Developmental Stages and Human Behavior.pdf

Developmental Stages and Human Behavior Stages of Life Transcript Phase Approximate age Highlights Prenatal Conception to birth Rapid development of nervous system Newborn stage and infancy Birth to 12 months Motor development, attachment, and bonding Childhood 12 months to 12 years Deve...

Developmental Stages and Human Behavior Stages of Life Transcript Phase Approximate age Highlights Prenatal Conception to birth Rapid development of nervous system Newborn stage and infancy Birth to 12 months Motor development, attachment, and bonding Childhood 12 months to 12 years Development of logical thinking Adolescence 12 to 18 years Abstract thinking, formation of identity, peer influence Adulthood 18 to 60 years Love, marriage, career stability Senior Years 60 years to death Decrease in physical ability, reflection on life, preparation for death peer influence Adulthood 18 to 60 years Love, marriage, career stability Senior Years 60 years to death Decrease in physical ability, reflection on life, preparation for death Human behavior is the result of a series of changes that take place during each stage of development, from birth until the end of life. The study of developmental changes over a person’s life span can aid the understanding of people’s behavior and provide anticipatory guidance to parents. It is structured based on age categories. Pre-Pregnancy Pregnancy outcome is influenced by factors preceding conception: ● ● ● Women's (and men's) general state of health prior to conceiving ○ Substance abuse ○ STI prevention and treatment ○ Chronic conditions (diabetes, epilepsy, depression) Social factors ○ Family and other support structures ○ Woman’s attitude towards her pregnancy ○ Intimate partner violence and other social hardships (poverty, level of education, workload) Public health measures targeting women’s health in the childbearing period lead to optimized well-being and decreased negative outcomes. Pregnancy Click through the interactive to learn about the factors influencing development during pregnancy. Pregnancy Transcript Psychological Factors Maternal stress affects the fetus by increasing adrenaline and cortisol levels. This can lead to decreased placental blood flow and fetal hypoxia. There may also be a central neurologic component causing abnormal placental blood flow. Epigenetic Changes ● The study of epigenetics is the heritable changes in gene expression (active vs. inactive genes) that do not involve changes to the underlying DNA sequence — i.e., change in phenotype without a change in genotype ● ● ● effects on how cells “read” the genes and terminally differentiate. Epigenetic changes involve at least three systems: ○ DNA methylation ○ Histone modification ○ Non-coding RNA (ncRNA)-associated gene silencing Multifactorial diseases are the genetic transmission influenced by environmental factors like age, the environment/lifestyle, and the disease state (e.g., atopy, depression). Nutrition (Maternal Nutritional Status) Poverty and domestic violence may result in preterm deliveries and may be small for gestational age (SGA) babies. ● ● ● Severe malnutrition in the mother, can lead to intrauterine growth restriction (IUGR) Vitamin deficiencies in vegan mothers Administer folic acid (prevent neural tube defects), vitamin supplements (careful with overdosing vitamin A- teratogenic) The study of teratology is compounds and environmental conditions that negatively interfere with normal in-utero utero development (teratogens), stress, nutrition, infections, and the microbiome are some examples. Exact mechanisms and modes of interference with normal development are not well defined, but DNA methylation changes and altered gene expression may be involved. Teratogens cause intrauterine growth restriction (IUGR). Metabolic Abnormalities ● ● ● Diabetes (e.g., macrosomia or congenital heart disease) Hyperthyroidism/ hypothyroidism Phenylketonuria Maternal Chronic Diseases Pregnancies in mothers with hypertension, renal failure, heart failure, sickle cell disease, or other chronic illnesses may result in premature births with low- or very low birthweight newborns; or IUGR with SGA newborns. Maternal Age Older mothers are more likely to develop complications affecting the fetus (preeclampsia with premature delivery) or to have babies with trisomies (trisomy 21). Congenital Infections Toxoplasma, treponema, and viruses can cross the placental barrier, which can produce congenital infections in the fetus. Examples: TORCH: Toxoplasmosis, Other [T. pallidum,Varicella- zoster virus (VZV), Parvovirus B19, HIV, enteroviruses, B. burgdorferi], Rubella