research on child development meaning

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• Rev Lat Am Enfermagem
• v.23(6); Nov-Dec 2015

Child development: analysis of a new concept 1

Juliana martins de souza.

2 PhD, Assistant Professor, Departamento de Enfermagem, Universidade Federal de Goiás, Catalão, GO, Brazil

Maria de La Ó Ramallo Veríssimo

3 PhD, Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil

Objectives:

to perform concept analysis of the term child development (CD) and submit it to review by experts.

analysis of concept according to the hybrid model, in three phases: theoretical phase, with literature review; field phase of qualitative research with professionals who care for children; and analytical phase, of articulation of data from previous steps, based on the bioecological theory of development. The new definition was analyzed by experts in a focus group. Project approved by the Research Ethics Committee.

we reviewed 256 articles, from 12 databases and books, and interviewed 10 professionals, identifying that: The CD concept has as antecedents aspects of pregnancy, factors of the child, factors of context, highlighting the relationships and child care, and social aspects; its consequences can be positive or negative, impacting on society; its attributes are behaviors and abilities of the child; its definitions are based on maturation, contextual perspectives or both. The new definition elaborated in concept analysis was validated by nine experts in focus group. It expresses the magnitude of the phenomenon and factors not presented in other definitions.

Conclusion:

the research produced a new definition of CD that can improve nursing classifications for the comprehensive care of the child.

Introduction

Child Development (CD) is a fundamental part of human development, emphasizing that the brain architecture is shaped in the first years, from the interaction of genetic inheritance and influences of the environment in which the child lives ( 1 - 2 ) .

To promote the health of children, it is essential to understand their peculiarities, as well as environmental conditions favorable to their development ( 3 ) . The understanding of caregivers about the characteristics and needs of children, as a result of their development process, promotes the integral development, because daily care is the major space for the promotion of CD ( 3 ) .

A valuable resource to the nurse performs their job facing all aspects of child development is the Systematization of Nursing Care. It proposes the use of the nursing classifications, standardizing the language used in assisting individuals, families and communities in different settings ( 4 ) . However, for use the nursing classifications in a plan of quality care in the approach of the CD, it is necessary that they address the entire complexity of this phenomenon.

A theoretical study of NANDA-International (NANDA-I) and of the International Classification for Nursing Practice (ICNP (r)) , which are the most disseminated classifications, found important limitations about the approach of CD ( 5 ) . NANDA-I aims to conduct the language standardization of nursing diagnoses ( 6 ) . ICNP (r) intends to be an unifying mark of nursing terminologies, and it was recognized by the World Health Organization (WHO) as a member of the Family of International Classifications ( 7 ) .

NANDA-I has real and risk diagnostics for CD, but there is no promotion diagnostics; these cover the development and growth in a single diagnosis, although they are separate phenomena, with different features and definitions and subject to various interventions ( 5 ) .

In ICNP, there are several focus terms related to the child development phenomenon, but these terms do not explain it. The focus terms growth and development are defined as separate terms, but their descriptions are confusing, mixing the two concepts ( 5 ) .

When considering the limitations of the CD approach in the two studied classifications, it is possible to suppose a few reasons why the topic has not yet been better studied in both classifications. One of them is the prioritization of biological aspects in health care, with few instruments and approaches that support promotion actions. In this sense, the development of the child is rarely observed in health care ( 8 - 9 ) . In addition, CD is a broad and complex process, better clarified in recent decades, including its relationship with the daily care and the influence of the environment on it ( 1 ) .

Thus, the difficulties in having nursing diagnoses related to CD can occur in the absence of an approach that encompasses the complexity of the term and the absence of a concept to support the specificity of nursing in the child health. Therefore, it is essential to perform the analysis of the CD concept, to subsidize the classifications of nursing diagnoses and provide diagnostics that enable the development of care plans aimed to CD.

This research aimed to perform the concept analysis of the term child development and analyze the new definition proposed as a product of the concept analysis.

