SECTION I:
INTRODUCTIONS
Time:
20 minutes
Objectives:

Trainees will introduce themselves to each other and the trainers.
Method:
Presentation by trainer, group discussion.
Handouts:
#1
#2
#3
PowerPoint
Agenda and Objectives
Competencies
PowerPoint presentation
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Introductions
Trainer Instructions
Introduce yourself and distribute Handout #1: PowerPoint; and review
Handout #2: Agenda and Objectives. Ask participants to review
Handout #3: Competencies
Choose from a variety of methods of introductions. For groups that have
attended several workshops together, extensive introductions may not be
necessary. The trainer may ask participants to identify children they are
close to (a birth, foster, adoptive, or god child, child of a close friend, etc.)
during introductions, and to put the ages of those children on their name
tents. The trainer may then use that information to call on participants for
examples during discussion of various developmental stages.
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SECTION II:
APPLYING PRINCIPLES OF DEVELOPMENT
TO CHILD WELFARE
Time:
1 ½ Hours
Objectives:

Trainees will identify their training needs for the workshop

Trainees will know the concepts and principles of "normal" child
development.

Trainees will understand why a thorough knowledge of child
development is essential for effective child welfare practice.
Method:
Small-group discussion, large-group discussion, lecture
Materials:



Participants’ “Child Development Pre-Training Assignment”
PowerPoint Presentation
Video: “Diversity: Contrasting Perspectives”
Notes to Trainers:
Throughout the curriculum there are numerous examples to illustrate
concepts of child development. You may use these examples, or
examples from your own personal or professional experience. Use
discretion about how many examples to give. Remember that examples
should be “short, sweet, and to the point”.
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A.
WIIFM and the Importance of Learning about Child
Development and the Effects of Abuse and
Neglect on Development
Time: 20-30 minutes
Trainer Instructions
Option 1
Conduct a small-group discussion to elicit participants’ learning needs
(“What’s In It for Me”) and to discuss why knowledge about child
development and the effects of abuse and neglect on child
development are important to child welfare workers.

Divide the group into small-groups of 4-5 people. If the group is large
and diverse enough, the trainer may divide it according to job
functions: intake and investigation, ongoing family services workers,
foster care workers, adolescent workers, etc. This will allow small-group
discussion to focus on very specific job functions.

Ask the participants to do the following. Allow approximately 10
minutes for the small-group discussion.

Discuss why it is important for them to learn about child
development and the effects of child maltreatment on child
development. Ask them to be ready to report out their ideas. The
group should assign one person to report on the group’s work.

Discuss the group’s learning needs for the workshop.

Conduct a large-group discussion on the importance of learning about
child development and the effects of maltreatment on development.
Ensure that the discussion includes the points listed below.

Ask each group to identify one of its learning needs. Record each
idea on a flip-chart. After each group has identified one its ideas, ask
the groups to identify any additional ideas. (They should not repeat
ideas that have already been identified.)
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
Identify any learning needs that will not be included in the workshop;
and inform participants that they can meet those learning needs in
other workshops offered by the OCWTP.
Option 2

Conduct a "What’s In It For Me" exercise to identify learning needs, as
described above.

Upon completion of the discussion of learning needs conduct a
lecture/large group discussion of the following content.
Content to be Discussed
1. The caseworker must be able to recognize the negative
effects of abuse and neglect on a child's development and
to obtain appropriate developmental, medical and mental
health services for those children

Children who have been abused or neglected are often delayed in
their development or may show abnormal patterns of
development, health problems, and behavioral problems. In fact,
most children in foster care have medical, mental health, and/or
developmental problems. (Vig et.al., 2005)

Child maltreatment can result in developmental delays (such as
delayed language development), developmental disabilities (such
as cerebral palsy), and social, emotional, and behavioral problems
(such as insecure attachment). Child welfare workers should
recognize early indicators of delays, disabilities, and problems in
order to begin developmental and treatment interventions as early
as possible.

Early intervention services can often limit how much
developmental delay or disability affects a child's development.

Children with serious developmental problems or disabilities are at
increased risk of maltreatment. By recognizing such delays and
disabilities, workers can often provide supportive and counseling
services to parents and thereby help to prevent maltreatment.
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
This workshop will provide information and handouts about normal
development, and indicators of delays in development. The
caseworker should know age-appropriate behavioral expectations
and be able to educate and counsel parents about proper child
care practices and discipline strategies.

The age and developmental maturity of the child will determine the
proper behavior management or discipline strategies for that child.
Abusive and neglectful parents often use discipline strategies that
are not appropriate for their children's level of development.
Examples
o The use of "reasoning" with a one-year-old, who can understand
neither complex language nor logic.
o The excessive use of force with a two-year old child, who is
developing autonomous behavior. Misunderstanding the child's
autonomous behavior can cause a parent to overact and lead
to conflict when he tries to regain control.
o The use of physical discipline with an infant. Infants lack the
cognitive ability to put the discipline into context, and therefore
experience the discipline only as a painful and disorienting
intrusion.

Many abusive parents have unreasonable expectations for their
children's behavior. Inappropriate developmental expectations
can make the parent misinterpret of the child's actions.
Examples
o A two-year old child who exercises autonomy by using the potty
only when he wants to is seen by the parent as "plotting ways to
get back at me." The two-year old controls his body functions as
an expression of developing autonomy, and it is normal for
children to be stubborn at age two. The child is not capable of
"plotting" in the manner the parent attributes to him.
o A crying infant who cannot be comforted is thought to be
"ungrateful and unappreciative of my care." Infants cannot
exhibit "appreciation" in the planful and reciprocating manner
that is typical of adults.
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o A three-year old, who is totally absorbed in Sesame Street and
does not respond to a parental request, is thought to be
"deliberately ignoring me." Three-year-olds may not able to fully
attend to more than one stimulus at a time. This may also be a
cognitive style of some older children and adults, and outside
the realm of "deliberate" action.

Workers should be aware of cultural differences in what behavior is
expected of children, and be able to assess the child's
development within the child's cultural context. For example, in
some cultures, there are longer silences during conversations than is
typical in American culture. This could be misinterpreted as
disinterest, or intellectual deficits.
2. Caseworkers should be able to help parents and foster
caregivers access services and activities to meet children's special
needs and to enhance development. Case-planning strategies should
focus on development problems and provision of family-centered
interventions.
3. Knowledge of child development is necessary to prevent
crisis for the child during placement into substitute care.
Accurate knowledge of a child's cognitive and emotional capabilities
can help caseworkers understand the child's experience of separation
and placement. The worker can plan and implement placement
activities that minimize the child's stress, and that help the child
constructively cope with the placement. This can help prevent an
emotionally disabling crisis and permanent negative consequences on
the child's development.
4. The worker must be aware of child development issues that
may increase risk of abuse or neglect for a child.
When considering risk-assessment as it relates to child development,
the worker must consider how several variables interact:
 Characteristics or conditions of the child that would increase the
real or perceived difficulty of parenting the child;

The parents’ capacity to parent the child appropriately; and
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
The parents’ ability to adapt his or her parenting methods to the
particular child.
5. Workers need to be knowledgeable about normal child
development in their work with children.
B.

Workers should consider developmental stages when interviewing
children, and in generally relating to children of different ages.

They need to know what normal sexual development is in order to
help assess whether a child has been sexually abused.
Principles of Development
Time: 1 hour
Trainer Note: It is critical that you are very familiar with the pre-training
handout for this discussion.
Trainer Instructions
Ask participants to take out their pre-training booklet for reference
during this discussion.
Ask the participants to identify something important they learned from
the content on “Basic Principles” and “Factors that Affect
Developmental Outcomes”. They may refer to the booklet during this
discussion.
Try to elicit a
pamphlet.
response for each of the principles discussed in the
Correct any misperceptions as needed.
Upon completing discussion, further discuss three of the concepts:
normal as a statistical concept, the cumulative nature
of
development; and the impact of culture on development, and how
they apply to child welfare work. Discussion points are listed below.
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Alternately, include the following discussion points when discussing the
pre-reading assignment.
Trainer Note: The PowerPoint Presentation includes several slides that
summarize information contained in the pre-training handout. Their use is
optional.
The purpose of this discussion is to briefly refresh participants’ memory. Do
not teach the content, even if it is evident that participants did not read
the content prior to attending the workshop.
1. Normal as a Statistical Concept
It is important for caseworkers to be aware of the statistical concept of
normal, because eligibility for special education services is determined
by how far from normal the child’s functioning is. Teacher observation
reports and achievement tests are conducted to determine whether
the child’s functioning in school (either academically or socially) is
significantly delayed, as compared to how other children his age
function. Workers should be aware that not all achievement tests or
teacher observation reports eliminate cultural bias.
2. The Cumulative Nature of Development
Trainer Instruction
Ask participants to identify Erickson’s psycho-social tasks of
development, and show the corresponding PowerPoint slide. Use this
as an example of the cumulative nature of development. Provide only
enough explanation of the stages that participants get a general idea
of the stages. Usually merely naming the psycho-social task is sufficient.
More detailed information will be provided during the discussion of
normal development for each age group.
Use failure to obtain basic trust as an example how failing to complete
a stage may affect a person’s functioning in adult life.
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The purpose of this discussion is to demonstrate how knowledge of
developmental tasks is important to caseworkers, not to teach Erikson’s
theory.
Content to be discussed

The successful completion of each stage depends on completing the
previous stages. If children have not mastered the prerequisite psychosocial skills when they attempt the next stage of development, they will
likely not succeed.

For example, if a child or parent has not developed basic trust, he
probably will not be able to trust the caseworker. The caseworker can
expect the child and/or parent to be suspicious, withholding, and
perhaps even angry. Caseworkers will need to work hard to develop
trusting relationships.
3. Impact of Culture on Development
Culture, by definition, is the total system of values, beliefs, attitudes,
traditions, and standards of behavior, or codes of conduct which
regulate life within a particular group of people. These codes of
conduct regulate virtually all aspects of social life including parenting,
family life, interacting with outsiders and authority figures; and
expectations regarding children’s development and behavior. (Rycus,
1998)
Research shows that development occurs in similar ways and in similar
time frames across cultures. However, expectations for children’s
behavior and parenting interactions vary among cultures, because of
their differing codes of conduct. The behavioral expressions of
development are shaped by children’s cultural environment.
Caseworkers should be aware of cultural differences in parenting so
they do not make errors in assessing the child’s behavior and
development or parenting practices.
Trainer Instruction
Show the video, “Diversity: Contrasting Perspectives”
BaerT
2013-12-31 19:01:05
-------------------------------------------Replaced with Casey video on early
childhood brain development:
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When you have viewed the tape, conduct a large-group discussion,
and ask questions to stimulate discussion. Include the following
discussion points.
Trainer Note: This video was developed for day care workers. An advisory
group of day-care workers and directors was involved in developing a
series of videos on early child development. They encouraged the
producers of the videotape to address cultural differences in child
development and their impact on caring for children in day-care centers.
A few portions of the video have been selected for this workshop and are
included on the DVD for this workshop. They highlight different cultural
perspectives in child-rearing practices and expectations for development.
Content to be Discussed

Codes of conduct regarding interdependence and dependence
shaped parental behaviors and expectations about toilet training and
feeding. These codes of conduct evolve out of culturally driven
assumptions about how the parenting tasks should be performed,
under what circumstances, and when exceptions can be made.

Other factors influence parenting practices regarding toilet training
and feeding. For example, temperamental differences in parents and
children, the desire to keep the child clean, or to not waste food, or
the need for feeding to be completed quickly all contribute to how a
child is taught to feed himself.

Codes of conduct regarding dependence and interdependence may
affect child-rearing practices at various ages.
Examples
o Some parents may encourage their preschoolers to play
independently, with little intervention from parents. Other families
may expect that the parent guide in the choice of play activities
more.
o Some families will encourage school-aged children participation in
lots of extracurricular activities; others may expect that the activities
be centered on home and family.
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o Some families may expect their adolescents to make significant
choices regarding their future on their own. Others may expect the
youth to seek parental advice, and abide by the direction parents
provide.

It is important to understand cultural differences in child rearing and
expectations for children’s development. Lack of understanding can
lead to errors in assessing children and their parents. Workers may
mistakenly assume that a child is developmentally delayed when, in
fact, the child has developed normally under the influence of a certain
cultural element.
Example
o In families who speak two or more languages many children start
speaking later than in families that speak only one language.
o Workers should provide parenting advice that is consistent with the
parents’ cultural practices. For example, the worker may need to
enlist someone from the parents’ cultural group to assist with toilet
training in a non-punitive manner.
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SECTION III:
INFANT AND TODDLER DEVELOPMENT
Time:
4 ½ hours
Objectives

Trainees will know the processes and milestones of normal infant
and toddler development.

Trainees will understand the potential negative outcomes of abuse
and neglect on infants and toddlers physical, cognitive, social, and
emotional development.

Trainees will know why infants and toddlers are at particularly high
risk of abuse and neglect.

Trainees will learn case-planning and treatment options for children
who are developmentally delayed.

Trainees will understand common special development problems,
and appropriate case-plan/treatment strategies.
Method

Lecture, large-group discussion

Video: Presentation by trainer- slides of normal development, group
discussion and exercises.

PowerPoint Slides including slides of normal development
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Handouts:
#4
#5
#6
#7
#8
#9
Promoting Attachment
Fetal Alcohol Syndrome
Prenatal Exposure to Drugs
Special Care for Severely Abused Infants
Failure to Thrive
Cerebral Palsy
Trainer Resources

Slide script: Normal Infant and Toddler Development.

Video: “A World of Hope – Identifying Developmental Delays 0-3”
from the series: “Identifying Developmental Delays”
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A.
Normal Infant and Toddler Development
Time: 1 ½ hours
Trainer Instruction
Present the slide program "The Normal Development of Infants and
Toddlers" to illustrate the developmental processes and milestones of
children from birth to age 3.
Trainees who have had previous training in normal child development
should be encouraged to participate by describing the behaviors
depicted in the slides and explaining their significance. Facilitate this
involvement by asking questions such as, "What are the important
milestones illustrated by this slide?" or otherwise prompting the group to
contribute.
B.
The Effects of Abuse and Neglect on Infants and
Toddlers
Time: 45 minutes - 1 hour
Trainer Instruction
The purpose of this exercise is to help trainees understand the negative
effects of maltreatment on infants and toddlers.
Instruct trainees to form into subgroups of not more than five members.
Provide each subgroup with flip-chart paper and markers.
Instruct each subgroup to discuss one of the following questions, and
record their conclusions on their flip-charts. Note: Alternately, the
trainer may ask participants to make notes and report out, without
writing their responses on the flip-chart. During discussion, the trainer
may summarize their responses on the flip-chart. This will require less
time.
1. What are infants and toddlers at higher risk of abuse and neglect?
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2. Why are infants and toddlers more likely than older children to suffer
severe and serious consequences from abuse or neglect?
3. List potential effects of abuse and neglect on physical, cognitive,
social, and emotional development. Differentiate tpe of
maltreatment. Note: The trainer may opt to assign each
developmental domain to a separate group.
Trainees should work in their subgroups for approximately 15 minutes, at
which time the trainer should reconvene the group. Each subgroup
should briefly present its list to the entire group. Subgroups should not
report an outcome if another subgroup has already discussed it.
Make sure to include all points listed below in the discussion.
Alternately, the trainer could conduct questions contained in the first
two questions (above) as a “lightening round”, and conduct the third
question as a small-group discussion, assigning each group only one
developmental domain and allowing 5 – 10 minutes for that discussion.
Content of Discussion
1. Characteristics of infants and toddlers that place them at
high risk of maltreatment from parents who are predisposed
to maltreat

Infants are demanding. They require constant attention and a
great commitment of time. Infants’ schedules often do not
coincide with their parents’ schedule. Sleep is frequently
interrupted, and new parents are chronically tired. This is inherently
stressful to even the most competent parent.

A crying (screaming) infant can be extremely distressing to a
parent, particularly if the parent is unable to quiet the infant.

Newborns are often not very pretty. They are red and wrinkled, and
may appear deformed to an uneducated parent. Their
appearance may frighten a parent, or may stimulate a parent's
feelings of poor self-esteem.

Newborns are not very social for the first three or four months. They
demand a lot and give little back. The parent must derive any
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pleasure from providing care, rather than expecting expressions of
gratitude or recognition from the infant.

Parents may have difficulty attending to infants who are premature,
sickly, have medical conditions, are irritable, colicky, or have
developmental delays or disabilities that require hospitalization
Sickly or premature infants demand more care than healthy infants.
Some infants and toddlers have more challenging temperaments
than others, and may be more frustrating to care for. On the other
hand, some parents may not provide enough stimulation for babies
who are placid, compliant, and easily entertained, since they don’t
demand much attention.

Not all children with the problems described above are maltreated
by their parents. The parents’ perception of the child, and the
quality of the parenting experience also contribute to the likelihood
of maltreatment:
o Some parents perceive a developmental disability to be a
punishment, curse, or terribly unfair burden on the family
o Parents who abuse their children often misinterpret children’s
natural curiosity, persistence, high activity, or stubbornness as
bad, evil, or irritating.
o Some parents look to their children for approval of their
parenting skills. They interpret a baby’s distress, a child’s
misbehavior, or developmental or emotional problems as
indicators of bad parenting. This can lead to anxiety and low
self-esteem for the parent, as well as lack of appropriate
discipline. (Hughes, 2006). In some situations the parent’s
inadequacy may have contributed to a child’s distress or
misbehavior. However, in most families, appropriate limit-setting
and other parental behaviors often result in tantrums, sulkiness
and a temporarily unhappy child. This is normal.
o Some parents are able to care for “easy” children, but not more
difficult children, or can more easily parent at certain ages, but
not at others. Caseworkers should assess the degree to which
the parent can adjust his or her parenting strategies to the
particular child.
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
The toddler is developing autonomy. "Me do it!" and "NO!"
characterize the behaviors of this stage, that often include
stubbornness,
rebelliousness,
tantrums,
angry
outbursts,
aggressiveness, obstinacy, and oppositional behavior. Struggles
for power and control may develop. Oppositional behaviors can
try the patience of even the most knowledgeable and
understanding parent.

Toilet training can be one of the most stressful developmental tasks
for both children and parents. Trying to toilet train a child before
the child or parent is ready can lead to extreme frustration and
feelings of failure on the parent's part. The child receives criticism
and often punishment for reasons he does not understand. Toilet
training can become a battleground between a parent who wants
social compliance and a child whose major developmental task is
to remain in control of his own body and his environment. Some
parents over-discipline their children for mistakes in toilet training. A
common injury occurs when parents place their children in scalding
water, as a punishment for toileting accidents.
Note: There is more discussion of toilet training later in the
curriculum.
2. Characteristics of infants and toddlers that make them
especially susceptible to serious outcomes from
maltreatment

Infants and toddlers cannot protect themselves. They can't run,
scream, or go for help. They are dependent and vulnerable. They
will die if they are not properly cared for.

Infants and toddlers are often socially isolated, since they are not
yet in school.

Very rapid brain and body growth during the first two years makes
the infant extremely susceptible to the effects of malnutrition.
Mental retardation and growth deficiencies can result.

The infant's soft skull and unprotected body are very susceptible to
injury. Head injuries easily lead to severe brain damage. The soft
bones of the skull are more likely to fracture from a blow.
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
Muscles are not developed adequately to protect the trunk and
abdomen, and blows to this part of the body will cause serious
internal injuries.

Head and neck muscles are not strong enough to withstand even a
mild shaking without brain and spinal cord injury.

Infants are more susceptible to infection; they have not yet
developed immunity to many environmental agents.

Infants and toddlers use their bodies to explore their environments,
to manipulate objects, to solve problems, and to master many
tasks. Physical injury, therefore, can seriously affect cognitive as well
as physical development.

Infants and toddlers are particularly vulnerable to the emotional
effects of abuse and neglect. They likely experience abuse and
neglect as raw, diffuse, pervasive and incomprehensible pain.
Abuse and neglect create barriers to attachment and the
subsequent development of trust. This can permanently impair the
child's relationship ability and create serious personality problems.
3. Consequences of abuse and neglect on physical
development

Chronic malnutrition of infants and toddlers results in growth
retardation, brain damage and, potentially, mental retardation.

Head injury can result in severe brain damage or death. Direct
blows to the head can create swelling of brain tissue and subdural
hematomas (pools of blood in the brain) that destroy brain tissue
and can result in brain stem compression and herniation, blindness,
deafness, mental retardation, epilepsy, cerebral palsy, skull fracture,
paralysis, and coma.

Injury to the hypothalamus and pituitary glands in the brain can
impair growth impairment and sexual development.

Less severe but repeated blows to the head can cause equally
serious brain damage. When injured, the infant's soft brain tissue
swells. Pressure inside the skull leads to a decrease in oxygen supply
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to the brain, and involved nerve cells die. This type of injury may be
detectable only with a CT scan, and, in the absence of obvious
signs of external trauma, may go unnoticed.

Blows or slaps to the side of the head over the ear can injure the
inner ear mechanism and cause partial or complete hearing loss.

Shaking a baby can result in bleeding around the brain, and
pooling of blood in the brain. Consequences include learning,
physical, and visual difficulties, blindness, hearing impairment,
speech disabilities, cerebral palsy, seizures, behavior disorders,
cognitive impairment and death (National Center on Shaken Baby
Syndrome). Additionally, bones in the neck and spine can be
injured, resulting in a collapse of the vertebrae. Spinal cord injury
can cause paralysis.

Internal injuries can lead to permanent physical disability or death.

Medical neglect: withholding treatment for treatable conditions,
can lead to permanent physical disability, such as hearing loss from
untreated ear infections, vision problems from untreated strabismus
(crossing of the eyes), respiratory damage from pneumonia or
chronic bronchitis, etc.

Neglected infants and toddlers have poor muscle tone and poor
motor control, exhibit delays in gross and fine motor development
and coordination, and fail to develop and perfect basic motor skills.
Since most of an infant's cognitive development is facilitated by
motor involvement with the environment, physical delays contribute
to cognitive delays as well.
4. Consequences of abuse and neglect on cognitive
development

Absence of stimulation interferes with the growth and development
of the brain. Generalized cognitive delay or mental retardation
can result.

Brain damage from injury or malnutrition can lead to mental
retardation.
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
Abused and neglected toddlers typically exhibit language and
speech delays, often because stimulation is lacking. They fail to use
language to communicate with others, and some do not talk at all.
This represents a cognitive delay that can also affect social
development, including the development of peer relationships.

Maltreated infants are often apathetic and listless, placid, or
immobile. They often do not manipulate objects, or do so in
repetitive, primitive ways. They are often inactive and lack curiosity,
and do not explore their environments. This lack of interactive
experience often restricts the opportunities for learning. Maltreated
infants may not master even basic concepts such as object
permanence, and may not develop basic problem-solving skills.
5. Consequences of abuse and neglect on social development
a. Maladaptive attachment.

It is estimated that up to 80% of maltreated children have
attachment problems (Carlson 2003). It also appears that early
experiences of separation and loss, as well as multiple caregivers
and traumatic disruptions, contribute to attachment problems.
Caseworkers will learn more about how to decrease the degree
of trauma foster care placement can cause in Core Module VIII.

Attachment problems are along a continuum from mild to
severe. At the most severe end of the continuum is Reactive
Attachment Disorder (which will be described later).

Babies develop attachment patterns in response to parental
behavior. However, there is not an exclusive, one-to-one
correlation between a particular maternal behavior and a
particular attachment outcome.

As discussed earlier, securely attached infants confidently and
directly seek comfort and solace from the caregiver when they
need it. The caregiver helps the child regulate his emotions and
reduce stress; and after receiving comfort, the infant quickly
resumes his previous activity. Parents of children who are
securely attached are usually consistently loving, nurturing,
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reasonably consistent and appropriately stimulating towards
their infants.

On the other hand, children living with parents who are
unresponsive and rejecting; who lack emotional warmth, who
avoid their infants, or who are inconsistent and unpredictable in
their interactions with their children often cannot develop secure
attachments with their parents. These insecurely-attached
infants do not appear to notice separation from the parent and
may not develop separation or stranger anxiety. Infants and
toddlers may willingly go to anyone, and show equal pleasure in
the presence of strangers and close family. This lack of
discrimination of significant people is one of the most striking
characteristics of abused and neglected children. (Rycus 1998)
Remember however, that there are considerable individual
differences regarding how easily children relate to adults who
are not their parents. It is important to differentiate this symptom
of poor attachment from the genuine comfort shown by children
who grow up in the midst of large-groups of family and friends.

Other insecurely-attached infants appear to cope with stress by
over-control of their emotions. They may tend to avoid contact
with their mothers and may not initiate interaction or seek
physical contact from their parents. Their ability to explore their
environment may be compromised. They may become severely
agitated and anxious during separation from their parents, and
may alternately seek contact and pull away from their parents
upon the parents' return.

