Children and Adolescents

John Sargent, MD

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• Learning Objectives:• 1) Understand the process and context of

the development of children• 2) Learn the process of adolescent

development through early, middle and late adolescence

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Development in Infancy

A.) Dependent upon health and capacities including motor skills, sensory abilities

B.) Dependent upon availability of attuned, available, caring adults

C.) Consistency of adult involvement is most important

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Importance of learning to communicate and to obtain consistent reinforcement of communicating wants and needs

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Importance of parental affiliation – parental caring for child as he or she is

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Early motor development enhances relating capacity and mobility – rolling over, sitting, crawling, walking, climbing, running

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Motor development both builds autonomy and the capacity for exploration but also increases the need for social interaction, supervision and limit setting

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Language development begins before age 1 with babbling, proceeds to single words, putting words together by age 2 and greater vocabulary and complexity of syntax through age 5

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Language development furthers modulation of emotions and impulses – through prefrontal cortical modulation of arousal

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Language development also furthers preoperational, egocentric thinking and capacity for solitary and peer play

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Preschool programs require capacity for nurturance, adult availability, physical play, routines, rest, use of language

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Importance of alternatives to language for developmentally delayed, deaf and autistic children

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School aged children engage increasingly in group experiences (teams, classes and clubs)

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Through progression to concrete reasoning school aged children require consistency, challenge and reinforcement and clear support for and standards for success

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Differences in cultural background, size, gender and skills become increasingly more important leading to in groups and out groups

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Specific vulnerabilities in preschool children include parental loss, parental neglect and domestic violence

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Specific vulnerabilities among school aged children include ADHD, learning disabilities and conflictual parental relationship

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Adolescence is the journey between childhood and adulthood

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PhysiologicCognitiveEmotionalBehavioral

change occurs, often asynchronously

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Goals of Adolescence

1.) Learn skills necessary to be prepared for occupational and relationship competency in adulthood

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Goals of Adolescence, cont.2.) Gain the capacities for self-direction and

decision making

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Goals of Adolescence, cont.3.) Have memorable and meaningful

experiences that represent contributions and lead to belonging

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Goals of Adolescence, cont.4.) Avoid problems that have long-term

consequences and a life of their own

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Goals of Adolescence, cont.5.) Build the capacity for autonomy upon a

foundation of connections and a set of personal values

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Some challenges which can persist into adulthood that frequently have inception in adolescence include:A.) eating disordersB.) substance abuseC.) incarceration and persistent

unlawful behavior

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Some challenges…, cont.

D.) handicap following injury/accidentE.) school failure/dropoutF.) HIVG.) teen pregnancy(ies)

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Frequently these risk factors occur together and have

exponential effects

Some challenges…, cont.

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Family and community factors can exacerbate riskA.) Parental substance abuse,

psychopathology, or criminalityB.) Conflictual parental relationship

or post-divorce conflictC.) Parental job loss or movingD.) Poverty

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Family and community factors…, cont.

E.) Poor schoolsF.) Community violence/school bullyingG.) Exposure to gangs and antisocial peers

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H.) Lack of access to resources and adult role models

I.) Lack of opportunity to develop and refine unique skills

J.) Inadequate or poor informationK.) A rejecting or unsupportive

community

Family and community factors…, cont.

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Role of cultural and ethnic/racial differenceA.) Differing views about American

cultureB.) Pressure to maintain culture of

originC.) Confusion about being true to

one’s own cultureD.) Defining a unique cultural

adaptation

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Sexual Orientation Issues

A.) Concerns about being differentB.) Family responsesC.) Peer acceptance and support

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Sources of resiliency among adolescentsA.) Adult/parental supportB.) IntelligenceC.) AttractivenessD.) Even/easy personalityE.) A unique talent or ability

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Other sources of resiliencyA.) Positive framing of contribution

and circumstances by othersB.) Experience of competent

problem-solvingC.) Experience of regard and an

expectation of honesty and integrity

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Course of Development

A.) Generally successful: 60% continuous growth

B.) Staggered but progressive growth: 20%

C.) Challenged development: 20% of youth – at risk for varied poor outcomes

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Characteristics of successful growthA.) Decreasing age of onset of

puberty (earlier for girls)B.) Consistent age of brain

maturation with completion of frontal lobe maturation at age 25

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Characteristics of successful growth, cont.C.) Supervision and support

synchronous with and consistent with fluctuating skills

D.) Opportunities for negotiation, communication and exploration of concerns through language

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Challenges to successful developmentA.) Arbitrary and excessive efforts at

external controlB.) Lack of appreciation of

adolescent ambivalence

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Challenges to successful development, cont.C.) Fluctuation between absent

supervision and authoritarian control

D.) Parental helplessness and abandonment

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Community problems that impact youth developmentA.) Lack of after school or

extracurricular opportunitiesB.) Lack of work opportunities

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Community problems that impact youth development, cont.C.) Negative views about teenagersD.) Confusion between recognition of

physical maturity and awareness of slow psychosocial/emotion regulation development

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Characteristics of Positive Youth Development:

ConfidenceCompetence

CaringConnectionCharacter

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Youth who do well:

A.) Have a positive connection with their school

B.) Have positive relationships with youth who have a positive relationship with school

C.) Are engaged positively with adults who care about them

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Adolescence can be divided into 3 sectionsA.) Early – ages 11-14B.) Mid – ages 14-16C.) Late – ages 17-19

Many aspects of adolescence persist into 20’s

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Early Adolescence

A.) Focus upon physical changesB.) Developing interests which may

change rapidlyC.) Need adult supervisionD.) Need structure and monitored

expectations

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Early Adolescence, cont.

E.) Want greater privacyF.) More aware of emotional

experienceG.) Beginning to reflect on self and

experienceH.) Impulse control can be a

challenge

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Mid Adolescence

A.) More time with peersB.) Strong desire to belong, activities

based on belongingC.) Beginning partnering

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Mid Adolescence, cont.

D.) Abstract reasoning, problem solving used more frequently

E.) Wants and utilizes more independence in decision making

F.) Expects competence and expects to make contributions to social groups

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Late Adolescence

A.) Greater self-direction, self-monitoring

B.) Greater capacity for judgment and impulse control

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Late Adolescence, cont.

C.) More independent decision making

D.) More involvement in longer term relationships

E.) Parents/adults more in the role of advisor/ mentor

F.) More consistent values and beliefs