Islamic University of Gaza
Faculty of Nursing
Lectures in Human
Growth and Development
Nurs. 321
Collected and prepared by:
Ali Hassan Abu Ryala
2013-2014
Growth and Development
Introduction
•
Human growth and development are orderly, predictable processes beginning with
conception and continuing until death.
•
All persons progress through definite phases of growth and development from simple
to complex, and highly individualized rate
•
It is the ability to progress through each developmental phase influences the holistic
health of individual.
•
The success or failure experienced within a phase may affect the ability to compete
subsequent phase.
•
If individuals experience repeated developmental failures, inadequacies may result.
•
When individual experiences repeated successes, health is promoted.
•
Understanding normal growth and development help nurses predict, prevent, and
detect any deviation from client’s normal expected patterns.
•
A clear understanding of those patterns assists the nurse in planning questions for
health screening, health history, and health teaching for client of all ages.
•
As infants and children grow and mature, they pass through predictable stages of
development.
•
Knowledge and assessment of growth and development help the nurse provide
screening for physical and emotional problems.
•
Offer anticipatory guidance to parents and caregivers.
•
Develop a relationship with the child to enhance the provision of health care.
Growth
•
Growth is a series of anatomical and physiological changes which after the body’s
size and composition.
•
Growth is an increase in size by multiplication of cells, and increase in numbers and
intracellular substance.
•
It is a continuous process although the rate of growth is far more obvious during the
first year of life than any other time.
•
Growth is measurable.
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Development
•
Development refers to the continuous process of unfolding and elaboration of
behavior which is results from the interaction
between human organism and
environment over the life.
•
Development is a maturation of organs and systems.
•
Development is gaining of skills, ability of adaptation, assume responsibilities,
•
Development is not measurable
•
Learning is implicated in development although it is not the same.
DEVELOPMENTAL SCREENING
•
Assessment tools have been created to determine the overall developmental age of a
child or to detect specific areas of development that are lacking.
•
The most widely used developmental screening tool is the Denver II Developmental
Screening Test (Denver II).
•
This tool provides for a quick overview of development in children from birth to age
6 years and identifies areas of strength and weakness relative to age norms.
•
Another method for developmental screening involves interviewing the parent or
caregiver about attainment of developmental milestones.
•
Persistent deficits or deficits in multiple areas indicate a more serious problem than
deficits in a single area.
Maturation
•
Maturation is the process of aging.
•
Involves individual’s biological ability, physiological condition, and desire to learn
more mature behavior
•
To mature, individual may have to give up previous behavior and learning, integrate
new pattern into existing behavior, or both.
•
Maturation influences the sequence and timing of changes associated with growth and
development.
For example: The infant relinquishes crawling for walking because walking permits more
extensive investigation of environment and more learning.
Differentiation
•
It is the process by which cells and structure become modified and develop more
refined characteristic.
•
It is simple-to-complex development of activities and functions.
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•
For example: Empryonal cells begin as vagus and undifferentiated and develop into
complex, highly diversified cells, tissues and organs.
Major Factors affecting growth and development
The human being is complex, open system, influenced by natural forces from within and
from the environment.
Forces of nature
•
Heredity
*it is responsible for characteristics of pattern growth, some familiar
diseases
•
Temperament
External forces
•
Family
*sleep, rest, and exercise (bed ridden vs. healthy child)
•
Peer group
*state of health
•
Life experiences
*living environment
•
Health environment
•
Prenatal health
•
Nutrition
*deficiencies produce growth defects, as rickets
•
Injury and illness
*occurring during birth or later, can affect G&D through damage
they cause vital organs
Principals of development
•
Development is a continues process
•
Development depends primarily on the maturation of nervous system.
•
The sequence of the development is much the same for all the children but the rate
will vary from child to child.
•
The direction of development is in the head to feet cephalocaudal direction.
•
Development involves differentiation of behavior.
•
Generalized mass activity gives way to specific individual response.
Domains of Development
•
Physical
•
Social
•
Emotional
•
Intellectual
•
Cognitive
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The descending stages of life
•
Conception
•
Uterine life (0-9 month)
•
Infancy (birth –1year)
•
Early childhood (1-6 years)
•
Late childhood (6-12 years)
•
Adolescence (12-20 years)
•
Young adulthood (20-40 years)
•
Middle age (40-65 years)
•
Old age (over 65years)
•
Death
Theory
•
Organized and logical set of statements about a subject, frameworks to clarify, to
make sense of.
•
Human Development Theory: Models intended to account for how and why people
become who they are, tries to explain and predict human behavior.
Why study theory?
•
Provides a framework
•
Offers logic for observations and explanations
•
How and why people act
•
Important for nurses to combine theory, practice, and research
•
Nurses assess responses to illness and treatments
What Do Theories Do?
•
Offer insight and guidance
•
Provide framework for acquiring new knowledge
•
Enhance communication of new knowledge.
Developmental Theories
Four areas of Theory Development
•
Biophysical Development
•
Psychoanalytic/ psychosocial development
•
Cognitive development
•
Moral development
Each theory describes the development stages and the tasks that should be accomplished in
each stage from perspective of the theorist.
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Significance
Help pediatric nurse to follow the development tasks that the child should accomplish in
his development stage and assists him/her in accomplishing them.
Developmental Theories
Biophysical development theory
•
•
•
Attempts to describe the way our physical body grow and change.
These changes are quantified and can compared against established norms.
Biological influences on development include many factors such as genetic, exposure
e to teratogens (infections, maternal disease, substance abuse, environmental
chemicals, or other hazardous substance).
Psychoanalytic/ psychosocial development theory
•
Attempts to describe the development of the human personality, behavior, and
emotions.
•
This development occurs with varying degrees of influence from internal biological
forces and external societal/ cultural forces.
•
These theories each have stages that the children go through while attempting to
resolve conflict between biological drives and social forces.
Cognitive Theory of development.
•
Is focused on reasoning and thinking processes, including the changes in how people
come to perform intellectual operations
•
These operations related to the way how persons learn to understand the world in
which they live.
•
Mental process; including perceiving, reasoning, remembering, believing, and permit
certain type of emotional behavior.
Example: the young child will have a different emotional reaction to the death of
grandparents as compared to an old sibling or a parent.
Moral Theory of development.
•
Focuses on discretion of moral reasoning which is (how people think about the rules
of ethical or moral conduct but doses not predict what a person would actually do in a
given situation).
•
Moral development is the ability of an individual to distinguish right from wrong and
develop ethical values on which to base his/her action
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Biophysical development theory
Arnold Gesell (1880-1961)
•
Arnold Gesell was psychologist
•
Arnold Gesell theory based on his observations of children as related to their physical
growth.
•
Although each child’s pattern of growth and development is unique, this pattern is
described by the activity of the genes.
•
Arnold Gesell belief that a child has to interact with nature in order to fully develop
and reach its potential. He fathered the theory of Maturation, which is the inner plan
that is developed by the action of the genes.
•
Gesell studied children’s development with intense observation and believed that
children are a bi-product of their environment and their internal make-up.
•
What he believed is that there are sequences to a child’s inner development that start
from conception and continue well after birth.
•
He stressed that a child definitely needed the social environment to realize his or her
potential but it should compliment the inner maturational principles.
•
He absolutely opposed teaching things to children that they were not ready to handle,
and felt it was important that children were not rushed into stages that posed a threat
to their internal growth.
•
The challenge that Gesell faced was unraveling the mystery behind the precise
mechanics of how the inner maturation worked.
•
He was only able to guess the approximate timing based on his observations.
•
The genes control maturation, and the genes determined the sequence, timing, and
form of emerging patterns that promote growth in children.
•
Gesell was a strong supporter of studying patterns; he felt that it helps determine the
process by which actions became organized.
•
He believes that all normal children go through the same sequences, but at their own
pace.
•
He believed that this pace is also driven by the child’s temperament and personality
that is associated with their genes and social environment.
•
When it came to child rearing he felt that parents needed to fully understand the laws
of maturation so that they would not force children into any of their own preconceived
patterns that is not naturally apart of the child’s inner make-up.
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•
Lastly he felt that teachers should adjust their instruction to the student’s age, grade,
growth rate, and their special talents and abilities.
•
This will allow for the child’s inner maturation pattern and the social environment to
work together
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Psychoanalytic/ Development
Sigmund Freud (1856-1939)
•
Sigmund Freud was the first person to provide a formal theory of personality
development.
•
Two internal biological forces essentially drive psychosocial change in the child:
sexual (libido) and aggressive energies.
•
Motivation for behavior is to achieve pleasure and avoid pain created by these forces.
•
The basis of fraud’s theory of development is derived from that the sexual energy of
the "id" finds different sources of satisfaction stages of psychosexual development.
•
Freud’s psychoanalytic model of personality development has 5 psychosexual
developmental stages associated with different pleasurable zones serving as the focus
for gratification and bodily pleasure.
Stage one: Oral (birth – 12mounths)
Infant gets pleasure from sucking and oral satisfaction (swallowing )
•
Oral receptive personality: when the child continue to seek the pleasure through the
mouth; overeating and smoking.
•
Oral aggressive personality: when oral pleasure is frustrated the child become
verbally hostile others
Stage two: Anal (1-3 yrs)
•
The focus of pleasure changes to the anal zone
•
Through the toilet-training process the child is asked to delay gratification in order to
meet parental and social expectation.
•
Anal retentive: if the child has excessive punishment for failure during toilet training,
the child is satisfied from holding back feces to show neatness.
•
Anal expulsive: child gains pleasure fro expelling the body’s waste products .If the
child is over satisfied in this stage he will defecate at inappropriate time and show
messiness.
Stage three: Phallic or Oedipal (3-6yrs)
•
The genital organs become the focus of pleasure
•
The time of imagination and as the child fantasizes about the parent of opposite sex as
his\her first love interest (Oedipal or Electra complex)
•
By the end of this stage the child attempts to reduce this conflict by identifying with
parent of the same sex in away to win recognition and accomptance.
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Stage four: Latency (6-11yrs)
•
Sexual urges, from the oedipal stage, are repressed and channeled into productive
activities that are socially acceptable; school work, riding bicycle, &playing.
•
Within the educational and social worlds of the child, there is much to learn and
accomplish.
Stage five: Gentile (Puberty thru Adolescence):
•
Sexual desires and interests are directed toward one’s pears.
•
Adolescent Boy girlfriend
•
Adolescent Female boyfriend
•
A time of turbulence when sexual urges reawaken and are directed to an individual
outside the family circle.
•
The beginning of a mature adult where sexual and aggressive "id" motives are
transformed into energy for marriage and occupation.
N.B:
These stages must be satisfied enough, if satisfied the person will become emotionally
mature if no the person will find difficulty and unresolved conflicts at any stage appears
through dreams or thoughts and inappropriate emotions.
Weakness of Freud theory
•
Based on limited sample
•
Little empirical support
•
Freud’s critics contend that the people are more influenced by their life experiences
than by their sexual energies
•
Freud based assumptions such as the oedipal complex are not applicable across
different cultures
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Psychosocial Development
