphetamine related
- No labor → elective C/S without labor
Recognizing Abnormal Transition (Term Infants):
- Prolonged or excessive respiratory distress and/or need for supplemental O2
- Failure to maintain normal temperature (worry about infection or CNS issues), glucose
- Lethargy, not interested in feeding, persistent hypotonia: babies should always be good feeders (unless premature)
- Apnea events with bradycardia or cyanosis
- Pallor with poor skin perfusion and delayed capillary filling time (shock, acidosis), or excessive ruddiness (plethora, polycythemia)
- Tremors, jitteriness
- Choking spells, cyanotic episodes, “spells” of any kind
importance of adequate lung inflation, surfactant production, and lung liquid absorption to the physiology of transition to extrauterine life
Establishes lung volume, FRC (functional residual capacity)
-Sets the stage for easy tidal breathing
Increased alveolar oxygen:
- Decreases pulmonary vascular resistance and increases pulmonary blood flow
- Increases arterial pO2 leading to constriction of ductus arteriosus
- Increases pulmonary blood flow leading to increased left atrial volume closure of foramen ovale flap
Take home:
-Lung inflation is the key to cardiovascular transition as well.
Within the amniotic sac, the fetal lungs are filled with fluid, and the pulmonary epithelium secretes fluid by active Cl- secretion, while Na+ absorption is limited.
- The fluid exits via the trachea into the amniotic space.
- This is the basis for testing amniotic fluid for lung maturity.
- At birth the fluid needs to be cleared quickly so that ventilation with air can be established.
- –Corticosteroids cause an ↑ Amiloride-Sensitive Selective Epithelial Na+ channels, ENac, during late gestation.
- –Causing fluid absorption.
- –↑ Intrathoracic pressure during labor results in more egress of fluid from the trachea; less emptying occurs during C-section without labor.
- –Hydrostatic forces move the fluid distally through the airways and into the interstitium with inspiration, no return to the air space during exhalation. FRC builds during inspiration.
Failure of fluid absorption = retained fetal lung fluid also called Transient Tachypnea of the Newborn, TTN.
- If excessive fluid / delayed absorption by the vasculature and lymph from the interstitium, oxygen is required.
- Observed in: C-section without labor, maternal β-blocker therapy, ineffective inspirations.
- Generally seen in term and late preterm infants, mild respiratory distress, short course, well-inflated but wet-looking lungs on CXR.
- Can progress to severe respiratory failure.
unique circulation of the fetus and how it differs from the newborn (adult) circulation
The fetal circulation
- The placenta is the organ of gas exchange, with the best-oxygenated blood coming to the fetus through the umbilical vein, shunting through the ductus venosus bypassing the liver to the right atrium (RA)
- The placenta has very low vascular resistance, creating a very low systemic vascular resistance as blood returns to it from the fetal aorta through the umbilical arteries
- Conversely the pulmonary vascular resistance is very high in the fetus, and the pulmonary blood flow is very low due to active pulmonary vasoconstriction
- Local hypoxemia, acidosis, fluid-filled lungs, and possibly leukotrienes maintain the vasoconstriction
- Blood is shunted from the right atrium (RA) to the left atrium (LA) through the foramen ovale, and from the pulmonary artery (PA, high resistance) to the aorta (Ao, low resistance) through the ductus arteriosus (DA)
- –In utero, < 10% of combined ventricular output goes to the lungs
- –In utero, the right ventricle (RV) is the systemic (main) ventricle as very little blood flow returns from the lungs to the left atrium and left ventricle (LA, LV) for exit out the Ao
- In utero, the pulmonary and systemic circulations are connected but parallel
Following birth
- the lungs expand with air, the placenta is removed from the circuit (the cord is cut), and the circulation changes dramatically
- With lung expansion, pulmonary vascular resistance begins to fall
- –Pulmonary blood flow increases, PaO2 increases
- –Venous return to the LA increases
- With cord clamping and cold stress/vasoconstriction, systemic vascular resistance increases
- Pressures in the LA become greater than in the RA, and the foramen ovale flap closes
- With increased PaO2, and ↓ in local prostaglandin and NO production, the DA constricts
- The circulations are now in series (as in the adult): blood enters RA, goes to RV, through PA to lungs, returns to LA, through LV and out to Aorta; 50% of combined ventricular output now goes to lungs
The following changes are reversible.
