Infant/Toddler Psychosocial Development PDF

Chapter 5:Infant/Toddler Psychosocial Development Learning Objectives: Infant and Toddler Psychosocial Development 1. Explain emotional development in infants and toddlers. 2. Describe temperament and the biological markers of temperament. 3. Describe infant social behavior. 4. Explain the significance of the still-face paradigm. 5. Explain the intergenerational transmission of caring. 6. Explain the dominance system. 7. Describe self-development. 8. Explain self-regulation and how it develops. 9. Describe early language development. 10. Discuss assessment of infants and toddlers. Emotional Development in Infants and Toddlers At birth, infants exhibit two emotional responses: Attraction and withdrawal. They show attraction to pleasant situations that bring comfort, stimulation, and pleasure, and they withdraw from unpleasant stimulation such as bitter flavors (disgust) or physical discomfort (pain) (Table 5-1). When the infant expresses attraction the Behavioral Approach System (BAS) is active; When the infant withdraws the Behavioral Inhibition System (BIS) is active. The brain circuits that control approach and withdrawal are not fully formed at birth (Izard et al., 1995). That is why newborns have limited emotional responses. Emotion Expression Age First Seen Context Interest or 3 Months The infant sees something Curiosity new that is not threatening. Surprise 6 Months The infant experiences an unexpected stimulus. 106 Joy 2 Months The infant is enjoying something, usually an (Laughter @ 3 interaction with another Months) person. Pain Birth The infant has been physically injured. Sad 3 Months The infant experienced loss of a rewarding stimulus. Disgust Birth The infant tasted something sour or bitter. Anger 4-6 Months The infant’s goal directed action has been blocked usually by another person. Fear 7 Months The infant interpreted the situation as threatening. Table 5-1 Primary Emotions 107 The emotions infants express are an import part of the mother-infant system because they communicate the infant’s needs. According to psychiatrist and attachment researcher John Bowlby, “the principal function of emotion is one of communication — namely, the communication, both to the self and to others, of the current motivational state of the individual” (Stevenson-Hinde, 2007, p. 339). Infants and toddlers have very limited self-awareness (see below); but infants learn about emotions when others respond to their needs. As described in Chapter 1 the BIS and BAS are behavioral systems that are active when an individual withdraws from threat or approaches a reward. During the first year of life, infants begin to express the primary emotions. Facial expressions of emotions are universal in humans and expressions are reflexes that can be modified over time (Izard et al., 1995). Infants show typical facial expressions (Table 5-1) after the brain pathways that are active during threat and reward states have developed and the infant has experiences with situations that elicit emotion (Izard et al., 1995; Tracy & Randles, 2011). Facial expressions then, like many behaviors in the first year directly reflect brain development. The primary emotions may be divided into two groups, those associated with threat (the BIS): pain, sadness, disgust, and fear; and those associated with reward (the BAS): interest, surprise, joy, and anger (Lewis, 2010). Although it is a negative emotion, anger is frustration of reward pursuit. The individual who experiences anger, is still motivated to pursue the reward (Lewis, 2010). Anger develops after 4 months, along with Piaget’s stage of secondary circular reactions. During this stage infants perform goal directed actions on objects. The BAS makes infants enjoy their goal directed actions. Stop them from their fun and some will become angry. Others might withdraw and show sadness. How an infant acts when frustrated is part of temperament (Fox et al., 2001). Temperament Parents are often surprised by differences between their children that seem to have been present from birth. Developmental psychologists have defined temperament so that they can measure individual differences that are present in infancy and see how these persist over development. Table 5-2 lists three approaches to temperament guided by three important questions. The first question is, how do caregivers experience their infant as different from other infants? Thomas and Chess (1977) noticed differences in their own children and set out to measure differences in infants. Their work focused on the infant part of the mother-infant system; they defined infant behaviors that impact caregiving the most. Thomas and Chess came up with two ideas of practical importance to parents and helping professionals. The first idea is that caregivers describe a cluster of behaviors that define difficult infants. These infant behaviors may make the mother-infant system less functional because the goal of the system is to provide for the infant’s needs. 108 Researchers Question Definition Components Thomas and How do caregivers ‘Primary innate Irritable distress Chess (1977) experience reaction patterns’ Social inhibition infants? Activity Attention Regularity Buss and Plomin What infant ‘inherited, relatively Emotionality (1975) characteristics stable during Activity become adult childhood, retained Sociability personality? into adulthood, Impulsivity evolutionary adaptive, and present primates’ Rothbart (1981) What biological ‘Constitutionally- Negative Affect differences cause based individual Surgency behavioral differences in Effortful Control differences? reactivity and self- regulation’ Table 5-2 Temperament definitions Thomas and Chess also introduced the phrase goodness of fit to describe the mother infant system. If the fit is good, parent and infant styles match, and communication and interaction can flow. If styles match, the system can function smoothly. Bowlby pointed out that caregivers change the style of infants over time, “what is happening in those early years is that the pattern of communication that a child adopts towards his mother comes to match the pattern of communication that she has been adopting towards him” (Stevenson-Hinde, 2007, p. 339). Goodness of fit and ease of communication then also help professionals assess the mother-infant system. From the point of view of caregivers there are three groups of infants: easy (40%), slow-to-warm-up (15%), and difficult (10%). Difficult infants react negatively to new situations, have trouble adapting to routine, and cry frequently. Caregivers of difficult infants may need extra support so that the mother-infant system can function well and provide for the infant. Is there really such thing as a “difficult infant”? The work of Thomas and Chess led to arguments between experts in development. Thomas and Chess came up with the idea of difficult infants because they interviewed parents who described what it was like to parent in the context of differing infant behavior (Thomas et al., 1982). Other researchers challenged the reality of “a difficult infant” stating the concept is a social construction. If the concept of a difficult infant is a social construction, then there are no difficult infants, only infants caregivers perceive to be difficult. In other words, difficulty like beauty is in the eyes 109 of the beholder. This argument took place in a WEIRD culture (Chapter 4) where scientists do not usually consider systems of individuals. They consider individuals to be islands independent of the other people in their lives. Scientists from WEIRD cultures may have trouble with the idea that individuals participate in collective systems. Individuals have biologically based behavioral traits AND they participate in systems comprised of others with biologically based behavioral traits. Individuals both impact and are impacted by the systems they are part of. Notice that the systems view is not just another way of looking at human life. Failure to understand that individuals belong to systems leads to wrong conclusions that may be harmful. The argument that difficulty is not a reality shows a failure to appreciate a dialectic― opposite ideas that are both true. The systems view allows us to appreciate that BOTH opposite views are true. Infants are individuals with differences based on genetics and prenatal development. Infants are also part of a mother-infant system. Some mothers may be more sensitive to infant behaviors than others because mothers too are individuals. Both mother and child can be changed by the system. Appreciating the mother-infant system allows clinicians to help caregivers. Some mothers of difficult infants tend to blame themselves for causing their infant’s difficulties (Thomas et al., 1982). This blame reduces their effectiveness as caregivers and further disrupts the mother-infant system. The disrupted system then cannot optimally provide for the infant. Caregivers are better off when clinicians help them understand that although they did not cause these infant problems, they still must cope with them. Caregivers are doing the best they can but with help they might be able to do better. (These are core assumptions of Dialectical Behavioral Therapy (Linehan, 1993)). The mother-infant systems view says that influence goes both ways. Not only do parents affect their children; children affect their parents. For example, infants with easy temperaments are easily soothed and are fun to be with. Parents feel more effective when they can soothe the child and elicit smiling and cooing. On the other hand, parents feel less effective when they cannot soothe a cranky or fussy infant (Eisenberg et al., 1999). There is not as much positive interaction and over time, parents may become punitive and less patient (Clark, Kochanska, & Ready, 2000; Eisenberg et al., 1999; Kiff, Lengua, & Zalewski, 2011). Parents of fussy, difficult children are also less satisfied with their marriages and have greater challenges trying to balance work and family roles (Hyde, Else-Quest, & Goldsmith, 2004). 