Erik Erikson 1902-1994
•
Erikson's theory consist of eight stages of development.
•
Erik Erikson explains eight stages through which a healthily developing human
should pass from infancy to late adulthood.
•
In each stage the person confronts, and hopefully masters, new challenges.
•
Each stage builds on the successful completion of earlier stages.
•
The challenges of stages not successfully completed may be expected to reappear as
problems in the future
"The individual change from stage to other stage by achieving development tasks of each
stage"
Psychosocial Stage 1 - Trust vs. Mistrust
•
The first stage of Erickson’s theory of psychosocial development occurs between
birth and one year of age and is the most fundamental stage in life.
•
Because an infant is utterly dependent, the development of trust is based on the
dependability and quality of the child’s caregivers.
•
If a child successfully develops trust, he or she will feel safe and secure in the world.
Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to
feelings of mistrust in the children they care for. Failure to develop trust will result in
fear and a belief that the world is inconsistent and unpredictable.
Psychosocial Stage 2 - Autonomy vs. Shame and Doubt
•
The second stage of Erikson's theory of psychosocial development takes place during
early childhood and is focused on children developing a greater sense of personal
control.
•
Like Freud, Erikson believed that toilet training was a vital part of this process.
However, Erikson's reasoning was quite different then that of Freud's. Erikson believe
that learning to control one’s body functions leads to a feeling of control and a sense
of independence.
•
Other important events include gaining more control over food choices, toy
preferences, and clothing selection.
•
Children who successfully complete this stage feel secure and confident, while those
who do not are left with a sense of inadequacy and self-doubt
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Psychosocial Stage 3 - Initiative vs. Guilt
•
During the preschool years, children begin to assert their power and control over the
world through directing play and other social interaction.
•
Children who are successful at this stage feel capable and able to lead others. Those
who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of
initiative.3
Psychosocial Stage 4 - Industry vs. Inferiority
•
This stage covers the early school years from approximately age 5 to 11.
•
Through social interactions, children begin to develop a sense of pride in their
accomplishments and abilities.
•
Children who are encouraged and commended by parents and teachers develop a
feeling of competence and belief in their skills.
•
Those who receive little or no encouragement from parents, teachers, or peers will
doubt their ability to be successful.
Psychosocial Stage 5 - Identity vs. Confusion
•
During adolescence, children are exploring their independence and developing a sense
of self.
•
Those who receive proper encouragement and reinforcement through personal
exploration will emerge from this stage with a strong sense of self and a feeling of
independence and control.
•
Those who remain unsure of their beliefs and desires will insecure and confused about
themselves and the future.
Psychosocial Stage 6 - Intimacy vs. Isolation
•
This stage covers the period of early adulthood when people are exploring personal
relationships.
•
Erikson believed it was vital that people develop close, committed relationships with
other people. Those who are successful at this step will develop relationships that are
committed and secure.
•
Remember that each step builds on skills learned in previous steps.
•
Erikson believed that a strong sense of personal identity was important to developing
intimate relationships.
•
Studies have demonstrated that those with a poor sense of self tend to have less
committed relationships and are more likely to suffer emotional isolation, loneliness,
and depression.
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Psychosocial Stage 7 - Generatively vs. Stagnation
•
During adulthood, we continue to build our lives, focusing on our career and family.
•
Those who are successful during this phase will feel that they are contributing to the
world by being active in their home and community.
•
Those who fail to attain this skill will feel unproductive and uninvolved in the world.
Psychosocial Stage 8 - Integrity vs. Despair
•
This phase occurs during old age and is focused on reflecting back on life.
•
Those who are unsuccessful during this phase will feel that their life has been wasted
and will experience many regrets. The individual will be left with feelings of
bitterness and despair.
•
Those who feel proud of their accomplishments will feel a sense of integrity.
•
Successfully completing this phase means looking back with few regrets and a general
feeling of satisfaction.
•
These individuals will attain wisdom, even when confronting death.
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Cognitive Development
Jean Piaget (1896-1980)
•
Jean Piaget is the most well known psychologist this field and who has influenced the
care of children.
•
Piaget was biologist who interested in children's thinking , in his work he attend to
find explanations for the ways in which children come to understand their work and
make judgment about it.
•
His studies were based on the development of the children ability to solve problems.
•
This involved interviews which used an open ended conversations-Like technique for
electing children Reponses.
•
Piaget concluded that children’s thinking develops in stages and that each stage is
prerequisite for the next one.
•
He gave an approximate age ranges for each stages with each stages thinking becomes
more complex until the child reach maturity.
•
His theory is based on using experiences to bile on their understanding.
•
Piaget divided schemes that children use to understand the world through four main
periods.
1. Sensorimotor period
2. Preoperational period
3. Concrete operational period
4. Formal operational period
Period One: Sensorimotor (birth- 2yrs)
•
The earliest kind of thought occurs through out the first 2 years of life.
•
The main quality characterizing the period is that thought drives from sensation and
movement and is so linked to child’s motor and sensory experiences.
•
Sensorimotor period consists of observing and adaptively manipulating one’s body
and environment with the earliest Sensorimotor input revolving around the feeding
experiences for example the infant gradually becomes able to organize information
and mentally coordinate the several related components of the experience such as
sucking ‘feeling ‘seeing ‘and tasting
Object permanence
•
Piaget claimed that babies under 8 months of age don’t have concept of permanence
i.e. once an object is out of sight they do not understand that is still exists
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•
His explanation for this was that they do not have the concept of permanence because
they can’t image of the object in it’s absence
•
Between 8months and 2years this concept develops so that by the age of 2 child
understands that things go in happening and objects have their own independent
existence
•
So the baby begins to search for an absent object rather than turning attention from it
when it disappeared
Reaching goals
•
Goal directed behavior appears in infancy and gradually include alternative ways of
achieving a goal
•
By the age of 12 months an infant can to search for toy that has rolled under a chair
and out of sight as discussed above
•
Also infant can go around a chair to repossess the toy rather than having to follow the
same path the toy took to end up under the chair
•
The 12 months- old begins to find a variety of ways to produce an outcome other than
process by which the event has occurred in the child ‘s past experience
Cause and effect
•
During the Sensorimotor period the infant gains primitive grasp of the connection
between cause and effect and becomes active in making things happen in accordance
with intention
•
The older infant can carry out a short series of related goal directed activities
•
Even by second birth day however the child is severely limited in his ability to think
which is bound to the concert aspects of sensation and activity and cant conceptualize
or deal abstractly with things beyond the scope of Sensorimotor experience
Period Two: Preoperational thought )2 to 7 years of age)
•
From 2to 7 years of age the child progresses through the preoperational thought
period
•
The preoperational thinker deals at a much higher level with symbols
•
In this stage uses language and memory and has a growing understanding of past ,
present , and future
•
However the child is not capable of understanding the fundamental relationships
between things or events
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Errors in thinking
•
Preoperational thinking is crazy by adult standards and leave’s the child with many
misunderstanding erroneous conclusion that may be quite surprising to older children
and adults
•
The preoperational child cannot coordinate several properties (e.g. size, color, shape
and number) of objects and event.
•
For example the preoperational thinker may correctly agree that object A is bigger
than object B but at the same time deny that B is smaller than A
•
A child at this age if given a marble and penny then a second marble and a second
penny and so forth one by one until there are an equal part of each
•
Will report that there are more marbles than pennies because the marbles take up
more space than pennies or there is more pennies
•
Because the coins make a tall stake
•
The child cannot’ understand that if one takes tow clay balls the same size and flattens
one into new shape the tow masses still contain equal amount of clay
•
Piaget attribute these error in understanding to the child’s not having yet developed
the concept of reversibility , or the ability to conceptualize that a completed process
can be preformed in reverse order so that the materials involved are returned to their
initial condition before age 7 or so a child does not grasp the basic relationship
between object or events to understand the process of transition
•
Preoperational thought is characterized by egocentrism. the preschoolers and early
school age are unable to take another point of view
•
Hence he is annoyed because another doesn’t know what the child has dreamed
•
Preschooler believe their experiences are universal and even the event revolve
around them to the extent demonstrated by a preschool child who when asked to
explain the sun’s daily movement across the sky “ replied it follow me “
•
Another characteristic of preoperational thought
is centering which is the tendency
to center attention on one feature of something and to see unable to see its’ other
qualities
•
The child with the marbles and pennies attend only to size of collection and deny its’
numerical features even though he was able to count
Period Three: Concrete operational thought (7 to 11 years)
•
In this stage the child gradually overcomes the earlier egocentrism and centering and
masters the concept of reversibility mentioned above, and conservation.
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•
Conservation refers to the ability to understand that a thing is essentially the same
even though its shape or arrangement is altered.
•
The previously mentioned example off clay masses is a problem in conservation of
mass.
•
Conservation of numbers is demonstrated by Piaget’s experiment in which a child
watches a fixed numbers of objects are collected together or spread out over a surface.
•
A preoperational child judges that the number of items is modified by their
concentration in space but a child in the stage of concrete operation doesn’t make that
mistake.
•
During the period of concrete operations the child becomes skilled at classifying
objects
•
Obviously the child of 11 has come a long way toward being able to observe , analyze
and understand
Period Four: Formal Operations (11yrs- adulthood)
•
The child doesn't attain a fully adult quality of thinking until the last stage of
cognitive development which called formal operations period
•
The changed between 11 and15 are enables the child to think introspectively and
solve complicated , abstract problems such as logical calculus
•
The young person can now form and test hypotheses
that require imaginative
departures
•
The new capacity to imagine how things might be if they were not as they are has
many sequences including empathy and compassion
•
“How would I feel if it happened to me “.
•
The idealism perhaps combined with intolerance.
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Moral Development
Jean Piaget (1896-1980)
•
Moral development theories try to explain “how individuals acquire moral values and
how such values help guide the way persons treat other people” (Thomas, 1977)
•
Piaget s Theory of moral development presented 3 stages of morality:
Premoral Stage.
•
The child has no obligation to rules
Conventional Stage.
•
Children follow the rules set up by those in authority, such as their parents, teacher,
religious people, and police.
Autonomous Stage.
•
Moral judgments are based on mutual respect for the rules.
•
The person considers the consequences of a moral decision.
Moral Development
Lawrence Kohlberg : (October 25, 1927)
•
Was an American psychologist born in Bronxville, New York, who served as a
professor at the University of Chicago as well as Harvard University.
•
Famous for research in moral education, reasoning, and development, he developed
stages of moral development.
•
A close follower of Jean Piaget's theory of cognitive development, Kohlberg's work
reflects and extends his predecessor's ideas, at the same time creating a new field
within psychology: "moral development.
•
Kohlberg initially interviewed boys at 10, 13, and 16 years.
•
Form series of moral dilemmas, he identified six stages of moral development under
three levels.
•
Kohlberg found a link between moral development and piaget’s cognitive
development.