Children whose parents are frightening to them will often display
disorganized or disoriented attachment. When the very person
on whom the child depends is the source of fear, the child is
placed in an “irresolvable conflict, being unable to both flee to
and flee from the caregiver.” (Carlson, 2003) This type of
attachment disturbance is the primary outcome of trauma
resulting from abuse. These infants display seemingly confused,
contradictory, and misdirected or undirected behavior. They
may show intense anger, may express fear at the sight of the
parent, and may try to move away from their parents. They often
display unusually extreme emotions, and are unable to soothe
themselves. Children with disorganized attachment often have
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significant behavioral, social, and school problems throughout
their lives.
b. Passive, apathetic, and unresponsive to others. Maltreated infants
may not maintain eye contact with others, may not become
excited when talked to or approached, and often cannot be
engaged to vocalize (cooing or babbling) with an adult. These
infants may not develop nonverbal communications that attract
and hold an adult's attention.
c. Delayed play skills. Abused or neglected toddlers may not
develop play skills, and often cannot be engaged in reciprocal,
interactive play. Their play skills may be very immature and
primitive. This can affect their relationships with other children.
6. Consequences of abuse and neglect on emotional
development

Abused and neglected infants often fail to develop basic trust in
their caretakers, and in their own ability to get their needs met. This
will impair the development of healthy relationships.

Infants and toddlers learn to regulate their emotions when they
receive empathic care from caregivers who regularly soothe the
child and help the child settle down when distressed. When this is
absent, infants often cannot learn to regulate their own emotions.
This is one of the characteristics of trauma resulting from child
abuse.
Furthermore, there are some neurological conditions, such as Fetal
Alcoholism Spectrum Disorder, and other drug exposed conditions
that pre-disposed children to problems with affect regulation. Child
maltreatment can exacerbate these problems.

If children experience their environment as chronically abusive they
may involuntarily adopt a set of physiological responses that help
them adapt to that environment.
These trauma-exposed children may be more likely to rely on a
more survival-oriented portion of the brain to process social
interactions. They attach emotions such as fear and anxiety, to
situations which consciously or unconsciously appear similar to
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situations in which they were abused or experienced trauma. The
resulting behavior (heightened alertness, hyper-vigilance, fight-andflight responses) are, essentially, survival mechanisms to ensure the
child is alert to dangers in the environment.
However, these adaptations may cause problems in other areas of
the child’s life. Toddlers, for example, may display “frozen
watchfulness” or “frozen alertness”. They also may overreact to
stress in the environment, and will have difficulty settling down after
experiencing perceived stress. This type of response can interfere
with a toddler's ability to play along side other children, and can
cause problems for day care providers and foster parents.

Maltreated infants are often withdrawn, listless,
depressed, and unresponsive to the environment.
apathetic,

Abused toddlers may feel that they are "bad children." This has a
pervasive effect on the development of self-esteem.

Punishment (abuse) in response to normal exploratory or
autonomous behavior can interfere with the development of a
healthy personality.

Children may become chronically
openly rebellious.

Abused and neglected toddlers may be fearful and anxious, or
depressed and withdrawn. They may also become aggressive and
hurt others
dependent, subversive, or
7. Trauma Resulting from Child Abuse (from “Defining Trauma and
Child Traumatic Stress” on www.nctsn.org/nccts/nav)

Recent developments in the field of child abuse research have led
the National Child Traumatic Stress Network to coin the phrase
complex trauma to refer to the pervasive effects of chronic child
abuse of young children. (Cook, 2003)

The consequences of complex trauma, when it occurs early in a
child’s life affect many facets of the child’s development. The
common characteristics of children suffering from complex trauma
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include several concepts already discussed: disorganized
attachment, poor affect regulation, hyper-alertness to perceived or
real signs of danger in the environment, inability to settle down after
becoming upset, and "flight", "fight" and "freeze" responses to
perceived danger. These problems are evident in children of all
ages, not just infants and toddlers.

C.
This kind of trauma can have long term negative consequences on
the child’s emotional and social functioning. This explains why many
children who have experienced such maltreatment have several
problems, and perhaps multiple DSM IV diagnoses, with one
common etiology: trauma resulting from maltreatment.
Treatment for Abused and Neglected Infants
Time: 20-30 minutes
Trainer Instruction
Conduct a lecture or large-group discussion covering the following
information. Ask participants to identify how they would obtain "Help Me
Grow" services in their communities.
Content to be Discussed
As part of their case planning process, caseworkers should ensure that
infants receive the treatment they need to help resolve the effects of
abuse and neglect.
1. Medical and Health Care

Workers should routinely ensure that the children on their caseloads
receive adequate medical and health services.

Caseworkers should ensure that infants receive the medical and
health care that they need.

Proper nutrition, immunizations, and prompt treatment for illness are
crucial.
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
The Child Abuse and Prevention Treatment Act’s (CAPTA) 2003
amendment requires that all children who have been involved in a
substantiated case of child abuse or neglect be referred to an early
intervention program. In Ohio, workers must refer these families to
the Help Me Grow program, which contracts with local providers at
the county level to provide health and medical care, as well as
programs for children with developmental disabilities.

In some cultures, it is customary to seek assistance from within the
cultural group, or within the neighborhood. People are reluctant to
go outside the group or neighborhood for help. Workers will need
to help these families find resources within their group or
neighborhood, or help them adjust to seeking help from outsiders.
For example, workers could ask respected members of the cultural
group to help the family accept help from outsiders.
2. Early Infant Stimulation Programs

Infants with developmental delays and their families should be
referred to early infant stimulation programs. They provide a wide
range of services: physical therapy, occupational therapy,
cognitive stimulation, and speech therapy. They also teach parents
how to work with their children to help the child develop to his
fullest potential. These services are available through the Help Me
Grow program throughout Ohio.
3. Treatment for Attachment Problems
Secure attachment is critical to healthy development and recovery
from trauma caused by child maltreatment.
Appropriate treatment for attachment problems consists of helping the
parents develop positive parenting skills. (Chaffin 2006) Parents/
caregivers should be helped to “attune” to their infants and develop
nurturing, supportive, empathic relationships with them. (Cook, 2003)
There are three types of strategies for helping parents improve
relationships with their children: (see the trainer resource paper:
“Attachment” for detailed explanation). Note that these strategies
can be adapted to children of all ages.
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
Arousal-Relaxation Cycle is based on our understanding that trust,
security and attachment are built when a consistent
adult
caregiver repeatedly meets a child’s needs. For example, a child
becomes hungry and cries, reflecting a state of tension and
arousal. The caregiver responds by meeting the infant’s needs,
feeding and comforting the infant. The child receives comfort,
which relieves tension and promotes contentment. The parent feels
secure, and happy that he has provided empathic care for the
child. The good feelings are mutually reinforcing and reciprocal.
This cycle in a healthy parent/child relationship is repeated multiple
times each day.” (Schooler, et.al., 1999) While there may be cultural
differences in parenting practices, the result is the same: the child’s
needs are met, and attachment is strengthened.
However, some children, such as severely abused children, do not
outwardly communicate distress; caregivers must learn to read
subtle cues.

Positive interaction cycle. The parent initiates affirming emotional
and social exchanges with the child. The cycle begins when the
parent engages the child in a positive interaction. The child enjoys the
interaction and reacts in an affirming manner. Both the child and the
parents feel a sense of self-worth and are motivated to continue to
interact. This type of interaction greatly enhances the attachment
process. When deliberately working to develop or improve
attachments, parents and caregivers should not wait for the children
to “take the first step”. A lack of trust, and ambivalence about
attachments, may make this impossible for many children. Parents
must be encouraged to regularly approach the child in a nonthreatening, gentle manner to initiate social interactions. Parents and
caregivers must be prepared to continue to engage the child in a
meaningful and pleasurable interaction without expecting the child to
reciprocate in kind. (Adapted from Schooler, et.al., 1999)

Claiming behaviors helps assimilate the child into the family, and
helps the child feel part of the family. Claiming activities
communicate acceptance and integration of the child into family life.
Claiming activities are symbolic. They communicate to the child and
the world at large, that the child is an integral member of the family.”
Examples of claiming behaviors might be: introducing the child to
others as a member of the family; including references to the child
in family histories; giving the child a special role or responsibility in
family traditions; including the child in important family events
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(Schooler, et.al., 1999). Specific claiming behaviors will vary among
families and cultural groups.
Mental health therapy for attachment problems consists of short-term,
specific counseling with parents and the child to provide stability in the
relationship, and increasing the positive quality of the parent-child
relationship. The focus is on providing a stable environment for the
child, and taking a calm, sensitive, non-intrusive, non-threatening,
patient, predictable, and nurturing approach to parenting. This
approach teaches positive parenting skills, rather than the child’s
pathology. (Chaffin, 2006)
4. Placement in a Supportive, Nuturing Home
Children in temporary foster care can make developmental gains
when they receive healthy stimulation, affection and nurturing.
D.
Recognizing Development Delays in Infants and
Toddlers
Time: 20 - 30 minutes
Trainer Instruction

Show the 15 minute video:
Developmental Delay, 0-3”.
“A
World
of
Hope
–
Identifying

Refer participants to their "Worksheet Ages 0 – 3” (Note: This handout is
in the back of trainee’s handout packet, with “Worksheet Ages 3-5”,
and the booklet, “Developmental Milestones Chart” contained in
participants’ post-training handout packet)

Conduct a brief follow up discussion, including the following:

Ask group members to identify their most important insights from the
video. Reinforce important points, and correct any misperceptions

Discuss how workers could observe infants during home visits, and
how they could use the worksheet.
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
Discuss resources available for children with developmental delays
or disabilities, i.e.: early intervention services through Help Me Grow

Discuss the importance of seeking consultation from professionals
familiar with the client's culture when a question regarding a child's
development arises
Trainer Note: This video was developed for day care workers to help
them identify possible developmental delays in children. The video
shows developmental delays in infants and toddlers.
E.
Special Developmental Problems of Infants
Time: 1 hour
Trainer Instruction

The purpose of this section is to familiarize trainees with some of the
special developmental problems that can result from abuse and
neglect of infants. Briefly present the content for each condition and
lead discussion about treatment interventions to meet the child's
developmental needs.

Slides of a child with cerebral palsy are included with the "Normal
Development" slides and should be shown to illustrate the condition.

Note that handouts for all these conditions are in the participant’s
handout packet.
Content to be Discussed

Abuse or neglect can cause several developmental conditions. For
each condition we will describe the early warning signs to promote
screening and early intervention, typical developmental outcomes,
and appropriate treatment approaches.
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1. Fetal Alcohol Spectrum Disorder
Trainer Instruction
Conduct a lecture or large-group discussion with PowerPoint
presentation and refer participants to handout #5, Fetal Alcohol
Spectrum Disorder.
Note that the PPT slide, “Growing up with FAS” is a series of
photographs of the same child at different ages.
Content to be Discussed
a. Description
Sokol et al (2003) state that prenatal alcohol “exposure has been
implicated as the most common cause of mental retardation and
the leading preventable cause of birth defects in the United States,
accounting for significant educational and public health
expenditures.” (Page 4)
Alcohol destroys and damages cells in the central nervous system.
Widespread destruction of brain cells in early fetal development
causes malformations in the developing brain structures. This, of
course, can produce abnormalities in brain function.
Some physicians and researchers are now using the term Fetal
Alcohol Spectrum Disorder to indicate the continuum of effects,
from severe to mild. The most severe end of the spectrum is often
called Fetal Alcohol Syndrome. It refers to a combination of
symptoms associated with prenatal exposure to large amounts of
alcohol. Fetal Alcohol Effect is a milder form, and refers to children
who have some of the following outcomes, but without the facial
features. Since there are no physical features, these children often
are not recognized as having FAE. The characteristics of Fetal
Alcohol Spectrum Disorder typically include the following:

Pre- and post-natal growth deficiency

An average IQ of 63, which falls within the mild range of mental
retardation
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
Irritability in infancy

Inattention, distractibility, hyperactivity,
childhood (Sokol, et. all, 2003)

Decreased reaction time in infancy and preschool children.

Mild to moderate degrees of microcephaly. (Microcephaly is
small head circumference. It is usually associated with varying
degrees
of
mental retardation
and
abnormal brain
development.)

Dysfunction in fine motor control, such as weak grasp, poor eyehand coordination, and tremulousness

Specific facial features, including thin upper lip, epicanthal folds,
low nasal bridge, minor ear abnormalities, flat mid-face. These
features often become less obvious during adolescence.

Difficulties with executive functioning: problem-solving, higherlevel thinking, self-monitoring, regulation of emotion, motivation,
judgment, planning, working memory, time perception. These
behaviors are often misinterpreted as willful, deliberate, or “bad
behavior”. This is unfortunate, because children with these
problems may not be accurately diagnosed, and may not
receive developmental services.
mood
disorders
in
b. Risk factors
The degree and type of damage done to the developing fetus
depends upon several factors. They include which developmental
processes occurring when the alcohol was ingested, how much
was ingested, and whether the drinking was chronic or binge
drinking. Research has shown that even low levels of alcohol
consumption and infrequent binges can damage the developing
fetus. Research has not identified a safe limit for drinking during
pregnancy. “The only prudent conclusion is that alcohol can affect
the developing brain even at low exposure levels. Abstinence
during pregnancy is the only way to avoid such effects”. (Goodlett
and West, 1992, p 64-65, found in Streissguth, page 61)
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c. Recommended interventions include:
The worker should ensure that specific developmental interventions
are included in the case plan, including any of the following that
are appropriate for the child and family.

Prevention, including counseling to pregnant women regarding
the risks to their offspring, and referral to medical services and
alcoholism programs.

Developmental assessment of children thought to have been
exposed prenatally to alcohol to identify growth retardation and
delay, and to diagnose fetal alcohol syndrome.

Referral of affected children to infant stimulation and early
intervention programs.
Training the parent or caregiver to plan and implement activities
that will address developmental delays and promote healthy
development of their children.


Advocating
for
special
school,
social,
and
work
accommodations throughout the child’s life so that he/she can
function to his or her full potential, and to prevent “secondary
conditions” such as depression and anxiety.

Counseling and education for parents about meeting the child’s
developmental needs and promoting optimal development and
adjustment.
2. Prenatal Exposure to Drugs
Trainer Instruction
Instruct participants to read the handout #6 “Prenatal Exposure to
Drugs.”
Ask various participants to identify one bit of information that was new
or surprising to them. As participants report out, clarify any
misperceptions, and elaborate as necessary. However, it is not
necessary to conduct a thorough lecture, since they have already
read the material.
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3. Failure to Thrive
Trainer Instruction
Refer participants to handout #7, Failure to Thrive and conduct a largegroup discussion, using the Classroom Performance System. Ask each
question, ask participants to respond with their keypad, and then
conduct a discussion. Provide more explanation for questions which a
large number of participants answered incorrectly, and less
explanation for questions that most people answered correctly. This
method can also be used to generate discussion among participants,
by asking participants to explain their answers. (“I see that a number
of you answered “B”. Can someone tell us her thinking about that?”)
Question # 1: Failure to thrive always results from attachment problems
between infant and their parents
True or False
Discussion
The term "failure to thrive" (FTT) has been used to describe a wide variety
of conditions in which infants fail to achieve age-appropriate weight and
height levels. Some, but not all failure to thrive is a result of neglect.
Block et al (2005) state that “inadequate nutrition and disturbed social
interactions contribute to poor weight gain, delayed development, and
abnormal behavior. The syndrome develops in a significant number of
children as a consequence of child neglect.”
The one characteristic common to these children is nutritional deficiency.
A number of problems can cause nutritional deficiency. It is often caused
by a combination of the following factors:

Organic diseases: Including but not limited to cystic fibrosis,
cerebral palsy, HIV infection or AIDS, inborn errors of metabolism,
celiac disease, renal disease, lead poisoning, major cardiac disease

Non-organic includes the following:
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o Unintentional:
Breast-feeding problems, errors in formula
preparation, poor diet selection, improper feeding technique
o Child neglect
FTT from neglect, or non-organic FTT often indicates attachment problems.
Non-organic FTT is often not merely a feeding problem; it often indicates a
serious problem in the attachment, especially disorganized attachment,
between the baby and primary caretaker. (Carlson, 2003)
Question #2: Which of the following is not characteristic of infants with
non-organic failure to thrive?
A.
B.
C.
D.
Emaciated appearance
Eagerness for social involvement
Immature posturing
Sleeping for longer periods of time
Discussion:
Following are common characteristics of children with non-organic Failure
to Thrive:

Some infants don’t respond or resist social involvement. Others
become distressed when approached. Many show a preference
for inanimate objects.

Most appear emaciated, pale, and weak. They have little
subcutaneous fat and decreased muscle mass.

The infants are often below their birth weight, indicating weight loss;
or their weight is well below the normal range.

Most are listless, apathetic, and motionless, and at times, irritable.

Infants may sleep for longer periods of time than is appropriate for
their age.

Infants may display immature posturing, more appropriate for
newborn or very young infants, including lying with hands held near
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or behind the head; legs flexed in a "frog" position;
inside fists.
thumbs closed

Some children display self-stimulatory rocking, head-banging, or
rumination (vomiting and swallowing).

Developmental assessment will likely reveal primary delays in gross
motor and social domains.
Question #3: Which of the following is a common characteristic of
parents of children with non-organic Failure to Thrive?
A.
B.
C.
D.
Parent has a good social support network
Parent can handle stress well
Parent shows little empathy for infant
Parent has health problems
Discussion:

Parents often show little ability to empathize with their infants; they
often misread or ignore their infant's cues. Their behaviors meet their
own needs rather than the needs of their infants.

Research has repeatedly described mothers of underfed children
as depressed, socially isolated, withdrawn, and anxious.

Many parents have histories of abuse and neglect, including an
absence of attachment, in their own early childhoods.

Parents often fail to interact warmly and in a nurturing manner with
their infants.

Many parents are "overwhelmed" by chronic stress, which can be
exacerbated by the demands of caring for an infant.

The parent may create an unpleasant or painful feeding situation
for the infant; as a result, the child may not be cooperative or may
reject food. The parent might be impatient, might force-feed the
child, or might remove food abruptly. When the child resists or fails
to eat, the parent may assume the child is not hungry and
discontinues the feeding.
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
Some parents, while expressing sincere concern about their
children's conditions, appear not to know how to interact
meaningfully with their infants. There is typically little interpersonal
activity between the parent and the infant. Some parents play with
their infants in the manner of a competitive peer rather than a
nurturing adult.
Question #4: Which of the following problems may be present in a
Failure to Thrive situation?
A. Parent thinks lack of weight gain is caused by physical illness
B. Parent may not be able to report how much the infant ate
C. Parent may improperly prepare formula
D. All of the above
E. None of the above
Discussion:
Specific problems related to feeding might include:

The parent may not realize the child is failing to grow, nor recognize
the lack of weight gain and emaciation.

The parent may notice the child's feeding but believe they are the
result of vomiting, diarrhea, or other physical illness, rather than
problems in the feeding situation itself. The parent may believe the
child is being adequately fed.

The parent may not be able to accurately report feeding times,
schedules, or the quantity of formula the infant has taken. The parent
may not be ensuring adequate caloric intake.

The parent may allow long periods of time to elapse between feedings
because "the baby doesn't appear to be hungry." Apathy and
listlessness that result from low caloric intake are mistaken for the
absence of hunger.

Breast-fed infants can be undernourished if the mother does not
produce adequate milk or does not know how to nurse her infant.
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Breast-fed infants over the age of 5 months may not be able to get
adequate nutrition from breast milk alone.
Question #5: In your opinion, which is most important in treating NonOrganic Failure to Thrive?
A. Instruction for parents on proper feeding technique?
B. Improvement of parent-child interactions?
Trainer Note: PPT Slide #168 shows the face of a baby who was Failure
to Thrive, and the same baby after treatment. This slide should be
shown after the discussion of treatment strategies.
Discussion:
Although proper feeding is essential to treating the child’s condition and
restoring his health, it will resolve the underlying conditions that
contributed to failure to thrive. Treatment approaches should include
both medical and environmental management, regardless of the cause
of the problem (Block, 2005). Treatment for non-organic FTT should
include the following elements.

Parents should be directly involved in all aspects of the treatment
program. Case plans should include supportive counseling and
education by a caring, nurturing professional to help parents feel less
guilty, anxious, and depressed. Case plans teach and reinforce proper
feeding methods and improve parent-child interactions. This
treatment program should begin in the hospital. If the parents are not
treated, the child can be expected to quickly regress when returned
to the home. In severe cases, death can result.

The parents' problems are not simply the result of a lack of parenting
knowledge. Simply teaching the parents proper feeding techniques is
not sufficient. Supportive counseling is often needed to help resolve
the emotional and social problems that contribute to the failure to
thrive dynamic. Additionally, therapy for improving the parent-child
attachment may be needed.
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
A thorough medical assessment must be conducted to determine the
etiology of the failure to thrive.

The American Academy of Pediatrics (Block, 2003) states that in severe
cases, where the child’s weight is less than 70% of expected weightfor-length, urgent intervention is needed. Immediate hospitalization
may be necessary, or placement in foster care. Treatment includes
providing caloric intake far in excess of that needed for maintenance
under normal conditions. This typically leads to rapid weight gain,
called "catch-up growth," in children who are undernourished from
underfeeding. Some infants achieve age-appropriate weight within a
couple of weeks.

Rapid "catch-up growth" during hospitalization is diagnostically
significant for this syndrome, particularly when the child is fed in the
hospital with the same formula used at home.

Some secondary physical conditions affecting the infant, as well as
apathy and depression, appear to be resolved as a result of intensive
feeding programs.

A team approach to treating FTT is needed. The team includes child
welfare caseworker, physician, and nurse, and often includes a
dietician.
4. Special Care for Severely Abused Infants
Trainer Instruction
Distribute the handout #8, Special Care for Severely Abused Infant.
Allow 5 minutes for participants to read the handout.
Conduct a brief discussion, by asking participants to identify one new
or surprising fact they did not know before. Discuss several comments,
and elaborate or further explain the concept, if necessary. It is not
necessary to thoroughly discuss all the information. Participants learn
while reading and listening to other participants’ ideas.
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5. Cerebral Palsy
Trainer Instruction
Ask trainees to locate their handout #9, Cerebral Palsy, conduct a short
lecture on the description of cerebral palsy, and show the PPT slides
and photographs depicting cerebral palsy.
Content to be Discussed:

Cerebral palsy is a developmental disability. According to the
National Institute of Neurological Disorders and Stroke, “cerebral palsy
is an umbrella-like term used to describe a group of chronic disorders
that appear in the first few years of life and generally do not worsen
over time. The disorders are caused by faulty development of or
damage to motor areas in the brain that disrupts the brain’s ability to
control movement and posture”. (NINDS web page 9-22-06)
There are multiple potential causes of cerebral palsy, including
prenatal and postnatal abuse (such as shaking babies, or blows to the
head) and neglect. Cerebral palsy can be present at birth, and is
thought to be the result of some prenatal insult from illness, injury, or the
presence of toxic substances. Mothers who have no prenatal care or
who abuse alcohol or drugs increase the risk of cerebral palsy in their
infants.
Child welfare workers must be skilled at recognizing the early warning
signs of cerebral palsy in populations of abused and neglected infants
and children. Recognizing early warning signs enables them to
intervene early.
Early symptoms of cerebral palsy are variable. In milder cases,
problems may not be apparent until the child reaches school-age.
Generally, the more severe the condition, the earlier it can be
detected.
There are many different conditions that fall within the broad term
"cerebral palsy," and there are considerable differences in descriptive
terminology in the literature. The types of cerebral palsy can, however,
be broadly divided into three major categories.
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Spastic cerebral palsy is characterized by stiff, chronically tensed
muscles combined with muscle weakness.
Athetoid cerebral palsy is characterized by slow, writhing,
involuntary and uncontrolled muscle movements, with muscle
weakness.
Ataxic cerebral palsy is characterized by motor in coordination and
difficulty with balance and depth perception.
Many persons with cerebral palsy have mixed types. 90% of cerebral
palsy is either spastic, athetoid, or a combination of both.
Trainer Instruction
Show the slides depicting a child with cerebral palsy.
In Chair
Scott is a 5-year old child with severe spastic cerebral
palsy. All four limbs are involved. Note the total body
tightness. This results from excessive stimulation to the
muscles from the motor centers of the brain. It is a
chronic condition. Scott's arms are straight and tight,
his fists are clenched. Notice the thumb of his left hand
is closed into his fist. His mouth is locked open. Notice
his eye contact with the photographer. While some
children with cerebral palsy are also mentally retarded,
over half are not. Scott is of normal intelligence.
On Floor
Scott shows typical positioning for children with spastic
cerebral palsy. The legs may be either stiffly straight or
tightly pulled into the bent knee position. Either way,
they are rigid and tight. The tongue thrust is also
typical.
Sees Toy
Early reflexes persist in children with cerebral palsy. This
is the ATNR, or asymmetric tonic neck reflex (the
fencing posture.) Because of the persistence of this
reflex, children with CP often cannot bring both hands
together at the midline. When the hands approach
midline, the reflex takes over and forces the body into
the fencing posture on the opposite side.
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Scott is looking at his toy and trying to maneuver
himself on the floor to get to it.
Places Blocks
He eventually does, and is able to put the square block
into its proper hole. The severe muscle involvement of
his mouth and
face interferes with speech
development. Alternate types of education, substitute
communication tools, and physical therapy are
needed to help him develop and use an alternate
means of communicating.
Jennifer
Part of the child welfare caseworker's responsibility is to
recognize early warning signs of cerebral palsy. They
are usually present at birth. We will review early
warning signs in a few minutes.
This is 5-month-old Jennifer. Her clenched fists, when
excited, are developmentally appropriate. Children
with spastic CP are chronically tight and stiff and
cannot relax their muscles.
Many children with cerebral palsy do not develop
spasticity until they are four to five months old.
Hypotonia (lack of muscle tone) and delayed motor
development mark their early development
Many children with cerebral palsy have very subtle
indicators, as identified in the handout. Workers should
be alert to early indicators so that assessment and
treatment can begin early, to maximize the child’s
functioning.
Trainer Instruction
Ask participants to review the handout #9, “Cerebral Palsy”, pages 2
and 3, on early indicators and treatment of cerebral palsy. They do not
need to read page one, since that is a review of the lecture material.
Upon completion ask participants to identify information that was new
or surprising to them, and indicators or cerebral palsy they could easily
identify during home visits. Note that foster parents sometimes are the
first to notice indicators of mild cerebral palsy.
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Finally, conduct a brief discussion on treatment interventions, stressing
the importance of early assessment, intervention, and case planning
for children with cerebral palsy.
It is not necessary to thoroughly teach the material, since participants
will have read the handout.
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SECTION IV:
THE DEVELOPMENT OF PRESCHOOL CHILDREN
Time: 5 hours
Objectives:

Trainees will know the processes and milestones of normal
development of children between the ages of 3 and 5.