The concept analysis aims to clarify, recognize and define concepts that describe nursing phenomena, in order to promote understanding. The clarification of a certain concept contributes to the knowledge construction of the area ( 10 ) .

The hybrid model of concept development was used in this research. It considers three interconnected stages for the development of the concept: theoretical phase, field phase and analytical phase ( 11 ) . In each one of the stages, the four categories of concept analysis must be composed of: attributes, antecedents, consequences and concept definition.

The theoretical phase corresponds to the study of literature. Since CD is a subject of study in several disciplines, it was important to consult databases which comprised other areas besides health, such as education, behavioral sciences and social sciences. Ten databases and two information portals for research were selected with expert support in information science: BVS, Lilacs, Cochrane Library, Cinahl, Pubmed, Francis, Edubase, Eric, Psycinfo, IndexPsi, Scopus and Web Of Science. Later, textbooks of pediatric nursing were consulted to contemplate some aspects of the concept that the articles from databases did not present.

Child Development and its corresponding descriptors were used, and limits that could ensure the comprehensiveness of the theme and reliability on clipping were established, reducing the number of studies to a viable volume: year of publication - 2011 and 2012; language - Portuguese, English and Spanish; and age group - under 1 year. Search issues followed the model of concept analysis. To set the antecedents of CD, we researched: What factors influence CD? To establish its attributes, the question was: What are the characteristics of CD? To find its consequences, the question was: What are the consequences of adequate CD and inadequate CD? And for its definition, the question was: What is CD?

The field phase consists of research with subjects of the practice who work with the phenomenon under study. Qualitative research was carried out, with semi-structured interviews with professionals working with child development in five municipalities of the state of São Paulo, Brazil, and who participated in earlier CD trainings, for being potentially interested in the subject and work in professional activities related to promotion of CD. The interviews followed the same issues of the bibliographic search. The data recorded and transcribed were subjected to content analysis, according to pre-established categories on hybrid method of concept analysis.

The analytical phase was the articulation of the results of theoretical and field stages and allowed the characterization of the concept components more broadly, as well as the elaboration of a definition of the CD term.

The CD definition elaborated was subjected to review by experts. Although the hybrid model does not propose this step, it was considered that it would give greater consistency to the concept created. To facilitate and intensify the discussion, we decided to perform the analysis of the definition of the concept in a focus group.

The experts were located from a group of people registered in the database of the research group Health Care and Child's Development Promotion, of the School of Nursing at the University of São Paulo, for being considered potential collaborators and meeting the selection criteria. The invitation to take part in the focus group was sent to 30 people who met the inclusion criteria: work with child health for over three years and be an expert, master or doctor in the area of child health. To encourage the participation of professionals outside São Paulo, the focus group was planned for the same day of other event of the research group, aiming to optimize the cost of transportation, since there would be no reimbursement of expenses for participants. The discussion was recorded and transcribed to support the description of the results.

The project was approved by the Research Ethics Committee of the School of Nursing at the University of São Paulo (protocol CEP 0114.0.196000-11), and all the participants signed a Free and Informed Consent Term.

The results were discussed according to the Bioecological Theory of Human Development ( 12 - 13 ) , composed of four interconnected elements: process-person-context-time. The development process involves the relationship between the individual and context, considers all interactions and conditions of these interactions with any implication for the development of the human being; the person is considered with all biological, cognitive, behavioral and emotional characteristics; the context refers to all environments that influence development; and the time involves the issues of temporality, constituting the cronosystem that suppress the changes throughout life ( 13 ) . The context is comprised in a broadened form, composed of: microsystem, which includes the nearest environments in which the child lives; mesosystem, which includes interaction of microsystems in which the child is present; exosystems, the environments in which the child is not inserted, but that affect their development, as the work of parents; and macrosystem, which encompasses social and cultural structures and socioeconomic conditions ( 12 - 13 ) .

