Child Development and Psychopathology
| Categories of Development |
To understand abused and neglected children, it is important to have a basic understanding of the common developmental tasks of childhood. Without this understanding, the inexperienced clinician may draw erroneous conclusions regarding problems that are in the realm of normal behavior, or he/she may fail to identify a problem that could have significant consequences for the child’s current or future adjustment. For example, attempting to provide therapeutic intervention for a 3-year old boy with nocturnal enuresis may cause frustration, anger, and undue pressure on the child, resulting in continued problems in bladder control and possibly exacerbating problems in other areas of his life. However, an understanding of child development would indicate that it is common for a 3-year old male not to attain complete nocturnal bladder control. Such understanding would enable the clinician to explain to the child’s parents that this situation is not abnormal and thus, remove the inappropriate perception of the child as having “a problem.” On the other hand, the failure to identify or treat this same condition occurring in a 9-year-old child may contribute to his/her sense of despair or embarrassment about the “problem,” possibly impairing the older child’s social and emotional development. It is vital, therefore, that all child clinicians should have a basic understanding of child development in order to provide therapeutic services to children, especially those who have been abused and neglected.
The categories of child development are grouped into intrapersonal development, interpersonal development, physical development, sexual development, and behavioral conduct development. Brief descriptions of the process of child development are provided, followed by a description of the major achievements/milestones according to each category. It is the intent of this section to give an overview of common patterns in child development.
Central to the process of human development is the organization, representation, and stability of an intrapersonal or “self” system.4 Many different theories of this self system exist. For example, Freud identified the individual’s structural system (i.e., the id, ego, and superego); Erikson depicted it as ego; and attachment and object-relations theorists described it as the process of separation and individuation (e.g., internal representation, object permanence). This is not to suggest that these are the only explanations for the intrapersonal process in human development. Several theorists assert that primary influences to an individual’s human development are partially or exclusively external to the self. The work of these theorists includes many of the behavioral, cognitive-behavioral, and social learning descriptions of human development.5 6
Kegan states that the process of intrapersonal development is central to all other forms of development, but that it cannot be simply encapsulated within a single unifying domain.7 He also indicates that individuals progress through life with specific goals and through specific eras or stages. The theme of this progression is the achievement of several age/development-related tasks, supported by ever-changing environments or cultures, with the goal being development of self. For children, intrapersonal development progresses from the infant’s capacity to create a preliminary concept of identity, to a sense of self, to his/her relationship with a primary caretaker.
- An infant’s world consists almost entirely of his/her relationship with his/her caretaker and the environment provided by that caretaker. Eventually this identity, the evolving self, changes and becomes qualitatively different from past forms as the child enters new relationships and internalizes past relationships. This includes the infant’s departure from his/her perception of the world from the perspective of the primary caretaker to newer and broader environments, and a greater reliance on a developing sense of self.
- For a toddler, this is initially a reformulation of self as a member of a family, in which the young child has an opportunity to practice interpersonal relations within a secure and confined (bounded) set of relationships and then as a child within a group of same-age children (i.e., peers at school).
- For a school-age child, intrapersonal development is manifested as a more independent agent with the capacity for the child to produce, negotiate, and achieve in a form yet further separated from his/her early primary relationships. There is again the reliance on internal capacities and his/her self, rather than on past relationships such as those with the child’s mother or father. In a sense, a school-age child becomes his/her own agent, rather than a member of a family or a child of a parent.
- With the coming of adolescence, a child begins to establish a formal sense of identity wherein higher order processes engage and truly become internal. Typically, self-sufficiency will not occur until late adolescence. Teenagers usually practice independent decision making, relationships, and emotional processes while under the domain of the parent. By late adolescence or early adulthood, however, it is the expectation within our culture that individuals should possess the capacity to function independently, manage emotions and behaviors, cope or adapt to adversity, and begin their own families. The hallmark of this period is the establishment of a meaningful interpersonal relationship (e.g., cohabitation, marriage) and the development of a family.
Interpersonal development is the ongoing process by which a child relates to others in his/her life and creates and adapts to relationships.
