GROWTH
AND
DEVELOPMENT
Part 3
Millenium Development Goals
http://nursethechild.weebly.com/
Specific Objectives:
By the end of this lecture, the student will be able to:
• Identify the importance of growth and development.
• Define growth and development.
• Mention the principles of growth and development.
• List factors affecting growth and development.
• Mention types of growth and development.
• Identify the stages of development.
Adolescent Development
in Context
Significant Interpersonal
Relationships During Adolescence
Parent-Adolescent Relationships:
Primary Questions

How do parent-adolescent relationships
change over the course of adolescence?
 What is the impact of adolescence on the family?
How does adolescent adjustment vary as a
function of variations in the parentadolescent relationship?
 What is the impact of the family on the
adolescent?
Changes in Family Relationships:
Autonomy

As children enter adolescence, they will strive toward
greater autonomy
 Autonomy refers to endorsing one’s actions and viewing
them as an expression of one’s self
 Establishing autonomy involves becoming a self-governing
person within relationships
Adolescents’ early attempts at establishing autonomy
frequently precipitate conflict between parents and
teenagers
 During adolescence, a shift occurs toward a more egalitarian
relationship
Changes in Family
Relationships:
Conflict

 Frequent, high-intensity, angry fighting is not normative
during adolescence
 There is a genuine increase in bickering and squabbling
between parents and teenagers during the early adolescent
years
 Much parent-adolescent conflict results from changes in the
adolescent’s reasoning about the legitimacy of parental
authority.
 Matters that parents see as moral or practical issues, adolescents see as
questions of personal choice, and they begin to challenge parental
authority when they believe it is not legitimate
Changes in Family Relationships:
Harmony

 Subjective feelings of closeness decrease during adolescence, as
does the amount of time parents and teenagers spend together
 Although perceptions of relationships often remain warm and
supportive, both adolescents and parents report less frequent
expressions of positive emotions
 Children who had warm, close relationships with their parents
during childhood are likely to remain close and connected to
their parents during adolescence, even though the frequency
and quantity of positive interactions may be somewhat
diminished
Influence of Parenting
on Adjustment
Four patterns of parenting:
Authoritative
(responsive and
demanding)
Permissive
(responsive but not
demanding)
Authoritarian
(demanding but
not responsive)
Indifferent
(neither responsive
nor demanding)
Influence of Parenting
on Adjustment

 Adolescents from authoritative homes are more responsible,
more self-assured, and more socially competent
 Adolescents from authoritarian homes are more dependent,
more passive, less socially adept, less confident, and less
intellectually curious
 Adolescents reared in permissive homes are often less mature,
less responsible, more vulnerable to peer pressure, and less
able to assume positions of leadership
 Adolescents reared in indifferent homes are disproportionately
impulsive, more likely to be involved in delinquent behavior,
and more likely to experiment with drugs and alcohol
Influence of Parenting
on Adjustment

Across a variety of outcomes, adolescents fare best in
homes that strike a balance between autonomy and
connectedness
 Such homes are characterized by a climate of warmth, in
which they are encouraged both to be “connected” to their
parents and to express their own individuality
 Such homes employ joint decision-making, whereby the
adolescent plays an important role in the decision-making
process but parents remain involved in the eventual
resolution
Friendships

In adolescence, friendships are the primary contexts
for the acquisition of skills – ranging from social
competencies to cognitive abilities – and socio-cultural
values and expectations
In adolescence, perceptions of parents as primary
sources of support decline and perceived support
from friends increases
High quality friendships become increasingly
important as sources of support for adolescents
experiencing emotional problems, though they do not
substitute for parental support
Romantic Relationships

 Romantic interests are both normal and important during adolescence
 Many adolescents regard bring in a romantic relationship as central to
“belonging” and status in their peer group
 This link is transactional: peer networks support early romantic
coupling, and romantic relationships facilitate connections with other
peers
 Although early dating and sexual activity are risk factors for subsequent
social and emotional difficulties, high quality romantic relationships are
associated with enhanced feelings of self-worth
 The developmental significance of romantic relationships depends more
heavily on the behavioral, cognitive, and emotional processes that occur in
the relationship than on the age of initiation and degree of dating activity
that an adolescent experiences

Interpersonal Contexts and the
Psychosocial Tasks of
Adolescence
Independence and Interdependence