110 The Biopsychology of Temperament As you learned in the last chapter and the last section, infant behavior at birth is automatic and infants only experience two emotional states, attraction, and withdrawal. The other basic emotions develop over the first year. Awareness and voluntary behavior also develop gradually in the first year. Temperament therefore unfolds over the first year and temperament does change (Rothbart et al., 2000). Even though infant behavior is automatic, between birth and 24 months babies are still different from one another in ways that reflect the functions of the BIS, BAS, and self-regulation. BIS temperamental traits include the irritable distress and social inhibition observed by Thomas and Chess (1977), emotionality observed by Buss and Plomin (1975), and negative affect observed by Rothbart (1981). Negative emotions come from the infant’s BIS functions (Fox et al., 2001, 2005; Rothbart et al., 2000). BAS temperamental traits include activity observed by Thomas and Chess (1977), sociability observed by Buss and Plomin (1975), and surgency (a personality trait marked by cheerfulness, responsiveness, spontaneity, and sociability) observed by Rothbart (1981). Positive emotions reflect how the infant’s BAS functions (Rothbart et al., 2000). Lastly, regularity observed by Thomas and Chess (1977); impulsivity observed by Buss and Plomin (1975); and effortful control reflect the development of self-regulation (discussed below). Thus, behavioral systems governing how reward and punishment are experienced, together with self-regulation determine temperament as observed by parents and researchers. These also determine child and adult personality as observed by clinicians and researchers (Fox et al., 2001, 2005; Rothbart et al., 2000). Identical twins can have different temperaments during the infant toddler period and so temperament at this age is not entirely genetic (Saudino, 2005). Temperament in about half of children also changes over the infant toddler period indicating that it may be shaped by the mother-infant system (Fox et al., 2005; Saudino, 2005). Biological Markers of Temperament Throughout this book we will discuss biological markers of temperament, how these change over the lifespan, and how biologic markers are linked to behavioral and emotional problems. The first biologic marker that has been studied in all age groups is frontal EEG asymmetry. The electroencephalogram or EEG measures brain waves through electrodes placed on the scalp. Brain waves are produced when many cells work together. By six months of age some infants have more frontal EEG asymmetry than others. EEG asymmetry is the difference between right brain and left brain EEG patterns so more asymmetry means the right frontal cortex is more active than the left frontal cortex (Coan & Allen, 2003; Hill et al., 2020). EEG studies show that the right frontal cortex is part of the BIS. When individuals withdraw due to fear or loss of reward the right frontal cortex is active. The left frontal cortex is part of the BAS. When individuals pursue a reward or feel happy the left brain 111 is active (Coan & Allen, 2003). In addition, asymmetry acts like a trait, some individuals have more left sided activity and others have more right sided activity. Infants with more right sided activity (more EEG asymmetry) experience more negative emotions and have higher hormonal responses to stress (K. A. Buss et al., 2003). Frontal EEG asymmetry predicts which infants respond to frustration with anger and which respond with sadness (Fox et al., 2005). Increased frontal EEG asymmetry in infants is moderately heritable (Hill et al., 2020) but this trait may change as individuals develop (Coan & Allen, 2003). Skin conductance is another biological temperamental trait. Skin conductance measured by electrodes placed on the skin, increases with sweat caused by sympathetic nervous system activation in response to fear or stress (Baker et al., 2013; Nigg, 2006). Infants that react with fear and increased skin conductance to new situations may be more prone to anxiety and fearfulness later in childhood. On the other hand, low fear and low skin conductance in infancy predict aggression at the start of early childhood. Low sympathetic nervous system activity links to low levels of arousal and fearlessness and so uninhibited toddlers are at-risk for aggression later on (Baker et al., 2013). Heart rate is determined by a mixture of sympathetic and parasympathetic influence. Toddlers who respond to new situations with inhibition (high BIS) have a more responsive sympathetic nervous system and higher resting heart rate. Uninhibited toddlers have lower heart rates for the same reason they have lower skin conductance (Kagan et al., 1984). Whereas skin conductance and increased heart rate results from sympathetic activity, heart rate variability with breathing or respiratory sinus arrhythmia (RSA) results from parasympathetic activity. When a child or adult breathes out, the heart rate slows due to increased parasympathetic nervous system activity. The next in-breath causes the heart rate to speed up again. This speeding up and slowing down of the heart rate with breathing or RSA, is large in some individuals and smaller in others. RSA is another biologic temperamental trait with links to behavior. High RSA in infancy correlates with the ability to pay attention (Richards & Casey, 1991). In later chapters we will discuss the correlates of RSA and the other biologic markers of temperament. Infant Social Behavior In Chapter 1 you learned that life history stages connect to special challenges. During the first two years, the challenge is trust verses mistrust (Erikson, 1950). If children receive care that is responsive to their needs, they develop trust in others. This trust is associated with feeling secure or safe; infants who feel safe and secure have hope. Infants who do not receive responsive care are at-risk for mistrust and despair. In the sections below you will see the contrast between trust and hope and mistrust and despair. Chapter 1 also described the four social behavioral systems: attachment, caregiving, dominance, and sex. The brain circuits responsible for attachment and 112 caregiving develop and are strengthened by experiences in the first two years of life. Experiences that impact the dominance system come next in early childhood; but as you will see infants are aware of social hierarchies. Aspects of the sexual system also develop in early childhood because from birth infants are surrounded by messages about gender. Behavioral systems develop sequentially in an important order: attachment, caregiving, and then dominance followed by sexuality. You will see that this sequence is important to wellbeing and self-regulation because the systems that develop first help to regulate those that develop later. We start by explaining attachment and the history of attachment research. Grief: A Peril in Infancy In 1947 René Spitz and Katherine Wolf released a film produced during their research, Grief: A Peril in Infancy. You can view it through the National Library of Medicine http://resource.nlm.nih.gov/9505470. This film shows the effect upon infants of prolonged absence of the mother. Several babies in a foundling home are shown. Early behavior, when the mother is still available, is compared to the child's expression and behavior once the mother has been away for some time. A smiling infant's affect becomes flat, and the infant shows visible distress. The film indicates that if infants are under a year old and the mother returns after an interval of fewer than three months, the babies tend to recover rapidly. If the absence is prolonged beyond this period, attachment becomes extremely difficult. The child becomes passive and apathetic and suffers damage to the personality. The film suggests that it is the emotional climate provided by the mother that allows the child's mind to develop normally. Why Do Infants Love Their Mothers? At the time of Spitz and Wolf’s groundbreaking research, many believed in Sigmond Freud’s ideas even though they were guesses and not proven by experiments. Freud said that food and oral pleasure are the primary reason babies love their mother. He taught that love for mother is secondary to hunger being satisfied and oral pleasure from feeding (Cassidy, 2008). These ideas could not explain why the babies Spitz and Wolf studied did badly even though they were fed. Biopsychological researchers (ethologists), such as Konrad Lorenz had already observed that baby geese follow their mothers after hatching from the egg even though the mother does not feed them. Scientists began to realize that something other than the need for food is responsible for emotional bonds. 