A child’s moral development didn’t advice if the childes cognitive development
didn’t also mature
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Level 1 (Preconventional)
Stage One: Punishment and Obedience orientation.
•
I must follow the rules; otherwise I will be punished.
•
The child will be home on time for supper because.... authority
Stage Two: Instrument Relativist orientation.
•
The child recognizes there is ore than right view.
•
The decision to do something morally right is based on satisfying one’s own needs,
and occasionally the needs of others
Level 2 (Conventional)
•
The person see moral reasoning based on his/her personal internalization of social and
other’s expectations.
•
Example: End- of- life support for loved one
Stage Three: Good boy nice girl orientation.
•
The individual wants to win approval and maintain the expectations of one
immediate group.
•
Staying after school to win the teacher’s approval.
Stage Four: Society- maintaining orientation.
•
Individual expand their focus from a relationship with others to societal
concern
Level 3 (Postconventional)
•
Individuals move away from moral decisions based on authority or conformity to
group to define their own moral values and principals.
•
Individuals start to look at what an ideal society would be like
Stage five: Social contract orientation.
•
An individual may follow the societal law but recognize the possibility of
change the law to improve society
•
Laws viewed as social contract but can be changed by democratic means.
Stage six: Universal ethical principles.
•
Defines rights by decision of conscience in accord with self choosen ethical
principles
•
Theoretical stage!!!!!!!!!
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Critics
•
Sample: males from western philosophies
•
Age and gender
•
Carol Gilligan believes there may be parallel ways that men and women developed
•
Separation and individuation are critically tied to male development
•
Male moral development may focus on: logic, justices, and social organization
•
Female moral development may focus on: interpersonal relationship
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FETAL GROWTH AND DEVELOPMENT
Previously, methods used to determine how well the fetus was growing and maturing
consisted of evaluating uterine growth and listening to fetal heart sounds. Advances in
knowledge and technology have provided newer methods for assessing fetal well-being and
maturity. Improved methods for assessment and diagnosis enable early intervention for
improved outcome.
Stages of Growth and Development
The growth and development of the fetus is typically divided into three stages.
Preembryonic Stage: Fertilization to 2 to 3 Weeks
•
Rapid cell division and differentiation
•
Develop embryonic membranes and germ layers
Embryonic Stage: 4 to 8 Weeks' Gestation
•
Most critical stage of physical development
•
Organogenesis
Fetal Stage: 9 Weeks to Birth
•
Every organ system and external structure present.
•
Refinement of fetus and organ function occurs.
Development by Month
First Lunar Month
•
Fertilization to 2 weeks of embryonic growth.
•
Implantation is complete.
•
Primary chorionic villi forming.
•
Embryo develops into two cell layers (trophoblast and blastocyst).
•
Amniotic cavity appears.
Second Lunar Month
•
3 to 6 weeks of embryonic growth.
•
At the end of 6 weeks of growth, the embryo is approximately (1.2 cm) long.
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•
Arm and leg buds are visible; arm buds are more developed with finger ridges
beginning to appear.
•
Rudiments of the eyes, ears, and nose appear.
•
Lung buds are developing.
•
Primitive intestinal tract is developing.
•
Primitive cardiovascular system is functioning.
•
Neural tube, which forms the brain and spinal cord, closes by the 4th week.
Third Lunar Month
•
7 to 10 weeks of growth.
•
The middle of this period (9 weeks) marks the end of the embryonic period and
the beginning of the fetal period.
•
At the end of 10 weeks of growth, the fetus is approximately (6.3 cm) from crown
to rump and weighs (14 g).
•
Appearance of external genitalia.
•
By the middle of this month, all major organ systems have formed.
•
The membrane over the anus has broken down.
•
The heart has formed four chambers (by 7th week).
•
The fetus assumes a human appearance.
•
Bone ossification begins.
•
Rudimentary kidney begins to secrete urine.
Fourth Lunar Month
•
11- to 14-week-old fetus.
•
At the end of 14 weeks of growth, the fetus is approximately (12 cm) crown-rump
length and (110 g).
•
Head erect; lower extremities well developed.
•
Hard palate and nasal septum have fused.
•
External genitalia of male and female can now be differentiated.
•
Eyelids are sealed.
Fifth Lunar Month