Trainees will understand the effects abuse and neglect can have
on the physical, cognitive, social, and emotional development of
preschool children.

Trainees will know strategies for providing services that promote the
healthy development of abused and neglected children.
Method:
Video, large-group discussion, small-group exercise
Training Materials:
Power Point slides
Handouts:
#10
#11
#12
#13
#14
#15
#16
#17
Structured Note Taking – Preschool Development
Cheryl part 1
Cheryl part 2
Therapeutic Interventions for Preschool Children
The Effects of Abuse & Neglect on Preschool Development
Reactive Attachment Disorders
Anxiety Disorders
Post-Traumatic Stress Disorder
Video: “Preschoolers, How Three and Four-year-olds Develop”
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A.
Normal Development of Preschool Children
Time: 1 ½ Hours
Trainer Instruction

Ask participants to take out handout #10 Structured Note Taking –
Preschool Development. Trainees should take notes on this handout as
they watch the video.

Introduce the video, “Preschoolers: How Three-and Four-Year-Olds
Develop". It was developed to educate child care providers. It
consists of video footage of three-and four-year-old children in a daycare setting and is divided into the following developmental domains:
social/emotional, cognitive, and physical.

Show the 4-year-old portion of the video, which is about 20 minutes
long. The four-year-old portion was chosen because this is the middle
of the preschool-age group.

Conduct a follow-up discussion of trainees’ insights upon conclusion of
each developmental domain segment. Use a variety of processes for
conducting these discussions, to decrease monotony and maintain
participant interest. Examples are as follows:

Instruct participants to take 3 minutes of “quiet time” to make notes
of their important insights. After about 3 minutes, conduct a largegroup discussion.

Divide the group into pairs, and ask them to discuss their important
insights for about 3 minutes. Follow up with a large-group discussion.

Ask participants to report on their important learning’s immediately
following the video. This is successful after the third portion of the
video, after participants have become acclimated to the largegroup discussion process.

Alternately, you may show the entire video and then conduct a largegroup discussion.

During large-group discussions, make sure the following content is
discussed, spending more time on content that is not included in the
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video, and briefly reviewing content that is included in the video. Note
that content on sexual development of preschoolers is included below,
and is not included in the video.

Enrich discussion with examples from your practice, participants’
examples, or by referring to children in the video. Some examples are
provided in the following content.
Content to be Discussed
1. Social Development of the Preschool Child
a. Interactive play. Children enter the preschool period with limited
play skills. Toddlers typically engage in parallel play, which is
actually solitary play in the presence of other children.
The development of language, with the subsequent ability to better
communicate with others, promotes the development of play skills.
Increasingly complex social interactions develop in stages
throughout the preschool period.

For three-year-olds, toys are the focus of most play. The
preschool child must learn basic social rules, such as sharing and
taking turns, before they will be able to play cooperatively with
other children. Three-year-olds are usually unable to share, and
frequent battles, ensue usually over who owns which toy.

Between ages four and five, children increasingly form friendships
with other children and will ask to play with certain friends. Play
is more cooperative and is governed by rules. Each child may
imitate a specific role in imaginative play, and children may
direct each other's activities to complement their own. Joint
involvement toward a common goal is more frequent.
Examples
Tonya and Leticia were playing "house" under the dining room
table. Tonya could be overheard directing Leticia, "Now you be
the mommy. You have to hold the baby so she won't cry, because
I'm working. I can't be disturbed."
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
Kelli, who understood the rules about taking turns, confronted
Brian, who had been monopolizing the paints and easel: "Can't
you see that I'm sad because you've been painting for too long!"

Robert and Billy were trying to build a "city" with blocks. The
"skyscraper" wobbled precariously. Billy told Robert, "you hold
the top and I'll make the bridge, so the building won't fall down
when the cars go over the bridge."
b. Magical and imaginative thinking are frequently expressed in play.
The preschool child will create fantasy characters and scenarios,
including imaginary friends. Well-developed language allows him
to talk to, and about, these friends.
c. The functions of play. Play is considered by many theorists to be the
"work of the child." Children engage in play for its own sake
because it is pleasurable. Culture influences how and what
children play. Some cultures may emphasize fantasy play, while
others promote athletic or social roles. Play is thought to serve
several additional functions for the preschool child. They include:

Development of language skills by conversing with
children and with adults about the play activities.
other

Practicing basic social skills: such as sharing, taking turns,
cooperating, and controlling one's own impulses.

Developing gross motor skills: by participating in activities and
games that provide new physical challenges and promote
refinements in balance and coordination.

Discharging emotional tensions and anxieties. This affective
function of play allows the child to safely express emotions that
would be socially unacceptable or dangerous in most situations.
Example
Michael was mad at his brother. While playing with his
"superheroes" he created a battle in which the "good guy" beat up
the "bad guy."
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
Coping with stress: Through play children can rehearse and try
out various coping strategies to help them deal with difficult
situations.
Example
Four-year-old Joseph was scheduled to see the doctor. He
initiated "playing doctor" with his younger sister, pretended to give
her a shot, told her it wouldn't hurt very much, and reassured her
that she would be all better soon.

Experimenting with social roles. Through imitation and
imaginative play preschoolers pretend to be someone, assume
the perceived characteristics of the role, and model the adult's
behaviors. Children’s play will typically reflect the cultural norms
for social roles. However, preschooler’s cognitive ability
precludes them from understanding the complexities and subtle
nuances in various social roles. Therefore, their play will reflect
simplistic, often stereotyped understanding of social roles. This is
especially true for gender roles.
Example
Jenny announced to Laurie that she was going to be the teacher,
and Laurie had to be the student and sit still. Jenny announced
she was going to write on the board and teach Laurie letters.

Reducing fears. The "imaginary companions" of many children
are wild animals who are made to be docile, cooperative,
friendly, and totally under the child's control.
d. Play is the preferred casework strategy when working with
preschool-age children. Using play greatly increases the worker's
ability to communicate with the child in a language the child
understands. Children are also more comfortable, and therefore
more willing to communicate, in a play mode.

Observing children's play can provide caseworkers with
considerable information about their feelings, perceptions,
needs, and developmental status.
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
The worker can also use play to develop the casework
relationship, especially the child's trust and confidence.
Children really like people who take the time to play with them.

Workers should have some art materials and small toys for
children to play with during discussions with them. Workers
should have dolls that represent a variety of ethnic groups or
physical characteristics so children can easily relate to these
toys. Playing with toys or using art materials often helps young
children discharge nervous energy. Caseworkers should not
interpret art work without additional training.

Projective materials such as a play telephone, microphone, or
magic wand can encourage children to talk. All of these
materials should be used to put children at ease, and help them
talk.

Play and art diagnostics and therapy are useful therapeutic
interventions with preschoolers. However, properly using these
methods requires specialized training.
e. Help parents understand the importance of play. Many abusive or
neglectful parents do not know how to promote or reinforce play
with their children, and do not realize the opportunities for play that
are available in their homes.

Caseworkers (or parent aides) can model ways that parents can
play with their children. Expensive, complex, or store bought
toys are not necessary. Even parents with parenting ability and
limited income can find play resources in their homes.
Additionally, some libraries circulate children’s toys.

Play is a universal activity. However, there are often differences
among cultures in how people play. When teaching parents to
play with their children, the worker should be familiar with
culturally-specific games, stories, activities, and play objects. This
will prevent trying to teach play strategies that are not
acceptable within the culture, and will also help to promote a
positive cultural identity. The worker can learn culturally-specific
play patterns by talking to and observing healthy families from
that culture, as well as by consulting community-based service
providers who specialize in working with families of a particular
cultural group.
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Example:
If a culture does not condone active physical play for girls, the
worker should not try to teach a mother to play tag in the yard with
her daughter.
2. Emotional Development of Preschool Children
a. The development of initiative:
Erikson describes the development of initiative as the preschool
child's most important developmental task.

The preschool years are a time of active discovery. A healthy
child is exuberant, self-directed, and a "self-starter." He delights
in orchestrating activities and being in charge. He takes
pleasure in "attack and conquest," and experiments with new
roles and skills.

“How much and in what ways a child can explore his
environment are guided by cultural norms. Some cultures
encourage the child to freely conquer his environment, while
others prefer that children operate within prescribed
boundaries”. (OCWTP, 2004)

Children must have a basic sense of trust in themselves and in
their environment to feel confident enough to initiate new
activities. They must also understand they are capable of
autonomous behavior.

The healthy development of trust and autonomy during the
infant and toddler stages contributes greatly to the preschool
child's confidence and sense of competence. Self- starting and
self-directed behaviors will be less well-developed in children
who are fearful, dependent, and unable to trust themselves or
others.
b. The development of self control
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
Preschool children are better able to control their emotions and
behavior. Their improved cognitive ability, including more
effective use of language, helps them think about problems and
solutions. Crying and temper tantrums in frustrating situations
decrease during the preschool years as children develop better
self-control. Improved coping abilities enable them to withstand
some frustration and discomfort without becoming so
emotionally aroused that their behavior becomes disorganized,
as is common for an infant or toddler.
Some parents notice that their preschool-age child can turn her
tears on and off at will. This is another example of her increasing
emotional control.

Preschool children are better able to delay gratification. "You
can have a cookie after dinner" does not lead to a tantrum.
The child is able to wait a short time for a reward. Studies
indicate that the child's previous experience affects his ability to
delay gratification (that is, having received the reward as
promised). Predictability and consistency in the child's
environment make him able to delay gratification.
c. The development of conscience

During the preschool period, the development of conscience
coincides with the development of self-control. By age 5, most
children understand the meaning of right and wrong, have
internalized their parents' prohibitions, and feel guilty when they
have done something wrong.

Their understanding of right and wrong is fairly basic; they
cannot understand abstract moral principles. They tend to view
rules concretely, in a "black and white" fashion. They interpret
right and wrong fairly strictly.

Children who grow up in chaotic environments where the rules
continually change or where no rules exist often show signs of
anxiety and emotional disturbance. Clear and consistent rules
provide children with a dependable structure and a sense of
security.
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
Workers should keep in mind that cultures differ considerably in
what is considered inappropriate level of activity and
exploration for preschool children. Workers should be careful not
to assume that children who are allowed more activity and
exploration are "out-of-control"
or "wild" without first
understanding the cultural context of the child's behavior.
d. Self-esteem

By age 3 the child has a rudimentary sense of "self." She
understands "I" and "me" and knows she is different from other
people. With the development of conscience, she will also
begin to evaluate her own behavior as "good" or "bad." She
feels pride when she is “good” and guilt or shame when she is
“bad”.

The preschool child's self-esteem is largely dependent upon
other people's reactions to her. The normal drive toward
initiative puts her in continual contact with other people. If
these people respond to her with praise and support, she is likely
to feel positive about herself, and her attempts at initiative will
be reinforced. This, in turn, promotes learning and mastery of
additional skills.

Conversely, if her initial attempts at initiative result in criticism or
punishment, she is likely to believe herself to be a bad child and
may experience guilt and shame. Low self-esteem and lack of
confidence result, and the child will be less likely to initiate and
engage in new activities. This can interfere with development in
all other domains.
3. Cognitive Development of the Preschool Child
The cognition of preschool children has certain very discernible
characteristics. When considered together, these can help us to
understand the "world view” of the preschool child.
a. Egocentric Thought

The scope of preschoolers’ awareness and understanding is
limited to their immediate experience. However, this is not the
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same as being "selfish" or "thoughtless," or mean that they only
think about themselves. Egocentrism describes the nature of
their thought processes. Their universe is circumscribed, with
themselves, their family, and their homes at the center. They
view the world only from this perspective.
Example
Four-year-old Hilary was explaining to her Dad where the sun
went at night. She pointed toward the horizon and said, "Over
there, just behind those trees. That's where the sun goes at
night." When asked how it got to the other side of the sky, where
it came up in the morning, she replied, "That's easy, silly. You
know the sun's hot, right?" "Right," said Dad. "Well, when the sun
gets to the ground behind the trees, it burns a hole in the ground
and goes under my house, and comes up on the other side."

Preschoolers do not realize that other people have perspectives
that might be different from theirs. They view everything through
their own eyes, and believe that their experiences are universal.
Example
Mike, age 4, could see that his Mom was upset because she was
crying. He gave her his teddy bear to make her feel better.

Preschoolers leave out important and obvious facts. When they
describe an event, preschoolers often leave out important and
obvious facts. They assume that everyone already knows the
details.

Preschoolers recognize visual cues of emotional states:
Preschoolers often recognize visual cues of emotional states, and
sometimes they can label them properly (mad, upset, happy,
sad.) They are, however, largely unaware of many feelings that
generate visible behaviors in other people.
Example
Kelli, age 3 ½, was watching her aunt come up the front
sidewalk. Aunt J. had just ended a long, tiring day and was
probably frowning as she approached the door. Kelli greeted
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her at the door with a concerned question, "Aunt J., why is your
face mad?"
b. Illogical thinking

Preschoolers draw conclusions from limited information: The
thought patterns of preschoolers appear illogical because they
draw conclusions from limited information, derived from their
circumscribed, often inaccurate understanding of the world.

Preschoolers have limited understanding of cause and effect. If
two events are linked sequentially, or two attributes of an object
coexist, one is often thought to have caused the other. Many
preschool children believe that their behavior caused them to
be placed in foster care.

Preschoolers have limited understanding of abstract concepts.
Preschoolers cannot think abstractly, nor understand concepts
that they cannot see, hear, feel, or manipulate. For example,
they cannot tell time, and they do not understand value of
money.
While preschool children's reasoning may be faulty by adult
standards, their conclusions make perfect sense to them, and
they will stubbornly cling to them when presented with more
complicated and more rational explanations. Following are
some examples.

Preschoolers may be afraid of being flushed down the toilet. In
their experience, everything that gets thrown in the toilet
disappears, never to be seen again. They cannot be talked out
of their fear.

Hilary said that the sun comes up because it's yellow. Tommy
said the moon shines at night because there's a man in it. Kelli
thought that lightning caused the rain.
Christopher's mother told him he couldn't go outside and play in
the yard until the dew on the grass dried. Christopher got a dish
towel from the kitchen and brought it to his mother so she could
dry off the grass for him.


Two pennies are better than a dime. Preschool children consider
attributes of the coins in the concrete terms they can
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understand: size and number.
Value is an abstract concept.
They do not understand value.
c. Vivid imaginations and magical thinking

Preschoolers cannot always differentiate between fact and
fantasy. In describing an experience, the child will often
embellish it to the point of fantasy.
Examples
o Mike, age 4, went to the circus and saw horses in the center
ring jump over low hurdles. When he later told his dad about
the circus, he described the "beautiful horses that were flying
in the air all around the circus tent." This should not be
considered lying, as in consciously fabricating to prevent
someone else from knowing the truth. It is imagination.
o Kelli, age 4, easily interweaves fact and fiction in her
imaginative play. One afternoon she came running into the
kitchen and told her mom, "I need some porridge. I need
some water. I need some poison. I'm going to mix them all
together and make a dog." Kelli's Mom said, "You don't want
to use poison. You know what poison is, don't you?" Kelli said
"No." Mom said, "It's bad stuff. Poison can kill you!" Kelli
thought for a moment, and then said "All right, I'll make a
dead dog."

The inability to separate fantasy from reality contributes to the
development of children's fears.
Examples
o At age 4, Leigh fell and knocked out a front tooth. Mom told
her to put the tooth under her pillow and the tooth fairy
would come and bring her money. Leigh became hysterical,
thinking a stranger would be sneaking into her bedroom in
the middle of the night.
o Kelli woke up crying in the middle of the night. "There's
something very strange going on here," she told her Dad.
"There's a doggie with something in his hair." Dad found a doll
in a chair casting a shadow on the wall. Turning on the light
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and explaining that it was only the doll's shadow did nothing
to calm Kelli's fear. The doll had to be moved, eliminating the
shadow before Kelli was assured that the threatening dog
was no longer in the room.
d. Preschoolers cannot place events in proper order

Preschoolers do not have a well-developed understanding of
time, particularly of long time periods. They may understand
"today," but yesterday and tomorrow are harder, and "next
week" is incomprehensible. They confuse first, middle, and last,
and cannot order events in time. The child might be able to
describe events, but the events will not likely be in sequential
order.
e. Role of cognition in the effects of maltreatment

A combination of faulty reasoning, the tendency to attribute
cause to events that happen concurrently, and an inability to
understand complex events contribute to preschoolers
developing inaccurate and distorted perceptions.

Abused preschool children almost universally believe that the
abuse was "punishment" because they did something wrong.
This thinking may persist well into the early school years.

It is also typical for young children in foster care to believe they
were "sent away" because they were bad. It makes no logical
sense to them that they should have to leave home because
someone else, i.e. their parents, did something wrong. If
necessary, the child will "invent" or fantasize reasons for their
"punishment" to give a cognitive structure to their abuse.
Example
o Lisa, age 6, had been placed in a foster home at age 5 l/2.
Her step-father was a violent and dangerous man who once
threw a cat through a plate glass window in a fit of temper.
He and his wife had a violent argument during which time the
police were called, and Lisa was removed to assure her
safety. At the time of the argument, Lisa had been in the
kitchen pouring a glass of milk, and she spilled it. Six months
after her placement, she solemnly assured the social worker
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that she was bad, and that she had to live in a foster home
because she spilled her milk all over the kitchen. When the
worker told her she was placed in foster care so her Daddy
wouldn't hurt her, she indicated her Daddy only hurt her
Mommy, not her, and that couldn't be the reason.
The preschool child's cognitive limitations, egocentric
thinking, and concrete perceptions of "right" and "wrong"
together can explain the common tendency for maltreated
children to develop poor self-images and self-esteem.
f. Memory and suggestibility
Preschool-aged children have limited life experiences and more
primitive methods of organizing and making sense of their
experiences. Their abilities to “comprehend, integrate, make
meaning of, and remember new experiences are correspondingly
more restricted.” (Pennsylvania 2003) Following are characteristics
of preschooler’s memory:

Free recall vs. cued memory. Preschool children are generally
deficient in free recall (retrieving memories from internal memory
strategies), but are better at cued recall (memory in response to
a stimulus, such as a question, person, smell, or sound that
triggers the recollection). (Pennsylvania 2003)

Many preschool children are capable of providing accurate
information from memory, especially if the interview is
conducted properly. Very young children, even as young as two
or three can “accurately recall information about personally
experienced events over extended periods of time” (Berliner,
1997, page 8).

Problems with recalling a single episode among a series of
episodes. Children and adults often have difficulty remembering
specific details of an event that has been repeated many times,
such as sexual abuse.
Example
“When asked to recall details for the most recent event, a child
witness became confused about whether the recent event
occurred in the family room or in her bedroom. It was important
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that the caseworker…understood….and was able to dispel the
misconception that the child was an incompetent witness”
(Myers, 1998).

Suggestibility. Preschool children are more susceptible to
repeated erroneous suggestions than older children and adults.
(Ceci, Huffman, Smith, and Loftus, 1994, page 338) Their desire to
please adults likely complicates this process. For instance, in
some custody disputes one parent will accuse the other of child
maltreatment after repeatedly questioning the child, with body
language and facial expression that suggests the “correct
answer”. Or, the parent will draw inaccurate conclusions from
the child’s incomplete recounting of events.
Example
“Daddy touched your wee – wee didn’t he?” The desired
answer is obvious. If repeated very frequently, and if the child
wants to please this parent, then the child may answer yes. Or, if
the father washed her genital area during a bath, the girl would
answer yes; while mother could conclude that the father had
touched her inappropriately.
4. Language Development
a. Preoperations. During the second year of life, children enter the
stage of cognitive development referred to by Piaget as
"preoperations." The ability to symbolize contributes to the
development of language. Between the ages of 3 and 5, the
expansion and refinement of language are the most critical, and
most obvious, cognitive advancements.
b. Child expands duos into full sentences by adding "linking words,"
including
prepositions,
conjunctions,
objects,
and
other
components. The child's grammar improves.
c. Vocabulary. The greater the child's vocabulary, the more likely the
child will be able to express complete thoughts. Thought and
understanding (receptive language) are generally more developed
than spoken (expressive) language until the child is about four.
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The child's spoken vocabulary increases exponentially. Preschool
children use and repeat new words, even when they do not fully
understand their meaning. They also make up words, with some
amusing results.
Example:
Hilary, 3 l/2, ran to answer a knock at the door. Two minutes later
she was back. Dad asked "who was at the door?" Hilary assured
him, "Don't worry Dad. He's gone." Dad questioned her; "Hilary,
who was at the door?" Hilary answered, "It was a peep. But he's
gone now." "A what?" asked Dad. "A peep. But he went away." It
was only after careful thought that Dad realized "a peep" was
Hilary's singular of the word "people," as in "many people," "one
peep."
d. Non-stop talk. Most preschool children talk nonstop. They enjoy
using language to communicate with others and often talk just to
talk. They are intrusive and will try to involve themselves in other
peoples' conversations. It is also common for them to talk to
themselves.
e. Asking questions. Preschoolers are adept at asking questions,
particularly "why?" They are not always interested in the answer.
They seem to enjoy interjecting the "why" just to keep the
conversation going.
f. Parents can promote their children's language development
through conversation and reading. Parents can be taught to
direct comments and questions to their children throughout the day
and engage them in conversation. Parents who cannot read can
be encouraged to look through a magazine or book with the child,
talk about the pictures, or make up stories. Between 15-20 minutes
of concentrated conversation each day can greatly promote the
child's language development.
g. Culture and language. The development of language ability is
universal. The nature of the language, the specific meanings of
words, and rules for when, and how, people talk with one another,
are culturally determined.

When a caseworker assesses a child's language development,
the assessment must be made within the child's cultural context.
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It is important not to confuse language delays or speech deficits
with language or speech differences.

Words may have idiosyncratic meanings within cultures or
subcultures, and the rules of grammar and syntax may not be
the same as in standard English. If a four-year-old’s language is
not understandable, and if words are not used properly in
context, the child may very well have speech and language
delays. However, the worker should not automatically assume
the child is delayed. It may be that the worker is unfamiliar with
the use of language in the family, and the
child's
communication skills are appropriate within that cultural context.
The worker should determine whether family members are able
to fully understand the child's language.