113 In the early 1950s biopsychologist Harry Harlow performed what is perhaps the most important psychological experiment ever done. Remember that hypotheses can only be proven through experiments. In an experiment, the researcher controls the independent variable and measures the dependent variable. Harlow directly tested whether food reward causes the emotional tie infants feel. Baby rhesus monkeys were taken from their mothers at birth and placed in a cage with two possible “mothers.” One mother was a wire cage with a nipple that supplied food. The other mother did not supply food but was a soft rug the infant could cling to. Thus, the independent variable was the two conditions “wire mother” or “cloth mother.” The dependent variable was the time the infant monkeys spent clinging to each mother. Infant monkeys in Harlow’s lab spent less than one hour a day with the wire mother, the source of food. Instead, they clung to the cloth mother an average of 17 hours a day. In a film Mother Love, released in 1959, documentary host Charles Collingwood asked Harlow, “Is that really love?” Harlow said, “Now Mr. Collingwood, wouldn’t you say that if you frightened a baby and it went running to its mother, was comforted, and then all the fear disappeared, and was replaced by a sense of security, that the baby loved its mother?” (Homunculus Cinematix, 2019, sc. 8 minutes). You are encouraged to watch the entire documentary on YouTube. Harlow’s research established that the reward of contact comfort is more important to primate infants than food reward. He also showed the link between contact comfort and reduction of fear. We now know that one of the functions of attachment is to decrease fear and allow the infant to explore. As explained in Chapter 4, exploration causes growth of the brain. When infants are fearful, they cannot explore enough to grow their brains. This lack of brain growth during infancy can have permanent effects on development. A condition in humans called non-organic failure to thrive is caused by lack of emotional security during infancy (Skuse, 1985). This condition reflects the despair associated with not being cared for. The Attachment System At the same time as Harlow performed his research, psychiatrist John Bowlby noticed that his adolescent and adult patients who were delinquent or clinically depressed had lost their parents as children. Bowlby understood human behavior from the 114 biopsychological (also called ethological) view that is presented in this book. Biopsychologists had already described behavioral systems, or sequences of behaviors animals use when pursing a goal. These observed behaviors relate directly to the motivational state of the animal. If a bear is hungry, it will rip apart a tree looking for grubs to eat. If a male peacock wants to mate, he will show off his feathers to a female. These sequences of behavior are observed because behaviors link to motivational states. Students benefit from understanding that for many reasons after about 1950 most psychologists gave up on studying motivation. An understanding of biopsychology is necessary to understand motivations because motivational goals are tied to biological needs. Bowlby used the phrase attachment behavioral system to refer to behavioral sequences observed in infants that relate to infant motivation to seek security and care from caregivers (Stevenson-Hinde, 2007). The motivation to seek security or relief from fear, is important to infants because they are small and vulnerable. Infants cannot defend themselves or provide for their own needs, all their security must come from the mother-infant system. What infant attachment behaviors are observed? Infants are born with reflexes that enable them to signal their needs. Experienced caregivers can distinguish infant cries of hunger, discomfort, and pain. As the brain and nervous system develop in the first two months, infants become capable of voluntary behavior, and they get used to being cared for and responded to. They learn what to expect when they cry out or act interested. Babies have evolved cuteness to elicit care from adults. By eight weeks, the first voluntary social behavior to emerge is the social smile. The social smile tells the parent, “I am here, and I see you!” Shortly after that babies make sounds and laugh to attract caregivers’ attention. Piaget noted that infants develop schemas of the way the world works. Schemas of attachment are called internal working models. These represent what infants have come to expect when they ask for help. As attachment researcher Mary Ainsworth noted, “a mother's prompt responsiveness to infant crying early on led an infant to cry less in later months rather than reinforcing a tendency to cry.” Responsive mothers teach their infants what to expect; infants who have expectations that their needs will be met cry less. In the 9 months following birth, infants develop a preference for mother and others who have provided them with care. By the time infants can crawl or walk away from caregivers, the attachment bond keeps them returning for safety. Infants of this age typically become very distressed when separated from familiar caregivers. Infants often form attachments to more than one adult, and they learn what to expect from each different caregiver. They show they have internal 115 working models that indicate learning about their interactions with each caregiver. We have used the term “mother-infant system” to refer to the reciprocal interactions the infant has with each caregiver. The Circle of Security Graphic of Attachment To help parents and professionals understand the attachment behavioral system, clinicians Kent Hoffman, Glen Cooper, and Bert Powell developed the Circle of Security graphic and Circle of Security Program (“The Co-Originators,” 2022). The graphic explains that infants and young children have motivation to explore their world so they can learn and grow their brains. While they are exploring, they need their caregivers to stand by and watch over them, to protect them from danger and to help them if they need it. Adults that do this are functioning as what Bowlby (1988) called, “a secure base.” Infants and children also need their caregivers to play with them and enjoy them. This playing and enjoying helps them learn to regulate and experience the positive emotions, of joy, affection, and curiosity. When infants and children have had enough of exploring, or they get hurt or frightened, they signal they need support. It is important that caregivers welcome them back and provide the comfort they need. When caregivers welcome children back and attend to their needs they act as what Bowlby (1988) called a “safe haven.” Children who have a safe haven learn to regulate 116 negative emotions of fear and sadness. The Circle of Security Program motto is “Always be: bigger, stronger, wiser and kind. Whenever possible follow my child’s need, whenever necessary, take charge.” Let’s take a close look at the motto. The advice to be bigger stronger, wiser, and kind comes directly from Bowlby who insisted that attachment is specifically to a person who can be protective. The advice to follow the child’s need can be thought of as referring to the Self-Determination Theory needs for competency, autonomy, and relatedness. Parents who recognize their child’s need for competency, support exploration. Parents who recognize their child’s need for autonomy try not to control them too much. Parents who recognize their child’s need for relatedness, have fun with them and comfort them when they need it. Parents who take charge calmly without becoming hostile, model self-regulation to their children (see below). Many useful videos and more information can be found on the Circle of Security International website. The authors of this book recommend that professionals working with young children and families, attend a Circle of