15- to 18-week-old fetus.
- 22 -

At the end of 18 weeks of growth, the fetus is approximately (16 cm) crown-rump
length and (320 g).

Ossification of fetal skeleton can be seen on x-ray.

Ears stand out from head.

Meconium is present in the intestinal tract.

Fetus makes sucking motions and swallows amniotic fluid.

Fetal movements may be felt by the mother (end of month).
Sixth Lunar Month

19- to 22-week-old fetus.

At the end of 22 weeks of growth, the fetus is approximately (21 cm) crown-rump
length and (630 g).

Vernix caseosa covers the skin.

Head and body (lanugo) hair visible.

Skin is wrinkled and red.

Brown fat, an important site of heat production, is present in neck and sternal area.

Nipples are apparent on the breasts.
Seventh Lunar Month

23- to 26-week-old fetus.

At the end of 26 weeks of growth, the fetus is approximately (25 cm) crown-rump
length and (1,000 g).

Fingernails present.

Lean body.

Eyes partially open; eyelashes present.

Bronchioles are present; primitive alveoli are forming.

Skin begins to thicken on hands and feet.

Startle reflex present; grasp reflex is strong.
Eighth Lunar Month

27- to 30-week-old fetus.

At the end of 30 weeks of growth, the fetus is approximately (28 cm) crown-rump
length and (1,700 g).
- 23 -

Eyes open.

Ample hair on head; lanugo begins to fade.

Skin slightly wrinkled.

Toenails present.

Testes in inguinal canal begin descent to scrotal sac.

Surfactant coats much of the alveolar epithelium.
Ninth Lunar Month

31- to 34-week-old fetus.

At the end of 34 weeks of growth, the fetus is approximately (32 cm) crown-rump
length and (2,500 g).

Fingernails reach fingertips.

Skin pink and smooth.

Testes in scrotal sac.
Tenth Lunar Month

35- to 38-week-old fetus; end of this month is also 40 weeks from onset of last
menstrual period.

End of 38 weeks of growth, fetus is approximately (36 cm) crown-rump length and
(3,400 g).

Ample subcutaneous fat.

Lanugo almost absent.

Toenails reach toe tips.

Testes in scrotum.

Vernix caseosa mainly on the back.

Breasts are firm.
- 24 -
Birth-4 Weeks (1 Month)
Motor development

Momentary visual fixation on objects and adult face.

Eyes follow bright moving objects.

Lies awake on back.

Immediately drops objects placed in hands.

Responds to sounds of bell and other similar noises.

Keeps hands fisted.
Socialization and vocalization

Mews and makes throaty noises.

Shows interest in human face.
Cognitive and emotional development

Reflexive.

External stimuli are meaningless.

Responses are generally limited to tension states or discomfort.

Gains satisfaction from feeding and being held, rocked, fondled, and cuddled.

Has an intense need for sucking pleasure.

Quiets when picked up.
4-8 Weeks (2 Months)
Motor development

Reflexive behavior is slowly being replaced by voluntary movements.

Turns from side to back.

Begins to lift head momentarily from prone position.

Shows eye coordination to light and objects.

If bell is sounded nearby, infant will stop activity and listen.

Eyes follow better, both vertically and horizontally. Focuses well.
Socialization and vocalization
- 25 -

Begins vocalization, especially to a voice.

Crying becomes differentiated.

Visually looks for sounds.

May squeal with delight when stimulated by touching, talking, or singing.

Begins social smile.

Eyes follow person or object more intently.
Cognitive and emotional development

Recognizes familiar face.

Becomes more aware and interested in environment.

Anticipates being fed when in feeding position.

Enjoys sucking puts hand in mouth.
8-12 Weeks (2-3 Months)
Motor development

When prone, will rest on forearms and keep head in midline makes crawling
movements with legs, arches back, and holds head high; may get chest off surface.

Indicates preference for prone or supine.

Discovers hands bats objects with hands.

Holds objects in hands and brings to mouth.

Has fairly good head control.
Socialization and vocalization

Smiles more readily, babbles and coos.

Stops crying when mother enters room or when caressed.

Enjoys playing during feeding.

Stays awake longer without crying.

Turns head to follow familiar person.
Cognitive and emotional development

Shows active interest in environment.

Recognizes familiar faces and objects.

Focuses and follows objects.
- 26 -

Shows repetitiveness in play activity.

Is aware of strange situations.

Derives pleasure from sucking purposefully gets hand to mouth.

Begins to establish routine preceding sleep.
12-16 Weeks (3-4 Months)
Motor development

Eyes focus on small objects, may pick a dangling ring.

Holds head up (when being pulled to sitting position).

Becomes more interested in environment.

Hand comes to meet rattle.

Listens turns head to familiar sound.

Sits with minimal support.

Intentional rolling over, back to side.

Reaches for offered objects.

Grasps objects with both hands, and everything goes into mouth.
Socialization and vocalization

Laughs and chuckles socially.

Demands social attention by fussing.

Recognizes mother.

Begins to respond to mothers voice.

Enjoys being propped in sitting position.
Cognitive and emotional development

Actively interested in environment.

Enjoys attention; becomes bored when alone for long periods.

Recognizes bottle.

More interested in mother.

Indicates increasing trust and security.

Sleeps through night; has defined nap time.
- 27 -
16-26 Weeks (4-7 Months)
Motor development

Shows momentary sitting with hand support.

Bounces and bears some weight when held in standing position.

Transfers and mouths objects in one hand.

Discovers feet.

Bangs objects together.

Rolls over well.

May begin some form of mobility.
Socialization and vocalization

Discriminates between strangers and familiar people.

Crows and squeals.

Starts to say Ma, Da.

Play is self-contained.

Laughs out loud.

Makes talking sounds in response to others' talking.

Begins fear of strangers, 8 -10 months
Cognitive and emotional development

Secures objects by pulling on string.

Searches for lost objects that are out of sight.

Inspects objects; localizes sounds.

Likes to sit in high chair.

Drops and picks up objects.

Displays exploratory behavior with food.

Exhibits beginning fear of strangers.

Becomes fretful when mother leaves.

Shows much mouthing and biting.
- 28 -
26-40 Weeks (7-10 Months)
Motor development

Sits without support.

Recovers balance.

Manipulates objects with hands.

Unwraps objects, Creeps.

Pulls self upright at crib rails.

Uses index finger and thumb to hold objects.

Rings a bell.

Can feed self a cracker and can hold a bottle. Chewing reflex develops.

Can control lips around cup.

Does not like supine position.

Can hold index finger and thumb in opposition.
Socialization and vocalization

Claps hands on request.

Responds to own name.

Is very aware of social environment.

Imitates gestures, facial expressions, and sounds.

Smiles at image in mirror.