Adolescence is a period of tension between
two developmental tasks:
 1) increasing connections to others beyond the
family and conforming to societal expectations
 2) attaining individual competence and autonomy
from the influence of others
Successful adolescent development involves
separating oneself from others while
simultaneously forming connections and
close relationships
Developing a Sense of
Independence

 Although the development of independence is often
cast as an individual accomplishment, it is embedded
in the interpersonal contexts of family and peer
relationships
 Independence is both a process and an outcome
 Independence is valued differently in different
cultural contexts
 There are two broad types of independence:
emotional and behavioral
Emotional
Independence

 Developing emotional independence involves increases in adolescents’ subjective
sense of independence, especially in relation to parents
 In early adolescence, this is achieved in part by separating oneself from and arguing
with one’s parents; through this process the relationship is transformed and the
adolescent develops both a new behavioral repertoire and a new image of his or her
parents
 In this sense, developing emotional independence is not primarily an individual
transformation but rather an interpersonal transformation in which patterns of
parent-child interaction are mutually (if unwillingly) renegotiated
 This transformative process yields three outcomes:
 1) A changed adolescent who now views him- or herself in a different light
 2) Changed parents who now view their adolescent (and perhaps themselves) in a
different light
 3) A changed, more egalitarian parent-child relationship
Behavioral
Independence
 Developing behavioral 
independence involves
increases in adolescents’ capacity for independent
decision-making and self-governance
 Parents facilitate the development of behavioral
independence in four ways:
 1) By modeling effective decision-making
 2) By encouraging independent decision-making in the
family context
 3) By rewarding independent decision-making outside the
family context
 4) By instilling in the adolescent a more general sense of
self-efficacy through the use of parenting that is both
responsive and demanding
Developing a Sense of
Interdependence

There are two psychosocial goals comprising
the task of interdependence:
1) Attachment
2) Intimacy
Attachment
 in adolescence is part of
 Achieving interdependence
a developmental attachment process begun at birth
 Attachment refers to a parent-child connection –
begun in infancy – that supports children’s efforts to
feel safe from threatening circumstances and to be
regulated emotionally
 Attachment to parents or caregivers forms the
substrate on which other attachments are built
 Representations of parent-child attachment relationships
organize expectations and behaviors in later relationships
 Healthy parent-child relationships expose children to
components of effective relating, such as empathy,
reciprocity, and self-confidence
Attachment

 Maintaining interdependence in adolescence
involves redistributing the functions of relationships
 Perceptions of parents as primary sources of support decline
and perceived support from friends increases
 In this process, attachment is transformed from a
relationship where one partner (the parent) cares for another
(the child) to one characterized by mutual caregiving
between two partners (friends or romantic partners)
 The quality of early attachment relationships predicts
the quality of all future relationships
 For adolescents to achieve interdependence, they
must build on earlier secure relationship patterns to
form and maintain further stable relationships
Intimacy

 Intimacy is an interpersonal process within which two
interaction partners experience and express feelings,
communicate verbally and nonverbally, satisfy social motives,
reduce social fears, talk and learn about themselves and their
unique characteristics, and become “close”
 As a psychosocial task of adolescence, intimacy refers to
experiencing this mutual openness and responsiveness in at
least some relationships with peers
 Concepts of friendship first incorporate notions of intimacy in
early adolescence
 Adolescents become increasingly capable of intimate
relationships as they develop a more sophisticated
understanding of social relations, and as they hone their ability
to infer the thoughts and feelings of others
Intimacy

 In peer relationships, spending larger amounts of time with
peers and correspondingly less time with adults contributes to
adolescents’ development of intimacy by increasing comfort
with peers and encouraging self-disclosure as well as openness
to others’ self-revelations
 Shared interest in mastering the distinctive social challenges of
adolescence also stimulates a desire to communicate with peers
 The superficial sharing of activities that sufficed between
childhood friends is supplanted, during adolescence, by the
potential for mutual responsiveness, concern, loyalty,
trustworthiness, and respect between adolescent friends
 Friendship in adolescence meets a basic psychological need to
overcome loneliness and develop a sense of belonging
Conclusions