Some cultures discourage children from approaching adults to
begin conversations. These children are taught to remain silent
in the presence of adults. “They are to be seen and not heard."
The worker may need to observe the child in situations in which
talking is encouraged, such as when playing with other children,
to determine the child's language ability. The worker may also
need to gather information from the parents.
5. Physical Development of the Preschool Child


Weight and height gains are fairly constant. The child gains weight
at approximately 4-5 pounds per year and grows approximately 3-4
inches per year.
An easy way to remember the average height and weight for a
three-year-old child is to think of "threes": 3 years, 3 feet tall, 33
pounds.

The rate of brain growth slows considerably. By early pre-school,
the brain will have reached approximately 4/5 of adult size.

The preschool child loses the swayed back and protruding
abdomen that are typical of the toddler.

Motor abilities may differ between boys and girls. Different cultural
expectations can affect the nature of motor development. In
cultures that reinforce "rough and tumble" play for boys, they will
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typically develop muscle strength and gross motor coordination;
whereas, quieter more "refined" play, such as use of toys, crayons,
and dolls, will generally promote the development of fine motor
coordination.

The preschool child cannot sit still for long periods of time.
Preschoolers prefer to be busy and active.
6. Sexual Development of Preschool Children
a. Characteristics of preschool sexual behavior

Some children engage in sexual behaviors more often than
others. The most common behaviors include self-stimulation,
exhibitionism, and behaviors related to immature sense of
boundaries. (Johnson, 1999, page 23)

Preschool
Children
develop
a
primitive,
stereotypic
understanding of gender-role differences. They are also
beginning to notice differences between female and male
bodies, and are interested in the differences.

Most young preschool children have not yet learned rules of
privacy, and are usually not self-conscious about their bodies.
For example, they will often toilet, bathe, and dress with open
doors, and in front of others. Older preschool children make lots
of “potty jokes.”
Many children begin to masturbate during this age, and have
not learned that this should be done in private.


Older preschoolers begin to understand “where babies come
from”. With concrete explanations, they can understand
pregnancy, birth and nursing.

They usually are not aware of intercourse, nor ask questions
about it. However, they may be aware of intercourse if they
have been exposed to sexually explicit materials or behavior, or
have heard about intercourse from an older child. However,
their understanding of it is often inaccurate. For example, they
may think that the man “pees in the lady.”
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
It is normal for boys and girls to look at and touch their own and
each other’s genital areas.

Some preschool girls may insert objects into their vaginas as part
of exploring their bodies.
b. Criteria for determining whether sexual behavior is normal or a
cause for concern
Trainer Note: The OCWTP offers the workshop: “Sexuality of Children:
Healthy Sexual Behaviors and Behaviors that Cause Concern”, a part of
the Sexual Abuse Intervention series.
When considering whether a child’s sexual behavior is normal or a
cause for concern, the caseworker should consider the behavior
within the context of his or her family and environment, and the
child’s developmental level. The number and frequency of sexual
behaviors vary among children. Some children may have minimal
interest and may display no sexual behaviors while others may be
engage in some sexual behaviors and may have considerable
interest and curiosity.

Normal sexual behavior:
o Is mutual. Sexual behavior is mutual, between children of
similar age, sized, and developmental status; the behavior is
voluntary.
o Have a playful affect. The overall affect is playful, light
hearted. The children are learning about their bodies.
o Is easily redirected. The child can easily be re-directed to
other activities.
o Does not persist beyond pain. The sexual behavior is
pleasurable, and the child stops the behavior when it
becomes uncomfortable.
The following behaviors may indicate that the child has been
sexually abused. However, other factors could explain the
behavior, such as the presence of sexually stimulating material in
the home. The worker should seek to understand the causes of
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these behaviors rather than assuming that these behaviors indicate
sexual abuse.
Sexual behavior that causes concern that the child may have been
sexually abused, or has a sexual behavior problem:
o Interferes with other activities. The child engages in sexual
behavior to the exclusion of other developmentally
appropriate activities such as playing, being with friends, etc.
o Involves coercion. The child coerces, intimidates, forces
other children to engage in sexual behavior, or the child hurts
another child with the sexual activity.
o Causes emotional distress. Either child experiences emotional
distress as a result of the sexual behavior.
o Is compulsive. The child does not stop the sexual behavior,
despite consistent and clear requests to stop. (CavanaughJohnson, 1999; Fridrich, 1998)
B.
Aspects of Preschool Development That May
Challenge Parents
Time: 15 minutes
Trainer Instruction
Conduct a large-group discussion of the following information.
Alternately, you may include the following information in
your
discussion of normal development of preschoolers.
Content to be Discussed
1. Challenges of Normally Developing Preschoolers

The inability of preschoolers to modulate their emotional responses,
to think and reason logically and to understand the consequences
of their behavior, often stretches parents’ patience. Preschool
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children who are very clingy, physically aggressive, or very
demanding can frustrate parents.

Parents who do not understand egocentrism may feel that the child
is being deliberately selfish, or even critical of the parent.

Even normal curiosity, messiness, dependence, or feistiness can be
challenging for parents who are temperamentally quiet, controlled,
and orderly, or who are very sensitive to noise and disruption.

In addition the following types of children are often considered
difficult to manage:
o Children who are clingy, overly dependent, stubborn, willful, or
overly aggressive;
o Children who have difficulty getting along with siblings or other
children;
o Children who can’t or won’t behave in ways consistent with their
parents’ expectations;
o Children who have difficulty mastering normal psycho-social
tasks
2. Special problems
There are a range of developmental and physical disabilities and
emotional and behavioral disorders that leave children at higher risk of
abuse, because of the extraordinary demands these conditions place
on the family’s patience, tolerance, understanding, and time (Rycus,
Hughes, 1998). Children with the following problems may be more
likely to be over-disciplined, especially when these conditions are
misunderstood, unrecognized, or untreated.

Children suffering from attention-deficit and/or hyperactivity
disorder;

Children who have a hearing loss, and therefore do not respond
to their parents;
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
Children who have a language delay and cannot adequately
communicate with their parents;

Children with special problems such as autism;

Children with a variety of physical disabilities such as cerebral
palsy.
Even for well-informed, tolerant parents, children with these problems
are often very frustrating, and demand extraordinary effort and time
from the parent. In addition, parents’ of these children often
experience emotional reactions similar to grief. They have lost the
dream of a “normal” child, and must work through anger and denial in
order to come to resolution.
Caseworkers should help parents obtain adequate diagnosis and
treatment for special problems, assist parents in learning specific
management techniques for these children, help the parent use
emotional and social support, and obtain occasional respite from
these parenting tasks.
Some parents of preschool-aged children may have misperceptions
and unrealistic expectations, such as:

The child’s poor conduct means that the parent is a failure.

Preschoolers should be able to think and reason logically, and to
understand the consequences of their behavior.

Preschoolers should be able to sit still for long periods of time.

When a preschooler says “I hate you”, he means exactly that.
Parents who have these types of misperceptions and unrealistic
expectations are likely to experience anxiety, doubt, and poor self
esteem, and may feel very frustrated with their children.
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C.
Developmental Considerations in Working with
Preschool-aged Children
Time: 15-20 minutes
Trainer Instruction

Ask the group to take out their pre-training reading assignment, and
review the question about interviewing the child in the case scenario.

Allow participants to individually review their responses to the questions
about working with preschool children.

Ask participants to compare their answers on the pre-training reading,
with what they now know about the cognitive, social, emotional
development of preschoolers, and to make changes or additions to
their list, if necessary. Allow about 5 minutes.

Discuss their ideas, and prompt for the following.
Trainer Note: Some trainees will likely arrive at the workshop without having
completed the pre-training worksheets pertaining to working with preschool aged children. They can still be involved in the discussion and can
use the worksheets that are included at the back of their handout
packets.
Content to be Discussed
1. Physical Development
a. Challenges
One of the biggest challenges in interviewing preschool children is
getting them to give the interviewer their full attention. Young
children cannot sit still for long periods of time, nor discuss a
particular topic for long periods of time. This will vary according to
temperament, age, and degree of stress. Hyperactivity and
attention disorders pose additional challenges
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b. Developmentally-appropriate strategies




Use child-sized furniture
Get on the floor to talk with the child, if necessary
Adjust to the child’s schedule – for naps, meal times, bedtime,
etc.
Allow for bathroom breaks
2. Cognitive Development
a. Challenges

Egocentric thinking. Preschool children do not understand what
is important to tell. They may assume that the interviewer knows
the same information that they know.

Lack of understanding about time. Preschool children cannot
tell time, and cannot recount at what time specific things
happened.

Inability to give sequential narration. Many interview protocols
require that open-ended questions be used first, to allow the
child freedom in talking about the maltreatment. However,
because of their ego-centric perspective, preschool children
usually cannot recount what happened in proper sequence.

Inability to represent themselves in pictures. Very young children
may be able to draw a primitive picture of their homes, but
cannot represent themselves in the house. Therefore, the use of
pictures to help disclosure may be of limited use. (Hewitt 1998)

Unclear speech. It is not uncommon for preschool children to
have speech patterns and word mispronunciations that are
difficult for strangers to understand.

Suggestibility and memory. Children are susceptible to believing
repeated erroneous information, and they have better cued
than free-recall memory.
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b. Developmentally appropriate strategies

Use concrete language, "Please tell me what you did at home
after you came home from preschool," rather than "How was
your day?"

Check frequently for comprehension; don’t assume the child
understands you.

Check frequently that you understand the child; don’t assume
you understand him/her.

Do not ask for free narrative, ask very focused questions instead.

Try not to use “yes – no” questions – it limits the child’s response.

Do not ask questions regarding time of day; instead, ask
questions that tie events to the child’s daily routine (i.e.: before
or after preschool).

Check the child's developmental level by engaging the child in
play. Then adjust the interview to match the child’s level of
social, emotional, and language development.
3. Social Development
a. Challenges

The desire to please adults. Preschool children want to please
adults. This is a normal coping strategy for children. The
caseworker’s body language and facial expressions may
encourage a child to emphasize certain parts of the disclosure.
Caseworkers may be unconscious of this, and may need to
practice neutral body language and facial expressions.

There may be cultural taboos against discussing “shameful”
issues with strangers or someone from outside the family.
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b. Developmentally-appropriate strategies

Don’t let your body language on other behavior encourage
specific responses. For example, do not nod your head or act
surprised or disturbed in response to the child's disclosure.
Furthermore, do not promise a treat for "doing a good job"
during the interview.

Use games, toys, and artwork to engage the child. Use toys, art,
props, etc. that are specific to various cultures, so children can
feel comfortable with them. Be careful not to over- interpret art
work; and ask your prosecuting attorney about anatomically –
detailed dolls during investigations. Defense attorneys often
claim that the child was “just pretending” with the dolls, and that
the disclosure was not true

If an adult has accompanied the child to the interview, ask the
adult to encourage the child to speak about "shameful" issues
such as abuse.
4. Emotional Development
a. Challenges

Children may be fearful or shy.

Children may be embarrassed about talking about some
aspects of their abuse in the present of a caring adult, fearing it
might disturb the adult.
Example
o One little girl was interviewed in a room with a one-way
mirror. Her mother, the non-offending parent, was watching.
The little girl was able to tell about how her step-father forced
her to have intercourse. However, she did not disclose that
he also anally penetrated her, for fear that this would be too
upsetting to her mother. The day before the trial, she
disclosed this information. This required an addition criminal
charge against the alleged perpetrator, and a delay of
several months in bringing the case to criminal court.
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Furthermore, there may be strong cultural or family
prohibitions about discussing shameful issues with strangers.
The worker may need to convince the accompanying adult
to encourage the child to speak about shameful issues such
as abuse.
b. Developmentally appropriate strategies

In some cases it may be necessary to allow a trusted adult to be
present to put the child at ease. However, during investigations,
the caseworker should be sure that adult is not also a
perpetrator.

The worker should build rapport by playing games, playing with
toys, doing artwork with the child, and talking with him or her
about things that are important to him.

The workers should help the child feel comfortable with her by
maintaining a friendly, supportive, yet neutral approach with the
child.

The worker should be aware of cultural variations in helping
children feel comfortable, and should adjust his or her approach
accordingly.
Examples
o In some cultures it is considered impolite to accept an offer of
food or drink when it is first offered. A child could be thirsty or
hungry, but may not be able to accept food or drink until it is
offered several times.
o Some children may be inhibited from addressing the worker
by her first name, and would feel much more comfortable
addressing the worker more formally (Miss Smith, or Mr. Mike).
o
In some families it is considered very impolite and
embarrassing to talk about bodily functions, such as going to
the bathroom. The worker may need to ask the person who
brought the child in to the office to take the child to the
bathroom, if needed.
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D.
The Effects of Abuse and Neglect on Preschool
Children
Time: 1 ¾ hours
Trainer Instruction - Small-group Exercise – Cheryl- Part I

Instruct participants to return to their small-groups.

Ask participants to find the handout #11: Cheryl - Part I.

Instruct participants to read the information on Cheryl – Part I, which
contains information from the intake worker who removed Cheryl and
placed her with her maternal aunt. Participants should imagine that
their supervisor has assigned them this case, and has instructed the
worker to gather as much developmental information about Cheryl as
possible.

Instruct participants to discuss the following questions in their smallgroups:


What would
development?
you
ask
Ms.
Robertson

How and what would you observe in Cheryl?
about
Cheryl’s
After 10 – 15 minutes of discussion, conduct a large-group discussion.
During discussion, ensure that workers have developed specific
questions or observations to ascertain Cheryl’s development in each
developmental domain, and to determine her service needs.
Note: It is not necessary for groups to record their work on flip-chart paper.
Content to Be Discussed
Examples of suggested questions for Ms. Robertson:

Please tell me about how Cheryl plays with other children her age.

What kinds of toys does Cheryl play with?
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
Do people outside the family understand Cheryl’s speech?

How well can Cheryl follow directions?

How well can Cheryl wait her turn, or wait for your attention? (ie:
delayed gratification)

What does Cheryl do when she's frustrated?

Tell me about how she gets along with you? Her sister? Your other
children?
Examples of what to observe:

Observe Cheryl playing with other children in the home in order to
assess her social skills and emotional development.

Engage Cheryl in some play or artwork to observe social skills, fine
motor skills, and the ability to take turns and share.

Observe Cheryl interacting with her aunt to get a general idea of
the nature of the attachment between them.
Trainer Instruction - Small-Group Exercise – Chery- Part II
The purpose of this exercise is for participants to “think developmentally,”
i.e.: consider all of Cheryl’s developmental needs, and how to develop
and implement a case plan that will meet those needs.

Instruct participants to find the handout #12: Cheryl-Part II and handout
#13: Therapeutic Interventions for Preschool Children. Alternately,
assign each small group one question to answer.

Instruct small groups to answer the following questions.
assign each small group one question.
Alternately,

How is Cheryl's development different from normally-developing
preschoolers?

Based on your assessment, what kinds of services would you put in
place for Cheryl’s needs? Use the “Therapeutic Interventions for
Preschool Children” as a resource for this discussion.
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
How would you help Cheryl and her aunt develop a positive
attachment
relationship?
Use
the
handout
“Promoting
Attachment” as a resource for this discussion.

Participants should be given 10 –15 minutes for this exercise

Upon conclusion of the Cheryl discussion, conduct a lecture or largegroup discussion on the effects of abuse and neglect on preschool
development. The trainer may include much of that content in the
discussion about Cheryl.
Note: It is not necessary for participants to record their information on flipchart paper.
Content to be Discussed
1. How Cheryl's Development is Different from NormallyDeveloping Pre-schoolers
a. Social development. Problems with social and emotional
development can be considered along a continuum of mild to
severe. Some problems result when children attempt to engage in
age-appropriate activities when they haven't mastered the prerequisite social skills. Other social or behavioral problems are
children's attempts to adapt to their abusive or neglectful
environment; and some problems result from damage done to the
child (i.e.: complex trauma). At the severe end of the continuum
are emotional disturbances. Cheryl has some severe problems
which are common in children who have been traumatized by
chronic abuse.

Cheryl's attachment with her aunt appears to be insecure. She
follows her aunt constantly, and frequently seeks proximity and
reassurance from her aunt.

Cheryl is delayed socially. She engages in parallel play and does
not engage in imaginative or cooperative play typical of
preschoolers. She fights with peers whenever frustrated rather
than trying to resolve disagreements verbally.
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b. Emotional development

Her frequent, violent temper tantrums and emotional outbursts
are outside of normal behavior for preschool children. These are
common outcome for children who have been traumatized by
are abuse. This may indicate emotional disturbance,

Night terrors may indicate anxiety or fear.
c. Cognitive development.

Cheryl appears delayed in speech and language. Her aunt
often cannot understand her. At this age; most children are
understood by their caretakers. Also, her use of very simple
sentences is more typical of 2 – 3 year olds.

Her short attention span may be a reaction to the chronic stress
of abuse. Children who are constantly alert to danger in the
environment, or who are constantly poised for "flight or fight" are
often unable to concentrate in school. Her short attention span
could also indicate attention-deficit disorder.
d. Physical development. Her awkward gait and general lack of
coordination are not normal for children of her age. It is unknown
whether this indicates a developmental delay or some type of
neurological problem, perhaps caused by pre-natal exposure to
drugs.
2. Service Planning for Cheryl
Case planning for Cheryl should include the following interventions:

Comprehensive developmental and psychological assessment of
Cheryl to determine the extent of her developmental delays and
emotional disturbance.

Evaluation by a physician for her awkward gait. The family doctor
may refer her for a neurological evaluation.

Permanency for Cheryl, and supplemental planning. According to
the case information, it appears that reunification with the mother
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may not be possible. A supplemental plan should be made. The
worker will need to assess whether it is best for Cheryl to remain with
her aunt and her sister. These are complicated decisions, and
specific assessment criteria that must be considered.
Trainer Note: If the question of whether Cheryl should remain with her
sister arises during discussion, allow only enough discussion to raise the
dilemmas involved. Trainees will receive full information on making
decisions about placing children in kinship placements, and about
whether children should be placed with their siblings, in Core Module VIII.
There is a considerable amount of new research and literature on this
topic.

Emotional support to the aunt. This may include a variety of services
including respite for the aunt and consulting with her about
managing Cheryl’s behavior at home.

Promotion of attachment between Cheryl and her aunt. The
caseworker may need to help Ms. Robertson understand that
Cheryl’s following her around and clinging are to be expected, and
are actually a positive sign, because Cheryl is communicating her
need for a secure relationship. The caseworker may need to help
the aunt and Cheryl develop attachment. The following
attachment strategies could be used:
o Arousal – Relaxation. Ms. Robertson should allow Cheryl to follow
her around until Cheryl feels more secure in the attachment.
Following temper tantrums, Ms. Robertson should help Cheryl
verbally express her anger, frustration, etc., empathize with the
emotion, and talk with her about more appropriate ways to
handle those emotions. Ideally, both should feel less stress after
these conversations. However, parenting Cheryl will be very
challenging, and the aunt should not be expected to handle
each tantrum or emotional outburst perfectly.
o Positive Interaction. Cheryl should have some individual time with
her aunt, doing some of Cheryl’s favorite activities, such as
reading, playing games, or baking cookies.
o Claiming. Ms. Robertson should include Cheryl in
family
activities, display her picture with pictures of her other children;
display her art work at home.
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
Day treatment program for Cheryl. Cheryl’s behavior is probably
too extreme for Head Start or other preschool programs. A day
treatment program which has the specialized staff and program
needed to help children with emotional and behavioral problems
may better meet her needs.
However, the aunt may not want Cheryl to attend a program
where she will be exposed to other children with serious emotional
or behavioral problems. If a day treatment program is not available
or acceptable to the aunt, then a Head Start program that has
some capacity to manage Cheryl's behaviors could be considered.

Speech Therapy would improve Cheryl’s speech and language,
which would likely decrease her frustration, and improve her peer
interactions.

Treatment goals. The National Child Traumatic Stress Network (Cook,
2003) recommends the following goals for children who have been
traumatized by maltreatment. They suggest that the treatment be
provided in phases, so as not to emotionally overload the child.
o Ensure a secure, safe environment.
o Ensure attachment with a nurturing, loving, safe adult who is
attuned to Cheryl’s needs.
o Help Cheryl learn to appropriately express and regulate her
emotions.
o Help Cheryl develop social skills appropriate to her age.
o Help Cheryl understand that her past maltreatment is not her
fault; and develop a more positive, adaptive view of herself in
her present situation.
o Help Cheryl develop effective problem-solving skills.
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3. Effects of Abuse and Neglect on Preschool Development:
Additional Information
Trainer Instruction

Ask participants to read their handout #14: “Effects of Abuse and
Neglect on Preschool Development”

Allow about 5 minutes for participants to read the handout, and then
ask participants to identify any information that is new or different for
them. Conduct a brief large-group discussion, reviewing concepts
from the handout that were not already discussed during the Cheryl
exercise.
E.
Emotional Disturbances Associated with Child
Maltreatment
Time: 45 minutes - 1 hour
Trainer Instruction

Ask participants to think about Cheryl, and begin discussing the
following emotional disturbances by asking: "What would Cheryl be
like, if she suffered from”… (anxiety, PTSD, reactive attachment
disorder). Then compare and contrast Cheryl's behavior with the
description of each disorder.

Provide the following information in lecture or large-group discussion,
and with CPS questions, where indicated.

Handouts pertaining to each of these conditions are included in the
participant’s handout packets. Unless otherwise indicated, use your
discretion on whether and when to direct participants to the handouts.
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Trainer Note: If these questions arise about other emotional
disturbances that are covered later in the workshop, you may include
those discussions here, rather than putting off the questions until later.
The following information should be provided as an overview.
Additional information is included in trainee handouts, for later
reference.
1. Reactive Attachment Disorder
Trainer Instruction
Refer participants to handout #15: Reactive Attachment Disorder
a. Description
Reactive attachment disorder is a rare emotional disturbance, and
is much more severe than the insecure and disorganized
attachment discussed earlier. Interference with intimate social
functioning is the core of this disorder. Children with this disorder
have significant disturbances in most of their relationships, across
most social settings, and among different caretakers, that were
evident prior to the age of 5 years. (DSM IV) This disorder is
associated with grossly pathological parenting where the parent
disregarded the child's basic emotional needs; persistent disregard
for physical needs; or changes of primary caregiver that prevented
formulation of stable attachments. (DSM IV)
In recent years Reactive Attachment Disorder has become a
diagnostic fad (Barth, 2005). Criteria that are outside of the DSM-IV
diagnostic criteria have been used to diagnose children with RAD.
It is likely that many of these behaviors would more properly be
diagnosed as several other disturbances such as conduct disorder,
and ADHD. (Barth, 2005) It is also possible for a child to have
Reactive Attachment Disorder and another disorder, such as
conduct disorder. This is important, because without proper
diagnoses, the children may not receive proper treatment for these
other disorders.
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b. Treatment
In the past, “attachment therapy”, ie: treatment for children with
attachment disorders included a variety of coercive methods to
force the child to submit to the will of the parents, such as forcibly
holding the child for long periods of time, and enforcing eye
contact. These methods have since been discredited by several
professional organizations (American Psychiatric Association,
American Academy of Child And Adolescent Psychiatry, the
American Professional Society on the Abuse of Children).
The field of attachment therapy has moved away from these
techniques, and now promotes the use of a variety of techniques to
help parents become attuned to their children; and to help children
learn to regulate their emotions and behavior, and come to terms
with trauma that may have occurred in their past. (ATTACh - White
Paper on Coercion) Appropriate treatment emphasizes short term,
specific counseling to provide stability and improve the quality of
the parent-child relationship. The focus is on providing a stable
environment for the child, and taking calm, sensitive, non-intrusive,
non-threatening, patient, predictable, and nurturing approach to
parenting. This approach emphasizes teaching positive parenting
skills, rather than the child’s pathology. (Chaffin, 2006)
The term "attachment therapy" is a catch-all term that does not
describe specific strategies. When referring children therapy for
attachment problems, workers should clarify which strategies will be
used. Furthermore, caseworkers should seek guidance from their
supervisors if the therapist suggests using any of coercive strategies.
2. Anxiety Disorders
Trainer Note: All of the information contained in the answers to the CPS
questions is also contained in the handout #16, Anxiety Disorders.
Trainer Instruction
Use the following CPS questions to stimulate discussion about anxiety
disorders.
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Question #6: Children with severe anxiety disorders feel very nervous
and fearful, but can maintain adequate functioning at school and with
friends.
True or False
Discussion
Anxiety disorders are different from temporary nervousness, or feeling
anxious in response to a specific situation. In general, the term “anxiety
disorder” refers to an excessively fearful or stressful response to a
perceived threat either in the present environment or anticipated for
the future. Anxiety disorders can result from child abuse and neglect.
By definition, all forms of anxiety disorders involve disruption of
functioning in important domains of life, such as school, social
functioning, and peer relationships.
When anxiety or fearfulness interferes with a child’s functioning in
preschool, at home, or with friends, caseworkers should consider the
possibility of anxiety disorder, and obtain mental health assessment
and intervention.
Question #7: Which of the following are appropriate interventions for
children who appear to be suffering from an anxiety disorder?
A. Obtaining an accurate assessment and treatment
B. Reassuring the child there is nothing to worry about
C. Prescribing prescription medication with no other intervention
Children with anxiety disorders must receive mental health therapy. The
therapist will likely teach the child some methods for controlling her
anxious reactions, such as systematic relaxation, and learning to stop
the escalation of anxious thoughts. Since the child will need to
practice these methods at home parents and foster parents should be
involved in therapy.
Medication can by very beneficial as an adjunct to psychotherapy,
but is not recommended as the sole form of treatment.
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3. Post-Traumatic Stress Disorder
Trainer Instruction
Conduct a large-group discussion which includes the following
information, and encourage participants to refer to the handout #17
Post-traumatic Stress Disorder.
Content to be Discussed
a. Description
Although many children experience what the National Child
Traumatic Stress Center has labeled "complex trauma" as a result of
maltreatment, only some fit the specific criteria for Post-traumatic
Stress Disorder (PTSD). PTSD is a diagnosis which has broader
application to people who have experienced a variety
of
traumatic events such a war, terrorism, shootings, as well as child
abuse. To be diagnosed with PTSD the child must have the
following symptoms for more than a month. (National Institute of
Mental Health)

Re-experiencing the event through play or in trauma-specific
nightmares or flashbacks, or distress over events that resemble or
symbolize the trauma.