Security class and also get trained to facilitate the program. Individual Differences in Attachment Behavior Temperament and experiences shape the way infants, toddlers and young children behave while exploring and returning to their caregivers for comfort. Mary Ainsworth (1978) observed infants and mothers in Uganda and the US and developed “The Strange Situation” protocol, for assessing what she called attachment styles in toddlers and young children. In this protocol, a child is placed on the floor in an unfamiliar room with many interesting toys. A stranger is in the room and the child’s caregiver initially sits in a chair beside the playing child. Most children will be eager to explore but some are more fearful. The child’s behavior with the toys and the caregiver is recorded. The protocol then calls for the caregiver to leave the room and the child’s response to the caregiver’s absence and return are recorded. Emotional responses to the caregiver leaving commonly include strong crying but some children appear indifferent. Most informative is whether the child is easily calmed when the caregiver returns. Sometimes during “reunion” anger and/or indifference are displayed. Although there are a range of possible emotional responses to this protocol, four categories of infants are observed with styles labelled secure, insecure resistant, insecure avoidant and disorganized. Children with a secure attachment style “usually are ready to explore when the mother is present, less so when she is absent and prompt to seek to be close to the mother in the reunion episodes or at least to initiate positive interaction with her across a distance, showing neither avoidance nor angry resistance” (Ainsworth, 1985, p. 775). (65% of US children) Children with an ambivalent (sometimes called resistant) attachment style “tend to be wary of the stranger, intensely upset by the separations and ambivalent to the mother when she returns, both wanting to be close to her 117 and at the same time being angry with her, thus being difficult to soothe” (Ainsworth, 1985, p. 775). (10-15% of US children) Children with an avoidant attachment style “tend to maintain exploration across all episodes, not to be upset by separations from the mother, and to avoid her when reunited” (Ainsworth, 1985, p. 775). (20% of US children) Children with a disorganized/disoriented attachment style seem to have an inconsistent way of coping with the stress of the strange situation. They may rock and show stereotyped movements. (5-10% of US children) These attachment styles reflect all aspects of temperament discussed above including how readily children explore, how they respond to new situations and how they regulate their emotions. It is likely that infants’ experience with their caregivers can shape temperament (Belsky & Rovine, 1987; Calkins & Fox, 1992; Vaughn et al., 1989). As children have experiences exploring and returning to the caregiver for nurture, they learn what to expect and develop internal working models. The attachment styles reflect these internal working models children have about how available and nurturing the caregiver is. The secure child feels safe exploring and is used to getting comfort from the caregiver when needed― the caregiver is a secure base and a safe haven. The ambivalent child is more fearful and tries to use the caregiver as a safe haven but is less sure of the secure base. The avoidant child acts like a secure base is not needed and does not use the caregiver as a safe haven. The child with disorganized behavior lacks a stable working model and is most at risk for mental health problems. The Still-Face Paradigm The Still-Face Paradigm was developed in 1978 by Dr. Edward Tronick and colleagues at the University of Massachusetts. You can watch Dr Tronick explain the paradigm by clicking on the photo on the left or on this text. In this experimental procedure a mother or father brings their infant or toddler to the laboratory and sits facing the infant interacting as usual for several minutes. The researcher then cues the parent to make an expressionless face and sit still. The parent sits unresponsive to infant behavior for a brief period while the infant is observed. On cue the parent returns to their usual self. Hundreds of research studies using this protocol show that parental unresponsiveness for even brief periods causes a lot of distress in infants. This distress is accompanied by sympathetic arousal and hormonal stress responses. Infants as young as one month of age respond 118 with increased distress to the still face. Older infants respond by trying to get the parent’s attention through pointing, verbalizing, or screaming. When these attempts are unsuccessful, they cry. When the parent returns to their normal behavior the infant takes several minutes to return to baseline. One explanation for infant distress from the still-face is that infants expect interactions with caregivers to be reciprocal. When the parent suddenly becomes unresponsive the infant becomes frightened. Support for this idea comes from the observation that infants respond less to strangers who adopt the still-face. Infant responses to caregiver still-face resemble those of infants who show disorganized attachment during the strange situation procedure. Disorganized attachment is thought to occur in the infants whose mothers have dissociative episodes due to prior trauma or severe mental illness. During these episodes mothers may be briefly unresponsive and so may frighten their infants (Mesman et al., 2009). Although the full meaning of the still-face effect is not yet known, these experiments show that infants are greatly affected by caregiver emotional responses. Separating Families at the United States Border About 4,000 children were separated from their parents beginning in April 2018 as they approached the United States border by Immigration and Custom Enforcement (ICE). Children were placed in separate facilities from their parents when they were being processed, and they were not told when they would be reunited. When enduring stressful situations, separation from one’s parents can be extremely detrimental to a child (Society for Research in Child Development (SRCD), 2018). Parental separations affect children’s stress management systems by changing how the body responds to stress. Long-term stress can disrupt brain functioning, cognitive skills, emotional processing, and physiological health. When exposed to stress, children typically look to their parents for support and care, and parents can reduce children’s stress. These separated children were already under extreme stress escaping their previous homes, and then were separated from the individuals who could support them through this process. Stress from parent separation places children at a higher risk for anxiety, depression, PTSD, lower IQ, obesity, impaired immune system functioning, and medical conditions (SRCD, 2018). Even after being reunited, children can experience attachment issues, poorer self-esteem, and physical and psychological health difficulties. As they age, they continue to exhibit an increased risk for mental health problems, problems in social interactions, difficulty with adult attachments, poorer stress management, and an increased risk for death. The American Psychological Association opposes policies that separate families given the negative outcomes suffered by children. To date less than half of separated children have been reunited with their parents. Read More 119 The Caregiving Behavioral System There are two partners in the mother-infant system, the infant, and the caregiver. Working models of attachment reflect the brain and mind of the infant, the one who needs care. Infants are born ready to form working models about receiving care. These models are necessary for survival. Is there evidence that infants also develop working models of giving care? The answer is yes, the caregiving system starts to develop around the first birthday. Infants simultaneously form attachment bonds and learn caregiving behaviors. Infants and children naturally imitate the behavior of others, especially the powerful others in their lives (Bandura et al., 1963). As soon as they show goal directed behavior infants imitate the actions of others. The one-year-old whose father offers a bite of food, also offers father a bite. Developmental researchers find that attachment styles are transmitted from one generation to the next because many people parent the way they were parented (Verhage et al., 2016). Child’s play and direct evidence for internal working models of caregiving The expectations infants have about giving and receiving care come from internal working models. These are formed as children have daily experiences of being care recipients. Internal working models are preverbal memories that become part of the wiring of the brain. As soon as they can play, children