- Immediately after birth, an infant demonstrates the capacity to engage in interpersonal relationships. Although the first few weeks of life are characterized by a minimum of initiated interpersonal actions toward others, the newborn is actively engaged in relationships. Simple responses such as crying, tracking visual stimuli, and responding to voices are attempts by the infant to interact with others within his/her environment. Although relatively unsophisticated, these attempts are important in obtaining attention and caretaking. Failure to receive attention could result in neglected conditions. For example, an infant who cannot elicit regular responses from his/her primary caretaker is less likely to be held, picked up, nurtured, fed, have his/her diaper changed, or receive other types of assistance.As an infant matures, his/her ability to interact socially with others becomes more sophisticated. At 2 months of age, an infant responds with a social smile evoked by a familiar face. The relationship with a primary caretaker is the infant’s first meaningful interpersonal relationship. This relationship, often described as the primary attachment relationship, is the source of security from which the infant begins to explore the world and other relationships.The attachment process is fundamental to the interpersonal development of the individual.8 An infant who is securely attached to his/her primary caretaker (when this relationship is stable, consistent, and nurturing) has more freedom to begin to establish other relationships, broaden opportunities for new experiences, and develop important interpersonal skills (e.g., maintaining eye contact, cooing, reaching out). An infant who does not possess a secure attachment to his/her primary caretaker demonstrates difficulties in interpersonal relations ranging from passivity to increased anxiety and avoidance in the presence of strangers to decreased responsiveness.
- During the preschool years, a child begins to broaden his/her relationships to include all immediate family members (both parents and siblings), some extended family members, and substitute caretakers (preschool teachers and day care staff). These are the dominant interactions of a preschool-age child. When a preschool-age child begins to understand his/her position in relation to others, he/she separates out his/her relationship with his/her primary caretaker. The child establishes him/herself in roles of playmate, brother or sister, grandchild, etc. The child is also provided some rudimentary expectations of how to relate to these individuals. For example, a preschool-age child is expected to share, take turns, help a sibling, and not hurt other children. He/she learns that obedience to these expectations results in praise and acceptance, while failure to obey results in disapproval and punishment. When he/she begins school, the child is expected to broaden his/her relationships with others. However, a school-age child begins to function as an independent individual and separates from prior familial relationships.
- A school-age child, acting as his/her own agent, establishes, develops, and maintains relationships with peers. The emergence of “best friends” is often seen at this age, a preference toward playing with specific peers because of their unique attributes or similar interests. While there is a continued sophistication in the development of relationships with family members, the school-age years mark a period during which a child’s interests are often directed toward friends and classmates. There are also indicators of continued complexity within the relationships the child has with peers, including the expectation of mutuality; inclusion and exclusion from groups (which gives rise to cliques, clubs, and social groups); beginning development of trust and shared secrets; and interpersonal alliances (e.g., buddies, pals, best friends). These alliances serve as the foundation for the next major advance in interpersonal relationships during the adolescent years – the development of complex interpersonal relationships.
- Adolescence begins the period in which children first have the capacity to engage in relationships with others focused on shared internal thoughts and feelings. This may be accomplished initially by extending prior “best friend” relationships. Friends expect that both will provide intimate information and respect the rights and vulnerabilities of holding such information. This relationship characteristic is the basis for relationships with the opposite sex, specifically the beginning of meaningful boyfriend/ girlfriend relationships.During adolescence, interpersonal constructs such as peer groups, “dating,” and “going steady” are established. Being part of a same-sex group and conforming to the group’s norms are significant aspects of the adolescent’s life. The adolescent begins to explore interpersonal characteristics such as mutual attraction, affection, sexual arousal, and the consistent appraisal of a relationship. Although these early boyfriend/girlfriend relationships occasionally result in long-term relationships, more frequently they are short-term. As a result, they become a means to explore the capacity of existing within an intimate interpersonal relationship; developing skills (communication, problem-solving, etc.); and maintaining relationship satisfaction. These skills become indicators of later successful marital relationships, which serve as the foundation for the establishment of a family. As many human development theorists have noted, the forming of a satisfactory and functioning marital relationship completes a cycle – birth of a child within a family, development of this child within the family, the child as an adolescent or young adult selecting a partner, and the creation of a family from which another generation of children will be born.