In the theoretical phase, 256 articles that met the criteria were selected and classified according to the four categories of concept analysis: concept antecedents (228 studies), concept attributes (5 studies), concept consequences (32 studies) and concept definition (23 studies). Of the 256 articles analyzed, only 12 were Brazilian. Most articles (210) were published in the year of 2011 and 46 were published until April 2012. Publishing journals were very varied, only two articles were published in journals in the nursing field, three in education, 16 in journals of child development, 23 in journals about human development, 29 in behavioral sciences and 183 in journals in the health area - 80 of these specific to pediatrics.

Six nurses, two pedagogues, one psychologist and one social worker attended the field phase; all were women, with an average age of 42.2 years. Half the participants had more than 10 years and three more than 25 years of academic completion. The time of work with child care ranged from two to more than 20 years.

The category antecedents of the concept was composed of factors related to CD found in literature and in the talks of professionals, not differing in content ( Figure 1 ). Theoretical and field phases were complementary, since sometimes the talk of professionals was more generic, but brought additional data to literature.

The category attributes of the concept demonstrates the characteristics present when the concept occurs, and such characteristics were verified both in the literature and field research, as the range of abilities in various development areas ( Figure 1 ). Searching the literature, few studies have addressed these abilities and they focused on evaluation and analysis of the achievement of certain abilities, such as language, to walk, pincer grasp and cognitive development, and was therefore necessary to complement the content by searching in textbooks about the major theories of CD.

Scholars and theorists whose studies are widely used in the CD approach, as Sigmund Freud, Erik Erikson and Jean Piaget explained the development in stages according to the approximate age, describing the characteristics of behavior or abilities of various areas of development, such as motor, cognitive, and emotional ( 14 - 15 ) . We concluded that such areas are the characteristics or attributes of development, so it is by the observation of behaviors and abilities in the areas of development that the course of development of the child can be verified.

For the category concept consequences, we selected articles that addressed evaluations of long term CD or in higher age groups, such as school children and teenagers. There were formed two sets of consequences: those relating to adequate CD and those relating inadequate CD. The interviews adressed the same two sets of consequences and the same topics ( Figure 1 ).

In the category definition of the concept, initially, we grouped articles that discussed more conceptual factors. However, we observed, both in these and in other studied articles, that there were no new definitions to the term child development, once they based on classical definitions of scholars to development. Seeking more data about the concept definition, we revised the main approaches of the development and principal authors of reference on the subject ( 14 - 15 ) .

Figure 1 summarizes the analytical phase of the study, of articulation between the data of the field and theoretical phases. The category antecedents is indicated by the connective "is influenced by"; the category attributes is indicated by the connective "is characterized by"; the category consequences is indicated by the connectives "when adequate leads to" and "when inadequate leads to"; and the category definition is indicated by the connective "is defined as".

As a product of the concept analysis, according to the hybrid model, the following definition of the term child development was elaborated:

"Child development is part of human development, a unique process of each child that aims to insert him/her in the society where he/she lives. It is expressed by continuity and changes in motor, psychosocial, cognitive and language abilities, with progressively more complex acquisitions in the daily life functions. The prenatal period and the first years of life are the foundation of this process, which arises from the interaction of biopsychological characteristics genetically inherited, and experiences offered by the environment. The experiences are constituted by the care that the child receives and the opportunities that the child has to actively exercise his/hers abilities. The care aimed at the needs of development enables the child to reach full potential at every stage of development, with positive repercussions in adult life" ( 16 ) .

This definition was submitted to the analysis of a group of experts. The focus group had nine participants, besides the researcher who coordinated the group, and her mentor as an observer. Seven nurses, one doctor and one physical therapist participated. There were people from the states of: São Paulo (five), Minas Gerais (two) and Paraná (two). They concluded their undergraduate courses from six to 30 years, but most of them (seven) had from 5 to 15 years of experience. As to professional qualification, one participant had specialization in the area of Neonatal and Pediatric Intensive Care and Public Health Management; two had specialization and master's degree; one had specialization, master's and doctoral degrees; and five had master's degree. Seven participants had publications in the pediatrics area.