- The DA constricts but is not anatomically closed for days to weeks
- The foramen ovale flap can reopen to allow blood to flow from RA to LA if RA pressure > LA
- Normal transitional circulation is a balance between pulmonary vascular resistance and systemic vascular resistance: blood flows from higher to lower resistance across these reversible fetal channels
- In the case of increased pulmonary vascular resistance, often accompanied by or aggravated by decreased systemic vascular resistance (hypotension), R to L shunting at foramen ovale + DA can recur or continue: known as Persistent Pulmonary Hypertension of the Newborn (PPHN)
- The placenta, however, cannot be replaced - that move was permanent.
concept of persistent pulmonary hypertension in the newborn
3 main categories of PPHN:
Abnormally constricted pulmonary vessels
- as with parenchymal lung disease, poor lung inflation following birth
- reversible with lung inflation, correction of acidosis
Abnormal pulmonary vascular musculature remodeled
- as with antenatal closure of DA, maternal NSAID use, chronic intrauterine hypoxemia
- not easily reversible
Hypoplastic pulmonary vasculature tree
- as with pulmonary hypoplasia from any cause – decreased vascular cross-sectional area
- not completely reversible
5 theoretical models for gender development with rationale and criticisms
Social Cognitive Development Theory:
- Children develop a sense of gender from what they observe and experience around them
- The interaction between the child’s thoughts (I am a girl) and behaviors (acting like a girl) lead to gender constancy.
- Cognitive consistency is self-satisfying, so children behave in ways that match their self-conception
- Gender identity becomes a basic organizer for the child’s gender learning
Social Cognitive Theory:
- Social cognitive theory posits that, through cognitive processing of direct and vicarious experiences, children come to:
- –categorize themselves as girls or boys
- –gain substantial knowledge of gender attributes and roles
- –extract rules as to what types of behavior are considered appropriate for their gender
- Through social interactions, children and adults develop internal self-conceptualizations about their gender that can have a huge impact on:
- –behavior
- –perspective
- –aspirations
- –self-satisfaction
- –self-esteem
- –mental well-being
Freud
-Psychoanalytic theory
—Intrapsychic processes drive gender identification and development.
—Identify first with opposite gender, develop erotic feelings for them (Oedipus/Elektra complex)
—get anxious due to fears of retaliation from other parent so identify with that parent instead to resolve the dilemma.
—Criticism
===No evidence. Kids tend to connect with nurturing, not threatening parents.
Kohlberg
- Cognitive Developmental theory
- –Children develop a sense of gender from what they observe and experience around them.
- –The interaction between the child’s thoughts (I am a girl) and behaviors (I am acting like a girl) lead to gender constancy.
- –Gender identification becomes the basic organizing principle to figure out what you’re supposed to do.
- Criticism
- –Little evidence.
- –Gender-linked behavior is seen before gender constancy or any recognizable cognitive understanding of gender has set in.
Bem & Markus
- Martin & Halverson
- Gender Schema Theory
- –Labeling oneself as male or female forms the basis for a cognitive schema for gender. —The schema expands as you get older.
- –Children act according to their gender schema motivated by wanting to match those of their own sex.
- Criticism
- –No evidence that a complex or extensive “schema” of gender leads to a stronger gender ID.
- –No info about how a schema translates into behavior.
Archer, Buss, Simpson & Kenwick
-Evolutionary Influences
—Gender differences are determined by what is biologically and evolutionarily successful including passing along their genes.
—Criticism
===Doesn’t really address developmental changes we see and doesn’t fit current behaviors.
-Hormonal influences
—Distinction in neuronal development drives gender differences.
—Example: lateralization of the brain is distinct between male and females
—Criticism
===Lateralization is minor and getting less pronounced with time, suggesting that differences are social and related to environment.
-Behavioral Genetics
—Some gender differences derive from genetics, others from environment.
—Criticism
===Hard to separate the two experimentally.
-Sociology
—Gender is mainly derived from culture → gender differences are decreasing as society becomes more permissive.
—Criticism
===People are not mere victims of their socio-cultural environment.
Bandura & Bussey
- Social-Cognitive Theory
- Mix of evolutionary forces, social and environmental interactions contribute to gender.
- –Everything influences everything.
- Through cognitive processing of direct and vicarious experiences, children come to categorize themselves as girls or boys, gain substantial knowledge of gender attributes and roles, and extract rules as to what types of behavior are considered appropriate for their gender.