 Adolescent development, though largely characterized by
biological changes, cannot be understood outside of the
interpersonal contexts in which it occurs
 Perceptions and expectations forged through parent-child
relationships mediate the psychological and behavioral impact
of pubertal changes and provide a foundation on which all
adolescent interactions and relationships are based
 By being mindful of the changes that occur during adolescence
and the ways in which parent-child interactions influence these
changes, parents will be better equipped to interact with their
adolescents in ways that equip them with the skills they require
to successfully navigate these transitions and maximize positive
developmental outcomes
for Health Promotion
I. Adolescent Safety
1.
Accidents, most commonly those involving motor
vehicles, are the leading cause of death among
adolescents.
Management:
- Parents need to have the courage to insist on
emotional maturity rather than age as a qualification
for obtaining a driver’s license
2. Drowning is another chief accident of adolescence, even
though it is largely preventable.
Management:
- Teaching water safety, such as not swimming alone or
when tired, is as important as teaching the mechanics
of swimming
3. The second most common cause of death among
adolescents is homicide, r/t to the easy availability of guns
to teenagers.
- Gang violence and the desire to protect them from
this add to this problem
4. Accidental gunshot injuries increase in early adolescence,
often for the same reason that drowning increases:
youngsters want to impress friends.
5. Athletic injuries tend to occur during adolescence
because of the vigorous level of competition that occurs.
- Overuse injuries result from poor conditioning
Suicide
Prevention
30
Suicide Prevention
Introduction
Objectives:
 The scope and importance of suicide prevention
 The negative impact of myths and misinformation
 How to identify a person at risk-signs symptoms
 How to effectively communicate with a suicidal person
 How to gain information to help the person
 How to refer a person for evaluation and treatment
31
Suicide Prevention
Myths and Misinformation

Myth: Asking about suicide will plant the idea in a person’s
head.

Reality: Asking a person about suicide does not create
suicidal thoughts any more than asking about chest pain
causes angina. The act of asking the question simply gives the
person permission to talk about his or her thoughts or feelings.
32
Suicide Prevention
Myths and Misinformation

Myth: There are talkers and there are doers.

Reality: Most people who die by suicide have
communicated some intent. Someone who talks about
suicide gives the guide and/or clinician an opportunity
to intervene before suicidal behaviors occur.
33
Suicide Prevention
Myths and Misinformation

Myth: If somebody really wants to die by suicide,
there is nothing you can do about it.

Reality: Most suicidal ideas are associated with the
presence of underlying treatable disorders. Providing
a safe environment for treatment of the underlying
cause can save a life. The acute risk for suicide is
often time-limited. If you can help the person survive
the immediate crisis and overcome the strong intent
to die by suicide, you have gone a long way toward
promoting a positive outcome.
34
Suicide Prevention
Myths and Misinformation
Myth: He/she really wouldn't commit suicide because…






he just made plans for a vacation
she has young children at home
he made a verbal or written promise
she knows how dearly her family loves her
Reality: The intent to die can override any rational thinking.
“No Harm” or “No Suicide” contracts have been shown to be
ineffective from a clinical and management perspective. A
person experiencing suicidal ideation or intent must be taken
seriously and referred to a clinical provider who can further
evaluate their condition and provide treatment as appropriate.
35
Suicide Prevention
Operation S.A.V.E.
Operation S. A. V. E. will help you act with
care and compassion if you encounter a
person who is suicidal.
The acronym “SAVE” summarizes the steps
needed to take an active and valuable role
in suicide prevention.




Signs of suicidal thinking
Ask questions
Validate the person’s experience
Encourage treatment and Expedite getting
help
36
Suicide Prevention
Operation S.A.V.E.
Importance of identification




Suicidal individuals are not always easy to identify.
There is no single profile to guide recognition.
There are a number of warning signs and symptoms.

Some of the signs of suicidality are obvious, but
others are not.
Signs and symptoms do not always mean the person is
suicidal but:

When you recognize signs, it is important to ask the
person how they are doing because they may mean
that they are in trouble.
37
SAD PERSONS:
Sex: male
Age: young, elderly
Depression
Previous suicide attempts
Ethanol and other drugs
Reality testing/ Rational thought (loss of)
Social support lacking
Organized suicide plan
No spouse
Sickness/ Stated future intent
Suicide Prevention
Signs of suicidal thinking
Signs and Symptoms:








Threatening to hurt or kill self
Looking for ways to kill self
Seeking access to pills, weapons or other means
Talking or writing about death, dying or suicide
Hopelessness
Rage, anger
Seeking revenge
Acting reckless or engaging in risky activities
39
Suicide Prevention
Signs of suicidal thinking