Routine avoidance of reminders of the event or a general lack
of responsiveness (e.g., diminished interests or a sense of having
a foreshortened future).

Increased sleep disturbances, irritability, poor concentration,
startle reaction and regressive behavior.
b. Behavioral indicators PTSD in preschoolers.

Fright reactions such as: fear of being separated from the
parent, crying, whimpering, screaming, immobility and/or aimless
motion, trembling, frightened facial expressions and excessive
clinging.
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
Regressive behaviors such as thumb-sucking, bedwetting, and
fear of darkness. Children in this age bracket tend to be strongly
affected by the parents' reactions to the traumatic event.
c. Treatment includes mental
medications.
health assessment,
therapy,
and
Clearly, there are many children who are traumatized by
maltreatment, but do not for the diagnosis of PTSD.
CPS Question #8: The caseworker's role in helping children receive
mental health counseling:
A. Ends once the child enters therapy;
B. Includes helping the parents/caretakers continue with therapy,
despite their reluctance to do so;
C. Includes changing therapists when parents don't like the therapist.
Discussion:
a. Treatment is critical in helping emotionally or behaviorally disturbed
youth resolve their problems. Linking a family with appropriate mental
health resources is only the first step in obtaining treatment for children
and families. There are many obstacles that the worker must help the
family resolve:

There may be cultural or family taboos against discussing family
matters outside the family.

In tight-knit communities families may be embarrassed that their
neighbors, friends, and extended family members may learn about
their participation in services.

Parents may resist discussing difficult issues or being confronted
(however gently) with their responsibility in the development of their
children's problems. As a result they may claim that they do not like
the therapist.
b. Support for treatment is critical. Research (McKay, et. al) has shown
that the following activities are associated with successfully engaging
families in children's mental health treatment:
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
The family is contacted early in the process, and repeatedly
throughout treatment, to help them stay involved.

The family is helped with the following issues:
o Relationship problems with the service provider
o Negative attitudes about services
o Family stress
o Discouragement from family and friends to seek or use help
Every attempt should be made to help families stay involved with
therapy, before changing therapists, or discontinuing therapy is
considered.

F.
Effects of Children Experiencing Domestic Violence
(15 minutes)
Trainer Instruction
CPS Question #9: Indicate the degree to which you agree with the
following statement: Domestic violence always has a negative affect on
a child’s functioning?
Answer: Strongly agree - agree - disagree - strongly disagree
Discussion
Some agencies assume that exposing a child to domestic violence is an
act of child maltreatment, assuming that there are always deleterious
effects on the child. However, whether a child is negatively affected or
not depends on several factors; the effect on the specific child should be
assessed. Following is specific information:

The effect on children is complex, and depends on the degree of
exposure to domestic violence and various moderating factors and
coping mechanisms. Edelson's (1999) review of the literature
(excluding studies with problematic methodology) showed that the
most common effects were as listed below, while a few studies
showed that some children showed no differences in functioning.
(Edelson, 1999)
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Children who were affected showed more of the following
problems than children who had not witnessed domestic violence:
o More aggressive, violent,
and antisocial (“externalized”)
behavior, and attitudes justifying their use of violence
o Fearful and inhibited (“internalized”) behaviors
o Lower social competence
o More anxiety, depression, trauma symptoms, and temperament
problems
o Lower cognitive functioning

Studies showed that there were considerable differences in how
children were affected; in fact some studies showed that large
numbers of children were not adversely affected. Children who were
younger, those who had experienced recent domestic violence, and
those who were both abused and neglected had the most problems.

Workers should carefully assess the effects on children, and protective
factors in families before making case decisions about families where
domestic violence occurs.

Children who are adversely affected should receive mental health
counseling.
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SECTION V:
THE DEVELOPMENT OF SCHOOL-AGE CHILDREN
Time
3 ½ Hours
Objectives

Trainees will know the processes and milestones of normal
development of children between the ages of 6 and 12.

Trainees will understand the potential negative outcomes of abuse
and neglect on the physical, cognitive, social and emotional
development of school-age children.

Trainees will know strategies for providing services that promote
healthy development of school-age children.
Method
Walk-around exercise, presentation by trainer, CPS questions, group
discussion, and exercises.
Materials
PowerPoint presentation
CPS questions
Handouts:
#18
#19
#20
Depression
Conduct Disorder
Laurie
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A.
Normal Development of School-age Children
Time: 1 hour
Trainer Instruction
Conduct large lecture or large-group discussion to include the
following content. Use CPS where indicated
1. Physical Development of the School-Aged Child

Physical growth between the ages of 6 - 12 is slow and steady.
Growth spurts do not normally occur during this period. The child
grows an average of 3-4 inches per year.

School-age children are active, energetic, and in perpetual motion;
they rarely stand still or walk when they can run, jump, tumble, skip,
hop, or climb.

School-age children can be readily engaged in activities that
promote the development and coordination of complex gross
motor and perceptual-motor skills. They direct their physical activity
into both formal and informal games and sports.

Fine motor skills are refined and practiced through painting and
drawing, crafts, using tools, building models, playing musical
instruments, and other projects that require the use of the hands.

Motor and perceptual-motor skills become increasingly well
integrated during this period. School-age children can perform
complex maneuvers with apparent ease.

Cultural factors may influence the development of motor skills.
Cultures that value physical strength and skill tend to reinforce
activities that involve gross motor abilities. In some cultures, girls
are discouraged from engaging in active, "rough and tumble"
physical play.
Cultures that place greater value on cognitive and social rather
than physical skills may tend to discourage active physical play. In
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this country, we typically expect children to sit for long hours at a
school desk. Because of this sedentary lifestyle combined with the
prevalence of television as a primary recreational activity, many
school-age American children are considered to be unfit.

School-age children are naturally physical. If given the opportunity,
they enjoy using their bodies in the performance of complex
activities and will create opportunities to do so.
2. Cognitive Development of the School-Aged Child
CPS Question #10: Which of the following is characteristic of school-aged
cognitive development?
A. There are no dramatic changes in cognitive development from
preschool development.
B. The ability to understand others’ perspectives develops during
this developmental stage.
C. Abstract thinking is well developed in school-aged children.
Discussion
The changes in the cognitive abilities of school-age children are
qualitative. There are distinct differences between the cognitive abilities
of preschool and school-age children that cannot be accounted for
solely by increased experience. These changes reflect what some
developmental theorists refer to as a "developmental leap," in which new
abilities emerge without obvious precursors.
Many theorists suggest that significant changes in the organization of the
child's brain permit the appearance of these new skills, specifically further
development of the cerebral cortex, the portion of the brain that controls
most higher cognitive functions.
Research has demonstrated that these changes occur in cultures that are
markedly different from each other in values, norms, and educational
practices, further suggesting a strong maturational component.
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Some of the differences in the cognition of preschool and school-age
children can be described as follows.
a. Language
CPS Question 11: Which phrase best describes school-aged children's
language:
A. Collective monologue
B. Language as a communication tool
C. Asking questions just to keep a conversation going
Discussion:

Answers A and C are typical of preschool language development.

School-age children use language primarily as a communication
tool to promote mutual understanding and to
enhance
relationships. Specific tools for communication include the
following:
School –age children:
o Actively listen to what other people say and consider these
communications carefully.
o Ask questions when they don't understand, and continue asking
questions until they are satisfied with the answer.
o Can request instructions or directions, and have the ability to
carry them out precisely.
o Consider the needs of the listener in a conversation and will try to
provide information the listener will find interesting or useful.
o Describe events logically and sequentially.
o Can discriminate between relevant and irrelevant information in
a conversation.
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o Have mutual conversations. Both parties are invested in the
communication, give and receive information, and exchange
thoughts and opinions. It is now possible to have a "discussion"
with the child.
b. The emergence of perspective-taking

Preschool children do not recognize that other people have
perspectives which might be different from their own.

School-age children develop the ability to understand other
people's perspectives. This ability emerges in rudimentary form
at the end of the preschool years and develops in stages
throughout childhood and into adolescence.

A child in a transitional stage of perspective taking may be able
to recognize and acknowledge that other people have
opinions, but he cannot mentally assume the role of the other
person.

Young school-age children can often understand how other
people feel but will have difficulty if their perspective conflicts
with another person's. They cannot grasp that two contradictory
perspectives can coexist, and that both may be valid.

By age 8-10, children can recognize the difference between
behavior and intent.
Example
If Tyrone's father accidentally steps on 3-year old Tyrone’s hand,
Tyrone will be angry at his father for hurting him. When Tyrone is
8 or 9, he'll understand that his father didn't mean to hurt him,
and he won't be angry. He understands his father's intentions
are different from his actions.

Caseworkers can help some abused and neglected children of
this age to understand that their parents didn't intend to harm
them. Some children will be able to accept a statement such
as, "my Mom didn't take care of me because she is depressed,"
or "my Dad got angry because he lost his job." The worker can
help the child to understand not to blame herself.
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
Throughout the school-age years, children become increasingly
aware of, and able to consider, the needs and feelings of others.
By the age of 10 or 11, children have the ability to listen to each
other's points of view and discuss them. When their views are in
conflict, they can identify solutions that consider what both
children want.
Example
When Sally wanted to play soccer and Tonya wanted to play in
the tree house, they agreed to play soccer first, and play in the
tree house later.

Having the ability to understand others' perspectives does not
guarantee that children will act in unselfish ways. It simply
means they have developed cognitively to a level where they
can accurately recognize and consider other people’s
viewpoints.
c. Development of concrete operations
Piaget labeled this stage of cognitive development "concrete
operations". Features of this stage of development follow:


The child has a relatively accurate perception of objects, events,
and relationships between them, as long as these are concrete;
that is, observable or touchable. Through observation the child
learns about the nature of objects and the causes and effects of
events.
School-age children no longer interweave fantasy and reality in
their conversations or play. Their imaginary friends disappear.
The child can recognize similarities and differences between
objects and people, as long as the attributes are visible and
concrete.
Examples
o The child might say an apple and an orange are similar
because they are both round, or because you eat them
both. A child at the stage of concrete operations would not
understand that apples and oranges belong to an abstract
"class" of objects called fruit.
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o Similarly, a dog and a lion would be considered alike
because they both have four legs and fur.
o The child might have difficulty recognizing the similarity
between a tree and a fly, and might insist that they aren't
alike, or suggest that they both live outside. The concept of
"living things" is too abstract for a child at this stage of
development to grasp.

The child can consider and reflect upon herself and her
attributes. She perceives and describes herself in concrete
terms. For example, “I'm a girl, I have brown eyes, I play the
piano, I like school." She is less likely to consider abstract
qualities, such as "I'm friendly" or "I'm artistic."

The child can consider two thoughts simultaneously. For
example, "I'm hungry, but if I eat something now, mom will be
mad, she'll think I'll spoil my appetite."

The child has a good understanding of concepts of space, time,
and dimension. School-age children understand how to
sequence events in time, i.e. first, next, and last, and can
therefore relate the events in a story in their proper, logical order
so others can understand.

The school-age child understands that the identity of an object or
a person remains constant, regardless of outward changes.
Example
School-aged children understand that when mother puts on a
mask, she is still mother. She hasn't been transformed into a
monster that will harm him. Young preschool children are not
able to separate the mask from the person, which accounts for
their common fear of masks.
d. Executive functions
During school-age and adolescence the parts of the brain
responsible for “executive function” are developing. This function
includes planning, consciously directing one’s activities, ability to
assess the meaning of complex emotional experiences; determining
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a course of action based on past experiences, and creation of an
inner frame of reference.
e. Memory improves

The child's memory improves as she gets older. The school-age
child can remember events that happened weeks, months, or
even years earlier. The child also has an increasingly good
short-term memory, which allows her to follow instructions, and
once she has learned, then to repeat complex activities on her
own without assistance.

These increased cognitive abilities promote the development of
more effective coping skills, including the ability to behave in
planful, goal-directed ways and to control one's own behavior.

Problem-solving strategies are closely linked to the family’s and
culture’s expectations.
Example
Some cultures encourage children to rely on their own problemsolving and critical thinking skills from an early age. In other
cultures children are expected to defer to their elders for help in
resolving some problems.

Some specific coping skills include the following:
o The child can now think about past actions or events and
remember their consequences. He can use this information
to plan strategies to solve problems and to meet his needs.
o The child better understands how her activities and behaviors
affect other people and events.
o School-aged children are less apt to respond to frustration
with emotional outbursts because they can think through an
alternate strategy to solve the problem.

Children's aptitude with language increases their coping ability.
They can "think to themselves," and they can use language to
communicate with other people, both of which assist them in
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solving problems and meeting their needs.
themselves helps to direct their behavior.
Repeating rules to
3. Social Development of the School-Aged Child
Trainer Instruction:
There are two options for conducting this portion of the workshop.
Option I: Conduct a "lightning round" exercise.

Hang flip-chart papers on the wall with the following headings:
"Friendships in School-Aged Children," "School-aged Children's
Understanding of Social Roles," "Sexual Development of School-aged
Children." For large-groups, hang two sets of flip-charts on the walls.
Note that the content on sexual development of school-aged children
appears in this curriculum after the discussion of emotional
development. Inform participants that you will discuss their ideas
about sexual development later in the workshop.

Divide the group into small-groups of 4-5 people, and station each
group at one of the flip-charts on the wall.

Instruct the groups to write everything they know about the topics
listed on the flip-charts.

Give each group 30-60 seconds to record their answers, then rotate
each group to the next flip-chart paper. Repeat this for a total of 3
rotations. In large-groups, ensure that half the groups work on one set
of flip-charts, and the other half work on the on the second set of flipcharts.

Use their responses on the flip-charts to generate
large-group
discussion on social development of school-aged children. Use the
content below, corresponding to the CPS questions, to guide your
discussion.
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Option 2:
Conduct a large-group discussion on social development of school-aged
children using the CPS questions listed below.
The social environment of most preschool children includes their home,
their immediate neighborhood, and possibly a preschool or church.
The social world of the school-age child, while still focused largely on
home and family, expands to include teachers, peers, and school mates,
as well as the larger world learned about in school and through other
means of communication such as books, movies, or television.
The school-age child's more sophisticated cognitive abilities and better
self-control affect both the quality of his interpersonal relationships and his
behaviors in social settings.
CPS Question #12: Which of the following is not true regarding schoolaged children’s friendships?
A. Friendships are shallow
B. Friendships often develop from common interest and proximity
C. School-aged children often have "best friends."
Discussion
Specific characteristics of school-age social development include the
following:

Many friendships develop between children because of common
interests or proximity. Friendships often do not cross settings.
Example:
A child might have one playmate who lives next door, a different friend in
his class, and yet another friend in his scout troop.

The child develops meaningful and mutual friendships with peers.

The child may have a "best friend" and also belong to a peer group.
Children this age usually choose friends of the same sex.
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Because many friendships are situation-specific, they may also be
transitory.
Example
A classic example is the behavior of children leaving friends they met at a
two-week summer camp. They claim undying friendship and promise
faithfully to call or write, but they demonstrate little interest in maintaining
the relationships once school and peer group activities resume.
CPS Question 13: In your opinion, how important are rules to schoolaged children?
A. Not very important
B. Somewhat Important
C. Very Important
Rules are important in guiding behavior. The child's ability to cope in a
complex world depends upon how well she understands the rules. The
child's understanding of the nature of rules, and their utility, becomes
more sophisticated as the child gets older. For example:

Play is largely rule governed. Children engage in board games,
sports, and group or team play, all of which require that rules be
followed.

Children age 5 or 6 believe rules can be changed to suit one's
needs, and they will alter the rules of a game at whim to get what
they want. This is a holdover from egocentric thinking, in which the
self is at the center of the world.
By age 7 or 8, the child is very conscious about obeying the rules,
even though she will test limits and challenge authority. Rules are
perceived as fixed, unchangeable, and handed down by an
ultimate authority. This leads to strict interpretations of what is right
and wrong. Issues of fairness are prevalent, and school-age
children become angry, enter into arguments, and complain
bitterly to adults if someone has broken an established rule or is not
treating them fairly.


By age 9 or 10, children begin to view rules as a useful means of
regulating their activities, but they understand that not all rules are
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inflexible. Rules can be negotiated and constructed by equals to
achieve an agreed-upon purpose. For example, if everyone in the
group agrees that the rules of a game should be changed, so be it.

Rules provide the child with structure and security. Rules describe
the laws of their world in concrete terms they can understand. In a
new or strange situation, the first thing a school-age child will do is
observe and ask questions to determine what is permitted and
what is not. Children respond with anxiety in situations where rules
are ambiguous or absent.
CPS Question 14: Which is true?
A. School-aged children's ideas about social roles are flexible.
B. Understanding social roles helps school-aged children adapt their
behavior to different situations.
C. School-aged children have considerable insight about the different
roles for men and women
Discussion:

The child is beginning to understand social "roles." The behaviors that
define the role are concrete and observable. In response to the
question, "what's a mother?" the child might say, a father "goes to
work to take care of the kids." A teacher "teaches letters and starts
games at recess." Social roles are at least partially determined by
cultural expectations and family values.

The child's conception of roles is that they are fixed and inflexible, and
concrete. They have little insight into the complexities of social roles, or
how one individual may adopt several roles. For example, mothers
shop for groceries, not teachers.

An understanding of roles helps the child adapt his behaviors to fit
different situations. He may be a dominant leader and give orders to
others on the school playground, sit quietly and be attentive in church,
and be helpful to his Mom by watching his younger brother.

Children of immigrant and refugee families often begin to have
internal conflicts regarding their parents’ expectations for
their
behavior and roles vs. the behavior demonstrated by American
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children at school. They often have considerable difficulty with this
conflict, because they want to please their parents and fit in at school.

Maltreated children may adopt specific roles in their families to
promote their survival. These roles are often maladaptive elsewhere.
Examples
o In chaotic, neglectful homes, where the parent is preoccupied
with his or her own situation, children may learn that being
histrionic is one sure way of gaining the parents attention.
o Some children learn to “parent the parent” – i.e.: attempt to
comfort the parent when he or she is distressed. It is normal for
sensitive children to do this to a limited extent. However, in some
dysfunctional homes, the child adopts this role as a primary
means of gaining parental attention.

The child is beginning to understand sex role differentiation. She
realizes that girls and boys are different and are expected to behave
differently. Comments such as "don't be silly, boys don't play with dolls"
exemplify the rigid role expectations of the child this age. Children will
emulate those qualities that their culture values for their gender. The
expectation that males and females are different in significant ways is
fairly universal, and culture determines acceptable behaviors for boys
and girls. Cultural mores regarding sexuality will also affect the values
that the child internalizes.
CPS Question #15: Looking back on your childhood, how would you
rate the amount of household responsibility you were given as a
school-aged child?
A. An appropriate amount
B. Too much
C. Too little
Trainer Instruction
Ask a few group members to explain their answers. Explore their beliefs
and feelings about the level of responsibility they had as children, and
weave in the following information.
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Content to be Discussed
As children mature, they are usually expected to take on chores, such
as the care of younger siblings and other responsibilities in the home.
The caseworker should be aware that cultures and families vary
considerably in the degree to which school-aged and teenaged
children take on family responsibilities. Some cultures expect more
responsibility at younger ages than other cultures.
Additionally, children vary in their ability to manage household
responsibilities because of variations in maturity. The worker should
assess whether the child is developmentally capable of performing the
required tasks and responsibilities; and whether the child’s attempts to
master his own developmental tasks are compromised by the required
responsibilities at home. The worker should also assess if the child is
taking on responsibility because the parent has abdicated
responsibility, or is absent from the home.
Inappropriate expectations for children include:
 Assigning the child responsibilities that are beyond his abilities
and/or maturity level;
 Assigning responsibilities that compromise the child’s development;
 Assigning tasks that are dangerous for the child to complete;
 Punishing the child for events that are out of the child’s control;
 Expecting the child to meet his parent’s or other adult’s need for
adult love, affection or sex.
4. Emotional Development of the School- Aged Child
CPS Question #16: To what degree do you agree with this statement:
School-aged children with good self-esteem are not sensitive to other’s
opinions about themselves.
Strongly Agree – Agree – Disagree – Strongly Disagree
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Discussion
Erikson considers "Industry" versus "Inferiority" to be the primary
developmental task of this age group. Throughout the school years,
children become increasingly decisive, responsible, dependable,
productive and goal-oriented about making plans and following through
with them. They are characteristically productive and results-oriented.
The child's self-esteem is largely dependent upon her ability to perform
and produce. A child’s self-concept will also be affected by societal
forces such as racism, sexism, and other forms of prejudice; as well as
dysfunctional family dynamics that are often present in homes when
children are abused and neglected.

The child who fails at being industrious is likely to experience feelings
of inferiority.

The child's increased awareness of others' perspectives, combined
with adherence to a well-defined set of rules that govern good and
bad behavior, lead the child to be sensitive to other people's
estimations of her. It is important to be "liked," to do well, and to be
viewed positively by others. The child is particularly sensitive to
criticism and feels personally inadequate when her performance
falls short.

In order to help develop positive self-esteem, it is important to
recognize children for their efforts and commend them for their
intent or attempt, rather than to judge their success solely on
outcomes or final products. It is important to recognize that some
cultures discourage recognition or commendation in public or in
front of a third party, because this elevates that person above
others in the group and disrupts group harmony. Workers should be
careful to abide by these cultural codes of conduct when visiting
families. They should also be careful not to assume that a parent is
not supportive if she refrains from praising her children in front of the
caseworker.

Throughout the school years, children develop increasingly good
self-control and frustration tolerance. They develop alternative
strategies to deal with frustration and are better able to control their
emotions. They have also learned to express their impulses and
emotions in safe, socially appropriate ways. Emotional tension is
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often released through hard physical play. Older children are also
better able to delay gratification.

There are cultural variations in how much emotional expression is
permitted, and in which settings. Children internalize these
expectations during this developmental stage.
Example:
Children whose families and cultures encourage free expression of
emotion may be louder and more boisterous than children who are
encouraged to be generally reserved. This can be misinterpreted,
especially when intensified by prejudice.
5. Sexual Development of School-Aged Children
Trainer Instruction:
Conduct a large-group discussion with CPS questions, ensuring that the
following content is discussed.
CPS Question 17: Which of the following is usually true about sexual
behavior of normally developing 6-9 year-olds:
A. Are increasingly exposed to sexually explicit information
B. Masturbate in public
C. Have accurate information about sexuality
Discussion:
While 6-9 year olds may be exposed to sexually explicit material, they do
not necessarily receive accurate information about sexuality. Children in
this age group may masturbate; however, they have become aware of
privacy standards, and will usually masturbate in private.
a. 6-9 year-olds: although there are differences among individual
children (as there are with all aspects of development) the
following are common and expected behavior for 6 – 9 year olds.
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
Are interested in, and have questions about pregnancy and
intercourse

Experiment with sexual swearing

Adhere to social divisions between girls and boys

Look for nude pictures in books, magazine, catalogues

Masturbate in private

Are increasingly exposed to sexually explicit material but do not
necessarily have accurate information about sex

Look for nude pictures in books, magazines, catalogues

Masturbation in private

Talk about sex with same gendered friends
b. 10 -12 year olds

Puberty (including menstruation and wet dreams) in some cases
begin.