virus, Cytomegalovirus (CMV), and Herpes Simplex Virus (HSV). There is poor motor and cognitive development in some of these children. Example: Congenital rubella can cause visual defects, deafness, and developmental delay. Pharmacoligical (Medications and Substance Abuse) Factors Drug Abuse ● ● ● Fetal alcohol syndrome Drug withdrawal syndromes Tobacco use can cause premature births or IUGR Medications ● ● Some prescription medications are contraindicated during pregnancy as they can potentially cause birth defects. Check the drug contraindications before administration (FDA website is a good resource). Teratogenic drugs ○ Acne medications (retinoids) ○ Anti-convulsants (phenytoin) ○ Certain antibiotics (tetracyclines) Stage of Fetal Maturation (Gestational Age-GA) The effect of teratogens depends on the GA of the fetus at which they impacted the pregnancy. Examples: ● ● Rubella: most life-threatening or debilitating effects in the first trimester, when critical organs such as the brain, sensory organs, and the heart are developing. Tetracyclin: tooth abnormalities mainly in the 2nd and 3rd trimester, when tooth development occurs. Delivery Complications Complicated delivery (hemorrhage, prolonged labor, or use of vacuum/forceps) can lead to injuries and/or birth asphyxia. Cerebral palsy is the upper motor neuron injury caused by birth asphyxia (hypoxicischemic encephalopathy). It leads to diminished motor activity and a negative effect on the child’s motor and cognitive development due to decreased interaction with the environment, it can cause decreased attachment and secondary developmental delay. APGAR Score The APGAR score reflects the need for resuscitation of the infant at birth and is an indirect indication of complications during delivery. It is completed at 1 minute and at 5 minutes. ● Looking at 5 parameters, graded 2 – 1 – 0: ○ Appearance (skin color) ○ Pulse rate (normally at least 100 BPM) ○ Grimace (reflex facial response to stimulation) ○ Activity (motor response to stimulation) ○ Respiration (look at chest movement and cry) The normal score is between 8 and 10, a maximum score is 10, the minimum is 0. A score of 0 is not an indication of death, as the newborn may be in primary asphyxia. APGAR Information Transcript APGAR Information The following parameters are assessed: A- Appearance (normal - 2, acrocyanosis - 1, generalized cyanosis - 0) P- Pulse (normal > 100 BPM - 2, bradycardia < 100 BPM - 1, absent - 0) G – Grimace (crying - 2, faint crying and grimacing - 1, no response - 0) A –Activity (fully flexed on stimulation - 2, some flexion - 1, flaccid - 0) R –Respirations (vigorous cry-2, bradypnea with weak cry-1, apnea-0). Maternal Support ● ● ● Emotional support to mothers during labor improves the outcome for both mother and infant. Allow the partner to be involved in the delivery as much as possible. Support from a “doula” significantly decreases the need for instrumental deliveries. Theories John Bowlby’s Attachment Theory Attachment theory is the deep and supportive bond between a child and caregiver/ other significant persons that creates a sense of safety and stability through meeting the physical and emotional needs of the child. Attachment patterns form as the brain develops, 3 months before birth and throughout infancy. Ainsworth’s “Strange Situation Test” (“Attachment Styles” Theory) Review the interactive to learn more about positive and negative attachment styles. Transcript Positive Attachment Early Manifestations ● ● ● ● ● Stranger anxiety is when the child displays a fearful response, such as crying or clinging to the parent in response to the approach of strangers. Separation anxiety is the fearful response when the parent attempts to leave the child (usually peaks at age 15 months). When they are past this phase, they are ready for school. Test: The parent leaves the room, and then the infant cries; the parent returns, and then the child stops crying. Ideal: The infant uses the parent/caregiver as a base for exploring, and will venture out, then return periodically to the parent. Essential for healthy neurological development and peaks at 2-8 months. Behaviors that Foster Secure Attachment ● ● ● ● Sucking: Infants will suck when they are not hungry, non-nutritive sucking is thought to inhibit a baby’s distress. Cuddling: Important, especially during feeding (body contact as well as eye-to-eye contact). The response from the infant reinforces the behavior in the adult, and the adult’s response enhances the development of attachment in the infant. Smiling: Provides reinforcement for positive bonding in both adults and infants. Crying: signal of