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




Feeling trapped
Increasing drug or alcohol abuse
Withdrawing from friends, family and society
Anxiety, agitation
Dramatic changes in mood
No reason for living, no sense of purpose in life
Difficulty sleeping or sleeping all the time
Giving away possessions
Increase or decrease in spirituality
40
Suicide Prevention
Ask questions
To effectively determine if a person is suicidal, one
needs to interact in a manner that communicates
concern and understanding. As well, one needs to know
how to manage personal discomfort(i.e., anxiety, fear,
frustration, personal, cultural or religious values) in order
to directly address the issue.
Know how to ask the most important question
The most difficult S. A. V. E. step is asking the most
important question of all –
“Are you thinking of killing yourself.”
41
Suicide Prevention
Ask questions
How DO I ask the question?

DO ask the question after you have enough
information to reasonably believe the person is
suicidal.

DO ask the question in such a way that is natural and
flows with the conversation.
DON’T ask the question as though you are looking for a
“no” answer. “You aren’t thinking of killing yourself are
you?”
42
Suicide Prevention
Ask questions
Things to consider when you talk with the person:
Remain calm
Listen more than you speak
Maintain eye contact
Act with confidence
Do not argue
Use open body language
Limit questions to gathering information casually
Use supportive and encouraging comments
Be as honest and “up front” as possible
43
Suicide Prevention
Validate the veteran’s experience
Validation means:






Show the person that you are following what they are
saying
Accept their situation for what it is
You are not passing judgment
Let them know that their situation is serious and
deserving of attention
Acknowledge their feelings
Let him or her know you are there to help
44
Suicide Prevention
Encourage treatment and Expedite getting help
For the cooperative person:
Tips for encouraging treatment:
1.
2.
3.
4.
5.
Explain that there are trained professionals available
to help them.
Explain that treatment works.
Explain that getting help for this kind of problem is no
different than seeing a specialist for other medical
problems.
Tell them that getting treatment is his or her
right.
If they tell you that they have had treatment
before and it has not worked, try asking: “What if
this is the time it does work?”
45
Suicide Prevention
Encourage treatment and Expedite getting help
Tips for expediting a referral:
1.
2.
3.
Assist the person in getting to a care facility by
personally taking them or arranging for transportation.
Call the VA Suicide Hotline number with the veteran to
get a referral started. 1-800-273-TALK – push “1”.
Call the local facility Suicide Prevention Coordinator –
you make access this person from the information desk
at any VA.
46
Suicide Prevention
Encourage treatment and Expedite getting help
For uncooperative people or those in immediate crisis:
As you encourage the person to seek help, some
situations may involve people who are hostile and
aggressive.
Here are some useful safety guidelines for working
with seriously and acutely distressed people:
[These rules are both for the person’s safety and yours.]
47
Suicide Prevention
Encourage treatment and Expedite getting help

Any time a person has a weapon or object that can be
used as a weapon – call for help.

If a person tells you that they have overdosed on pills or
other drugs or there are signs of physical injury – call for
help.

In addition to calling for help, if you are confronted with a
hostile or armed person, leave the area and attempt to
isolate the person. If the person leaves your area, attempt
to observe his or her direction of movement from a safe
distance and report your observations as soon as
authorities arrive on scene.
48
Suicide Prevention
Operation S. A.V. E.
SUMMARY
Operation S. A. V. E. can save lives by helping you become
aware of:
Signs of suicidal behavior and giving you the skills to:
Ask questions
Validate the person’s experience and to
Encourage treatment and Expedite getting help
49
Suicide Prevention
Operation S. A.V. E.
By participating in this training you have learned:








The scope of the problem of suicides among the
veteran population
The importance of suicide prevention
The negative impact of myths and misinformation
How to identify a person who may be at risk
Some of the signs and symptoms of suicidal thinking
How to effectively communicate with a suicidal person
How to gain information to help the person
How to refer someone for evaluation and treatment
50
Suicide Prevention
Operation S. A.V. E.
There are plenty of resources available to
someone who is suicidal but we need you to
partner with us in identifying the suicidal person
and getting them into treatment.
51