- Infants are totally dependent at birth. Visual acuity is poor, eye muscles are weak, and the infant’s field of visual focus is short and limited. Hearing is developed in the uterus, with newborn infants displaying a capacity to turn their heads toward sound almost immediately after birth. Average infant length and weight is approximately 20 inches and 7-1/2 pounds, respectively. Boys are slightly longer and heavier than girls. Survival of the newborn is enhanced by several innate reflex abilities (protective head turning, startle reflex, grasp, rooting, and sucking), but the newborn infant is almost completely dependent on a caretaker to provide nutrition and comfort.As the infant begins to grow, physical changes are dramatic, with significant gains in most areas made during the first few weeks and months. With this rapid rate of physical development, there is a pattern of development from the general to the specific – from the overall use of the body to a gradual acquisition of use of distinct body parts (e.g., arms to hands to fingers).Infants typically double their birth weight after 5 months and triple their birth weight by their first birthday. At 1 year of age, they have increased in size by 50 percent (approximately 30-35 inches) and grow an additional 5 to 7 inches during the second year. Sleeping patterns are often irregular. The infant possesses a short sleep cycle and wakes one to three times during the night. The age at which infants begin to sleep through the night varies considerably, although this is typically accomplished by the age of 1 to 2 years. Motor development makes rapid gains during the first 2 years of life, with the achievement of sitting without support and standing (at approximately 6 months of age), crawling (at around 7 months of age), walking (at approximately 1 year of age), and climbing stairs (at approximately 18 months of age).
- As the toddler grows older and begins to master walking, there is an increase in exploration, which facilitates even greater physical development. Through exploration, the toddler begins to improve both gross motor skills (arms and legs) and fine motor skills (hands, fingers). Although there continues to be wide variation in height and weight, an established pattern of growth begins that is distinct for both boys and girls. This growth trajectory has been plotted for children 2 to 18 years by the National Center for Health Statistics.By the age of 2-1/2, the toddler is able to throw a ball, jump in place, hop on one foot, and display rudimentary drawing skills. By age 4, the child can catch a bounced ball, draw a figure, and walk heel-to-toe. During this period, a child also acquires the ability to provide for his/her own health maintenance (under the supervision of a parent). He/she can dress him/herself, brush his/her teeth, and comb his/her hair. A well-balanced diet is essential for continued physical development. For many parents, this may be difficult because some children develop irregularities in their eating patterns (e.g., avoidance of certain foods, craving for favorite foods). Sleep patterns become more stable; at this age, a child typically sleeps through the night and requires 10-12 hours sleep each night.A common problem for preschool-age children is the risk of accidental injury. This may be the result of the child’s ability to explore his/her environment without having the cognitive capacity to make risk judgments. Therefore, the caretaker must ensure that dangerous materials are kept out of reach, that consistent supervision is provided, and that the home environment is adapted to reduce accidental injuries (e.g., electric outlets have protective covers; breakable or glass objects are moved out of reach, etc.).There is a broad range of ages during which children become toilet trained; boys are typically slower to train than girls. Pediatricians recommend that toilet training be initiated no earlier than 18 months of age. This is due primarily to the physical limitation of the child (muscle control). But the process of toilet training is far more than physical capacity. The process also involves intellectual, emotional, and family supportive resources to manage this complex developmental task.
- Most school-age children (ages 5-10) have established gross and fine motors skills, consistent control of their bowels and bladders, and can demonstrate physical mastery in a variety of areas. Both gross and fine motor skills become considerably more developed as the child grows older. Eye-hand coordination and manual dexterity become precise as is demonstrated by the development of printing and cursive writing skills. Gross motor skills have developed to enable the child to master complex tasks such as riding a bicycle, skating, swimming, climbing, and running. A child of this age is expected to maintain a broad range of daily living skills, including caring for his/her own personal hygiene (dental care, bathing, grooming, etc.) and selecting appropriate clothing (casual versus formal, cool versus warm weather).Although there is still risk of accidental injury, this risk is no longer based on issues related to the household environment (e.g., ingestion of poison). During this period, accidental injuries tend to occur more as a result of the external environment and the child’s involvement in dangerous versus safe activities. Bicycle riding safety skills, fire safety, and prevention of water-related accidents should be stressed.Sleep patterns have been established; 10-12 hours of sleep are required each night. Because children of this age are so active, it is essential that they maintain a regular and balanced diet.