distress in the infant, initiates secretion of milk in the mother. Foundations of Secure Attachment Infant cries, gurgles, or tracks with eyes, this signals to ensure caregivers respond and meet their needs. A consistent, significant adult reacts by soothing and meeting the baby’s needs, and the stimulus from the baby is managed, and their feelings are regulated by the predictability of an adults’ reaction to the child’s needs. The development of related beliefs and expectations about caregivers with the foundations for a set of communicative strategies, the ability to foster healthy, meaningful future social interactions, and influences the future adult personality is the foundation of secure attachment. Negative Attachment Styles Ambivalent/Resistant Attachment ● Mixed reactions to the mother: cries when separated from her, but when she approaches, angrily pushes her away. Avoidant Attachment ● Does not cry or show distress when separated and ignores the mother when she returns. Distorted/Disorganized Attachment ● Disorganized behavior when the mother leaves the room, also on her return (moves towards mother, then away; freezes and goes into a corner), not soothed if made contact with the mother. Behaviors If the baby’s signals (crying, gurgling, or eye tracking) are met with little, irregular, or no response (e.g., due to limited parental emotional or physical availability), the baby learns over time that their needs may not be met through communication with others and develops a different set of responses. Examples: ● ● ● ● ● ● ● limited communication overt and relentless communication impulsive behavior poor empathy stalled development of physical and sensory skills poor emotional and social communication poor capacity to develop meaningful relationships Developmental Milestones Review the tabs to learn more about developmental milestones. Monitoring The purpose of regular developmental screening is to identify and react to developmental delays, provide anticipatory guidance to assist parents or guardians in understanding the expected growth and development of their children, recognize pathology, and, most important, in children with cerebral palsy - avoid secondary developmental delay. Remember, well-informed parents are our best allies in diagnosing and managing developmental delays. Milestones: Pearls and Pitfalls The Center for Disease Control (CDC) uses as a standard for the milestones the cut-off age, beyond which all children should normally achieve a certain milestone. This means that should a baby fail to achieve a milestone by that age, there is a high likelihood of a developmental pathology. In many textbooks and well-baby information resources, the age of achieving a certain milestone is usually the average/median age at which most children would achieve it. This makes these milestone criteria more sensitive (but less specific) so that there is increased awareness in monitoring these “at-risk children”. Developmental Milestones and their Determinants Gross and fine motor milestones include central nervous system (CNS) structural and functional integrity, myelination, cognitive, language, social milestones (neuro- and sensory-integrity), and environmental factors. Cognitive and Intellectual Development The emergence of the ability to think and understand. A child's development in terms of information processing, conceptual resources, perceptual skills, language learning, and other aspects of brain development. Controversy in cognitive development has been “nature vs. nurture,” which is a false dichotomy. Abnormalities in cognitive development may be caused by motor developmental disorders. Preschool Cognitive Development Conservation is the changing the form of a substance or object does not change its amount, overall volume, or mass. Example: Lack of conservation (normal in pre-school): Have glasses of different shapes and sizes filled with same amount of water and the child chooses the glass that is the tallest because they perceive the taller glass as having more water inside of it (even though the tallest glass is the thinnest). Cognitive Development (Jean Piaget) Review the image to learn more about Jean Piaget's Cognitive Development. Cognitive Development Transcript Sensory-motor – 0-2 years ● Understanding that objects exist and events occur independently of one's own actions (‘object permanence’). Pre-operational – 2-7 years ● ● Thinking at a symbolic level but not yet using cognitive operations. Cannot use logic, transform, combine, or separate ideas. Concrete operational – 7-11 years ● ● The beginning of logical or operational thought is the ability to use logical