8937603/06
Hello crisisline 2333 G or 211 S
II. Nutritional Health
1.
Adolescents experience so much growth that they may
always feel hungry
2.
If adolescent’s eating habits are unsupervised, they will
tend to eat faddish or quick snack foods rather more
nutritionally sound ones
3.
Some may turn away from the five pyramid food groups
to eat great quantities of sweets, soft-drinks, or empty
calorie snacks which leaves them poorly nourished
despite the large intake
4.
Adolescents who are slightly obese because of
prepubertal changes may begin to low-calorie or
starvation diets to lose excess weight
5. An adolescent needs an increased number of
calories to maintain a rapid period of growth
6. Because vegetables generally contain fewer calories
than meat, adolescents need to consume large
amounts of them to achieve an adequate caloric
intake with a vegetarian diet
7. Athletes need more carbohydrate or energy than
do people who do not engage in strenuous activity,
and the source of carbohydrate that best sustains
athletes comes from the breakdown of glycogen
because this supplies slow steady release of glucose
8. As a rule, the goals of nutrition that are best for
everyone, such as eating a well-balanced diet, are also
best for athletes, rather than diets that interfere
with carbohydrate, fluid or fat intake
III. Adolescent Development in Daily
Activities
1.
Maintaining adequate sleep, hygiene and exercise are
important and should become the adolescent’s
responsibility rather than the parents’.
2.
Parents can, however, encourage adolescents to engage
in healthy patterns of living-primarily to role modeling.
3.
Dress and Hygiene: They are capable of total self-care
and because of their body awareness, they may even be
overly conscientious about personal hygiene and
appearance
4.
Care of teeth: They are generally very conscientious
about tooth brushing because of the fear of developing
bad breath
5. Sleep: Although it is widely believed that adults need 8h
of sleep a night, some need more and others can adjust to
considerably less
- Many adolescents attempt to get by with too little
sleep, because they are constantly busy and because staying
up late is a symbol of the adult status they long for
6. Exercise: Adolescents need exercise everyday to maintain
muscle tone and to provide an outlet of tension.
-Although they are constantly on the go, they often
receive little real exercise
IV. Healthy Family Functioning
1.
Early adolescents may have many disagreements with
parents that seem partly from wanting more
independence and partly from being so disappointed in
their bodies
2.
It is frustrating for children to be told by parents that
they are too old to behave in a certain manner when
they still don’t feel or look older
3.
At other times, just when they begin to accept their
maturing appearance, parents tell them they are too
young to do something
4.
Adolescents find even more fault in their parents and
wonder how they can exist with their outdated ideas
5. They have trouble respecting parents who are so
obviously imperfect
- School marks may slump as a reflection of
this “fallen angel” syndrome
- These adolescents may follow health advice
poorly because they view health care personnel in
the same light
6. By the time they are 16, adolescents generally
become more willing to listen and to talk about
problems
Adolescents are not only large in
number but also the citizens and
workers of tomorrow.
More than 33% of the disease burden
and almost 60% of premature deaths
among adults can be associated with
behaviors or conditions that began or
occurred during adolescence.
Thus focusing attention on diseases
experienced during adolescence and on
risk factors rooted in adolescence
makes sense.
In line with the global policy changes on adolescents and youth,
the DOH created the Adolescent and Youth Health and
Development Program (AYHDP) which is lodged at the National
Center for Disease Prevention and Control (NCDPC) specifically
the Center for Family and Environmental Health (CFEH). The
program is an expanded version of Adolescent Reproductive
Health (ARH) element of Reproductive Health which aims to
integrate adolescent and youth health services into the health
delivery systems.
Developmental theory
Freud theory
(sexual development).
Piaget theory
(cognitive development ).
Erikson theory
(psychosocial development).
Freud theory
(sexual development)
Infancy stage 
Toddler stage 
Preschool stage 
School-age stage 
Adolescence stage 
Oral-sensory stage
Anal stage
Genital stage
Latency Stage
Pubertal stage
Piaget theory
(cognitive development
Infancy stage 
Toddler stage 
Preschool stage 
School-age stage 
Adolescence stage 
Up to2 years  sensori -motor
2-3 years  pre-conceptual phase.
Up to 4years  pre-conceptual
phase.
7-12 years  concrete-operational.
12-15 years  preoperational
formal operations
15 years - through life  formal
operations
Erikson theory
(psychosocial development)
Trust versus mistrust.
Infancy stage 
Toddler stage 
Preschool stage 
School-age stage 
Adolescence stage 
Autonomy and self
esteem versus shame
and doubt.
Initiative versus guilt.
Industry versus
inferiority.
Identity and intimacy
versus role confusion.