The group considered that the definition should be more concise, highlighting child development as fundamental to human development, the active role of children in the development process and care as a key element for the promotion of child development. The considerations on the definition of the concept were compatible with the results of the concept analysis, but we realize that they had not been properly incorporated in the first definition proposal.

The definition was rewritten as:

"Child development is a fundamental part of human development, an active and unique process for each child, expressed by continuity and changes in motor, psychosocial, cognitive and language abilities, with acquisitions progressively more complex in the functions of daily life and in the exercise of their social role. The prenatal period and the first years of child life are crucial in the development process, which is constituted by the interaction of biopsychological characteristics genetically inherited, and experiences offered by the environment. The achievement of the potential of every child depends on the care responsive to their needs of development" ( 16 ) .

The results of the concept analysis showed the incorporation of knowledge consistent with the bioecological theory, both in analyzed studies and in the interviews, as pointed out in this discussion, which was structured according to the four elements of the theory process-person-context-time ( 13 ) .

In relation to the process, the interactions of the child, recognized as a central component of development, have achieved great prominence in the field phase. In the theoretical phase, studies that analyzed the bond and the interaction of the parents with the child also showed this relationship. However, we observed in the two data sets an emphasis on the role of caregivers and less emphasis on the active role of the child in the interactions with people, objects and symbols present in their immediate environment, as is highlighted by the bioecological theory.

Interaction is crucial to development. When relationships are imbued with affection, they allow the formation of a bond that will continue to exist, even when these individuals are not together, being fundamental to the child in the establishment of relations in other social contexts beyond the familiar environment ( 13 ) .

Still concerning the process, the characteristics of caregivers, especially their mental health, directly affect their interaction with the child. In this sense, the role of the professional can be a factor of support to assist in improving this relationship.

A second element of the bioecological theory is the person, considering his/her biopsychological characteristics and those built when interacting with the environment ( 12 ) . In the bioecological model, the characteristics of the person are both producers and products of development, because they are one of the elements that influence the form, content and direction of the proximal processes. The person is in the center of the ecological system ( 12 ) .

For the professionals who participated in this study, it seems that environmental aspects supersede the individual, since they stood out. Intrinsic factors of the child were cited in the field phase as factors influencing CD, but with superficial narratives; in the theoretical phase many studies showed the influence of prematurity and low birth weight, child nutrition, growth and diseases.

In relation to the context, the environment in which the child is inserted had highlights in the theoretical and field phases, in line with Bronfenbrenner, who stresses the importance of the environment in the context, dividing it into mesosystem, microsystem, exosystem and macrosystem (12-13). In this study, the factors cited as influential for child development are parts of all these systems:

• - Microsystem: evidenced in the family environment and in some studies in shelters. The importance of the bond, parental interaction with the child and features of the environment in which the child lives were also highlighted;
• - Mesosystem: the influence of environments in which the child in development is inserted, such as day nurseries, was identified in several studies and in professionals' statements;
• - Exosystem: the relationship between exosystem and development was not referred to directly in the field phase. We did not find studies in the theoretical phase that referred to this focus. However, it is possible to identify the existence of this level, although not explained, when considered the influence of interactions, since the exosystems directly influence these relationships, as an event in the work of parents or school of the brothers which reverberate in the microsystem and existing relations;
• - Macrosystem: some studies and professionals' statements point out the broader structure factors that influence development, such as socioeconomic and cultural conditions.

The fourth element of the theory (time) showed up in the results as the data referred to a development process that does not occur instantly during children's interactions and experiences, but are being built in their life time. The two sets of data mentioned only the individual development processes, without referring to the idea of continuities and changes in the development of children that could be identified as products of socio-historical changes between generations.