- The adolescent years mark significant changes in a child’s physical development, primarily because of the onset of puberty. These changes include development of primary sexual characteristics (i.e., changes in males and females that contribute to reproductive maturity) and secondary sexual characteristics (e.g., the growth of additional body hair and changes in voice pitch and body shape).
One of the most fundamental aspects of every individual is his/her sexuality. The process of sexual development and its relationship to the knowledge, behavior, and attitudes of children is a natural and complex interactive phenomenon. From birth, children are exposed to an ever-changing sexually oriented society that profoundly influences their development in a variety of ways. Factors such as intrafamily dynamics, extended and intergenerational family relationships, school relationships, peer relationships, and the media may have an immediate and long-term impact on a child’s total development. Sexual adjustment results in individuals who, at every stage of their life cycle, are confident, competent, and responsible in their sexuality.
The discussion that follows describes milestones in the individual’s sexual development:
- During infancy, many children engage in repeated self-stimulation of the genitals, with periodic erections for boys and vaginal lubrication with girls. Children at such a young age also seek physical affection and closeness (e.g., hugging, touching) through contact with their primary caretakers. This behavior is not directly sexual, but it is a source of physical contact that is pleasurable to the infant and young child.
- During the preschool years (ages 25), children have developed a sense of their ability to stimulate their genitals and will frequently engage in “masturbatory” behavior. A child’s verbal skills have developed to the point that he/she can identify and label body parts and functions, although these terms are usually rudimentary in form. Many young children enjoy the physical sensation of nakedness and often display a sense of “body exhibitionism” (especially around bath time). Perhaps most importantly, it is common for children of this age to begin to explore their bodies and compare their anatomies to their peers. Within a school or day care setting, this behavior often occurs in places such as shared toilet facilities.The combination of verbal ability, cognitive development, and sexual/body exploration also marks the beginning stage of inquiry. Children may begin to ask their parents about differences in bodies, where babies come from, and about appropriate terms for body parts. This phase is often the first and most natural opportunity for parents to begin to communicate with children about reproduction, sexual norms and communication, and the family or cultural values associated with sexual behavior and ideas (e.g., hugging, touching, cuddling).
- For school-age children, the level of sophistication has increased significantly. Both boys and girls have the interest and verbal capacity to exchange sexual ideas and feelings. Additionally, for most children, the process of self-stimulation or masturbation may continue, although typically this behavior is relegated to a more private situation. Sexual exploration may continue within sex play or sexual modeling, although much of this behavior is kept hidden from the view of adults.
- During adolescence, the onset of puberty and physical changes occur in boys and girls between 10 to 14 years of age. Girls tend to progress through pubertal changes earlier than boys. This is facilitated by a broad range of hormonal and physical changes, including breast development, menarche, and hair growth for girls, and viable sperm production, facial hair growth, and voice change for boys. Traditionally, adolescence also brings about a significant increase in the need for privacy and a shift away from discussing sexuality with parents. Concurrently, there is an increase in talking about sexual thoughts and feelings within the same-sex adolescent peer group. The establishment of opposite-sex intimate relationships (i.e., boyfriend/girlfriend) also brings the opportunity for sexual expression and sexual relationships.
In examining the developmental process of a child’s behavioral conduct, it should be noted that there are a wide range of behavioral styles and patterns of behavior. However, there are at least two major themes consistent throughout the child’s and adolescent’s development – the acquisition of self-control or self-discipline and the adoption or adherence to rule-governed behavior.
In general, it is the responsibility of parents, the family, the school, peers, and other groups in the child’s environment (e.g., neighbors, relatives, youth groups) to assist the developing child to gradually acquire the ability to control his/her own behavior and adhere to specific rules. To achieve satisfactory late adolescence or adulthood, the individual must have acquired these characteristics to a sufficient degree so he/she can maintain and regulate his/her own behavior within interpersonal relationships. This ability enables the individual to participate in relationships such as friendships, intimate spousal relationships, coworker relationships, and/or continuing relationships with the family of origin.