Offers toy to adult, but does not release it.

Begins to test parental reaction during feeding and at bedtime.

Will entertain self for long periods.
Cognitive and emotional development

Begins to imitate.

Shows more interest in picture books.

Enjoys achievements.

Has strong urge toward independence locomotion, feeding, and dressing.
- 29 -
10-12 Months (1 Year)
Motor development

Cruises around furniture.

Beginning to stand alone and toddle.

Turns pages in book.

Tries tossing object.

Shows hand dominance.

Navigates stairs; climbs on chairs.

Builds a tower of 2 blocks.

Puts balls in box.

May use spoon.

Can release objects at will.

Have regular bowel movements.
Socialization and vocalization

Uses jargon.

Points to indicate wants.

Loves give-and-take game.

Responds to music.

Enjoys being center of attention and will repeat laughed-at activities.
Cognitive and emotional development

Shows fear, anger, affection, jealousy, anxiety, and sympathy.

Experiments to reach new goals.

Displays intense determination to remove barriers to action.

Begins to develop concepts of space, time, and causality.

Has increased attention span.
- 30 -
Growth and Development child form 1-6 years
12-18 Months
Motor development
•
Walks up stairs with help, creeps downstairs.
•
Walks without support and with balance.
•
Falls less frequently.
•
Throws ball.
•
Stoops to pick up toys, look at bug.
•
Turns pages of book.
•
Holds and lifts cup.
•
Builds 3-block tower.
•
Picks up and places small beads in container.
•
Begins to use spoon.
Cognitive and emotional development
•
Has vocabulary of 10 words that have meanings.
•
Uses phrases, imitates words.
•
Points to objects named by adult.
•
Follows directions and requests.
•
Imitates adult behavior.
•
Retrieves toy from several hiding places.
Psychosocial development
•
Develops new awareness of strangers.
•
Wants to explore everything in reach.
•
Plays alone, but near others.
•
Is dependent on parents, but begins to reach out for autonomy.
•
Finds security in a blanket, toy, or thumb sucking.
1 -2 Years
Motor development
•
Walks up and down stairs.
•
Opens doors; turns knobs.
- 31 -
•
Has steady gait.
•
Holds drinking cup well with one hand.
•
Uses spoon without spilling food (may prefer fingers).
•
Kicks a ball in front of him without support.
•
Builds a tower of 4-6 blocks.
•
Scribbles.
•
Rides tricycle or kiddies car (without pedals).
Cognitive development
•
Has 200-300 words in vocabulary.
•
Begins to use short sentences.
•
Refers to self by pronoun.
•
Obeys simple commands.
•
Does not know right from wrong.
•
Begins to learn about time sequences.
Psychosocial development
•
Uses word mine constantly.
•
Is possessive with toys.
•
Displays negativism uses no assertion of self.
•
Routine and rituals are important.
•
May begin cooperation in toilet training.
•
Resists restrictions on freedom.
•
Has fear of parents' leaving.
•
Shows parallel play.
•
Dawdles.
•
Resists bedtime uses transitional objects (blanket, toy).
•
Vacillates between dependence and independence.
2-3 Years
Motor development
•
Throws objects overhead.
•
Pedals tricycle.
•
Walks backward.
•
Washes and dries hands.
•
Begins to use scissors.
- 32 -
•
Can string large beads.
•
Can undress himself.
•
Feeds himself well.
•
Tries to dance.
•
Jumps in place.
•
Builds tower of 8 blocks.
•
Balances on one foot.
•
Swings and climbs.
•
Can eat an ice cream cone.
•
Drinks from a straw.
•
Chews gum without swallowing it.
Cognitive development
•
Shows increased attention span.
•
Gives first and last name.
•
Begins to ask why.
•
Is egocentric in thought and behavior.
•
Beginning ability to reflect on own behavior.
•
Talks in short sentences.
•
Uses plurals.
•
May attempt to sing simple songs.
•
Has vocabulary of 900 words.
•
Begins fantasy.
•
Begins to understand what it means to take turns.
•
Can repeat three numbers.
•
Shows interest in colors.
Psychosocial development
•
Negativism grows out of child's sense of developing independence says to every
command.
•
Ritualism is important to toddler for security (follows certain pattern, especially at
bedtime).
•
Temper tantrums may result from toddler's frustration in wanting to do everything for
self.
•
Shows parallel play as well as beginning interaction with others.
•
Engages in associative play.
•
Fears become pronounced.
- 33 -
•
Continues to react to separation from parents but shows increasing ability to handle
short periods of separation.
•
Has daytime bladder control and is beginning to develop nighttime bladder control.
•
Becomes more independent.
•
Begins to identify sex (gender) roles.
•
Explores environment outside the home.
•
Can create different ways of getting desired outcome.
3-4 Years
Motor development
•
Drawings have form and meaning, not detail.
•
Copies a circle and a cross.
•
Buttons front and side of clothes.
•
Laces shoes.
•
Bathes self, but needs direction.
•
Brushes teeth.
•
Shows continuous movement going up and down stairs.
•
Climbs and jumps well.
•
Attempts to print letters.
Cognitive development
•
Awareness of body is more stable; child becomes more aware of own vulnerability.
•
Is less negativistic.
•
Learns some number concepts.
•
Begins naming colors.
•
Can identify longer of two lines.
•
Has vocabulary of 1,500 words.
•
Uses mild profanities and name-calling.
•
Uses language aggressively.
•
Asks many questions.
•
May not be abstract enough to understand body parts that cannot be seen or felt.
•
Can be given simple explanation as to cause and effect.
•
Thinks very concretely; demonstrates irreversibility of thought.
•
Immature concept of death believes it is reversible.
•
Has beginning understanding of past and future.
•
Is egocentric in thought.
- 34 -
Psychosocial development
•
Is more active with peers and engages in cooperative play.
•
Performs simple tasks.
•
Frequently has imaginary companion.
•
Dramatizes experiences.
•
Is proud of accomplishments.
•
Exaggerates, boasts, and tattles on others.
•
Can tolerate separation from mother longer without feeling anxiety.
•
Is keen observer.
•
Has good sense of mine and yours.
•
Behavior still frequently ritualistic.
•
Becomes curious about life and sex. Often indulges in masturbation.
4-5 Years
Motor development
•
Hops two or more times.
•
Dresses without supervision.
•
Has good motor control climbs and jumps well.
•
Walks up stairs without grasping handrail.
•
Walks backward.
•
Washes self without wetting clothes.
•
Prints first name and other words.
•
Adds three or more details in drawings.
•
Draws a square.
Cognitive development
•
Has 2,100-word vocabulary.
•
Talks constantly.
•
Uses adult speech forms.
•
Participates in conversations.
•
Asks for definitions.
•
Knows age and residence.
•
Identifies heavier of two objects.
•
Knows weeks as time units.
•
Names days of week.
- 35 -
•
Begins to understand kinship.
•
Knows primary colors.
•
Can count to 10.
•
Can copy a triangle.
•
Has high degree of imagination.
•
Questioning is at a peak.
•
Begins to develop power of reasoning.
Psychosocial development
•
May have an imaginary companion.
•
Has a sense of order (likes to finish what was started).
•
Is obedient and reliable.
•
Is protective toward younger children.
•
Begins to develop an elementary conscience with some influence in governing
behavior.
•
Has increased self-confidence.
•
Accepts responsibility for acts.
•
Is less rebellious.
•
Has dreams and nightmares.
•
Is cooperative and sympathetic.
•
Shows generosity with toys.
•
Begins to question parents' thinking.
•
Identifies strongly with parent of same sex.
- 36 -
Growth and Development Child 6-12
Motor development
6 years
•
Is active and impulsive.
•
Balance improves.
•
Uses hands as manipulative tools in cutting, pasting, hammering.
•
Can draw large letters or figures.
7 years
•
Has lower activity level.
•
Capable of fine hand movements; can print sentences.
•
Nervous habits, such as nail biting, are common.
•
Muscular skills, such as ball throwing, have improved.
8 years
•
Moves with less restlessness.
•
Has developed grace and balance, even in active sports.
•
Has developed coordination of fine muscles, allowing child to write in script.
9 years
•
Uses both hands independently.
•
Has become skillful in manual activities because of improved eye-hand coordination.
Cognitive development
6 years
•
Begins to learn to read. Defines objects in terms of use. Time sense is as much in past
as present.
•
Is interested in relationship between home and neighborhood; knows some streets.
•
Uses sentences well; uses language to share others' experiences; may swear or use
slang.
•
Distinguishes morning from afternoon.
7 years
•
More reflective and has deeper understanding of meanings.
•
Interested in conclusions and logical endings. Begins to have scientific interests in
cause and effect.
- 37 -
•
More responsible in relation to time, is more punctual. Sense of space is more
realistic; child wants some space of own.
•
Knows value of coins.
•
Concept of death maturing includes idea of irreversibility.
8 years
•
Thinking is less animistic. Is aware of impersonal forces of nature. Begins to
understand logical reasoning, conclusions, and implications.
•
Less self-centered in thinking. Personal space is expanding; goes places on own.
Aware of time; plans events of day. Understands right from left.
9 years
•
Intellectually energetic and curious. Realistic; reasonable in thinking. Able to plan in
advance. Breaks complex activities into steps.
•
Focuses on detail.
•
Sense of space includes the entire earth.
•
Participates in family discussions.
•
Likes to have secrets.
•
Psychosocial development
5-9 years
•
Still requires parental support, but pulls away from overt signs of affection.
•
Peer groups provide companionship in widening circle of persons outside the home.
Child learns more about self as he learns about others.
•
Chum stage occurs at about age 9 or 10. Child chooses a special friend of same sex
and age in whom to confide. This is usually child's first love relationship outside of
home, when someone becomes as important to him as himself.
•
Play teaches the child new ideas and independence. Child progressively uses tools of
competition, compromise, cooperation, and beginning collaboration.
•
Body image and self-concept are fluid because of rapid physical, emotional, and
social changes.
•
Latency-stage sexual drive is controlled and repressed. Emphasis is on the
development of skills and talent.
•
Patterns of play
6-7 years
•
Child acts out ideas of family and occupational groups with which he has contact.
- 38 -
•
Painting, pasting, reading, simple games, watching television, digging, running
games, skating, riding bicycle, and swimming are all enjoyed activities.
8 years
•
Child enjoys collections; loosely formed short-lived clubs; table games; card games;
books; television; and records.
Late Childhood (9-12 Years)
Motor development
•
Energetic, restless, active movements such as finger-drumming or foot-tapping
appear.
•
Has skillful manipulative movements nearly equal to those of adults.
•
Works hard to perfect physical skills.
Cognitive development
10 years
•
Likes to reason, enjoys learning.
•
Thinking is concrete, matter of fact.
•
Wants to measure up to challenge.
•
Likes to memorize, identify facts.
•
Attention span may be short. Space is rather specific (ie, where things are).
•
Can write for relatively long time with speed.
11 years
•
Likes action in learning.
•
Concentrates well when working competitively.
•
Can understand relational terms, such as weight and size.
•
Perceives space as nothingness that goes on forever.
•
Can discuss problems.
•
Can conceptualize symbolically enough to understand body parts.
•
Can describe some abstract terms.
12 years
•
Enjoys learning.
•
Considers all aspects of a situation.
•
Motivated more by inner drive than by competition.
•
Able to classify, arrange, and generalize.
•
Likes to discuss and debate.
•
Begins conceptual thinking.
- 39 -
•
Verbal, formal reasoning now possible.
•
Can recognize moral of a story.
•
Defines time as duration; likes to plan ahead.
•
Understands that space is abstract.
•
Can be critical of own work.
Psychosocial development
•
Gang becomes important, and gang code takes precedence over nearly everything.
Gang codes are typically characterized by collective action against the mores of the
adult world. Here, children begin to work out their own social patterns without adult
interference. Early gangs may include both sexes; later gangs are separated by sex.
•
May strive for unreasonable independence from adult control.
•
Usually interested in religion and morality.
•
Has increased interest in sexuality.
•
May reach puberty; resurgence of sexual drives causes recapitulation of Oedipal
struggle.
•
Patterns of play
•
Continues to enjoy reading, TV, and table games.
•
More interested in active sports as a means to improve skills.
•
Creative talents may appear; may enjoy drawing, and modeling clay. By age 10, sex
differences in play become profound.
•
Occasional privacy is important.
•
Begins to have vocational aspirations.
- 40 -
Adolescent Growth and Development
Early Adolescence (12-14 Years)
Motor development
•
Usually uncoordinated; has poor posture.
•
Tires easily.
Cognitive development
•
Mind has great ability to acquire and use knowledge.
•
Abstract thinking is sufficient to learn multivariable ideas such as the influence of
hormones on emotions.
•
Categorizes thoughts into usable forms.
•
May project thinking into the future.
•
Is capable of highly imaginative thinking.
Girls:

Physical changes include beginning of menarche; growth of axillary and perineal hair;
deepened voice; ovulation; further development of breasts.

Nutritional need for iron and calcium increase dramatically.
Boys:

Physical changes include growth of axillary, perineal, facial, chest hair; deepening of
voice; production of spermatozoa; nocturnal emissions.
Child development theories

Freudian: 12-14 years Begins Stage of Sexuality

Eriksonian: 12-14 years Identity vs. Role Diffusion

Piagetian: 12-14 years Begins Stage of Formal Operations
Psychosocial development
•
Interest in opposite sex increases.
•
Often revolts from adult authority to conform to peer-group standards.
•
Continues to rework feelings for parent of opposite sex and unravel the ambivalence
toward parent of same sex.
•
Affection may turn temporarily to an adult outside of the family (for example, crush
on family friend, neighbor, or teacher).
- 41 -
•
Uses peer-group dialect highly informal language or specially coined terminology.
•
Peer groups are especially important and help adolescent to define own identity, to
adapt to changing body image, to establish more mature relationships with others, and
to deal with heightened sexual feelings. Cliques may develop.
•
Dating generally progresses from groups of couples to double dates and finally single
couples.
•
Teenage hangout becomes important centers of activity.
•
Begins questioning existing moral values.
Adolescence

This is the transition from childhood to adulthood

The time for formulating a sense of personal identity

The time for gaining liberation from the family unit

The time for driving moms and/or dads out of their minds

The age of adolescence is generally regarded as 11-19 years (this is very flexible)

Some persons continue to function as adolescents well into the 20’s or more
Teenage years

This is the beginning of the transition from childhood to adulthood

The term puberty is restricted to PHYSIOLOGIC phenomena

Notice the difference between the definition of adolescence and puberty

Puberty is a stage of adolescence
True teenage years

This the point at which reproduction is possible

Reproductive capabilities are internal phenomena

True puberty, therefore, is not noticeable externally
Cognitive Development

Concrete Operations (Ages 7-11) - The child can deal with properties of the
immediately present world in solving new problems
- 42 -

The child can not yet deduce (reach conclusions by reasoning) or reason
hypothetically

Reason at this level is inductive (they made decisions based on the influence of
others) Formal operations (ages 12-15)

Child develops capacity to make free use of hypothetical reasoning

Learns to attack problems from the angle of all possible combinations of relations

Can systematically isolate variables

Become INTROSPECTIVE
Criteria indicating the presence of formal operations include:

Ability to manipulate two or more variables at once

Must be able to demonstrate changes that come with time

Ability to hypothesize about the logical consequences of events

Ability to foresee the consequences of his or her actions

Must be able to detect the logical consistency within a statement

Must think realistically about self, others, and their world

Must be able to think without egocentrism (thinks about the whole and not the self)
Gender Differences


Menarche
o
The first menstrual period
o
This event separates the prepubertal from the postpubertal girl
Nocturnal Emissions
o
This is a guy thing
o
More arbitrary
o
This is the division between prepubertal and postpubertal boys
Reproductive Maturity
Gametogenesis is usually delayed for one to two years after external
phenomena are exhibited.
Generalities of Changes in Adolescence

Rapid growth (early in adolescence)
- 43 -

Confused by changes

Curious about final outcome

Personal interest in their own development

Measure my height!

I need a new bra!
Teenage years - Early Adolescence

Rebellion against home

Vacillation between considerable maturity and babyishness

Absorption with close friend of same age and sex

Moodiness

Sloppiness & disorder (Matthew!)