All aspects of the process, context and person can be classified as protectors, when offering favorable influences to CD or as a risk or vulnerability to CD, when their influences are potentially harmful. Therefore, all these aspects should be the focus of attention in public policies and in social and community practices.

To cover the search results, the proposed definition incorporated factors that are not explored in other definitions, such as mention children as active in their development and care as a central element of this process. This definition is compatible with the bioecological theory of development, because it presents the concept of person in development, environment and interaction between them, and also evidences the four theory elements: process, person, context and time, as follows.

• - Process: explicit throughout the concept, emphasizing the importance of care aimed at the needs of development; is related to interactions, bonds, and affection, stressing the importance of the experiences of the child.
• - Context: all levels of context are considered essential because they determine child's experiences and the care they receive; includes family and other environments that will share this care and experiences.
• - Person: development is an unique process for each child, of continuity and changes of motor, psychosocial, cognitive and language abilities, and of biopsychological characteristics, genetically inherited.
• - Time: the definition presents research findings from neuroscience and contemporary researches for child development as a fundamental part of human development, highlighting the prenatal period and the first years of life as a milestone of this process. The definition of the concept reflects current science.

Thus, this definition may subsidize nursing classifications in the elaboration of diagnoses, interventions and outcomes related to child development.

It is important to stress that the choice of the focus group as a technique for performing the analysis by experts was crucial, because it provided discussion among experts and immediate result, without requiring new steps of data analysis and re-evaluation by the experts, which is observed in the literature as a difficulty of methods that require several steps of analysis ( 17 ) . The experience of the participants in the research and academic writing, whether in graduate studies or guidance of students of undergraduate research, in their role as teachers, favored the discussion of the concept presented, achieving great depth of analysis.

It is possible to point out as a limitation of this study the need to delimit the search time on literature review for a year, but by observing the quality of the results obtained, it was considered that there were no losses and, therefore, the search expansion for this research was not considered. The inclusion of textbooks to compose the attributes and definitions of the concept could also be limiting, however, criteria were used for choice of references, assuring the content quality.

The selection of subjects involved in the CD training project of the municipalities was important because, for the concept analysis, it is crucial that participants have extensive experience in the matter. However, it can be one of the limitations of the study, since the statements incorporated knowledge covered during training, and research with professionals with other experiences may differ.

The performance of concept analysis, according to the hybrid model, was crucial for the elaboration of a concept that took into account the complexity of the phenomenon, since data from the literature review and field phase were complementary and demonstrated the incorporation of updated knowledge among professionals. Such analysis, in addition to the expert analysis, contributed to the construction of a concept applicable in practice, because, when presenting the development as a result of the interaction of the child with the environment and the relationships existing therein. This will subsidize the revision of nursing diagnoses and the appropriate selection of actions to promote CD, a fundamental aspect to the actions of the nurse in monitoring the health of the child.

1 Paper extracted from doctoral dissertation "Child development: concept analysis and NANDA-I's diagnoses review", presented to Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil. Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, process # 2011/51012-3.

What Is Early Childhood Development? A Guide to the Science (ECD 1.0)

Healthy development in the early years (particularly birth to three) provides the building blocks for educational achievement, economic productivity, responsible citizenship, lifelong health, strong communities, and successful parenting of the next generation. What can we do during this incredibly important period to ensure that children have a strong foundation for future development? The Center on the Developing Child created this Guide to Early Childhood Development (ECD) to help parents, caregivers, practitioners, and policymakers understand the importance of early childhood development and learn how to support children and families during this critical stage.

Visit “ Introducing ECD 2.0 ” for new resources that build on the knowledge presented below.

Step 1: Why Is Early Childhood Important?

This section introduces you to the science that connects early experiences from birth (and even before birth) to future learning capacity, behaviors, and physical and mental health.