Initiate competitive games involving urination and sexuality,
such as “peeing” contests, strip poker, truth or dare, stripping for
club initiation

Engage in interactive touching (stroking/rubbing; open-mouthed
kissing, re-enacting intercourse)

Giggle and talk about physical changes

Often feels awkward about physical changes in their bodies;
worry that they are developing too slowly or too rapidly; are
concerned and embarrassed about physical changes

Focus on their body development and compare themselves to
same-gender peers

Read information about sex with avid interest
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
Show intense interest in viewing other’s bodies

Practice discreet masturbation

May begin sexual/romantic fantasies

Begin boy-girl social relationships: flirting, hand holding, kissing,
spending time together

Engage in boy-girl sexual exploration with approximately sameaged peers

Experience erections that result from erotic as well as non-erotic
stimuli
6. Challenging Aspects of School-aged Children
Trainer Instruction
Conduct a large-group discussion of the following content.
Alternately, this information can be included in the content on normal
development of school-aged children.
Content to be Discussed
During this stage of development, children become increasingly
autonomous at school and at out- of- home activities. School-aged
children are expected to master increased responsibility at home and
school; are generally expected to manage their emotions and behavior;
and are expected to contribute to the well-being of the home and school
by performing chores and assignments, and by following their parents’
and teachers’ instruction.
The following are often very frustrating to parents, especially if they have
misperceptions or unrealistic expectations of their children:
• Children who are unwilling or unable to follow through on parental
and school expectations,
• Children who cannot or will not perform school tasks or home
chores;
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• Children who are physically aggressive or very oppositional;
• Children who fight and argue excessively with siblings;
• Children who are extremely sensitive;
• Children who are physically or cognitively limited;
• Children who are fearful or display anxious behaviors;
• Children who are socially isolated;
• Children who are very active; and
• Children who have emotional or behavioral disturbances, physical
disabilities, or developmental delays or disabilities (Rycus and
Hughes, 1998)
Again remind the trainees that it is not the mere presence of these
problems that increases risk to the child. When these problems exist and
the parent has unrealistic expectations or misperceptions of the child, or
when the parent cannot adequately manage these problems, and the
parent uses physical discipline, abuse from over-discipline may become
more likely.
B.
The Effects of Abuse and Neglect on the Schoolage Child
Time: 1 ¼ hour
Trainer Instruction

Introduce the 7-minute video clip from “Understanding
Traumatized Child” by informing participants of the following:


the
This video shows therapists, teachers and former foster children,
talking about the effects of chronic maltreatment on the child.
There is no one-to-one correspondence between maltreatment
and the effects on the child. However, the age of the child,
frequency of the abuse, and the severity of the abuse will all
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determine how greatly maltreatment affects the child. The people
in this video are discussing situations in which children were
frequently, seriously maltreated early in early childhood.

Instruct participants to write down important insights from the video.
Allow three minutes for this activity.

Conduct a discussion, ensuring that the following content is discussed.
Some of this content is included in the video, other content is not. Ask
probing, provocative questions to bring out the points that are not
included in the video.
Content to be Discussed
1. Effect of Maltreatment on School Performance.

The highly-structured school setting, with its many demands, can be
very threatening. Frequent emotional outbursts, an inability to sit
still, and other emotional responses to frustration are typical.

Academic challenges are threatening. The child has developed
few problem-solving or "attack" skills, and may lack the confidence
and persistence necessary to learn academic skills.
Lacking social skills, the maltreated child is likely to be scapegoated
or ignored by other children. This further affects self-esteem.


Children who are anxious are typically unable to concentrate on
schoolwork. They may be less persistent and avoid challenging
tasks. They expend their emotional energy trying to maintain selfcontrol, worrying about what may happen when they go home,
and coping with anxiety or depression.

Conversely, they may be overly-reliant on teacher guidance and
feedback. (Cook, 2003)

The child’s inability to interact competently with peers significantly
influences his academic performance. Students who are not able
to participate in classroom discussions or group projects are at an
academic disadvantage.
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
There are higher rates of grade retention and dropping out among
maltreated children (Cook, 2003)
2. Effects of an Abusive or Neglectful Home on the Child



When the environment is unpredictable, rules are rarely clear. The
parent may impulsively change the rules, or may react differently to
the child's behavior or to a situation at different times. In a
neglectful home, there may be no rules. The child is left without a
clear structure to guide his activities. The results in anxiety and an
inability to perform.
The absence of predictable outcomes interferes with the child's
ability to learn coping strategies to effectively manage and master
his environment. The child may not learn that she can manage the
environment.
When rewards are inconsistently given or absent, the child may
learn that the only way to assure having something is to take it
when you can. The child learns to behave impulsively, and is
rewarded immediately. She doesn’t develop the ability to delay
gratification.
3. Effect of Maltreatment on Emotional Well Being

Abuse and neglect deprive a child of the unconditional
acceptance and nurturance that should communicate the child’s
fundamental worth.

Maltreated children often experience severe damage to selfesteem from the many denigrating and punitive messages received
from an abusive parent, or from the absence of positive attention
and recognition in a neglectful environment. The child interprets
this treatment to mean that he has done something wrong that he
has failed to figure out the right rule or formula for success, or that
he has worth.

The child's security is depends upon a predictable and
understandable world. When the world is erratic and
incomprehensible, and painful things happen at random, the child
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often becomes chronically anxious or depressed. The child's ability
to trust can be seriously damaged.

He may have little impulse control and often cannot avoid
expressing his feelings or actions. The child may be easily
frustrated, and often feels helpless and out of control.

The child may be unable to regulate his emotions in a “normal”
way. There may be extremes of emotions. The child may attempt to
control her emotions through dissociation (emotional numbing),
avoiding affectively-laden situations. Older school-aged children
and adolescents may turn to drugs and alcohol to “self medicate”.
Alternately, some children may overly constrict their emotional
expression.
The child may present as being emotionally labile, and may
demonstrate extreme responses to minor stressors, with rapid
escalation and difficulty calming down.


Some maltreated children, who are always alert to danger, may
misperceive others as wanting to hurt them.

Children are at risk of developing emotional disturbances, which will
be discussed later.

Maltreated children may act out anxiety, anger, and frustration in
negative and antisocial behaviors, including hitting, fighting,
breaking objects, swearing, verbal outbursts, lying, and stealing.
Sometimes the term "ED" (Emotional Disturbance) is used to describe
these children in school settings.

The child may react to perceived danger with a “fight,” “flight,” or
“freeze response”.
4. Effects of Maltreatment on Relationships with Parents and
Other Adults

The child's ability to enter into meaningful relationships with other
people may be seriously compromised.
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
The child may not turn to adults for help or comfort when in need.
Her experience has taught her that it will not be given, or that there
may be painful consequences when she seeks help.

The child might be suspicious and mistrustful of adults, or
conversely, overly solicitous, agreeable, and manipulative. Both
are responses to lack of trust and an attempt to protect oneself.

The child may talk in unrealistically glowing terms about his parents.
This may be an attempt to convince himself of the adequacy of
those he must depend upon. Alternately, it is often frightening to
the child to believe that the parent who is supposed to care for the
child also hurts him.

The child may work hard to meet her parent's expectations for her.
"Role reversal," typical in situations of child abuse, is prevalent in
school-age children.

The child may not respond to praise and attention.

The child might excessively seek adult approval and attention.

A child who has experienced attachment problems as a result of
maltreatment may believe that he is unlovable, and may expect to
be rejected. Expecting rejection, he may test the foster and
adoptive parent’s commitment with a variety of negative behaviors.
5. Effects of Maltreatment on Relationship with Peers

Maltreated children are robbed of the chance to learn that their
social behaviors can elicit reasonable and consistent responses
from other people. This prevents them from developing confidence
in their ability to control the environment and influence how others
relate to them

The child may feel inferior, incapable, and unworthy around other
children, especially if he has not learned appropriate social skills.
The child may be hypersensitive to other children's perceptions of
him and may be embarrassed and ashamed if he can't measure up
to the group's expectations. He may have difficulty making friends,
may feel overwhelmed by peer expectations for performance, and
may withdraw from social contact.
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
The child may act out feelings of helplessness and lack of control by
attempting to control, exploit, manipulate, or coerce others. The
child may be bossy, a bully, or domineering with other children. She
may blame others when things go wrong or pick fights to legitimize
her aggression.

The child's lack of social skills and inappropriate behaviors may lead
to his being scapegoated by peers, which further damages selfesteem.
6. Effects of Maltreatment on the Child’s Ability to be SelfDirected and Competent

Children who are maltreated are often punished for autonomous,
self-directed behavior. The abused child may learn that selfassertion is dangerous and may assume a more dependent posture
to avoid injury.

The child may not have the opportunity to develop and master
age-appropriate skills. The child may feel inferior when compared
to other, more competent, children. This further threatens selfesteem.

The child may exhibit few opinions, or show no strong likes or dislikes.
It may be hard to engage the child productive, goal-directed
activities.

The child may be unable to initiate, participate in, or complete
activities. The child may give up quickly and lose interest when
activities become even a little challenging.
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C.
Emotional Disturbances Associated with
Maltreatment
Time: 30 minutes
1. Depression
Trainer Instruction
Conduct a lecture or large-group discussion, using the following CPS
questions.
Note: Handouts regarding these emotional disturbances are included
in the participants’ handouts #18: Depression, #19: Conduct Disorder,
Content to be Discussed

All the emotional disturbances that have been discussed thus far can
also be present in school-aged children, although the expression of
symptoms will be different, at this higher developmental level.

Two additional disturbances which some school-aged children
experience, and which are associated with maltreatment, will now be
discussed.
CPS Question #18: How much do you agree with the following
statement? Children who are depressed show symptoms similar to
depressed adults.
A)
B)
C)
D)
Strongly Disagree
Disagree
Agree
Strongly Disagree
Symptoms of depression in children can be significantly different from
symptoms of depression in adults. In childhood, symptoms of depression
can appear somewhat different than symptoms in adults. Irritability is
often more prominent in children as opposed to a noticeable
appearance of sadness that may be present in adults. In adolescents a
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pervasive lethargy may signal depression more so than in adults (but not
always). Depressive symptoms in children and adolescents may include*:












Sadness that won't go away;
Hopelessness, boredom;
Unexplained irritability or crying;
Loss of interest in usual activities;
Changes in eating or sleeping habits;
Alcohol or substance abuse;
Missed school or poor school performance;
Threats or attempts to run away from home;
Outbursts of shouting, complaining;
Reckless behavior;
Aches and pains that don't get better with treatment;
Thoughts about death or suicide
*NIMH Fact Sheet on Major Depression in Childhood and Adolescence
Childhood depression can affect a child's cognitive emotional and body
functioning as well as his behavior.
Children with bipolar disorder (a subtype of depression) may have
behavioral symptoms similar to attention-deficit hyperactivity disorder
(ADHD) including agitated behavior and lack of concentration. They also
have excessive temper outbursts and mood changes.
Being the victim of abuse and neglect, especially chronic abuse and
neglect, is associated with depression. Children of parents who have
affective disorders are at increased risk for acquiring affective disorders
themselves.
Depression can be a long-term effect of abuse and neglect; there is a
strong correlation between adult depression and history of child
maltreatment.
Workers should be aware of depression symptoms in order to identify and
obtain treatment for the affected children as early as possible.
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2. Conduct Disorders
Trainer Instruction
Ask participants to read the handout #19 “Conduct Disorders” and to
make note of important learnings or insights.
Ask participants to identify any new, important, or unique learnings
from the reading. Take several comments, and elaborate or clarify if
needed. It is not necessary to teach the entire content, since
participants have already read it.
D.
Developing a Service Plan for a School -Aged
Child
Time: 45 minutes
There are three options for conducting this exercise, as described below.
Trainer Instruction: Option #1

Ask participants to take out handout #20 – "Laurie."

Divide the group into four subgroups. Each subgroup should be
assigned one of the four discussion questions on the handout. They
should discuss it, and prepare to present their ideas to the entire group.
Trainees should work in their subgroups for approximately 15 minutes;
then reconvene the group. Each subgroup should present their
conclusions to the entire group. Lead discussion to assure that all
points are covered.

Make sure participants give adequate thought to Laurie's needs in
developing the service interventions. Be alert for superficial solutions,
such as "send her to mental health for counseling." Challenge trainees
to justify their recommendations on the basis of information in the
assessment, and help them to reformulate their recommendations
when necessary.

Use the information below to guide discussion, and ensure all points are
covered.
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Trainer Instruction: Option #2

Ask participants to read the "Laurie" case example and the questions.

Conduct a large-group discussion and include the content below.
Trainer Instruction: Option #3

Prior to the exercise, prepare a chart on flip-chart paper as shown in
below, and assign each group a number.

Divide the group into 4 small-groups. Assign one of the following roles
to each group: caseworker, foster mother and father and casework
supervisor.

Explain to the groups that they will be responsible for preparing one
member of their group to play their assigned role in a panel discussion
on the “Oprah Winfrey” show.

Assign specific questions to each role:
Group
1
2
3
4
Role
Caseworker
Foster father or mother
Teacher
Supervisor
Questions
Question 1
Question 2
Question 3
Question 4

Allow 10 –15 minutes for participants to prepare their roles.

For the report-out, conduct an “Oprah Winfrey” style panel discussion.
Use your creativity in portraying Oprah; for example use props, such as
a long table for the “panel members” to sit around, put a water pitcher
and glasses on the table, or use a play microphone.

Ask the assigned questions of each panel member, and ask
provocative questions of panel members and “audience” members to
stimulate discussion and opposing points of view.

If needed, the trainer can bring an idea into discussion by stating that
she read the idea in a book, and wondered what the panel of experts
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thought about it. Or, the trainer can take a “commercial break” to
discuss an issue, and then go back into the Oprah discussion.

Make sure participants give adequate thought to Laurie's needs in
developing the service interventions. Be alert for superficial solutions,
such as "send her to mental health for counseling." Challenge trainees
to justify their recommendations on the basis of their assessment of
Laurie and help them to reformulate their recommendations when
necessary.
Trainer Note One benefit of this strategy is that participants have an
opportunity to think about what it would be like to be Laurie’s foster
parent, teacher etc. During the “panel discussion” participants often
experience “a – ha” realizations about the importance of the teacher
and foster parents having regular communication; and the importance of
designing behavior-management strategies that can realistically be
implemented in the classroom or foster home.
Content to Be Discussed
Question # 1:
Assess Laurie's development in all four domains. How do
her behaviors reflect developmental delays and
unresolved or poorly resolved developmental issues?
a. Physical development. There is no information to suggest that Laurie
has significant physical delays. She appears to be developing
normally.
b. Cognitive development. Laurie is below grade level and is not doing
well in school. Her IQ is in the normal range, and there is no evidence
of an attention-deficit or learning disorder. She uses language
appropriately. Her academic delays are probably related
to
emotional and environmental factors, including an inability to
concentrate in school, and the disruption from changing schools each
time she is moved. Her lack of learning does not appear to reflect an
inability to learn.
c. Social development. Laurie has few social skills. She is egocentric in
her peer relationships and believes she should be at the center of
games and activities. She cannot share or take turns. She gravitates
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to the youngest children on the playground. Her social skills are at a
late-preschool developmental level.
d. Emotional development. Laurie shows multiple signs of insecure and
absent attachment. She is cling and indiscriminately affectionate, and
she exhibits many attention-seeking behaviors. Laurie also shows many
signs of emotional disturbance:

Laurie lacks trust: as evidenced in her clingy, demanding, attentionseeking behaviors, hoarding of food, and manipulativeness.

Laurie hoards food. This can be interpreted as an attempt to take
control of her environment and to assure that her needs are met.
Taking other people's belongings also suggests previous deprivation;
there is no evidence that her behavior is intended to be malicious.

Laurie wets the bed and has night terrors. These are signs of
generalized anxiety and emotional distress.

She is easily frustrated and has poorly developed coping skills. She
has not developed internalized controls to deal with frustration, and
she reacts to stress at the developmental level of a 2-4 year old
child, with emotional overflow, physical outbursts, and tantrums.

She has a short attention span. However, there is no evidence of
attention-deficit disorder or hyperactivity. Her inability to sit still is
more likely an emotional response to frustration or anxiety, or a
pressing, chronic need to seek attention from other people.

She displays autonomous behaviors; however, she is easily thwarted
and reluctant to engage in activities in which she has little skill. She
expresses a normal interest in being involved with other people and
in trying new activities. However, feelings of inferiority and low selfesteem appear to interfere with her ability to stick to things when
they are too challenging, or when she experiences even small
failures.
Question #2:
How would you suggest that Jean deal with the following
problems? How would you explain why Laurie has these
behavior problems?
Remember, you want to help Laurie develop more normally and acquire
age-appropriate skills at the same time you are managing her behavior.
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You also want to support Jean and her family and help to preserve the
placement.
a. Hoarding food

Food hoarding often starts when the child fears that she will not
have enough to eat. However, it often persists after the child has
access to plenty of food. It becomes an emotional crutch for the
child; and food becomes symbolic of love and nurture.

Laurie should not be punished or criticized for hoarding food. She
should be reassured that she can keep food that won’t spoil in her
box, and should be assigned her a corner of the refrigerator where
she can keep her perishables. When her food spoils, help her throw
it out herself and replace it with something fresh. The other children
should be helped to understand the reasons for Laurie's behavior
and to be supportive and reassuring. The hoarding should diminish
as she feels more secure.
b. Bed Wetting

There could be physical problems that result in bed wetting.
Emotional problems, such as anxiety, can also cause it. A physical
exam should be sought to rule out any physical problems, including
bladder infections. (Bladder infections in young children may be
symptomatic of sexual abuse.) The physician should be consulted
regarding the benefits of medication.

Jean can restrict liquid intake before bed, and can wake Laurie
and take her to the bathroom before Jean goes to bed.

Laurie should be responsible to notify Jean if the bed is wet, and
Jean and Laurie should change the linens. Jean should comment
on Laurie's success when the bed is dry, but Laurie should never be
punished or chastised for wetting. Laurie cannot control the wetting;
therefore, making her responsible for a dry bed set up a
performance test that Laurie can't live up to. Likewise, the family
should not use a behavioral chart to track and reward “dry nights”.
Since she likely has no control over her enuresis, such pressure to
perform will likely increase Laurie’s anxiety.
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c. Stealing

The foster family should set clear rules that Laurie not take other
people's belongings without asking permission. Family members
should be instructed to place important items out of reach to lessen
the temptation.

When the family discovers that Laurie has taken something, they
should expect her to return the item. The family should negotiate a
way for Laurie to pay back the person from whom she stole. This
could be performing someone else's chores or paying the other
person an amount of money equal to what she took.

Laurie should be taught to ask permission to borrow other family
members' possessions, and whenever possible, should be allowed to
borrow or use the object. She should also be prompted to return
things and rewarded for doing so. Laurie could also perform small
tasks for money, which can then be used to purchase things she
wants. Her rewards should be immediate at first. She does not yet
have the emotional ability to delay gratification.

Finally, the foster parent and caseworker should determine the
purpose of the Laurie’s stealing, and adjust how they manage the
problem accordingly. For example, the stealing may be an
attempt to take control, to feel powerful, and at times, to get
attention. The foster family should not reinforce these behaviors by
becoming upset (which communicates that Laurie does have
power and control over them); or talking at length about why
Laurie took the item (this gives her considerable extra attention for
stealing). Other acceptable means of getting and expressing
power and control should be developed and reinforced.
Conversely, if the purpose of the stealing is to deliberately hurt the
foster parents, they would need help in strengthening the
relationship between Laurie and themselves. Stealing is often a
complex problem which may require assistance from an
experienced mental health practitioner or psychologist.
Question #3: How should the teacher deal with the following problems?
a. Seeking attention from the teacher

The teacher should use selective and differential reinforcement to
promote desirable behaviors. The teacher should liberally reward
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Laurie with attention for sitting in her seat, for doing her work, and
for not bothering other children. At first, the teacher will need to
reward Laurie's compliance every few minutes.

When Laurie is disruptive, the teacher should return her to her seat
with as little attention or interaction as possible. Laurie will learn
that the teacher's praise and attention come from cooperative
behavior. Longer periods of "good behavior" can be rewarded
with the teacher's undivided attention for a period of time.

Also, the teacher should help Laurie to recognize when she
becomes too physically affectionate with a person that she does
not know well, and offer her more socially-appropriate ways to be
friendly. Similar strategies should also be applied in the foster home.
b. Messy, incomplete homework papers and performance below grade
level in all subjects

Differential and selective reinforcement should again be the
strategy. No attention should be given to messy papers. Laurie
should simply be instructed to re-do them neatly and completely,
and should be amply (and tangibly) rewarded both for her attempts
to do better, as well as for the finished product. Monetary reward
or use of stars or stickers on her good papers by the teacher and
the foster parents would be appropriate rewards.

Laurie may be eligible for special educational planning. Teachers
would be asked to evaluate her social and academic adjustment,
and would give an achievement test. She could be eligible for
special services, such as tutoring, to help her “catch up” to her
classmates.
c. Lying to the teacher

Jean and the teacher should talk frequently, and if Laurie is caught
lying, it should be discussed with Laurie matter-of-factly.

The teacher should be made aware of Laurie's attempts to
manipulate and should be instructed how to avoid being
manipulated. This includes checking Laurie's stories with Jean
before reacting to them. For example, the teacher should have
responded to the sweatshirt story with, “Sounds like you'd like to
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have a sweatshirt.
one."
Question #4:
Let's tell Jean, and maybe she'll help you get
What additional community resource services would you
include in your case plan for Laurie?
Identify possible resource agencies and the types of services you would
recommend. What kind of support would you provide to the foster
parents?
a. Referral to a children's mental health center or child therapist
Individual play therapy or counseling, and possibly a play group, can
help Laurie deal with underlying emotional problems and issues of
separation caused by the disrupted adoption and foster care
placements.
b. Special recreational opportunities
Highly structured group activities designed to develop social skills,
promote impulse control, and provide children with opportunities to
succeed would be preferred. These may be available through a
children's mental health center. Normal community activities, such as
Brownies or school clubs, would not generally be appropriate, as the
leaders of these groups are typically not prepared to intervene
therapeutically, which would be necessary were Laurie to benefit from
group activities.
c. Permanency
All attempts should be made to provide Laurie with a stable and
permanent home. An appropriate adoptive family should be sought
immediately and provided with intensive post-placement support.
d. Respite and other supportive services

Jean and her family should receive with respite and supportive
services. Jean should be encouraged to alert the worker when the
stress of caring for Laurie becomes excessive, or when she would
like some time alone with her own children. Laurie might be cared
for by other foster families for a weekend, or an after-school or daycare program might be used as needed.
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
The foster parents should receive considerable support in managing
Laurie, and to help develop an attachment relationship with Laurie.
For instance, it may be necessary to arrange regular one-on-one
time for Laurie and Jeanne, in order to enhance the relationship.

If Laurie is to receive mental health counseling, one of the foster
parents should participate so that he or she can learn about how to
support the therapeutic approach at home, and implement any
appropriate behavior-management methods.
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SECTION VI:
ADOLESCENT DEVELOPMENT
Time:
3 hours
Objectives

Trainees will know the processes and milestones of the normal
development of children age 12 to 18.

Trainees will understand the potential negative effects of abuse and
neglect on the physical, cognitive, social, and emotional
development of adolescents.

Trainees will know how to assess youth who display behavior
problems as a result of maltreatment.

Trainees will know strategies for providing services to adolescents
that promote healthy development and treat developmental
problems.
Method:
Presentation by trainer, group discussion, exercises, video
Training Materials:
PowerPoint Presentation
Handouts:
#22
#23
#24
#25
Francie
Terry
Kathy
Lee
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A.
The Nature of Adolescence: A Developmental
Transition
Time: 30 minutes
Trainer Note: The purpose of this section is to help trainees consider their
own experiences as adolescents in order to help identify and introduce
the pertinent issues related to adolescent development (ie: identity,
independence, reconciling issues of sexuality, friends as a secure base of
support and identity, and developing positive self-esteem.) Through the
discussions trainees should learn that despite common developmental
issues, adolescent experiences vary greatly. The developmental process
is affected by the child's personal attributes, the family, and the
environment, including the culture in which the child is raised. Trainees
should also learn that what appear to be dissimilar behaviors may be
attempts to resolve similar problems and issues. This should not become a
lengthy discussion of personal problems or issues experienced during
adolescence.
Trainer Instruction

Ask participants to think of a) five words that describe them as
adolescents, and b) the cultural, environmental and family factors that
influenced them during adolescence.

Begin by describing yourself - model the level of detail needed.

Conduct a large-group discussion to report out. As various trainees
report out, compare and contrast how various people coped with
common, central issues of adolescence. You may need to ask
additional questions to generate discussion. Suggested discussion
questions are listed below.