Establishment of independence of self: “Who am I?” “ What kind of person am I?”

Rapid growth

Body-conscious

Appearance of sexual maturity

Skin problems

Constantly hungry (more than during young years)

Companionship at meals and at after-school snacks provides dining pleasure

Sleeps more than during younger years

Sleepy at “getting up” times

Wants to sit up at night as sign of increasing maturity

Clash between physiology and culture
Teenage years - Early Adolescence Special Characteristics of Boys

Boisterous

Clumsy

Secretive, “clams up at home.”

Aggressive

Dirty - Can’t seem to get the kid near the bathroom

Boys in puberty gain more weight and height than girls

Much talk about sex and girls

Out of house more and more

Much talk about sex and girls
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
Out of house more and more

More talk about sex and girls
Teenage years - Early Adolescence Special Characteristics of Girls

Vague and diffuse

Crush on older men

Interested in romantic love

Playacting

Talkative, but not communicative

Giggly!!
Early Adolescence

Boys express their sexuality through masturbation

Same-gender sexual encounters are relatively common

These occur frequently enough to be considered as a variant of normal sexual
development

Questions that adolescents have about erotic feelings or behaviors toward the same
sex need to be addressed directly and fully explored

NOT HELPFUL: Tell the adolescent that this is no more than a passing stage of
development
Middle Adolescence

Often the greatest experimental, risk-taking time

Drinking, drugs, smoking, and sexual experimentation are often of the highest interest
to those between 12 and 16 years

This is when first intercourse, first drink, or first pregnancy occur

Adolescents in this phase of development often have little concept of cause and effect

Omnipotence and invulnerability are the rule

This results in an inability to link drinking with auto accidents - drinking with
pregnancy or STD’s

Striving for independence and autonomy is greatly increased

Parental conflicts occur which need confrontation and resolution

Teenage-parental conflicts are normal and necessary
- 45 -

Adolescents confide in each other

Sexual development results in unpredictable surges in sexual drive

This is accompanied by unavoidable sexual fantasies and impulses

Sexuality is the MAJOR preoccupation of the middle adolescent

Sexual activity occurs more frequently among boys than girls. Possibly because:

Females less likely to discover sexual responses spontaneously because their sexual
organs are less prominent and less subject to manipulation

Testosterone increases are found in both boys and girls but much more abundant in
boys

High testosterone found in males may result in greater sexual aggressiveness and
more purely physical drives and gratifications

Girls tend to view sexual gratification as secondary to fulfillment of other needs such
as love, affection, self-esteem, and reassurance

Girls, thus, are less likely to abstain from sex in a relationship

Motivation to participate in sexual activity can arise for two reasons:

To gratify true sexual impulses

To gratify nonsexual needs (achieve sense of closeness to someone, bolster selfesteem, to consolidate gender identity, or to act out against authority
Late Adolescence - Both Sexes

Rebellious

Concerned with personal appearance (can’t get them out of the bathroom)

Moody

Interest in opposite sex

Establishment of ego identity - “Where do I fit into the world?”

Ambiguity of society toward adolescent helps to compound the problem

Growth finally subsided

Full stature almost attained

Sleep requirements approaching adult level

Food requirements approaching adult level

Companionship when eating

Intimate relation with buddy fades

Greater interest with opposite sex

Needs acceptance by society, in job, and in college
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
Needs parental respect for opinion and acceptance of maturity

The big question: “Who am I as a vocational being?”

Work opportunities during the late adolescent years allow exploration of tentative
career choices

A choice of a vocation reinforces the adolescent’s self-concept and is important to
identity formation
Late Adolescence

Factors influencing vocational choice:

Family values

Social class

Socioeconomic conditions

Need for prestige

Volitional independence

Special abilities

Motivation

Vocational indecision commonly caused by:

Family influence: Dad’s a doctor and I want to be a rock star

The individual’s interests: This is when the adolescent is talented and/or interested in
more than one area, thus, what should that person chose as a vocation
Special Characteristics of Boys in Late Adolescence

Sexual problems prominent and demanding

Interest in plans for career

Less interested than girls in mate seeking
Special Characteristics of Girls in Late Adolescence