This 3-minute video portrays how actions taken by parents, teachers, policymakers, and others can affect life outcomes for both the child and the surrounding community.

InBrief: The Science of Early Childhood Development

This video from the InBrief series addresses basic concepts of early childhood development, established over decades of neuroscience and behavioral research.

This brief explains how the science of early brain development can inform investments in early childhood, and helps to illustrate why child development—particularly from birth to five years—is a foundation for a prosperous and sustainable society.

Step 2: How Does Early Child Development Happen?

Now that you understand the importance of ECD, this section digs deeper into the science, including how early experiences and relationships impact and shape the circuitry of the brain, and how exposure to toxic stress can weaken the architecture of the developing brain.

Three Core Concepts in Early Development

Advances in neuroscience, molecular biology, and genomics now give us a much better understanding of how early experiences are built into our bodies and brains, for better or worse. This three-part video series explains.

8 Things to Remember about Child Development

In this important list, featured in the From Best Practices to Breakthrough Impacts report, the Center on the Developing Child sets the record straight about some aspects of early child development.

InBrief: The Science of Resilience

This brief summarizes the science of  resilience and explains why understanding it will help us design policies and programs that enable more children to reach their full potential.

Step 3: What Can We Do to Support Child Development?

Understanding how important early experiences and relationships are to lifelong development is one step in supporting children and families. The next step is to apply that knowledge to current practices and policies. This section provides practical ways that practitioners and policymakers can support ECD and improve outcomes for children and families.

From Best Practices to Breakthrough Impacts

This report synthesizes 15 years of dramatic advances in the science of early childhood and early brain development and presents a framework for driving science-based innovation in early childhood policy and practice.

Three Principles to Improve Outcomes for Children and Families

Understanding how the experiences children have starting at birth, even prenatally, affect lifelong outcomes—as well as the core capabilities adults need to thrive—provides a strong foundation upon which policymakers and civic leaders can design a shared and more effective agenda.

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

1 Chapter 1: Introduction to Child Development

Chapter objectives.

After this chapter, you should be able to:

• Describe the principles that underlie development.
• Differentiate periods of human development.
• Evaluate issues in development.
• Distinguish the different methods of research.
• Explain what a theory is.
• Compare and contrast different theories of child development.

Introduction

Welcome to Child Growth and Development. This text is a presentation of how and why children grow, develop, and learn.

We will look at how we change physically over time from conception through adolescence. We examine cognitive change, or how our ability to think and remember changes over the first 20 years or so of life. And we will look at how our emotions, psychological state, and social relationships change throughout childhood and adolescence. 1

Principles of Development

There are several underlying principles of development to keep in mind:

• Development is lifelong and change is apparent across the lifespan (although this text ends with adolescence). And early experiences affect later development.
• Development is multidirectional. We show gains in some areas of development, while showing loss in other areas.
• Development is multidimensional. We change across three general domains/dimensions; physical, cognitive, and social and emotional.
• The physical domain includes changes in height and weight, changes in gross and fine motor skills, sensory capabilities, the nervous system, as well as the propensity for disease and illness.
• The cognitive domain encompasses the changes in intelligence, wisdom, perception, problem-solving, memory, and language.
• The social and emotional domain (also referred to as psychosocial) focuses on changes in emotion, self-perception, and interpersonal relationships with families, peers, and friends.

All three domains influence each other. It is also important to note that a change in one domain may cascade and prompt changes in the other domains.

• Development is characterized by plasticity, which is our ability to change and that many of our characteristics are malleable. Early experiences are important, but children are remarkably resilient (able to overcome adversity).
• Development is multicontextual. 2 We are influenced by both nature (genetics) and nurture (the environment) – when and where we live and our actions, beliefs, and values are a response to circumstances surrounding us.  The key here is to understand that behaviors, motivations, emotions, and choices are all part of a bigger picture. 3

Now let’s look at a framework for examining development.