act-out caregiving behaviors in play; and as soon as children can speak, they speak about these preverbal memories indirectly in play (Cooper & Quiñones, 2022). If dolls are available for play, both boys and girls dress the dolls, change their diapers, keep them warm, and give them affection (Cooper & Quiñones, 2022). In this play children both identify with the doll showing empathy and practice caregiving behaviors. Parents and early childhood educators can standby, observe this play and comment on it, “you are taking care of the doll like we take care of you.” This joint play and commenting makes the child’s preconscious working models conscious. By identifying with the caring actions of the more powerful caregiver, the toddler at play comes to associate caring with being powerful. Brain circuits that enable empathy are also engaged. Empathy is part of the caregiving system because to give care a person must be able to understand what the care recipient needs (Preston, 2013). Empathy in Infants and Toddlers “Empathy is the capacity to comprehend the minds of others, to feel emotions outside our own, and to respond with concern, kindness, and care to others’ suffering…Empathy is thought to have evolved out of the mammalian caregiving system to promote adaptive responses to the needs of kin, as well as to promote cooperation and resource sharing among group members” (Stern & Cassidy, 2018, p. 1). It follows there are three parts to empathy: emotion sharing, cognitive understanding and perspective taking (also called theory of mind), and empathic concern for the others’ welfare with motivation to act. Emotion sharing is present from birth onward 120 as even newborns 36 and 72 hours old cry in response to the cries of another baby and not to other sounds of the same intensity (Sagi & Hoffman, 1976). The ability to read the emotions of others enables children to learn about dangerous situations by watching how other people react. Social referencing or looking to others’ emotions for information about a situation begins at about 12 months of age. For example, children use social referencing when they look to a parent in the presence of an unfamiliar person or animal. If the parent does not show fear, the child will feel safe. Social referencing shows that very young children can read the emotions of others and use the information they get from their observations to guide their own behavior. Interesting research shows that typically developing toddlers under the age of 18 months recognize others’ emotional states and modify their behavior to avoid making adults angry (Infant, Control Thyself | I-LABS, 2014). Watch the video on YouTube. Early empathy takes the form of emotional contagion (crying when others cry) and is a reflex present at birth. Even infants under 8 months show awareness of helping others when they clearly prefer puppets they have seen helping others. This preference indicates they understand that being helpful is a quality of some individuals and not others (Hamlin et al., 2007). (Visit YouTube to watch a video about this research, covered in the New York Times.) True empathic concern develops by 8 months of age; and attempts to help the distressed other increase steadily between 8 and 16 months. Toddlers respond most to their mother’s distress but they do show concern for experimenter distress (Knafo, 2006; Roth-Hanania et al., 2011). While many toddlers show empathic concern, motivation to care, and imitation of caregiving behaviors, some do not (Stern & Cassidy, 2018). In the first two years of life empathy becomes a stable trait of toddlers and individual differences are apparent. It is therefore important to understand the factors that affect the development of empathy. By two years of age 25% of the individual differences in trait empathy are due to genetics and there are no measurable sex differences in empathy during the toddler years (Knafo, 2006). Although empathy in toddlers results from the child developing internal working models of caring interactions, maternal warmth and sensitivity also enhance empathy in other ways. Toddlers of warm, sensitive, and responsive mothers have more advanced cognitive and language ability. They also play more with their mothers. Higher levels of empathy are found in toddlers who play more with their mothers and have higher cognitive and language skills (Moreno et al., 2008). In infancy and early childhood, socioemotional learning and cognitive development go hand in hand. 121 The Dominance System As you learned in Chapter 1 and the two prior sections, group life affords people with safety and care and typically developing infants have working models of attachment and caregiving by 1 year of age. Competition for resources and status is the other side of group life. Infants are born predisposed to learn how the social world works; they develop internal working models of safety and care and also competition and status (Thomsen, 2020). Notice that in the normative developmental sequence, models of safety and care get a head start that allows empathy to regulate motivation for competition and status. By six months of age infants have a desire to control objects in the environment and they experience agency. They also understand the agency of others (Kamewari et al., 2005). Agency means a “feeling of control over actions and their consequences” (Moore, 2016). Agency is linked to the fundamental human need for autonomy as we emphasize in this book. Experiences with agency give rise to 1) a sense of self that is required for competition and 2) self-concepts that are required for evaluation of status. Throughout life, agency and status concerns are tied to the sense of self and self-concepts. Self-interest can be at odds with caring for others, that is why greedy people can be considered selfish. Self-Development By the middle of the second year, most toddlers have a concept of themselves as a physical being with recognizable characteristics. The development of self- concept is directly observed in children's behavior; most children recognize themselves in mirrors and pictures by 18 months of age (Stipek et al., 1990). Notice that the 18-month-old toddler shows a consciousness of self that parallels the kind of consciousness they have about objects in the world around them. At this time they show this consciousness by using the words I, me and mine (Mascolo & Fischer, 2007). Mothers of toddlers also notice they increasingly want to do things for themselves (Stipek et al., 1990). They begin to show agency as they enter the Erikson stage of Autonomy vs Shame and Doubt. Not all toddlers show the same amount of agency, some are more energetic, and goal directed than others. Agency is an aspect of temperament; and individual differences in agency come from individual differences in reward responsiveness (Rothbart et al., 2000). Dominance Behavior and Internal Working Models Studies of one- and two-year-old children in daycare reveal that they compete for resources such as toys and use aggression in this competition. Aggression is not 122 typically seen in children under 12 months (Russon & Waite, 1991; Strayer & Trudel, 1984). “Dominance” of one toddler over another means one consistently wins the competition for resources. Even at this young age, there are clear stable linear dominance hierarchies. These hierarchies reduce the level of aggression because children remember a peer’s status and defer to those of higher rank. Children of this age are also more likely to imitate peers of higher rank. Despite the competition, most interactions between peers in daycare are friendly (Strayer & Trudel, 1984). Researcher Lotte Thomsen and colleagues used an innovative method to investigate whether preverbal infants understand social dominance. They showed the infants a series of cartoons depicting a large and small box moving along the same path getting in each other’s way. On some of the trials the “large (box) prostrated itself and yielded the way so that the small (box) could complete its path to the end” (Thomsen et al., 2011, p. 477). Infants 9 months of age and older responded to the video in ways that indicated they were surprised when the large box moved over for the small box and not vice versa. Infants of all ages were not surprised when the smaller box yielded to the larger. The researchers concluded that preverbal infants mentally represent social hierarchies based on size. To the infant, physical size determines who is number one. In the family, fathers and older siblings are larger; starting in the second year, infants defer more to fathers than to mothers. Mental representations of dominance are present before most infants have experiences competing with peers. They likely learn about dominance relationships by observing others in the family. To listen to a podcast about this research visit Science Magazine. The Sexual System “The capacity for a sexual response