Include the following information in the discussion.
Content to be Discussed

Identity.
Adolescents struggle with answering questions such as, who am I?
What do I like? What do I feel? What do I want to be, separate
from anyone else's expectations of me? The process of trying to
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define one's values and beliefs, make career choices, determine a
purpose in life, and develop a positive self-image.
Suggested questions to generate discussion: What did you do to
establish your identity? Who helped you? Who hindered you?

Independence/Dependence.
During adolescence, youth begin the process of growing away
from one's family and assuming control over one's life, being
responsible for one's actions, dealing with ambivalence about
being on one’s own, anticipation, excitement, and fear, and
developing skills and confidence in coping with a complicated
world.
The task of adolescents becoming independent, and parents
“letting go” is often a difficult. Many factors contribute to the ease
or difficulty of accomplishing this task. They may include the youth's
and parents' temperaments; cultural and family expectations
regarding teen behavior, relationship with parents and becoming
independent; and any psychopathology present in the family.
Suggested questions to generate discussion: What did you do to
become independent from your parents? What helped or hindered
you in becoming independent? Who helped you figure out what
you would do after graduation?

Reconciling issues of sexuality.
Adolescents often experience awkwardness in sexual relationships,
embarrassment about one's own body and physical changes, a
need for acceptance by opposite-sex peers, effects on self-esteem,
and moral conflicts. A history of, or current, sexual abuse often
complicates adolescents’ sexual development.
Suggested follow up questions: Who helped you learn about
sexuality? From your current perspective, was that person really
helpful?

Friends as a secure base and source of identity.
Discussion points: Adolescents rely heavily on the security or
touchstone provided by friends or through peer group membership.
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During adolescence the group may define one's identity and
provide an alternative structure to the family setting in which to test
out new behaviors.
Suggested questions to generate discussion: How did friends help
you during adolescence? Looking back, were those people really
helpful?

Development of positive self-esteem.
The development of positive self esteem is the ongoing process of
self-evaluation, self-criticism, and attempts to formulate a positive
sense of one's worth and abilities. The development of positive self
esteem can be compromised with a history of abuse or neglect.
Suggested question to generate discussions: What helped you feel
good about yourself during adolescence?
B.
Normal Adolescent Development
Time: 1 to 1/14 hours
1. Introduction
Because adolescence is a period of extremely rapid change, and
because it covers approximately 8 years of the child's life,
adolescence is usually sub-divided into stages called early, middle,
and late adolescence. While the exact age at which individual
children go through these changes may vary, the stages are fairly
consistent in normally-developing adolescents.

Early adolescence refers to the period between about age 12 and
14. In American culture, the 13-year-old eighth-grader epitomizes
this group of children.

Middle adolescence includes youth between the ages of 14 and
17. Most high school students, grades 9 through 12, fall into this
category.
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
Late adolescence refers to youth between the ages of 18 and 21
and represents the final developmental step into adulthood.
Recently graduated high school students and college students
would be included in this category.
Most adolescents served by child welfare agencies are 18 years old or
younger. They may also be developmentally younger than is
expected for their chronological age. We will, therefore, focus
discussion on early and middle adolescence.
2. Physical Development of Adolescents
Trainer Instruction
Conduct a lecture or large-group discussion with CPS questions as
indicated.
Content to be Discussed
The hormonal changes of puberty promote development in two critical
areas.

Growth spurt- There is rapid physical growth of bones, muscles, and
other body tissues. Much of physical growth takes place during a
"growth spurt," in which the child grows several inches and gains
considerable weight in a relatively short period of time.
Girls mature physically on the average two years earlier than boys.
Most girls experience their growth spurts between the ages of 11
and 14, boys between 13 and 17. There is a wide "normal" range of
onset of puberty in both sexes.

Hormonal changes lead to the development of both the sex organs
and secondary sex characteristics.
In girls, hormonal changes promote breast development, pubic
hair, maturation of the uterus and ovaries, and menstruation. The
average age range for the onset of menstruation is 11 to 14.
In boys, the sex organs grow in size, and the testicles begin to
produce semen. Erections, which first occur in the infant, become
more frequent, and ejaculations are now possible. Secondary sex
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characteristics include the development of pubic and body hair,
facial hair, and changes in the tone and quality of the voice. The
onset of puberty in boys ranges from about age 12 - 15.

Emotional responses to puberty are variable. Many adolescents are
somewhat ambivalent about the physical changes. They may be
concurrently proud or pleased, or embarrassed and self-conscious.
At times, they worry about whether they are normal.
A girl's attitude about menstruation is largely determined by the
attitude of family and friends. She may experience it with pleasure
and pride, and consider it a "rite of passage." She also may
perceive it as an annoyance at best, and unpleasant and painful
at worst.
The onset of menstruation can be very stressful for girls who have
not been properly prepared, and who neither expect nor
understand the changes in their bodies. They may fear the
bleeding is a sign of internal injury or damage. It is particularly
traumatic for a girl who has been sexually abused and who, as a
result, is likely to believe that she has been physically harmed.
Unexpected and unexplained erections in adolescent boys can be
the source of extreme embarrassment. To be called on in class to
go to the board or stand up and recite at the time of an erection is
a typical fear of many adolescent boys.

An adolescent's body image is rarely objective. Most teens exhibit
anxiety about their physical appearance and are likely to be very
self- conscious of the changes. Minor physical features assume
enormous significance, and teens can spend considerable
emotional energy scrutinizing themselves in the mirror and trying to
hide, or otherwise change, perceived flaws. This self-consciousness
can lead to behaviors adults consider illogical and oppositional.
The adult usually cannot see the perceived flaw, much less consider
it worth worrying about.
It takes time to re-acclimate to rapid changes in body size and
appearance. Boys who grow several inches in as many months are
often awkward and clumsy until they re-learn coordination. The
changing voice is unpredictable for a period of time; the youth
sounds like someone else to himself.
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Early or late onset of puberty can have emotional and social
significance for some youth. Research suggests that boys who
mature early tend to be more self-confident and socially
appropriate in their behavior than boys who mature late; latematuring boys are found to be less poised, and often perceive
themselves to be less adequate. Differences in girls were similar but
less marked. Many youth experience a significant gap between
their physical and emotional maturity, which can cause emotional
conflict.

The following examples illustrate the effects on some youth of early
or late puberty.
Examples
o During junior high school, Bill had been a popular, active, and
verbal student. He had many friends. He was 15 when he
entered high school, and he was still very thin and very short. His
voice had just begun to change, and it cracked with some
regularity. Many of the other boys in his class were tall, strong,
muscular, and in Bill's eyes, considerably more attractive than he.
They were athletic; Bill was repeatedly "bowled over" by heavier
boys during football practice in gym class. Many boys were
shaving; Bill had the barest beginnings of "peach fuzz" on his
upper lip. He was interested in girls, but he felt that they weren't
that interested in him. Other boys seemed to talk to girls with
ease; he was very embarrassed. He felt inadequate and
unpopular.
o Marjorie was an extremely pretty child. She was eleven when
she began her menstrual periods, and she had fully developed
breasts and body curves by the time she was thirteen. She
began to attract considerable attention both in and out of
school; boys flocked around her in the lunchroom and in the
halls. Truck drivers and construction crews whistled at her as she
walked by, and men often stopped on the street to stare at her.
High school boys, and even a few college students, asked her
for dates. Marjorie was initially thrilled by all the attention and
pleased that she was so popular. She begged her mother to let
her date one of the high school boys, and then became very
frightened when she was alone with him in the car and he tried
to kiss and fondle her. She also became increasingly
embarrassed by all the attention she received from adult men,
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and felt increasingly alienated from her girlfriends, who did not
receive such attention and who appeared to be jealous and
resentful of her. She eventually began to wear sloppy sweatshirts
and baggy jeans to hide her body.

Generally, youth are most self-conscious about their bodies during
early adolescence. By middle to late adolescence, physical
development has usually stabilized and the youth has become
more comfortable with his or her physical self. However, while less
extreme, self-consciousness is still the norm in late adolescence.

Body image is affected by emotional factors, including emotional
responses to maltreatment, including the following:
o Youth, most often girls, who have high or perfectionist
expectations for themselves, may perceive themselves as fat
and unattractive even when they are very normal in build.
Eating disorders in adolescents, such as anorexia and bulimia
indicate serious psychological problems.
o Sexual abuse can have a pervasive negative effect on a youth's
body image. Sexually abused children are commonly
embarrassed and ashamed of their bodies, certain that they
have been permanently physically damaged. They often
describe themselves in derogatory terms such as "fat" and "ugly"
and "ruined."
o Youth who have sustained permanent physical injuries from
abuse, including scarring and physical malformation, are also
likely to have low self-esteem and be ashamed and
embarrassed by their physical deficits.
3. Cognitive Development of Adolescents
CPS Question #19: Which of the following statements is accurate about
teen cognitive development?
A. Once teens develop patterns of sophisticated cognitive abilities,
they utilize them consistently
B. There is an emerging ability to think hypothetically
C. Because of the emotional roller coaster of adolescence, teens’
problem-solving skills usually revert back to trial-and-error.
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Piaget refers to the stage of cognition that emerges during adolescence
as formal operations. Hypothetical thinking is one aspect of formal
operations.
Not everyone achieves formal operational thinking. Research suggests
that a combination of factors, including cultural influences, level of
education, the presence of emotional problems, and intelligence may
affect the emergence and the ultimate degree of sophistication of these
cognitive skills.
Research supports the contention that the ability for formal operational
thought has a maturational component. However, the formal education
found in a college or advanced technical school setting can greatly
improve their cognitive skills. In other words, these-highly developed
cognitive abilities are affected by environment and culture.
Formal operational cognition includes the following.

The ability to think hypothetically. The youth is able to calculate
the consequences of thoughts, actions, events, or behaviors,
without ever actually performing them. Hypothetical reasoning is
often referred to as "if-then" reasoning; for example, "if I were to do
X, then Y would probably happen." It allows the youth to consider a
large number of possibilities and plan one's behavior accordingly.

The ability to think logically. The youth is better able to think in
logical terms and can use logic in abstract thought. She can
identify and reject hypotheses or possible outcomes on the basis of
their logic.

The ability to think about thought. Preoccupation with thought itself,
and especially with thoughts about oneself, is characteristic of
adolescent cognition. Introspection and self-analysis are common.

The development of insight. Perspective-taking assumes its most
advanced form during late adolescence; the youth is able to
understand and consider not only the perspectives and views of
other people, but the perspectives of entire social systems (such as
America's attitude toward Communism.) The youth is able to
consider how his behaviors affect other people, and how other
people's behaviors affect him.
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
The emergence of systematic problem-solving. The ability to
manipulate abstract concepts, to hypothesize possible outcomes,
and to understand logical relationships greatly facilitates planning
and problem-solving. The youth can attack a problem and think
about it in detail, weighing all possibilities in order to think of, and
choose, a solution. The youth can also evaluate the success or
failure of his solution and make adaptations as needed.
However, these cognitive abilities develop gradually over the teen years,
and teens often use them inconsistently. Additionally, teens’ desire for
intense emotional experience and to be accepted by peers can “cloud
their judgment”.
2. Social development of adolescents
Trainer Instruction
Conduct a lecture or large-group discussion using the following CPS
questions:
CPS Question #20: Which of the following is true regarding social
development of young teens?
A. They often reject parents’ standards;
B. They rarely form strong friendships with peers from the opposite sex;
C. Social acceptance is based on values such as independence and
concern for others
Discussion
Cognitive and emotional development affects social development of
adolescents. The youth's improved insight and perspective-taking ability
lead him to change his expectations of interpersonal relationships and
increase this capability for self-disclosure and intimacy. The development
of identity and independence also has strong influences on how youth
relate to other people.
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a. Young adolescent (age 12-14) social development
Young adolescents are very different from older adolescents (age
16-18) in their social interests, the nature and quality of their social
interactions, and their level of interpersonal skill. Adolescent social
development occurs in a progression of steps, as follows.

The first step in the development of an independent "self" is to try
to psychologically distance oneself from one's family, and
particularly one's parents. In early adolescence, parents'
standards are often summarily rejected, and teens accuse their
parents of being out of touch and old fashioned, and not
understanding.

Concurrently, the youth establishes a strong identification with
peers. The peer group provides teens with strong support and
clear standards of behavior. Young adolescents form many
kinds of peer groups, usually composed of same-sex youth.
Members conform to the group's standards of conduct, dress,
language, and demeanor. Acceptance by the group depends
upon adopting the group's norms. Standards are explicit and
often unforgiving.

The teen’s family and culture will have guidelines about how
peers interact during adolescence. For example, some cultures
may limit peer interactions to structured events, while others may
permit the youth to engage in friendships freely.

Social status is largely related to group membership. Youth who
belong to groups with high social status are popular and may be
envied by youth who are not part of the group. Youth who are
highly visible and who have desirable attributes usually comprise
these groups. Youth who view themselves as less adequate or
popular may try to emulate the values and standards of the "in"
crowd. The standards that determine status may be different in
different social environments, but they are fairly rigidly applied
within a group.

Social acceptance in young adolescents depends upon
conformity to observable traits or to roles that group members
value. Other people’s social worth is rarely based upon an
insightful assessment of their personal attributes. In this regard,
young adolescents may be fickle and hypocritical. They may
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greatly alter their behavior, compromise their beliefs, and even
reject childhood friends to gain acceptance into the clique or
group that provides them with the most social status.
In immigrant and refugee families, there are often generational
differences in how quickly acculturation takes place. Often, the
children strive to fit in with American culture at school, while
parents expect adherence to traditional cultural norms
regarding behavior and allegiance to family. Some immigrant
and refugee families who have been exposed to sensational
American television believe that teens in America are wild,
uncontrolled, and put themselves in threatening situations.
Considerable conflict and over-discipline can result when
parents attempt to force their teens to maintain traditional
codes of conduct, or otherwise limit behavior. First generation
immigrants and refugees often have more difficulty with this than
parents who have become more acculturated. (Phinney 2000)

The young adolescent's need to be independent from parents is
generalized to adults outside the family, particularly adults in
authority positions. Teachers, police, and the parents of one's
friends are commonly the target of criticism. Yet, these same
youth may develop "crushes" on adults or older youth, and they
may try to emulate these adults' mannerisms, dress, or behavior.
This role modeling is superficial; rarely do these youth actually
know or understand these adults well.

Young adolescents are often very shy, embarrassed, and selfconscious and ambivalent about sexual relationships. Early boygirl relationships usually involve group dating and activities or just
"hanging out." In this manner, the youth can test out their social
skills within the security and support of their same-sex peer group.
b. Middle adolescence social development
CPS Question #21: Which of the following is most accurate about
friendships among teens during middle adolescence?
A. They are more likely to have more arguments with their friends
B. Because they are self-centered teens in middle adolescence often
cannot provide emotional support to their friends.
C. They expect mutual understanding, loyalty and emotional intimacy
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Discussion

During middle adolescence, youth continue to associate with their
peer groups; however, one-on-one friendships with same and
opposite sex peers become increasingly important. These
relationships are often based upon criteria that were absent from
their previous relationships, including mutual understanding, loyalty,
and intimacy. Middle adolescents commonly talk to each other
with great intensity and conviction about very personal feelings and
issues.

Increased insight and perspective-taking ability enable youth to
understand that others have feelings and experiences both similar
to and different from their own. The recognition of similarities
promotes mutual understanding and support. The recognition of
differences provides opportunities to assess oneself and to try out
different styles of thinking and acting.

Remember that teens who have been traumatized by abuse often
do not have the ability to recognize their own emotions nor the
emotions of others. This will have a negative impact on their social
development.

Self-revelation is a first step toward developing interpersonal
intimacy. Intimacy requires that the youth understand herself and
communicate her feelings and thoughts to others. Developing
intimacy is a difficult and gradual process and partly depends upon
the youth's experiences with intimacy of the family. Youth who are
raised in families where intimacy is absent, or in which interpersonal
relationships are distorted, may have considerable difficulty learning
and becoming comfortable with self-disclosure and self-expression.

Middle adolescents expect loyalty, confidence and trust from
friends as a way to make intimacy safe. Good friends are expected
not to disclose personal information to others and to remain loyal
and understanding, regardless of the information shared.

The youth's ability to discriminate individual differences leads to
conscious choices of adults that he likes and wants to know better.
During middle adolescence, many youth are intensely curious
about how adults feel and think, and perceive the world. They see
adults as possibly having answers to some of their questions and
concerns. If adults, including parents, can share their thoughts
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openly, without lecturing or being otherwise authoritarian, youth will
often listen and will consider the adult's opinions.

Youth who are capable of self-disclosure also expect the same from
adults. They respect honesty and straight-forwardness. They are
quick to point out hypocrisy and dishonesty in adults.
3. Sexual development of adolescents
Trainer Instruction
Conduct a discussion or lecture to include the following. CPS questions
will be used later in this section.
Content to be Discussed

There are specific cultural expectations regarding sexuality for
teens. In some cultures, for example, girls are expected to maintain
their “purity” while sexuality for boys is considered a rite of passage.
In some cultures, the birth of a baby outside of marriage is
considered shameful, and the girl may be sent away for the
duration of the pregnancy. In other cultures there is more
acceptance of the baby. Teens often experience considerable
angst regarding the degree to which they will abide by familial or
cultural expectations regarding sexual behavior.

Early expressions of sexuality are largely exploratory and may
involve considerable experimentation, including self-exploration
and masturbation. Motivation to engage in sexual behavior may
include biological and hormonal pressure, curiosity, the need for
practice, a desire for social acceptance, and an attempt to
increase self-esteem. Being pushed into sexual activity before one
is emotionally ready, either by peer pressure or a need for
acceptance, can contribute to emotional distress.

During middle adolescence, many youth become sexually active.
There are significant differences among individual youths in the
expression of sexual behavior, depending upon several factors.
Among these are personal readiness, family values and standards,
peer pressure, religious affiliation, internalized moral standards, and
opportunity.
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
Negative effect of sexual abuse. Sexual abuse almost universally
negatively affects sexual development in adolescent boys and girls.
Porter, Blick and Sgroi (1985) describe the tendency for sexuallyabused youth to view themselves as "damaged goods;" that is,
mysteriously altered and somehow permanently damaged
physically and socially by their sexual experiences. The authors
suggest that other people's emotional responses to a "sexually
experienced child" can also contribute to the child's negative selfperception and a poor sexual self-image. Intense guilt, shame,
poor body image, lack of self-esteem, and lack of trust in sexual
relationships are frequent developmental outcomes of sexual
abuse. All these can pose serious barriers to a youth's ability to
enter into mutually satisfying and intimate sexual relationships.
Trainer Instruction

Ask participants to read the handout #21, Facts on American Teens’
Sexual and Reproductive Health. To save time, you could divide the
reading assignment, give separate sections to different people, and
ask them to report out only on their section.

Ask them to identify information that was new or surprising to them.

Then conduct a lecture or large-group discussion which includes the
following information:
Content to be Discussed
When working with adolescents on issues of sexuality, it is important to:

Advise them to delay sexual intercourse. Adolescents who delay
sexual intercourse are less likely to regret the timing of their first
sexual experience, have fewer sexual partners, and are less likely to
be involved in coercive sexual relationships. (Terry-Humen 2006)

Encourage teens to reduce frequency of sexual activity and the
number of sexual partners. Both of these factors place teens at
higher risk of pregnancy and sexually-transmitted infections.

Educate teens that oral sex poses the risk of contracting sexually
transmitted infections, including gonorrhea, Chlamydia, herpes, and
HIV, among others. Many teens believe that oral sex does not
expose them to sexually transmitted infections.
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4. Moral development in adolescence
Moral development is a component of social development that
deserves special attention in any discussion of adolescence.
Lawrence Kohlberg has conducted much of the research that has
identified predictable stages of moral development in youth. (Rycus,
1998)
CPS Question #22: Which of the following is most characteristic of
adolescent moral development?
A. Moral thought always ensures moral behavior
B. Adolescents begin to develop insight regarding the necessity of
following rules and laws for the good of society.
C. Moral standards are not yet internalized during adolescence
Discussion

Under age 11 – pre-conventional The moral development of most
children under the age of eleven is at the pre-conventional level.
Pre-conventional morality is largely rules-driven. For most preschool
children, morality is based upon a "punishment/ obedience"
perspective. The child recognizes the superior power of an
authority and conforms to rules (is obedient) simply to avoid
punishment. Later in childhood, children begin to understand that
rules can be useful in promoting "self-interested exchanges."
Specifically, children obey the rules in order to get what they want.

Adolescents – conventional morality. Significant changes in moral
thought are brought about by advancements in abstract thinking,
perspective-taking and insight. Adolescents are often able to
understand that moral principles have social utility; rules exist for
the betterment of society and the benefit of its members. This
perspective is called conventional morality. There are two stages
in conventional moral thought.
o Golden Rule: The first level is epitomized by the Golden Rule;
ethical behavior is behaving in ways that benefit, and do not
harm, other people.
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o “Law and order”: This second level perspective holds that rules
exist for the good of society, and citizens must uphold the law
because the system could not function unless considerable
conformity and cooperation were present.
The standards of conventional morality, whether they are
interpersonal or legal in origin, are internalized. The person does
not need a strong external authority present at all times to enforce
the rules.
Youth who have developed to the conventional level experience
shame, guilt, and other self-blame when they fail to live up to
internalized moral standards or the expectations of important
others.

In assessing the moral development of youth, it is important to
differentiate between moral thought and moral behavior. Young
adolescents, particularly, may espouse certain moral principles but
behave in ways that contradict their expressed values. Lack of selfcontrol or strong positive reinforcement are powerful stimuli to act in
ways that are not consistent with espoused values. By middle to
late adolescence, most youth are better able to control their own
behavior to coincide with internalized values and beliefs.
5. Emotional development of adolescents
Trainer Instruction
Conduct a lecture or large-group discussion. Discuss CPS questions where
indicated.
Content to be Discussed
The principal task of emotional development during adolescence is
development of an individual identity. This task is not easy to accomplish.
In actuality, identity formation may continue well into early adulthood.
Life-span developmental psychologists also believe that while certain
components of identity are established during the adolescent years and
remain relatively stable, identity continues to be redefined throughout
the life cycle, with intermittent "life crises" that promote a reassessment of
oneself and a reformulation of values and directions.
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Adolescence, however, is the first time in the life cycle that the
development of identity is of central importance and a primary
developmental task. Specifics about identify formation follow:

A primary impetus for identity formation is the need for youth to
separate from their parents and to prepare to live independently.
To do this, they must develop a set of standards, values, beliefs, and
rules that can provide them with the structure and guidance
previously provided by the family.

Cultures vary considerably in expectations for the development of
independence and interdependence.
Examples
o Some cultures expect adolescents to stay at home until they are
married and can establish a home of their own, others expect
that adolescents will leave home earlier and experience the
world.
o Some cultures expect that adolescents will rely on and follow
parental advice for all important aspects of their lives; other
cultures expect adolescents to make many decisions on their
own and to consult with parents only when necessary.
o There is considerable variation in how many home responsibilities
adolescents are expected to fulfill, versus responsibilities
associated with school, job, sports, or extracurricular activities.
6. Emotional development in young adolescents
CPS Question #23: To what degree do you agree with the following
statement: Early adolescence is “stormy” for most teens.
A Strongly Disagree
B. Disagree
C. Agree
D. Strongly Agree
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Discussion
Some teens are very emotionally labile, have considerable difficulty in
getting along with their parents, and become involved in much risky
behavior. Other teens are able to modulate their emotions, manage their
relationships with their parents with finesse, and find less risky ways of
testing their limits. However, virtually all young teens deal with the
following issues:
a. Emotionally labiality
Early adolescence is an emotionally chaotic period, and the young
adolescent is more emotionally labile than at any other time during
development. The early adolescent period is inherently stressful
because of the rapid changes and difficult challenges. Youth are
also more aware of their feelings and emotional states, and they
recognize their feelings to be an inherent part of themselves. The
degree to which they experience feelings is new, and open to
examination and experimentation.
Probing parent questions such as "Why are you acting this way?"
only increase the youth's confusion, since he is generally not able to
answer the question. The early adolescent is truly at the mercy of
his emotions.
b. Engaging in activities that promote intense emotional experience.
While young adolescents seek activities that promote intense
emotional experiences, they typically lack the ability or experience
to modulate or control their intense emotions.
c. Risky behavior
For some youth, experimentation with drugs and alcohol are
attempts to magnify emotional experiences, as are driving at
excessive speeds, performing "dare devil" stunts, or otherwise taking
risks. However, the combination of volatile emotion, experiential
innocence, lack of judgment, and dangerous activity can have
devastating and even life-threatening consequences.
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d. Primitive attempts to individualize oneself.
Youths express individuality by adopting attitudes and values that,
at least on the surface, appear to contradict those of their parents.
Conflicts between early adolescents and their parents generally
occur in arenas where the expression of values is very concrete,
such as hair style, manner of dress, etc. The youth at this age lacks
both the cognitive ability and the experience to evaluate parental
values and standards on their own merit.
e. Substituting the structure of the peer group for the structure of the
family.
Youth consider themselves independent because they are
behaving differently from their family. However, they typically fail
to recognize that their excessive conformity to group standards
does not reflect greater independence; it simply reflects
dependence on a different group of people to provide selfdefinition.
The peer group does serve a function, however. It encourages
youth to try out different ideas and behaviors, in a generally
accepting and supportive setting. It is the first step in validating the
development of independent ideas. Peers often help each other
make significant life decisions. Furthermore, reliance on peers and
the peer group is a first step towards developing meaningful social
relationships outside the family that are necessary for adult
functioning.
7. Emotional development in middle adolescents
Trainer Instruction:
Conduct a large-group discussion, incorporating the CPS question
where indicated
Content to be Discussed
a. Perspective taking ability during middle adolescence permits the
child to recognize differences in people's values and beliefs, which
stimulates more intensive examination of other people's values. The
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youth begins to wonder about the validity of teachings that were
previously accepted without question. The awareness of
inconsistencies in values creates ambiguity and may be very
threatening. The youth is also more introspective and wonders
about his own values.
CPS Question #24: Which of the following is accurate:
A. Inability to successfully complete earlier psycho-social tasks will
hinder the teen’s ability to solidify his identity.
B. Teens who were neglected as children are well prepared to
develop a solid personal identity
C. Failure to solidify identity helps in the establishment of mature
intimacy.
Discussion:
b. Formulation and definition of one's personal identity is the focal
point of middle adolescent emotional development.
According to Erikson, identity formation includes both cognitive and
affective (feeling) aspects.

