Children and Adolescents

1. Children and Adolescents John Sargent, MD

2. 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

3. 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

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

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

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

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

8. 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

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

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

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

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

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

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

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

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

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

18. Adolescence is the journey between childhood and adulthood

19. Physiologic Cognitive Emotional Behavioral change occurs, often asynchronously

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

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

22. Goals of Adolescence, cont. 3.) Have memorable and meaningful experiences that represent contributions and lead to belonging

23. Goals of Adolescence, cont. 4.) Avoid problems that have long-term consequences and a life of their own

24. Goals of Adolescence, cont. 5.) Build the capacity for autonomy upon a foundation of connections and a set of personal values

25. Some challenges which can persist into adulthood that frequently have inception in adolescence include: A.) eating disorders B.) substance abuse C.) incarceration and persistent unlawful behavior

26. Some challenges…, cont. D.) handicap following injury/accident E.) school failure/dropout F.) HIV G.) teen pregnancy(ies)

27. Some challenges…, cont. Frequently these risk factors occur together and have exponential effects

28. Family and community factors can exacerbate risk A.) Parental substance abuse, psychopathology, or criminality B.) Conflictual parental relationship or post-divorce conflict C.) Parental job loss or moving D.) Poverty

29. Family and community factors…, cont. E.) Poor schools F.) Community violence/school bullying G.) Exposure to gangs and antisocial peers

30. Family and community factors…, cont. H.) Lack of access to resources and adult role models I.) Lack of opportunity to develop and refine unique skills J.) Inadequate or poor information K.) A rejecting or unsupportive community

31. Role of cultural and ethnic/racial difference A.) Differing views about American culture B.) Pressure to maintain culture of origin C.) Confusion about being true to one’s own culture D.) Defining a unique cultural adaptation

32. Sexual Orientation Issues A.) Concerns about being different B.) Family responses C.) Peer acceptance and support

33. Sources of resiliency among adolescents A.) Adult/parental support B.) Intelligence C.) Attractiveness D.) Even/easy personality E.) A unique talent or ability

34. Other sources of resiliency A.) Positive framing of contribution and circumstances by others B.) Experience of competent problem-solving C.) Experience of regard and an expectation of honesty and integrity

35. 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

36. Characteristics of successful growth A.) Decreasing age of onset of puberty (earlier for girls) B.) Consistent age of brain maturation with completion of frontal lobe maturation at age 25

37. 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

38. Challenges to successful development A.) Arbitrary and excessive efforts at external control B.) Lack of appreciation of adolescent ambivalence

39. Challenges to successful development, cont. C.) Fluctuation between absent supervision and authoritarian control D.) Parental helplessness and abandonment

40. Community problems that impact youth development A.) Lack of after school or extracurricular opportunities B.) Lack of work opportunities

41. Community problems that impact youth development, cont. C.) Negative views about teenagers D.) Confusion between recognition of physical maturity and awareness of slow psychosocial/emotion regulation development

42. Characteristics of Positive Youth Development: Confidence Competence Caring Connection Character

43. 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

44. Adolescence can be divided into 3 sections A.) Early – ages 11-14 B.) Mid – ages 14-16 C.) Late – ages 17-19 Many aspects of adolescence persist into 20’s

45. Early Adolescence A.) Focus upon physical changes B.) Developing interests which may change rapidly C.) Need adult supervision D.) Need structure and monitored expectations

46. Early Adolescence, cont. E.) Want greater privacy F.) More aware of emotional experience G.) Beginning to reflect on self and experience H.) Impulse control can be a challenge

47. Mid Adolescence A.) More time with peers B.) Strong desire to belong, activities based on belonging C.) Beginning partnering

48. 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

49. Late Adolescence A.) Greater self-direction, self-monitoring B.) Greater capacity for judgment and impulse control

50. 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