is present from birth. Male infants, for example, get erections, and vaginal lubrication has been found in female infants” (DeLamater & Friedrich, 2002). The “term intersex… (refers) to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female” (Sax, 2002). Applying this definition, the prevalence of intersex births is 0.018%. Allowing for a “non-binary” gender category on birth certificates would help this small minority of individuals because it is best not to subject them to surgery as infants (Dickens, 2018). Current best practice calls for waiting to see how gender identity develops in the individual and not subjecting them to any procedures until they are old enough to consent (Dickens, 2018). Children are surrounded by messages about gender from birth. Given that toddlers have working models of attachment, caregiving, and dominance, it would be surprising if they did not have gender schemas. Remember that humans are “sexually dimorphic” in many respects meaning that the bodies of genetic males and females differ in ways that extend beyond the genitals. Males are on average larger; and the male brain is larger, organized differently and develops more slowly (Cosgrove et al., 2007). Humans are 123 likely born ready to acquire gender related schemas and apply them to self. That being said, individual differences exist for all the social behavioral systems. These individual differences shape personality. The first stage of gender development is recognition of male and female categories as indicated by different responding to stimuli associated with maleness and femaleness. Schemas related to gender categories are usually acquired by 6 months of age. By 9-12 months infants put gender schemas together and know that male faces, hair styles and dress go with the deeper male voice and that female appearance goes with the higher pitched female voice (Martin et al., 2002). Similar to the other social behavioral systems, gender schema knowledge is preverbal. As infants learn words, they attach names to gender schema. Naming facilitates further learning. Gender schemas applied to the self are usually not present in the infant toddler period but some studies have found that boys and girls have gender-typed toy preferences (Huston, 1985). Adults unconsciously push babies toward gender typed toys as shown in this BBC video. Infant and Toddler Cognition In the last chapter you learned that infant cognition is centered around sensory motor experiences. In the first 3 months, reflex behavior is replaced by voluntary behavior and in the first year the visual system develops. Sight quickly becomes the most important sense and infant attention is focused mainly on what they can see (Colombo, 2001). Three-month-old infants remember what they have seen and experienced. These memories guide their behavior and help them to learn routines (Rovee-Collier & Cuevas, 2009). Infants as young as 6 months can learn through imitation (Rovee-Collier & Cuevas, 2009). At nine months of age, infant memory and agency have matured enough so that infants will look for a hidden object. Developmental psychologists call this “object permanence;” we now know that infants as young as 3 months underestand that objects they cannot see still exist (Bremner et al., 2015) so object permanence develops before 9 months. Don’t be surprised if you see “object permanence” listed as a developmental milestone achieved at 9 months; clinicians and researchers came up with that before recent research showing this ability in very young infants. At 12 months of age infants start using words to symbolize objects. Serve and Return Clinicians at Harvard University Center on the Developing Child use the phrase “Serve and Return” to describe the way caregivers stimulate infant cognitive development. “When an infant or young child babbles, gestures, or cries, and an adult responds appropriately with eye contact, words, or a hug, neural connections are built and strengthened in the child’s brain that support the development of communication and social skills” (Serve and Return, n.d.). Cognitive development in the first 6 years of life is dependent on social and emotional development. Numerous studies show that sensitive and responsive parenting correlate with language skills, self-regulation 124 and brain development (Kok et al., 2015; Romeo et al., 2018). Infants’ expectation that their “serves” (babbles and gestures) will be “returned” accounts for why the caregiver still-face discussed above is so disturbing to them. Self-Regulation Domain Related Abilities Age Milestones Positive Influences Attentional Arousal Control Begins at 3 months; Caregivers with Control Attention Control improves steadily predictable but flexible routines Emotional Control Distraction: Effortful 5-6 months Sensitive, non- use of attention to intrusive caregivers control emotions. Behavioral Effortful control: 12 months with Warm, sensitive, Control suppressing urges steady improvement non-punitive Compliance: over second year caregivers. following caregiver Positive demands relationships with fathers. Table 5-3. Self-Regulation terms and definitions. Everyone at every age behaves in a goal directed way. That is, people strive to get rewards and avoid punishments. Many goal directed behaviors are not in the individual’s long-term best interest. For example, a toddler who has a tantrum to try to get something also puts a stress on their caregiver. A teen who takes up smoking endangers their longterm health. Behaviors are self-regulated when they serve an individual’s long term best interest and/or help to maintain healthy relationships. During development individuals learn to regulate themselves to achieve the best longterm reward and least longterm punishment. Without self-regulation behavior is impulsive and unplanned and has unintended consequences. Self-regulation is formally defined as as the ability to control inner states or responses including thoughts, emotions, attention, and behavior. In the first six months of life infants lack self-regulation and depend on caregivers to regulate and soothe them. During infancy much of self-regulation is actually co-regulation. Self-regulation first manifests after 3 months of age. At this time, infants begin to be able to control their attention and so partly self-soothe and distract themselves. What evidence is there that infants and toddlers cope? Coping is emotion regulation under stress (Zimmer-Gembeck et al., 2017). Emotion regulation in the first two years can be seen when infants and toddlers try to recover from or avoid crying and anger episodes. Infants and toddlers may also manage positive emotions by maintaining interest and joy without becoming overly exuberant. In the first three months behaviors such as eye closing, turning the head away, and non- nutritive sucking are used to regulate emotions and attention. After 3 months, vision, 125 and the ability to turn the head and move the arms and legs increases and you may observe older infants looking at their hands, turning their heads away or moving arms and legs when they are overstressed (Kopp & Neufeld, 2003). Caregivers of 5-6 month old infants teach distraction by showing interesting objects to infants or handing them objects to hold in their hands (Kopp & Neufeld, 2003). After 12 months infants actively solicit help from caregivers to regulate fear. Behaviors include walking or crawling to the caregiver, tugging at caregiver clothing, and using the shoulder as a comfort (Kopp & Neufeld, 2003). Toddlers may also use transitional objects to help with coping. Transitional objects such as blankets and teddy bears are used most by 18 month old toddlers; up to 60% will use them and some will continue this coping strategy in early childhood (Kopp & Neufeld, 2003). Late in the second year some children use language to assist with emotion regulation. They may have words for sleep, pain, distress, pleasure, disgust, affection and compliance (good boy/girl) (Bretherton et al., 1986). For infants and toddlers, behavior regulation often means going along with caregiver requests. To do this they must either stop themselves from doing something (DON’T requests), or make themselves do something they don’t want to do (DO requests). Research shows that DON’T requests are easier for 12-24 month old toddlers than are DO requests (Aksan & Kochanska, 2004). It is also easier for toddlers to comply with a caregiver’s request when the caregiver is watching. Children who comply with requests when no one is watching are said to have internalized rules and committed compliance. Toddlers vary in their ability to comply with DO and DON’T requests when caregivers are watching and when they are not watching. Behavioral self-regulation also called effortful control, begins to be a trait individuals have more or less of (Eisenberg et al., 2011). What can caregivers do to help infants and toddlers develop self-regulation? As discussed above, caregivers who act as a secure base and a safe haven, support exploration and coping with negative emotions. This caregiver behavior helps the toddler to develop a secure attachment style and this is connected to better coping and more positive emotions (Zimmer-Gembeck et al., 2017). Some studies show that toddlers with avoidant attachment are better able to cope with negative emotion on their own but these children have trouble regulating anger. Toddlers with resistant attachment have the most trouble with emotion regulation (Zimmer-Gembeck et al., 2017). Experts on attachment note that most children have a “primary attachment figure” that helps them learn self-regulation in the first two years. Most often this caregiver is the mother and for many children, mothers and fathers help in different ways (Sroufe & McIntosh, 2011). 