There are a broad range of behaviors that demonstrate the child’s transition through the process of acquiring these skills and several periods throughout childhood with common behavioral conduct issues. This section identifies some of the major developmental transitions through the use of several common behavioral examples:
- One characteristic of infants is the absence of any sense of self-control or adherence to rules. Thus, a newborn is completely dependent on his/her primary caretaker and must rely on the caretaker to regulate almost all aspects of his/her life, including eating, sleeping, protection from danger and harm, etc. However, a few days after birth, caretakers begin to impose changes to the infant’s schedule to comply with adult behavioral patterns and social dictates. These changes may take the form of encouraging the infant to stay awake during the day in order to sleep more at night, beginning to schedule eating or nursing to regular intervals, and being involved in daytime activities and play rather than at night. Gradually, during the first 2 years of life, caretakers impose rules and begin to expect the infant to regulate his/her own behavior within certain specific limits (e.g., eating at mealtimes, engaging in interactive play, sleeping through the night).
- With toddlers, caretakers face the challenges of oppositional and defiant behavior, characterized by the child’s frequently saying “no” to requests or directions. Kegan states that this phase of childhood is the demonstration of a very healthy developmental change.9 As a representation of his/her autonomy, a 2-year old child learns that he/she has the capacity to make decisions independent of the primary caretaker. Although few would argue that a 2-year old child should make any decisions of importance, it is important to recognize that the child is no longer completely dependent on his/her primary caretaker for all aspects of life. By strongly asserting “no,” the toddler establishes his/her right to make decisions on his/her own, and thus, takes an important step away from complete dependence on his/her caretaker. The child is symbolically asserting that he/she is no longer a dependent, voiceless infant. Making decisions is very important for the child’s emerging autonomy.
- The objective for preschool-age children is the acquisition of self-control within the domain of their immediate family as well as understanding and complying with family rules. Many family rules imposed on a preschool-age child are manifested in a manner unique to each family, but are built on common family themes. For example, parents may have a household rule that the child is to stay out of the garage unless supervised by an adult – the underlying theme being that “certain places or things are for adults and may be dangerous to young children.” In a second example, the parents do not allow their preschooler to strike another child in the family. Here, the underlying theme is that “it is not acceptable to hurt others.”By providing rules and the expectation that stated rules are to be obeyed, the family begins to help the preschool-age child master his/her own behavior. The family is providing a structure within which rules can be tested and followed. Not only must parents provide rules and expectations for young children, they must be rational and consistent in the enforcement of those rules. Fairness and consistency help to promote self-control and positive self-esteem. Additionally, by providing reasons for the rules, parents help the preschool-age child benefit from sound decisions as well as begin to serve as behavior models. The child also soon learns that he/she may suffer the “natural consequences” of impulsive behavior and poorly reasoned decisions. An important aspect of this stage of development is the ability of the parents to gauge what decisions their child is capable of making (i.e., those involving minimal risk) and what decisions they should make for their child (i.e., those involving high risk).
- As children enter the school-age years (approximately age 5 to adolescence), they begin to assert themselves as individuals separate from the family. During the school day, the child is required to continue this process of behavioral self-control and adherence to rules imposed by school teachers and other school personnel. Typically, the school replaces the structure of the home, with teachers acting as substitutes for parents by establishing and enforcing environmental rules. Throughout the elementary school years, teachers impose greater expectations for the child by demanding that he/she spend more time completing academic tasks, decreasing the amount of free-time or play time, and expecting the child to regulate his/her own behavior (with close supervision). Ideally, the parents and family are developing parallel expectations for the child within the home and school environment.As a form of assistance in structuring their world and managing impulsive behavior, children often spend an inordinate amount of time establishing themselves in comparison to their peers. During this stage, the child becomes very concerned with his/her physical abilities compared to the physical abilities of his/her classmates, often attending to status concepts such as “best,” “last,” “worst,” “smallest,” etc. A child is perceived as having high status if he/she has a socially desirable quality (e.g., if the child is the fastest runner or the smartest in class). On the other hand, the child is perceived as having relatively low status if he/she exhibits a socially undesirable quality (e.g., poor eyesight, obesity).The comparison process also creates important changes for school-age children with regard to interpersonal relations. Competition is often the hallmark of school-age children because they view it as a test of who is best at a given task. Rules surrounding competition reflect a child’s attempt to manage his/her own behavior through the adoption of his/her own self-governed rules. The establishment of groups from which the child is included or excluded is another example of the comparison process. Boys may build forts, which have prohibitions against girls, while girls may engage in activities at the exclusion of boys. Such actions continue to provide for the development of self-control and adherence to socially tied rules. Many of these rules, however, are created by the child or his/her peers and are supported by adults and the media.