Cognitive component. "Self" is an abstract cognitive concept.
The ability to objectively view the components of one's "self"
requires perspective taking ability and insight. The development
of identity includes organizing one's perceptions of one's own
attitudes, values, behaviors, and beliefs into a coherent "whole."
One's identity remains stable across changing environmental
conditions.

Affective component. The affective component of self refers to
feelings of self-worth and self-esteem. A "positive self image" is
the belief that one's "self” has inherent value and is acceptable
to oneself and to others. Healthy self esteem helps one to be
objectively critical of one's shortcomings and gives one the
confidence to attempt changes.
c. Identity confusion, according to Erikson, is the negative outcome of
failure to develop a positive identity. Some degree of identity
confusion is a normal developmental problem, and should be
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expected. For most individuals, however, the confusion is generally
resolved by late adolescence or early adulthood.
According to Erikson, identity confusion can manifest itself in a
number of ways and can be affected by a lack of resolution of
earlier developmental tasks. Youth who have been subjected to
child maltreatment are especially vulnerable to these problems,
since they often have been unable to achieve the psycho-social
tasks of earlier developmental stages. For example:

Failure to achieve basic trust, which often occurs as a result of
chronic, early child maltreatment, can have the most severe
consequences on the development of identity. These youth
exhibit what Erikson calls an almost "catatonic immobility." They
fail to understand that changes in their lives are possible; much
less understand their own role in promoting these changes. These
youth cannot tolerate momentary delays in gratification; they
have no confidence that the passage of time will provide a
remedy. The youth feels impotent to change things, and cannot
look with any confidence toward the future. He is truly lost.

Similarly, failure to achieve autonomy, initiative, and industry can
affect the adolescent's ability to develop a stable, positive
identity. These youth may exhibit feelings of self-doubt and
shame; pervasive guilt, self-criticism, poor perceptions of selfworth, and overly rigid expectations for one's own behavior;
and a sense of inadequacy and inferiority concerning taskrelated competence.

Youth may try to deal with these negative outcomes by
overcompensating. They may become narcissistic and
unrealistically self-complimentary, or harbor grandiose ideas of
their capability and have high expectations for their
performance in the future. The youth can also give in and
behave in self-defeating ways, or fail to even try to master the
challenges of developing an independent self. These youth
appear to be lost and directionless, and without the motivation
to try.

The failure to achieve identity can interfere with development in
the next of Erikson's stages, the development of mature intimacy.
According to Erikson, to be comfortable in intimate relationships,
one must have a well-developed and positive sense of self. The
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experience of emotional and sexual intimacy can be
threatening to persons without a strong identity. Erikson suggests
that while identity developing, adolescents may avoid intimacy
out of fear of "losing themselves in the other person." At its most
pathological, adults without a firm sense of identity avoid all
intimate relationships and maintain a state of personal isolation.
d. Concept of self. By the end of middle adolescence, most youth
have developed a concept of themselves that offers enough
structure and stability to allow them to pursue new activities, such as
entering the work force, continuing their education, or starting their
own family. The adolescent's ability to function in the world will
continue to improve as he grows and his identity becomes more
stable.
8.
Specific Identity Issues
a. Gender identity

Adolescence is a time of experimentation; some engage
experimentally in same-gender sexual activity. This does not
necessarily indicate gay or lesbian orientation. (Ryan 2001)

Gay and lesbian adults and adolescents report feeling
“different” from early childhood. As they develop cognitively,
they come to a fuller understanding of their sexual orientation
and society’s stigma.
They must learn to manage a stigmatized identity, often without
social support and instruction on how to do so, since they may
not receive support from families, and may not have any known
role models. Additionally they do not have fully-developed
cognitive, social and emotional resources. Furthermore, some
religions do not accept gay or lesbian identity – which may
cause further distress for adolescents struggling with their sexual
identity.


Gay and lesbian youth who are members of ethnic minorities
often must manage more than one stigmatized identity. Many
ethnic groups may interpret being gay or lesbian as a rejection
of the ethnic group. Therefore, less support will be available to
gays and lesbians in their group. (Ryan 2001)
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
Workers should be aware of the significant emotional and social
struggles many gay lesbian youth face, and should help them
find support. Many high schools have student organizations to
provide support for gay and lesbian students; and some
communities have similar organizations
b. Issues related to cultural, ethnic, and racial identity formation

Adolescence is a time of exploring the significance of race,
ethnicity, and culture, and how these apply to the individual. A
teen’s past experience with her ethnic or group identity are
important as she determines whether her identity is positive,
negative, or in transition. For example, some teens form
intercultural friendships, while others may experience rejection
from dominant culture peers who were previously friends. This
may be especially important with respect to dating. The child’s
experience with prejudice and racism has a dramatic affect on
how she feels about her ethnic, cultural, or racial identity.
--- adapted from OCWTP Post Adoption curriculum: “Successful
Trans-cultural Parenting: Dealing with the Dynamics of
Difference” (Ginther and Severs, 2004)
In addition to normal identity struggles, adolescents who are bicultural may have to deal with issues related to group
identification. For example, “black Latinos may identify with
black groups in the community or white Latinos with their Anglo
neighbors, both often incurring the anger or mistrust of their own
community.” (Quinones-Mayo 2005) This may raise additional
issues for the adolescent and family.
c. Identity issues for adopted children

Adolescence is a particularly difficult time for adopted people.
The circumstances of the adoption, and the emotional struggles
common to adopted children “add another layer of adjustment
to two tumultuous tasks: identity formation and separation from
family”. (Ginther and Severs, 2004)

Adolescents often try on different personas; and early attempts
at identity formation are essentially rejection of parental values.
“When children have more than one family …on which to base
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their self-concept, the struggle to form an identity becomes
much more complicated.” (Ginther and Severs, 2004)

C.
Workers should be aware that these struggles may erupt in
angry, “unruly” behavior and significant conflict with parents,
who may not be aware of that the youth is struggling with
identity issues. Counseling from a therapist with expertise in
adoption issues may help resolve these difficulties.
Challenging Aspects of Parenting Adolescents
Time: 15 minutes
Trainer Instruction
Conduct a lecture or large-group discussion on the following content.
Alternately, this information can be covered during the discussion of
normal adolescent development
Content to be Discussed
1. Adolescent struggles with developmental tasks

The adolescent’s new-found ability to think hypothetically, her need
to become independent from her parents, and her fluctuating
emotions often result in “rebelliousness”, criticism, and questioning
of her parent’s values, beliefs, and authority.

Many parents have difficulty with these aspects of adolescence;
especially those parents who have a great need for authority,
control, and order in their families.

Teens who demonstrate these aspects of adolescence in the
extreme,
or
who have
additional emotional problems,
developmental disabilities, or physical challenges pose additional
challenges for parents.
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
Teens who are especially challenging of their parents’ authority, or
who engage in frequent arguments with their parents and those
who are involved in delinquent behavior, drugs and alcohol abuse,
or sexual acting-out are also very frustrating to parents.

Any of these problems can result in serious conflict between teens
and their parents. While most families are able to resolve these
struggles peacefully, some parents resort to extreme physical
discipline, or rejecting teens from their homes. Teens who run away,
or whose parents tell them to leave home are often forced to live
on the street and are vulnerable to a range of problems including
predatory adults, prostitution, substance abuse, and health
problems.
2. Parent’s perceptions
D.

Parents who expect to have complete control of their adolescents,
and who interpret their teen’s questioning of authority and efforts
towards independence as disrespectful, ungrateful, etc., likely
experience frustration during their children’s adolescent years.

During adolescence, teens become increasingly influenced by their
peers, and may engage in activities that their parents oppose
(drinking, drug use, staying out too late, associating with
undesirable friends). Some parents who feel threatened that their
teens are no longer under their control may use extreme measures
to control their teens’ behavior. Physical abuse can result.
Conversely, parents who do not recognize their teen’s continued
need for guidance and structure may not provide adequate
supervision.
Working with Adolescents
Time: 15 minutes
Trainer Instruction

Ask participants to take out their pre-training assignment and review
their responses regarding how they would work with adolescents.
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
Ask participants to make changes or additions to their pre-training
work assignment, as necessary.

Conduct a large-group discussion about their insights into working with
teens.
Trainer Note: Some trainees will likely arrive at the workshop without having
completed the pre-training worksheets pertaining to working with
adolescents. They can still be involved in the discussion and can use the
worksheets that are included at the back of their handout packets.
Content to be Discussed
Workers should consider using the following approaches when working
with teens

Talk with teens in comfortable environments. Child- sized interview
rooms are not suitable for teens. Do something active, when possible,
such as going for a walk, playing basketball, etc.

Be patient with teens. Remember that higher level cognitive abilities –
like judgment, critical thinking, etc. are still developing, and may be
inconsistent. Do not be surprised when they do something
unreasonable, or make mistakes.

Directly involve teens in problem-solving and case-planning. Solicit their
input as much as possible.

Do not condescend or patronize. Relate, as much as possible, in an
adult-to-adult manner.

Do not take obnoxious, disrespectful behavior personally. Remember
that this behavior may be a cover for more threatening feelings. In
youth who have experienced chronic maltreatment and complex
stress, these behaviors may also result from being hyper-alert to
perceived danger.

Do not expect teens to develop deep relationships with foster parents.
Remember that they are at a developmental stage of becoming
autonomous from parents.
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
Consider families of friends, coaches, teachers, etc. as placement
possibilities for teens.

Recognize the importance of peer support in teens’ making significant
life decisions. When possible and appropriate, help teens utilize peer
support, encouragement, and assistance with problem-solving and
decision-making. Counseling groups and support groups for teens can
often help teens cope with a variety of problems.

Be genuine. Most teens appreciate adults who are genuine and
trustworthy in their approach. Attempts to dress like teens or use teen
jargon, if not genuine, are often met with suspicion.
E.
Application Exercise: Differential Assessment of
Adolescents
Time: 30 - 45 minutes
Trainer Instructions
Refer participants to Handout #22 Francie, #23 Terry, #24 Kathy, and
#25 Lee.

Instruct participants to read the four case examples and think about
the following:




What is the teen’s developmental level?
What are his or her strengths?
What are you concerned about for this youth?
What would your service plan for this youth be?

Conduct a large-group discussion, ensuring that the case information
found below in the "Trainer's guide for follow-up discussion" is included.

Throughout the discussion, be sure to make the following points:

Youth with very different personalities, needs, and problems may all
act out in the same way, but for very different reasons.
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
The behavior is only a starting point for performing an assessment.
To make accurate judgments, one must go well beyond the
"presenting problem," (the behavior) and conduct a differential
assessment of each youth's level of development, needs, problems,
and individual areas of strength.

A case plan must be appropriate for the teen’s specific strengths
and needs.
Refer back to concepts previously discussed in the workshop, and to
the posters or flip-charts in the training room, as a review of earlier
content.
Trainer Note: The purpose of this exercise is to help trainees understand the
importance of conducting thorough differential assessments of
adolescents with behavior disorders.
The exercise uses case studies of youth who display similar behavior
patterns. All youth are 16 years old. Their family backgrounds are
dysfunctional in some way. However, the youth show differences in their
levels of development, personality dynamics, and coping abilities.
Trainer's Guide for Follow-Up Discussion: Francie

Francie’s cognitive development is at an egocentric level, typical
of a preschool child. She has no awareness of other people's
perspectives. Her ability to understand the world is grossly deficient.

She has no awareness of cause and effect in interpersonal
relationships, and therefore is largely unaware that she has any
control over her environment. Things happen "out there" arbitrarily
and at whim. She's a victim.

She has not progressed to understanding rules, and therefore there
is no understandable structure in her world. She is not mentally
retarded, although her measured IQ on a standardized test would
probably be depressed because of social and environmental
deprivation. Her social perception is extremely deficient.

Francie’s social development is primitive. She behaves in ways
calculated to get her own needs met and is inconsiderate of other
people. She sees people as resources to meet her needs. Her
emotional responses to other people are deficient. She does not
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appear to recognize other people as human beings with intrinsic
worth.

Her emotional development is very disturbed. She is a child without
reciprocal attachments. She exhibits a kind of “bottomless pit"
dependency, with a pervasive lack of trust, and has significant
deficiencies in autonomy, initiative, and industry. Concepts of self
or identity have little meaning.

She is impulsive and lacks frustration tolerance. She has not
developed the ability to use language or other more developed
coping skills to manage stressful situations. She goes immediately to
"emotional overload" in even minimally stressful situations.
Treatment for Francie

"Insight" or "counseling" therapy is not appropriate. Francie doesn't
have the ability to understand her own or other peoples' feelings, or
to understand the dynamics of her behavior.

Francie must learn at a very basic level that she can have an effect
on what happens to her. Her personality disorganization is likely the
result of her very chaotic and disorganized early environment. Her
current environment must be highly structured and concrete, with
positive reinforcement for very specific tasks. She must be taught
that she has the power to get what she wants by performing
specific behaviors. This will take a lot of time. Residential
placement or a very highly-structured treatment foster home, are
probably the best placements.
Trainer's Guide for Follow-Up Discussion: Terry

Terry is well-defended against underlying anxiety and depression.
He has learned to cope with his fears of close relationships and his
anxiety about his own competence by taking charge with a
vengeance. His general mode of operating is "do it to them before
they know it's happened." His manipulative strategies assure that he
will be in control, and therefore, at least in his own mind, safe.

His perspective-taking ability is distorted. He assumes that others will
try to use him to their own advantage and won't meet his needs
unless he "takes it" from them by manipulating them. This is because
he perceives other people's motivations to be similar to his own. He
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is only marginally aware of individual differences and does not
understand other people's feelings and motivations.

Cognitively he is at the level of concrete operations. He depends
upon "rules," i.e. manipulation strategies, to get him what he wants.
He fails to understand differences in individuals, and does not use
knowledge of other people's needs and feelings in
his
manipulations. His strategies may be simplistic, and when his
manipulations fail, he believes it to be the fault of his skill at
implementing the strategy rather than any problem with the
method.
Note: There are manipulators who function at much higher levels of
social awareness. These persons have exceptional insight into other
people's feelings, needs, and beliefs, and they are able to use this
information very effectively in their manipulative behaviors. They are
slick, shrewd, and utterly believable in their attempts to "con" others.
Terry has not developed to this level of interpersonal sophistication.

Terry copes with anxiety and feelings of dependency through
denial, and by blaming others for his problems. He has very low selfesteem, in spite of insisting (and believing) that he is competent
and invulnerable.

His tendency to use other people prevents him from developing
mutually-satisfying interpersonal relationships. He knows only two
interpersonal strategies: con and conform. He is emotionally and
socially isolated. Relationships with others are superficial and shortlived. He is quickly alienated by others, who become angry at
having been "duped" or used.
Treatment for Terry

The manipulator is very difficult to treat. His unwillingness and
inability to engage in relationships with either adults or peers makes
relationship therapy ineffective. He is likely to react to the worker by
conforming in early stages of counseling as a means of maintaining
control. He may verbalize how helpful counseling is, and talk
agreeably about his problems. When the counselor realizes that the
child's involvement has been false, and that he never intended to
change, the therapist is likely to feel angry and used. It is common
for the counselor to want to punish the child for his "insensitive"
treatment. This counter-transference reaction is not helpful. When
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working with a manipulator, one must expect to be manipulated
and not take it personally.

Treatment for substance abuse, preferably on an in-patient basis,
would be recommended.

This adolescent is best treated in a very well-controlled environment
with explicitly clear expectations for behavior, and well-defined,
predetermined consequences for non-compliance. Behavioral
interventions are most appropriate. Strict limits and enforced
consequences will get the child's attention. The manipulator should
be managed with direct and immediate intervention, but without
rejection or hostility from the adult. There must be continuous open
communication between adults who are working with this child,
including teachers, social workers, parents, employers, etc., to
prevent him from playing one authority against the other.

Despite the child's rejection of adults, the caseworker should relate
to the child as genuinely and openly as possible. The worker should
be empathetic and supportive, but should let the adolescent know
when she thinks his behavior is insincere. The worker should
acknowledge and reward any genuine expression of feeling. The
worker should also communicate that she values the child as a
person, even when she does not approve of his behavior. Attempts
should be made to engage the child in productive school or work
activities to build self-esteem and competence. The worker should
find ways to help the child reduce his fear of close relationships and
become more comfortable with directly expressing his feelings and
needs.

Residential treatment in a controlled group setting with therapists
who are well-equipped to deal with this type of child, or placement
in an exceptionally well-trained foster family, can also be
considered. The establishment of one good interpersonal
relationship should be considered a significant success.
Trainer's Guide for Follow-Up Discussion: Kathy

Kathy's cognitive development is at the formal operations level.
She has developed insight and is able to adopt the perspectives of
others.
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
Kathy's social development shows some immaturity, in that she is
willing to participate in activities she considers wrong to achieve
group acceptance. However, this is not abnormal for adolescents.
She appears to have developed conventional morality with clear
values of right and wrong. The excessively rigid moral values of her
parents might, in fact, contribute to rigid self-expectations and
assuming more shame and guilt than she should.

Kathy exhibits numerous signs of emotional distress and disturbance,
which are likely a result of ongoing sexual abuse. She is extremely
anxious and chronically depressed. Under her compliant exterior,
she is an angry child. Her anger erupts in areas that are well
removed from their source, for example, it is exposed to peers over
minor matters. She is not able to express her anger directly toward
her parents; it is too frightening. Kathy's depression should also be
taken seriously. Her potential for suicide should be thoroughly
assessed.

Kathy has approached the school counselor many times, but she
does not open up to her. Kathy would be accessible in a stable,
supportive relationship with an adult counselor.
Treatment for Kathy

Assuming that the sexual abuse is substantiated, father should be
asked to leave the home until specific mental health treatment
goals are met and it is safe for him to return home. Her father must
be able to accept responsibility, and her mother must be able to
genuinely support her, if she is to be helped to resolve her problems
within her home setting. Trainer Note: The OCWTP Sexual Abuse
Intervention Series workshop, “Case Closure and Reunification”
contains information about therapeutic milestones in sexual abuse
cases.

If this is not possible, placement out of the home and emancipation
services should be considered if Kathy's family is not amenable to
treatment.

Crisis intervention and long-term individual counseling with a
therapist who is skilled in working with sexually-abused youngsters is
recommended for Kathy. Her mother and father should also be
referred for counseling with a therapist who is knowledgeable
about treatment of sexual abuse.
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
Joint counseling with Kathy, mother, and father, should be
considered only after the necessary pre-requisite therapeutic goals
have been achieved in individual counseling. However, it is
questionable whether Kathy's parents will be amenable to
treatment. Her father, particularly, displays some traits suggestive of
personality disorder. Whether her mother can be worked with is
questionable.

Kathy needs to develop relationships with trusted, consistent,
accepting, and supportive adults who can be there when needed.
The caseworker, therapist, or advocate/volunteer can fill this role.
Foster caregivers can assist with this function, if Kathy is placed out
of the home.

Therapy should focus on Kathy's feelings and should provide
opportunities for her to express her anger, guilt, and shame in
response to the sexual abuse. Therapy should help her to develop
a positive self-image and an accurate perception of her role and
response to the sexual abuse situation. Kathy will be able to control
her behavior better when she has developed a more realistic
perception of her situation, and is less anxious and depressed.

Therapy should focus on continued self-development, and on
improving self-esteem through positive mastery of school, work, and
interpersonal activities.

Kathy's depression should be taken seriously, and the potential for
suicide thoroughly assessed and explored. A medical evaluation to
assess the value of antidepressant medication
might be
considered.
Participation in a support/treatment group with other sexuallyabused teens would be recommended.

Trainer's Guide for Follow-Up Discussion: Lee

Lee functions at a concrete operational level of cognitive
development. He understands rules, but views them as
manifestations of power and authority rather than as structures for
justice and social guidance. He has limited perspective taking
ability. He knows that people are different form him, but has no
insight into other people's feelings and behaviors.
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
His moral development is at a pre-conventional level. He complies
with rules without question if they are backed by authority.

He understands that there is a system to getting along in the world.
However, he believes the answer is outside of himself. His success is
determined by aligning with the "right people," that is, adults or
peers who have power, and therefore, have the key to success.

His lack of awareness of other people's needs and feelings, and his
low self-esteem, contribute to deficiencies in social skills. His peer
relationships are poor. More socially-competent peers see him as
inept and do not include him in their activities, except as a tag
along. He is not given equal status.

His emotional development has been thwarted, but not at the level
of trust (he appears to be very trusting, and in fact, is open to letting
others help him.) He lacks autonomy and exhibits little self-direction.
His opinions and actions are determined by anyone in close
proximity, whom he perceives as having power and authority. He
has very low self-esteem. He lacks initiative and industry as well. His
concept of himself is in very concrete terms. He has no insight into
his feelings, nor can he describe what makes him different from
other people. He would have considerable difficulty establishing a
stable sense of identity.

He has potentially good relationship ability. He looks to others for
help, and would not be difficult to engage in relationships. He
would not participate as an equal member of a relationship, but
would behave much as a younger child would with an esteemed
adult.
Treatment for Lee

Treatment goals are to develop Lee's self esteem and his awareness
of himself as a capable, important individual. To do this, he will
need to learn how his behavior affects others, learn to recognize his
own feelings and what generates them, and begin to think about
his likes, dislikes, and wants apart from others opinions.

Positive, consistent, and nurturing relationships with caring adults in
therapeutic roles can be very effective treatment strategies. The
caseworker/therapist should work individually with this child,
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perhaps using activities as a focus, to promote social and emotional
development.

A structured therapeutic peer-group can teach Lee social skills and
help him assert himself in a group. The opportunity to identify with
accepting, competent peers is also suggested. If this child needs
placement, a treatment-oriented foster home is recommended.
The child should not be placed in a group setting.

The child is not ready for insight therapy. Reality therapy, positive
reinforcement for appropriate behaviors, and the use of positive
relationship would be recommended.

Differential reinforcement is preferred to punishment. Natural and
logical consequences should be used as discipline to reinforce the
concept that his behavior affects what happens to him. Adult
attention should be made contingent upon desirable behaviors.
Do not spend hours talking to this child about what he did wrong.
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SECTION VII:
EVALUATION AND CLOSE
Time: 20 minutes
Materials:
Action Planning Forms
Developmental Milestones Chart
Worksheet Ages 3 – 5
Post – training assignment:
Using Tools to Assess Development
Workshop evaluation form
Trainer Instruction

Instruct participants to complete their Action Plans, and ask a few
participants to describe how they will use information from the
workshop in their work.

Ask participants to take the Milestones Chart with them to Module VIII:
"Separation, Placement and Reunification" since they will use the chart
in that workshop.

Distribute the Post – Training Assignment handout, and ask them to
complete it during the next two weeks. Inform participants that this
post-training exercise was designed to help them apply and practice
some of what they have learned during this training. The assignment
will instruct them to use some of the tools discussed during training to
observe and assess the development of a child. When the assignment
is completed, they should discuss their conclusions with their
supervisors.

Distribute the workshop evaluation form, and ask participants to
complete it, including constructive feedback about how the workshop
could be improved.

Share any additional closing thoughts, and close the workshop.
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