126 Mothers carried this baby, that is a different deal. We (men) did not, we cannot nurse. It is a different deal. It does not mean fathers are less important. Why would it make you feel less important as a father if you’re not a primary attachment figure? Children need way more than that. They need guidance, they need limits, they need role models, they need to believe that they can do things, they need a ton. And frankly I think there are some things that fathers are better at than mothers. Alan Sroufe (2011), emphasis added. In writing this and the prior chapters, we adopted Alan Sroufe’s view as expressed in the quote above. Most often the primary caregiver is the mother, and mothers and fathers have different relationships with infants and toddlers. This description of reality is not meant to indicate what an ideal family is; only what the most prevalent family is. Furthermore, experts advise that infants should be breastfed for at least six months unless there are reasons this is not possible. The demands of breastfeeding make mothers the primary attachment figure. Fathers are important to infant and toddler development too. Whereas mothers’ main job is to calm infants and toddlers, play with father causes positive excitement. This play helps children learn to regulate positive emotions (Feldman, 2007). Remember that infants have working models of dominance. Beginning in the second year of life, children comply with fathers’ requests more readily than with mothers’ requests (Nigg, 2006). Again this reflects the usual family where the father is physically larger and the mother is the primary attachment figure. Infants may be predisposed to learn patriarchy because they learn differences between men and women early and they measure dominance by size and strength. Compliance with authority is important to learning to get along in the family and in school as discussed in Chapter 6. Language Development One would naturally expect that prediction of the behavior of a complex organism (or machine) would require, in addition to information about external stimulation, knowledge of the internal structure of the organism, the ways in which it processes input information and organizes its own behavior. These characteristics of the organism are in general a complicated product of inborn structure, the genetically determined course of maturation, and past experience (Chomsky, 1959, p. 26, emphasis added). Language is a system of communication that uses symbols in a regular way to create meaning. How do babies learn to understand and speak their native language? This question was the basis for a debate between linguist Noam Chomsky and behaviorist B.F. Skinner that illustrates why learning theory alone cannot explain development (Harris, 2013). Skinner’s book (1957) Verbal Behavior, discusses the idea that children 127 learn language through reinforcement learning. In reviewing this book, Chomsky (1959) wrote that reinforcement learning could not possibly account for language; and he proposed that the mind contains a “language acquisition device (LAD)” that is responsible for why infants and toddlers learn language so easily. Scientists have yet to find this LAD but the infant brain is ready to comprehend and imitate language; and experience with language shapes the structure of the brain. There are specific language circuits in the brain devoted to comprehension and speech production (Poeppel, 2014). Chomsky also proposed that some aspects of grammar are common to all language because these are connected to the way the brain processes language information. According to our biopsychological perspective, language is one of many behaviors human beings are born predisposed to learn. With learning the structure of the brain is progressively altered as individuals mature. If you have been around infants, you know that infants are noisy creatures. In addition to distress cries, infants produce vocal sounds beginning soon after birth. Infants are intrinsically motivated to make these sounds, just as they are intrinsically motivated to learn to use their arms and legs, hands, and feet. Infants vocalize to caregivers, but they also vocalize when not interacting with anyone. One study documented infants vocalizing 4-5 times a minute while awake! At 3, 6 and 10 months, 75% of infant vocalizations are a form of verbal self-play and not related to social interaction (Long et al., 2020). Around the world the first infant vocalizations are similar, and infants respond to the sounds of all languages. At 7 months, infants begin to babble in a way that is specific to their native language (Boysson-Bardies et al., 1989); they also lose some ability to appreciate differences between language sounds (Werker & Tees, 1984). All language has the same basic structure, that likely reflects how the brain processes information (see above). A phoneme is the smallest unit of sound that makes a meaningful difference in a language. For example, the word “bit” has three phonemes. A morpheme is a string of one or more phonemes that makes up the smallest units of meaning in a language. Some morphemes are prefixes and suffixes used to modify other words. For example, the syllable “re-” as in “rewrite” or “repay” means “to do again,” and the suffix “-est” as in “happiest” or “coolest” means “to the maximum.” Syntax or grammar is the set of rules of a language by which meaning is constructed. Each language has a different syntax, but these differences have evolved over time and closely related languages have common syntax (Longobardi & Guardiano, 2009). Interestingly the syntax of language and syntax of music have much in common (Asano & Boeckx, 2015). Pragmatics, or how we communicate effectively and appropriately with others incorporates social rules. Examples of pragmatics include turn- taking, staying on topic, volume and tone of voice, and appropriate eye contact. 128 Birth to 3 Months 4 to 6 Months Reacts to loud sounds Follows sounds with his or her eyes Calms down or smiles when spoken to Responds to changes in the tone of voice Recognizes caregiver voice and calms down Notices toys that make sounds if crying Pays attention to music When feeding, starts or stops sucking in Laughs response to sound Makes gurgling sounds and raspberries when Coos and makes pleasure sounds alone or playing with caregiver Has a special way of crying for different needs 7 Months to 1 Year 1 to 2 Years Enjoys playing peek-a-boo and pat-a-cake Knows a few parts of the body and can point to Turns and looks in the direction of sounds them when asked Listens when spoken to Follows simple commands (“Roll the ball”) Understands words for common items such Understands simple questions (“Where’s your as “cup,” “shoe,” or “juice” shoe?”) Responds to requests (“Come here”) Enjoys simple stories, songs, and rhymes Babbles using long and short groups of Points to pictures, when named, in books sounds (“tata, upup, bibibi”) Acquires new words on a regular basis Babbles to get and keep caregiver attention Puts two words together (“More cookie”) Communicates using gestures such as Asks one- or two-word questions (“Where kitty?” waving or holding up arms or “Go bye-bye?”) Imitates different speech sounds Uses many different consonant sounds at the Has one or two words (“Hi,” “dog,” “Dada,” or beginning of words “Mama”) by first birthday Table 5-4. Language Milestones The order in which infants, toddlers and young children learn to comprehend and produce speech is consistent across children and cultures (Hatch, 1983). The language milestones in Table 5-4 illustrate typical language development during the infant toddler period. From birth to 3 months infants respond to sound and recognize the voices they hear every day. They also utter a variety of sounds. Cooing consists of consonant and vowel sounds, and should be present by 4-6 weeks (Coplan, 1995). Also in the first 3 months, babies make raspberries and gurgling noises, In the 4-to-6-month period infants laugh and produce one syllable sounds. After 6 months infants begin babbling