- Criticism
- –Can’t really create a hypothesis-driven experiment to test this given that it tries to combine too many things.
differentiate between terms gender identity, gender stability, gender consistency, and gender constancy
Gender identity:
-label self and others as boy or girl, but believe it is possible to change/switch gender
Gender stability:
-recognize gender is stable over time but not over situations (boys can become girls if they wear a dress)
Gender consistency:
-gender is invariant despite changes in appearance, dress, or activity
Gender constancy:
- realize gender is consistent over time and situations
- belief that gender is fixed and irreversible
- begin to identify with people of their own gender and behave in gender appropriate ways
differentiate between sexual behaviors in children that are typically considered normal and those that are typically considered abnormal
Normal and common:
- touching/masturbating genitals in public/private
- viewing/touching peer or new sibling genitals
- showing genitals to peers
- standing/sitting too close
- try to view peer/adult nudity
Less common and normal:
- rubbing body against others
- trying to insert tongue in mouth while kissing
- touching peer/adult genitals
- crude mimic of movements assoc w/ sexual acts
- sexual behaviors that are occasionally, but persistently, disruptive to to others
Uncommon in normal children:
- asking peer/adult to engage in specific sexual acts
- inserting objects into genitals
- explicit imitation of intercourse
- touching animal genitals
- sexual behaviors that are frequently disruptive to others
rarely normal:
- any sexual behaviors involving children who are 4 or more years apart
- a variety of sexual behaviors displayed on a daily basis
- sexual behavior that results in emotional distress or physical pain
- sexual behaviors associated with other physically aggressive behavior
- sexual behaviors that involve coercion
relative incidence of child abuse as a pediatric diagnosis
child abuse and neglect:
25/1,000
relatively common childhood disease
sexual abuse:
-incidence has gone down drastically since 1992, but has had a slight increase recently
neglect substantiation rates:
-declined
number of foster care children:
-33% decline
diagnose physical and sexual abuse
Abuse:
- physical
- sexual
- emotional
- Munchausen Syndrome by proxy
Neglect:
- physical
- emotional (non-organic failure to thrive)
- medical care
common historical findings in child abuse cases:
- discrepant history (does not fit w/ physical findings)
- –caretaker may not know; imperative not to accuse the caretaker
- delay in seeking care (abuser hopes injury is not serious vs a protective parent vs healthcare professional)
- stressed caretaker
- behavior by the child that triggers the abuse
- –crying or toilet accidents
- –never tell a caretaker “just let the baby cry” unit you ask about how they feel when a baby cries uncontrollably
- prior history of abuse in the abuser
- unrealistic expectations of the child
- social isolation of caretaker
- pattern of increased severity of injury if first injuries unrecognized
- use of multiple hospitals or caretakers
interventions proven to prevent the physical and sexual abuse of children
approaches to sexual abuse prevention:
- resistance building
- –“good touch/bad touch” safety training
- –some evidence this works
- external inhibitors
- –adding parent volunteers to boy scout trips, for ex.
prevention of sexual abuse:
- 40% reduction of sexual abuse in last decade and we have no clue why
- parent education
- –parents as first teachers, parenting classes
- public health nurse home visitation
- –PHN visitation during first 2 trimesters of pregnancy and first 2 years of life can reduce physical abuse by 87% over lifespan of child
- –should be a basic health benefit, not a “program”
- Strong communities for Children
- –someone will notice and do the right thing
- SEEK
- –primary care health based screening and intervention with social worker support to create a “safe environment for every kid”
studies that suggest a biologic basis to abusive and neglectful behavior and the child’s ability to “survive” it
Kessler and Norepinepherine
-FosB knockouts treatable
Caspi and the Dunedin Boys
-MAO Activity predicts outcomes
Finkelhor and the declining incidence of abuse and neglect
-Is the increased use of psychopharmacologic agents responsible?
Pedophiles have reduced volume of the amygdala (area of brain critical for sexual development) compared to non-pedophiles
Felitti “Adverse Childhood Experience” studies.
genetics and epigenetics both play a role
summarize adolescent morbidity statistics
mortality:
- preventable deaths 72.3%
- –COD: accidents > homicide > suicide
- –critical to talk to your pts
morbidity:
- 831,000 pregnancies
- 4 million STDs
- 1/3 high school males carry weapon
- 6% physical fight