thought or operations (i.e., rules) and the ability of conservation (number, area, volume, orientation), reversibility, seriation, transitivity, and class inclusion. Can only apply logic to physical objects (hence concrete operational), they are unable to think abstractly or hypothetically. Formal operational – 12-18 years ● Formulate abstract ideas without any dependence on concrete ● manipulation. Systematic Approach to Milestone Evaluation Review the interactive to learn more about the Gotta Find Strong Coffee Soon mnemonic. Milestone Evaluation Transcript Neonatal Period (0-1 month) G: ● ● Increased flexor tone at limbs Primitive reflexes (" survival reflexes"): stepping, Moro F: ● Primitive reflexes: grasp S: ● Primitive reflexes: rooting, sucking, and alert to sound C: ● Interacts with mother during feeding (can only see clearly objects 12 in. from face, focus on mother's face) S: ● ● ● Imitates facial expressions Clings and cries, but is consolable Matching response to visual and auditory stimuli is entertainment 2 months (First time milestones are checked) G: ● ● Pushes up when prone Head lifting ( neck control) at 45°, when lying on the face F: ● ● ● Hand is open 1/2 the time Sucks hand Bats at objects S: ● ● Turning to sound Cooing and gurgling sounds C: ● Following objects past midline S: ● ● Prefers usual caregiver, attachment Social smile 4 months G: ● ● ● ● Lifts head 90° or raise up to chest (2x better than at 2 months) Rolls over front-back Pushes on elbows Sits with support F: ● ● Finds midline Reaches for objects, picks them up, shakes them and puts them in mouth S: ● Coos (vowel sounds), starts babbles, "ga-ga", and copies sounds C: ● ● Purposeful object exploration Adapts to routines S: ● ● Laughs, smiles when recognizes familiar faces and plays Cries for different needs 6 months G: ● ● ● ● Sits tripod without support Rolls both ways Bounces on legs Puts feet in the mouth F: ● Tries to get toys by raking movements and can move them from one hand to another S: ● Nonspecific babbles with sounds M and B C: ● ● ● Recognizes familiar faces (visual acuity is same as an adult) Responds to own name Looks for dropped or partially hidden objects S: ● ● Express emotions and plays with parents Starts developing stranger anxiety Remember: "sit at six" = half-way between birth (just lying flat) and 1 year (walking) 9 months G: ● ● ● Pulls to stand with support and stands Crawls/creeps on hands and knees Sits with hands free F: ● ● Inferior pincer grasp Points to objects S: ● ● Specific babbling: mama and dada Gestures "bye-bye' and "up" C: ● ● ● ● Favorite toy and blanket Understands "no" Gesture games: "pattycake' Object permanence: "peek-a-boo" S: ● ● Stranger anxiety Starts developing separation anxiety Remember: You crawl and pull to stand at 9 months, which makes sense: you are 1/2 way between sitting at 6 months and walking at 1 year. 12 months G: ● ● Walks with wide-based gait Throws toys F: ● ● ● ● Fine pincer grasp (with fingertips) Voluntary release Puts toys in container Finger-feeding S: ● ● ● 1- word phrases Waves bye-bye Follows simple requests C: ● ● ● ● Fully developed object permanence: finds hidden objects Tries to repeat words Shakes head as "no" Narrative memory: requests reading from book S: ● ● ● At least one word meaning besides mama and dada Shy with strangers and separation anxiety Explores from secure base Yippee! Achieved the 1-year goal: can walk and talk Review Infancy (1 to 12 months) Remember, the goal of the first year’s gross motor development is to be able to walk (walk at 12 months). At 6 months, you are halfway there; remember, "sit at six”. Just with these two milestones, you can pretty much fill in everything else!!! Look for motor, cognitive, and social development. Review of First Year’s Gross Motor Achievements The goal is walking! ● ● ● ● ● 2 months: lift head 45° 4 months: roll over, first front to back, then back to front (easier if you can push off with hands!) 