Interest in boys, now directed toward mate seeking

Absorbed in fantasies of romantic love

Less interested than boys in plans for career

Sexual problems less demanding than in boys
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Adult hood Growth and Development
Age (20-40)
Early adult hood
•
Development or potential for development continues through out the life span.
•
Some theorists have proposed that development stages occur in adulthood.
•
The nature of development in maturity is different from during childhood and
adolescence which is more related to social and cultural forces than to physical and
cognitive development.
•
It is difficult if not impossible to pinpoint stages of adult development on the basis of
age alone because others have a role such as occupation, socioeconomic status.
•
A cultural demand which is varies from individual to another.
Example: marriage may occur during adolescence, early adulthood, old age or may not at all.
Adult development “Maturity”
•
There is a legal definition of maturity within the social system " a person is mature to
vote at the age of 18 years according to low".
•
Also there is informed social definition of maturity "someone who employed is
financially independent or is a parent".
•
According to psychological independent and autonomy, independent decision making
and some degree of stability, wisdom, reliability, integrity and compassion.
•
Freud defined psychological maturity quite simple "as the ability to work and love".
•
What ever combination of characteristic may be included in definition of maturity
there is no clear age demarcation for it occurrence.
Age clocks
•
Studies of human behavior suggest that each of us has internalized social clock by
which we judge age appropriate activities or on other word we have build in
expectation, constraint, and pressure for various stage of life e.g. playing sport or
dancing.
•
These bound arise may sometimes have.
•
Psychological base they are more often social in nature.
•
Negatron and Moore "1968" define three age periods or stages of adulthood.
•
Young adulthood (20 and early 30).
•
Middle adulthood (40 and 50).
•
Senescence hood (65 and over).
- 48 -
•
These age guidelines are not always accurate indicators of person internalized
judgment of behavior.
•
Socioeconomic status rural or urban setting, ethnic background wars, financial
depressions or other life event may strongly influence the definition, expectation and
pressure of adulthood.
•
The age clock set in part by social class, the higher the class the more likely in the
luxury of delay in moment from one stage to another.
•
Part of self concept which is a central to the integration of the personality.
Studies of adult development
•
It is important to individuals as they progress through their particular life spans, it is
desirable to compare people at selective point in their life or at different ages get at
the same point in historical time
e.g. person who is 30 year old is different from who 50 but being 50 in 2000 is different from
being 50 in 1970.
•
Major life event differ in their effect at different age groups so 25 years old may or
may not act differently toward depression as 45 years old man.
•
We can study adult development among population by selecting several group of
individual at different age and study them at one point in time the then these group
can be followed and checked at regular intervals during several years.
Marriage
•
Throughout out many periods of history and in many cultural groups marriage has
been the dominant life – style for large group of adult population.
•
This form of marriage provides certain stability for the rearing of children as well as
certain regularity.
•
Indeed the institution of family "is often one of the most clearly delineated social
institutions in a society.
•
Most culture has specific premarital traditions such as dating, courting and period of
engagement or rites of passage such as a formal wedding.
•
In the Arab Moslem society tradition the prescribed ritual leading up to marriage is
formal wedging then marriage and the man should psychologically and financially fit.
•
It is preferable to have marriage from the same religions and ethnic back ground.
The family
•
The family continues to be a primary socializing agency or institution for the adult.
- 49 -
•
Both the nuclear family structure and the extended family structure place demand for
new role and relation ships upon the adult involved.
•
An adult who marries into extended family must adapt and adjust to this new and
rather intense group.
•
Families go through cycles with certain function demanded at various time periods.
The family of orientation:
•
When the individual leaves his original family which may occur at the time of
marriage.
•
Marriage with all attendant adjustment of establishing relation ship with new family
network.
•
the third milestones is the birth of first child and the beginning of parent hood "family
of procreation"
•
The fourth milestones such as the birth of the last child the departure of the last child
from the family and the death of a spouse communal family.
•
Communal families fulfill many of the functions common to nuclear and extended
families.
•
they provide context for interpersonal intimacy
•
establish rules or norms for interpersonal responsibility
•
Supply shared value and ideas for development of a life style.
Parent hood
•
Wife and mother, husband and father, marriage and family home and children, each of
coupled word has it implicit assumptions and expectation
•
Parent hood requires new role and responsibilities on the part of the mother and
father; it creates demand for response on the part of parent and provides "anew social
status" for them.
•
Parenthood is one milestone all individuals are probably quite unprepared to meet.
Adjustment to parent hood likely to be dramatic like:
•
Learning nutrition, and child care.
•
Going for a doctor for regular checkup.
•
Buying baby clothes, choosing the name.
•
Deciding on breast feeding or bottle feeding.
All of these are minor consideration for the new parent compared with experience when the
infant born who bring a physical and emotional strain such as:•
Disturbance of sleep and routine.
- 50 -
•
Financial drain
•
Increase tension and conflict over responsible.
•
The mother is tired, father feel neglected.
Stages of parenthood
The anticipatory stage:
Refer to the pregnancy and the new roles and perception that is require, husband and wife are
now prospective parent and they face external social adjustment such as they become family
not couple and adjust to this new status within their community group.
The honey moon stage:
The period, during which the parent child attachment relation ship is formed, the period is
one of excitement over formation of new relationship and the time of uncertainly over the
meaning of parental love.
Plateau stage:
parent are involved in acting out their rolls as father and mother, there are problem of the
family within the community as socialization of the child, religious education future family
planning, involvement in the local school etc. are part of parenting.
Occupational choice
•
There are several factors that have an impaction on occupational choice such as:
social class, ethnic origin- intelligence, sex- race or parental occupation.
•
Most people tend to focus upon an occupation during late adolescence or early
adulthood.
•
Many of the social and psychological influences that direct their choice occurred in
the early year of child hood.
•
The person cognitive and emotional development acquisition of attitudes and value
are emotional attitudes and values are to career, choice and job success.
Work and life style
•
To great extent a person work may determine his life style.
•
The work determines his friendship patterns, level of sophistication opinions and
political affiliations.
•
The man who begin anew job is faced with certain adjustment in routine and with new
pattern for performance, the man need to discover the unwritten rules of the new job
situation, , what is the expectation for appropriate clothing, speech etc.
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Middle Adulthood
Age (40-65)
Physical & Cognitive Development
Physical Development in Middle Adulthood
Physical Changes
Sensory and Motor Functioning
Sexual and Reproductive Functioning
Health
•
Sensory Functioning declines are small and gradual from early to middle adulthood:
noticeable in mid forties
Vision
•
Ability to focus declines
•
Decline in visual acuity-sharpness of vision
•
Need more brightness
Hearing
•
Hearing loss for high-pitched sounds
•
Men have twice loss rate as women
Motor Functioning
Strength and coordination decline
•
Due to loss of muscle mass, replaced by fat
•
Exercise program and good nutrition can increase muscular bulk and density
•
The more people do, the more they can do
•
Endurance holds up better than strength
•
Reaction time slows, especially for motor responses
•
Experience makes up for physical changes
Sexual and Reproductive Functioning
Decline of reproductive capacity
•
Women: ability to bear children ends
•
Men: can father children, but have reduced fertility
•
Both experience decline in sex hormones
Noticeable Visible Signs of Aging
Physical appearance
- 52 -
•
Different Interpretation of signs of aging for men and women.
Height and Weight
•
Losing height (1/2 inch per decade).
•
Gaining weight
•
Body fat (20 percent or more).
•
Obesity leads to health problems and a shorter life span.
Strength, Joints, and Bones
•
Decrease in muscle strength.
•
Decreased efficiency of tendons and ligaments.
•
Progressive loss of bone.
•
Women have twice the rate of bone loss as men.
Female climacteric
•
40-65 year period of physiological changes that brings on menopause
Menopause
•
Cessation of ovulation and menstruation
•
Occurs one year after last menstrual period
•
Less production of estrogen
•
Periods become irregular
•
Hot flashes due to expansion and contraction of blood vessels
•
Lower levels of estrogen linked to higher risk of osteoporosis and heart disease, heart
reduces above risks but increases risks of uterine cancer, breast cancer & blood clots
•
Experiences of menopause vary by culture
•
Attitudes toward women and aging
•
Effect of diet
Male Climacteric
•
Changes begin 10 yrs later than women
•
Enlargement of prostrate gland (Causes problems with urination)
•
Testosterone levels decline gradually
•
Sperm count declines, slower motility of sperm
•
Less frequent erections & less powerful ejaculations
•
Takes longer to recover
•
Minority experience erectile dysfunction (impotence)
•
Multiple causes due to illness, stress, health habits
Health
- 53 -
•
Hypertension increases from midlife
•
Can lead to heart attack or stroke or cognitive impairment in late life
•
Leading causes of death are cancer, heart disease, and stroke
•
Changes in lifestyle have reduced mortality
Stress and Health
•
Stress prompts physiological reactions which weaken the immune system
•
Increases vulnerability to illness
•
Stress causes blockage of the arteries
•
Lifestyle factors affect stress levels
•
Regular exercise, good nutrition, adequate sleep, frequent socializing, no smoking,
little alcohol associated with less stress
•
Personal mastery and control minimizes stress
Cognitive Development in Middle Adulthood
1. Intelligence
2. Post formal Thought
1-Intelligence
1-- Cognitive development is multidirectional
•
Gains in some areas, losses in others
2- Cross sectional measures of intelligence show decreases with age
•
May be cohort effect of better/more schooling
3- Longitudinal measures show increase, at least until fifties
•
May be inflated due to practice effects and attrition uneven performance due to
influences of neurological aspects, which decline with age and cultural aspects which
improve with age
4- Fluid intelligence peaks during early adulthood and then declines
•
Ability to apply mental powers to new problems
5- Perceiving relationships, forming concepts, drawing inferences
6- Decline probably due to changes in brain
7- Crystallized intelligence improves through middle age and on
•
Ability to remember and use information acquired over a lifetime
8- Depends on education and culture
9- Uses stored information and automatic processing
10- IQ tests may lack ecological validity
•
Rely on timed, physical responses
- 54 -
11- Reaction time slows with age
12- Results may be due to physical, not cognitive changes
•
Adults face real-life problems
13- Need measures of practical problem solving
2-Postformal Thought
1.
Goes beyond abstract, formal thought
2.
Relies on subjective feelings and intuition as well as logic
3.
Relativistic
•
Sees shades of gray, interprets meaning
•
Integrates opposing views
•
Able to reconcile/choose among conflicting views
•
Thesis, antithesis, synthesis
Personality continuity and change
The (theory of disengagement) is a description of the change that takes place in personality
through adulthood (cumming and henty 1961)
- 55 -
Death and Dying
•
Death is “the final stage of growth”
•
Experienced by everyone and no one escapes
•
Young people tend to ignore its existence
•
Usually it is the elderly, who have lost others, who begin to think about their
own death
Terminal Illness
•
Disease that cannot be cured and will result in death
•
People react in different ways
•
Some patients view death as a final peace
Stages of Death and Dying
•
Denial – refuses to believe
•
Anger – when no longer able to deny
•
Bargaining – accepts death, but wants more time
•
Depression – realizes death will
come soon
•
Acceptance – understands and accepts the fact they are going to die
Summary
Death is a part of life
•
Health care workers will deal with death and dying patients
•
Must understand death and dying process and think about needs of dying patients
•
Then health care workers will be able
to provide the special care these individuals need
Human Needs
•
Needs: lack of something that is required or desired
•
Needs exist from birth to death
•
Needs influence our behavior
•
Needs have a priority status
•
Maslow’s hierarchy of needs
Altered Physiological Needs
•
Health care workers need to be aware of how illness interferes with meeting
physiological needs
•
Surgery or laboratory testing
•
Anxiety
- 56 -
•
Medications
•
Loss of vision or hearing
•
Decreased sense of smell and taste
•
Deterioration of muscles and joints
•
Change in person’s behavior
•
What the health care worker can do to assist the patient with altered needs
Summary
•
Be aware of own needs and patient’s needs
•
More efficient and quality care can be provided when know needs and understand
motivations
•
Better understanding of our behavior and that of others
•
Good communication skills allow development of good interpersonal relationships
•
Health care worker also relates more effectively with coworkers and other individuals
The End
Ali H. Abu Ryala
- 57 -