- Adolescents have some ability to regularly maintain behavioral control and relatively superficial relationships. An adolescent can satisfactorily manage most aspects of his/her life and make daily decisions without consulting his/her parents. An adolescent should have a basic understanding of the reasons for culturally or environmentally imposed rules as well as an ability to adhere to those rules.Two significant changes occur during adolescence. The first concerns the transition from externally imposed to internally regulated rules and expectations. That is, rather than complying with demands, expectations, or instructions provided by parents, teachers, or other authorities, an adolescent begins to shape his/her own self-defined demands, expectations, and instructions. In many situations, these self-imposed rules may be the same as those imposed by others (e.g., compliance within a school setting, managing health status), but some rules may be significantly different from those previously imposed. Adolescents often desire and require greater personal freedom, resulting in greater autonomy in making decisions about such issues as music, clothing, and social contacts. Parentadolescent difficulties often arise when the authority of the parents to manage the adolescent’s life conflicts with his/her newly developed authority to manage him/herself.As stated previously, successful parenting of an adolescent requires that the parents relinquish some authority and allow the adolescent to make age-appropriate decisions (i.e., those that involve relatively low risk). However, the parents retain the right to make other decisions (i.e., those that involve relatively high risk). This process involves the second major change for developing adolescents – the ability to communicate with others from a position that assumes to regulate their thoughts, emotions, and involvement in interpersonal relations.By demonstrating internal control, an adolescent begins to assert him/herself as capable of maintaining intimate relationships with others (e.g., girlfriends and boyfriends). The adolescent is able to negotiate relationships independently with parents and others. The demonstration of this internal control is not always consistent or stable, which suggests periods of perceived instability, irrational thinking, and/or emotional overload. Often, an adolescent perceives the involvement of authorities (especially parents) as an insult to his/her integrity (the adolescent sees him/herself as independent from parental domain) and rebels against such perceived intrusions. With consistent regulation of both external behavior and internal representations of him/herself, an adolescent begins the transition to adulthood.
Everyone experiences some type of problem, trauma, disadvantage, or distress during their childhood. If trauma or distress is common to childhood, it becomes important to examine the manner in which children cope with these experiences and the ways in which they continue to function and interact with themselves and with others. Some children appear to be devastated by these types of events, whereas other children appear to thrive and continue regular daily functioning with relative ease under what would usually be considered severely adverse conditions.
What is clear is that there are many common events that pose risks to a child’s ability to manage adequately him/herself and his/her relationships with others. What remains unclear is how a child may manifest abnormalities or psychopathology. Additionally, to be aware of what is “abnormal” or “pathological,” it is essential for the professional to understand what is “normal” or healthy within the individual. With children, development results in frequent and regular changes according to some general patterns and trends. Therefore, any attempt to understand the relationship between normal and abnormal within an individual child must also take into account his/her developmental status. If professionals assume that adaptation (the ability to alter one’s typical method of functioning to fit new circumstances) is a normal and healthy part of a child’s development, then it could be argued that maladaptation is the failure of the child to cope with events in his/her life and/or exhibit a means of coping, which results in dysfunction.
For more information, contact the National Clearinghouse on Child Abuse and Neglect Information at nccanch@calib.com.
Updated on July 13, 1999, by webmaster@calib.com.
CL Wacholtz
Transition Counseling Services 
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