6 months: sit (halfway to the goal, halfway through the year, “sit at six”) 9 months: crawl, stand (halfway between sitting and goal) 12 months: walk (the goal) Childhood Children aged 1 to 12 years. The highlights of this period are perfecting gross and fine motor skills, acquiring new ones, which increases mobility and independence, language acquisition, the ability to think and reason logically, and socialization outside of the family circle. Click on the tabs to learn more about social factors, phases, and gender identity vs. gender identification in childhood. Social Factors Social factors affecting development during childhood include family circumstances, child abuse, hospitalization, death, and birth order. ● ● ● ● ● ● Family Stability ○ Provides for the physical and emotional needs of the child ○ Safe environment for the child to develop ○ Model of social relationships (love, care, respect, loyalty). Divorce/Separation ○ Negative effect if there is no resolution of the conflict between parents. ○ Abandonment by one parent or lack of support from the family also has a negative impact. Adoption ○ It should be discussed openly, in a positive manner which increases confidence and stability. Child Abuse (physical and emotional) ○ Significant negative effect on development and behavior. Hospitalization ○ May react with regression of behavior/development. ○ Not permanent and resolves within weeks of discharge. Death and Dying ○ Response depends on the age and level of understanding of death ○ ● and dying. ○ Children should be included in the grieving process. Birth Order and Child Spacing Phases Review the interactive to learn more about childhood phases. Childhood Phases Transcript Toddler: 15 months G: ● Walks F: ● ● Uses cup Stacks 2 blocks S: ● ● ● ● 5 words Jargoning Points to one body part Follows 1 step verbal directions without gesturing C: ● Experiments with toys to make them move S: ● Shares interest: points to toys and brings them to parents Toddler: 18 months G: ● ● ● ● Climbs stairs Stoops and recovers Runs Removes clothing F: ● ● ● ● Uses spoon Hand preference Scribbles with fisted pencil grasp Stacks 4 blocks S: ● ● 10-25 words Points to 3 body parts ● Labels familiar objects C: ● ● Imitates housework Symbolic play with toys S: ● ● Increased independence Parallel play Toddler: 2-2 ½ years = “Terrible Two’s” G: ● ● ● ● ● ● Jumps on 2 feet Stands on tip-toes Climbs stairs one foot at a time Throws a ball Opens doors Capable of daytime bladder control ( at 2 1/2 y-o) F: ● ● ● ● Uses fork Stacks 6 blocks Imitates vertical stroke Handedness established S: ● ● ● ● ● 50+ words 2-word phrases Understands pronouns, plurals Knows body parts Follows 2-step commands C: ● ● ● ● Imitates adults New problem-solving exercise without rehearsal Experiments with toys to make them move Gender identity S: ● ● ● ● Testing boundaries, temper tantrums Negativism ("no" is extensively used) Selfish ("mine"!) Gender-specific parallel play Preschool: 3 years G: ● ● ● ● Pedals trike Up the stairs alternating feet Dresses self Hops on 2 feet in place ● ● Catches balls Toilet trained F: ● ● ● ● Turns book pages Draws circle Unbuttons shirt Stacks 9 blocks S: ● ● ● ● ● 200 words 3-4 word phrases Uses pronouns, plurals States full name, age and gender Follows 3-step verbal directions C: ● ● ● ● ● ● ● Curious, "Why" questions Simple time concepts Identifies simple shapes Names objects in pictures Compares 2 objects Counts to 3 Fixed gender identity S: ● ● Begins to take turns and share toys, cooperative Role play Preschool: 4 years G: ● ● ● ● Hops on one foot Balances on one foot for 4s Alternates feet when going down the stairs Undresses and grooms-self F: ● ● ● Cuts shapes with scissors Buttons Draws X, rectangle S: ● ● ● ● All words intelligible Uses past tense Uses plurals, prepositions Compound 4-word phrases C: ● ● Tell stories Opposites ● ● ● Identifies 4 colors Counts to 4 Begins to be curious about sexual characteristics S: ● ● ● ● Imitates adult roles Cooperative and fantasy play Empathy and rules- moral development Imaginary friends, nightmares Preschool Cognitive Development Conservation is the changing the form of a substance or object does not change its amount, overall volume, or mass. Example: Lack of conservation (normal in pre-school): Have glasses of different shapes and sizes filled with same amount of water and the child chooses the glass that is the tallest because they perceive the taller glass as having more water inside of it (even though the tallest glass is the thinnest). By 6 years (end of the Preschool phase) ● ● ● ● ● ● Language is fluent, speech is clear, and can make conversation with strangers. Capable of symbolic thought (understands simple poems). Egocentric: “The world revolves around me, I should get what I want, and everyone should see the world as I see it”. Imaginary friends (goes away by 9 years). Co-operative and “let’s pretend” play is important for development. Expresses emotions: love, happiness, envy, and jealousy (e.g., sibling rivalry). School Age (6 to 11 years) ● ● ● Able to express ideas Develop logical reasoning: e.g., "if 3+2=5, then 5- 3= 2”; Conservation: understands that changing the form/shape of a substance or object does not change its amount, overall volume, or mass. Formal learning begins and students start to understand