Developmental Influences on Child Health Promotion

Part 2: Psychosocial, Cognitive, Moral Development Ricci, chapters 25-29

G&D Theories• Piaget—cognitive—learning to think, reason,

make judgments• Erikson—psychosocial—personality

development • Kohlberg—moral—development of a sense of

right and wrong

Piaget• Sensorimotor phase—learning thru senses and motor

skills. Object permanence is major task.• Preoperational phase—egocentrism—inability to see

others’ point of view. Concrete thinking based on what is observed.

• Concrete operations—mostly concrete thinking with beginnings of abstract thought. Conservation and reversibility are major concepts

• Formal operations—abstract thinking. Develops a workable philosophy of life.

Erikson• Trust vs. mistrust (0-1). Relationship to primary

caregiver is essential to establishing trust.• Autonomy vs. shame & doubt (1-3). Need to do things

for self. When stopped or made to feel wrong about it, feel shame and doubt.

• Initiative vs. guilt (3-6). Creating and starting things on one’s own. Egocentrism causes guilt.

• Industry vs. inferiority (6-12). Need to feel worthwhile and important is crucial. Comparison to peers creates feelings of inferiority.

• Identity vs. role confusion (12-18). Striving for a sense of self and belonging and finding a direction are important. Demands on self and from others can create confusion.

Kohlberg• Preconventional level—doing what is

right to avoid punishment or because it is in his own best interests and is fair

• Conventional level—tries to live up to others expectations; what is right is whatever is society’s rules

• Postconventional level—doing good acc’d to what is best for greatest #; universal moral principles of justice, equal rights, and respect for human dignity

Developmental Tasks—Infant

• Trust• Begins separateness • Develops and desires affection• Preverbal communication of needs• Learns language• Fine and gross motor skills• Explores environment• Develops object permanence

Toddler• Egocentric• Begins socially acceptable behavior• Separateness• Increased verbal communication skills• Tolerates delayed gratification• Controls body functions• Begins self-care

Preschooler• Sense of initiative• Increased language skills• Behaves in socially acceptable ways• Develops conscience• Identifies sex roles• Develops readiness for school

School Age• Active and cooperative member of group• Learns rules/norms of society; adapts to

moral standards• Increased psychomotor and cognitive skills• Masters time, conservation, and reversibility• Masters oral and written communication• Wins approval from adults and peers• Builds a sense of industry and + self-concept• Gives affection without expecting anything

Adolescence• Develops group and self identity• Gains independence from parents• Develops value system• Develops academic & vocational skills• Develops analytical skills• Adjusts to rapid physical & sexual changes• Develops sexual identity• Develops multicultural skills• Considers and chooses career

Role of Play in Development

• Universal language of children• Provides socialization• Stimulates development—physical, emotional,

and cognitive, moral• Develops creativity• Provides outlet for fears• Helps develop self-awareness

Social Character of Play• Solitary or onlooker play—plays by self or enjoys

watching others (infancy)• Parallel play—plays with same toy, but with no

interaction (toddler)• Associative—plays same thing as others in

group, but no group plan or goal (preschool)• Cooperative—together with others, play is

organized with group goal (school-age)

Developmental Assessment

• To identify children whose developmental level is below normal for chronologic age and who therefore require further investigation

• Remember, most are only screening tools, not diagnostic.

Risk Factors p. 1055

• LBW, prematurity• CNS problems or neuromuscular issues• Hyperbilirubinemia/kernicterus• Congenital malformations (syndromes)• Chronic OM• Inborn error of metabolism (PKU)• Perinatal infections• Parental issues—drugs, ETOH, low income,

mental illness, etc

Warning Signs (p. 1056)

• No response to stimuli, does not interact with others• No babbling• Persistent primitive reflexes• Abnormal posturing—head lag, fisting, arching, tiptoeing• Failure to achieve gross and fine motor milestones• Failure to achieve language milestones; echolalia• Extreme aggressiveness, fearfulness, sadness• Easily distracted, can’t concentrate• Rarely engages in fantasy play• Failure to achieve personal-social skills or self-help activities

Denver Developmental Screening Test II

• AKA “Denver II” or DDST• Widely used, standardized measures• Tests personal-social, language, fine, gross

motor skills• Examiners must be specifically trained and

certified in use of the tools• Have to have a “kit” with specific items to

administer the test and follow instructions in the manual to ensure validity of the test.

Interpretation of Denver• Don’t use the word “test” with a parent, but tell

them it is a guide • If child “fails” skill, reevaluate in 1-4 weeks• If still problems, do not freak parents out; remind

them this is screening only• Refer to pediatrician or developmental testing

center for further evaluation