using multiple syllables repeated over and over. Infants can comprehend speech before they can say words. The first words are usually understood at 8 or 9 months and spoken at 12 months. By 24 months toddlers can produce short sentences and short questions. Independent of the native language, on average girls acquire language earlier than boys but sex differences are small (Wallentin, 2009). Infant Directed Speech Have you ever noticed that adults tend to use “baby talk” when talking to infants and toddlers? Infant-directed speech is used automatically by caregivers of all cultures because it helps infants learn language. This way of speaking involves exaggerating the vowel and consonant sounds, using a high-pitched voice, and delivering the phrase with great facial expression (Clark, 2009). Infants are frequently more attuned to the 129 tone of voice of the person speaking than to the content of the words and are aware of the target of speech. Werker, Pegg, and McLeod (1994) found that infants listened longer to a woman who was speaking to a baby than to a woman who was speaking to another adult. Adults may use this form of speech to clearly articulate the sounds of a word so that the child can hear the sounds involved. This type of speech also grabs the infant’s attention and so sets up a pattern of interaction in which the adult and child are in tune with each other. Watch a YouTube BBC video on infant-directed speech also called parentese. Is There a Sensitive Period for Language Development? A sensitive period is a time in development when individuals are more responsive to certain stimuli and quicker to learn particular skills. In Chapter 3 you learned that the brain grows in size dramatically during the infant-toddler period because cells migrate into the outer layers of the cortex and connections form. Brain development after birth allows for experience to shape brain structure. Cells that form connections persist and those that do not undergo programmed cell death (Lenroot & Giedd, 2006). These findings from neuroscience account for sensitive periods in development. Evidence that the first 3 years of life is a sensitive period for language development comes from three sources, studies of hearing-impaired infants, studies of infants learning a second language, and studies of neglected children. About 3 out of every 1000 infants have hearing impairment (CDC, 2021). The earlier children are diagnosed with hearing impairment and receive treatment, the better their language development will be (Houston & Miyamoto, 2010). W hen children’s hearing loss is identified during newborn screening, and subsequently addressed, the majority show normal language development when later tested at 12-18 months (Stika et al., 2015). Tomblin et al. (2015) reported that children who were fit with hearing aids by 6 months of age showed good levels of language development by age 2. Those whose hearing was not corrected until after 18 months showed lower language performance in the early preschool years. Some infants with hearing loss can be helped more with cochlear implants than with hearing aids. Studies of children who received cochlear implants show that the earlier they receive them the better their language development is (Houston & Miyamoto, 2010). Non-hearing infants who are taught sign language early also do better (Houston & Miyamoto, 2010). Studies of children learning a second language show that the earlier they start the more proficient in the second language they will be (Houston & Miyamoto, 2010). Studies of immigrant infants show that the earlier they begin to learn the new language the better their second language skills are, whether or not they remain fluent in the primary language (Norrman & Bylund, 2016). Language delay is a frequent finding in neglected and/or abused children, affecting 30- 60% of this group under age 3 years (Sylvestre et al., 2016). Both speech and 130 comprehension are lower in groups of neglected and abused children (Sylvestre et al., 2016). Neglect and abuse affect social functioning by causing trauma and also by failing to provide the child with the interactions needed to learn language. The tragic case of Genie Wiley is an example of what can happen in severe neglect. She was kept without meaningful social interaction until she was rescued at age 13. Linguists who worked with her were initially encouraged by her rapid learning of words. However, Genie was never able to gain full language function. A documentary made about Genie is available on YouTube. Taken together findings in hearing impaired, second language learners and abused and neglected children indicate that the sensitive period for language development is birth to about 3 years of age. Recovery from deprivation is more likely when children receive treatment and remediation early. Autism Spectrum Disorders in Toddlers Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 44 children in the United States. ASDs are four times more prevalent in boys than girls and are the most common form of developmental disability. An infant with an affected sibling is 10 times more likely to be affected compared to the general population. Parents of children with ASD usually notice concerns around the child’s first birthday including: 1) Social communication difficulty (low eye contact, lack of shared attention, low smiling, low social interest, lack of pointing); 2) Play behavior shows reduced imitation and repetitive actions with objects; 3) Language delay; 4) Sensory difference (under and over responsiveness) 5) Gross and fine motor deficits 6) Impairment in eating, sleep and attention (Zwaigenbaum et al., 2009). Watch YouTube Video “Signs of Autism”. Screening for ASDs in toddlers is usually done with the MCHAT-R available through the Autism Speaks Website. Early intervention may improve outcomes for children identified early. Most children with autism are not identified until after age 4. Assessment of Infant-Toddler Development Early Language Milestone Scale The Early Language Milestone Scale- Second Edition (ELM Scale-2) assesses speech and language development from birth to 36 months of age. The ELM Scale-2 is ideally suited to help clinicians implement the mandate to serve the developmental needs of children from birth to 3; the ELM Scale-2 also can be used with older children with developmental delays whose functional level falls within this range. The ELM Scale-2 consists of 43 items arranged in three divisions: Auditory Expressive (which is further subdivided into Content and Intelligibility), Auditory Receptive, and Visual. The test 131 takes 1 to 10 minutes to administer, depending on the child's age and the scoring technique employed. The Neonatal Behavioral Assessment Scale (NBAS) is used to assess infants up to 2 months of age. The NBAS assesses the newborn’s behavioral repertoire with 28 behavioral items, each scored on a nine-point scale. It also includes an assessment of the infant’s neurological status on 20 items, each scored on a four-point scale. One in six American children has a developmental disability or developmental delay (CDC, 2022) and many of these children do not receive the early intervention they need. The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening for all children during regular well-child visits at 9, and 18 months and autism screening at 18 and 24 months. Pediatricians and nurse practitioners usually do this screening using the Ages and Stages Questionnaire or other validated measure. Parents and other caregivers can track their child’s developmental progress using tools available from the CDC, Learn the Signs. Act Early program. This program includes the CDC’s Milestone Tracker app, to help parents and providers work together to monitor child development. Globally, the most commonly used developmental assessment tool is the Ages and Stages Questionnaires for birth to age 6. This tool tracks developmental progress and socioemotional development. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) comprehensively assess children within the age range of 1 to 42 months (Pearson Education, 2016). Children are evaluated in five key developmental domains, including cognition, language, social-emotional, motor, and adaptive behavior. The Mullen Scales of Early Learning (Mullen, 1995) is another commonly used comprehensive assessment of language, motor, and perceptual abilities in children from birth to 6 years. The Early Language Milestone Questionnaire (Figure ) enables clinicians to track and screen for problems with language development (Coplan, 1995). References Ainsworth, M. S. (1985). Patterns of infant-mother attachments: Antecedents and effects on development. Bulletin of the New York Academy of Medicine, 61(9), 771. Ainsworth, M. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Lawrence Erlbaum. Aksan, N., & Kochanska, G. 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