and apply math and science concepts, learn poetry, reading, writing, and computer skills. School Age Social and Sexual Development ● ● ● Strong peer interaction: ○ Child has “best friends” ○ Gender identification, girls play with girls and like “girls” games; boys play with boys and enjoy “boys” games. Capable of showing empathy and concern for others Latency period of sexual development. Gender Identity vs. Gender Identification Gender identity is the child’s perception of their own gender (toddler stage 2-3 years). Gender identification is recognizing other children’s gender and forming socialization preferences based on this recognition. Most are binary gender and identifies as either a boy or girl. Adolescence Click on the tabs to learn about the different stages of adolescence. 12 to 18 Years ● ● ● ● ● Transitional stage from the dependency of childhood to relative independence of adulthood. Capacity to understand and apply abstract & complex concepts. Focal point is the formation of an identity and personal opinions with changes in the person’s behavior and social roles. Concerns about their looks and eating disorders may occur at this time. Develop interest in members of the opposite sex; spend more time with their friends and less time with their parents. Physical and Sexual Development Puberty marks the onset of adolescence, the age at which puberty begins and ends is variable. The body changes to the mature adult male/female shape, and females mature faster. Some cultures have formal ceremonies at the beginning of adolescence as an initiation of the passage to adulthood. There is a renewed sexual curiosity at this time, and it is for sexual gratification. Tanner Stages of Development The onset and progression of puberty are so variable Tanner has proposed a scale, now uniformly accepted, to describe the onset and progression of pubertal changes. Tanner Stages Transcript Stage I ● ● ● Testicular volume <3ml No pubic hair Elevation of papilla only Stage II ● ● ● Testicular volume <3ml; scrotal skin texture changes Sparse growth along labia/base of penis Breast bud stage Stage III ● ● ● Increase in penis size with further testicle enlargement Darker, coarser, more curly hair Enlargement of breast and areola Stage IV ● ● ● Further enlargement of testicles; development of glans penis Adult hair type on smaller area Projection of areola and papilla Stage V ● ● ● Adult size and shape Hair spread to medial surface of thighs Recession of areola to contours of the breast; projection of papilla only Boys and girls are rated on a 5-point scale. ● ● ● ● Boys are rated for external genitalia development & pubic hair growth. Girls are rated for breast development & pubic hair growth. Stage 1 = pre-pubertal Stage 5 = full adult sexual development (in most cases, puberty is completed by 16 years). Cognitive Development Progression to abstract thinking by mid-adolescence. Not all people will make this transition, and a few will remain concrete thinkers as adults (about 10%). The ability to build up complex hypotheses, cogent arguments and draw inferences, and the ability to make associations, outside the realm of reality are some characteristics of abstract thinkers. Personality and Moral Development The adolescent will challenge rules but should come to a resolution and develop their own belief system, which may or may not be the same as their parents. They are preoccupied with defining self-identity (learning about self) – but note: not egocentric. In fact, develop an interest in moral and ethical issues and may embrace generous causes, and they develop their conscience as individuals, and establish long-term life goals. Social Factors Affecting Development The factors affecting other age groups are peer group pressure, risk-taking behavior for example, drugs, sexual promiscuity, pregnancy, and occupational choice are social factors affecting development during adolescence. Goal The goal of development during adolescence is that at the end of adolescence, an individual becomes a well-adjusted, productive adult! Additional Information . CDC’s Developmental Milestones ages 0- 5 years CDC’s Developmental Milestones | CDC . CDC’s Module 2: Understanding Children’s Developmental Milestones and Quiz Training Module 2 | Watch Me! | Learn the Signs. Act Early. | NCBDDD | CDC Guidelines USMLE Tip: use as a guide for gross motor development, in this area, there is more consistency between various milestones. It is best to stick to the CDC.gov guidelines! In case of a dispute, the official version is always going to be acceptable. Quiz Quiz | TBL: Life Cycle Contact Dr. Adora Otiji Email: [email protected]