Periods of Development

Think about what periods of development that you think a course on Child Development would address. How many stages are on your list? Perhaps you have three: infancy, childhood, and teenagers. Developmentalists (those that study development) break this part of the life span into these five stages as follows:

• Prenatal Development (conception through birth)
• Infancy and Toddlerhood (birth through two years)
• Early Childhood (3 to 5 years)
• Middle Childhood (6 to 11 years)
• Adolescence (12 years to adulthood)

This list reflects unique aspects of the various stages of childhood and adolescence that will be explored in this book. So while both an 8 month old and an 8 year old are considered children, they have very different motor abilities, social relationships, and cognitive skills. Their nutritional needs are different and their primary psychological concerns are also distinctive.

Prenatal Development

Conception occurs and development begins. All of the major structures of the body are forming and the health of the mother is of primary concern. Understanding nutrition, teratogens (or environmental factors that can lead to birth defects), and labor and delivery are primary concerns.

Figure 1.1 – A tiny embryo depicting some development of arms and legs, as well as facial features that are starting to show. 4

Infancy and Toddlerhood

The two years of life are ones of dramatic growth and change. A newborn, with a keen sense of hearing but very poor vision is transformed into a walking, talking toddler within a relatively short period of time. Caregivers are also transformed from someone who manages feeding and sleep schedules to a constantly moving guide and safety inspector for a mobile, energetic child.

Figure 1.2 – A swaddled newborn. 5

Early Childhood

Early childhood is also referred to as the preschool years and consists of the years which follow toddlerhood and precede formal schooling. As a three to five-year-old, the child is busy learning language, is gaining a sense of self and greater independence, and is beginning to learn the workings of the physical world. This knowledge does not come quickly, however, and preschoolers may initially have interesting conceptions of size, time, space and distance such as fearing that they may go down the drain if they sit at the front of the bathtub or by demonstrating how long something will take by holding out their two index fingers several inches apart. A toddler’s fierce determination to do something may give way to a four-year-old’s sense of guilt for action that brings the disapproval of others.

Figure 1.3 – Two young children playing in the Singapore Botanic Gardens 6

Middle Childhood

The ages of six through eleven comprise middle childhood and much of what children experience at this age is connected to their involvement in the early grades of school. Now the world becomes one of learning and testing new academic skills and by assessing one’s abilities and accomplishments by making comparisons between self and others. Schools compare students and make these comparisons public through team sports, test scores, and other forms of recognition. Growth rates slow down and children are able to refine their motor skills at this point in life. And children begin to learn about social relationships beyond the family through interaction with friends and fellow students.

Figure 1.4 – Two children running down the street in Carenage, Trinidad and Tobago 7

Adolescence

Adolescence is a period of dramatic physical change marked by an overall physical growth spurt and sexual maturation, known as puberty. It is also a time of cognitive change as the adolescent begins to think of new possibilities and to consider abstract concepts such as love, fear, and freedom. Ironically, adolescents have a sense of invincibility that puts them at greater risk of dying from accidents or contracting sexually transmitted infections that can have lifelong consequences. 8

Figure 1.5 – Two smiling teenage women. 9

There are some aspects of development that have been hotly debated. Let’s explore these.

Issues in Development

Nature and nurture.

Why are people the way they are? Are features such as height, weight, personality, being diabetic, etc. the result of heredity or environmental factors-or both? For decades, scholars have carried on the “nature/nurture” debate. For any particular feature, those on the side of Nature would argue that heredity plays the most important role in bringing about that feature. Those on the side of Nurture would argue that one’s environment is most significant in shaping the way we are. This debate continues in all aspects of human development, and most scholars agree that there is a constant interplay between the two forces. It is difficult to isolate the root of any single behavior as a result solely of nature or nurture.

Continuity versus Discontinuity

Is human development best characterized as a slow, gradual process, or is it best viewed as one of more abrupt change? The answer to that question often depends on which developmental theorist you ask and what topic is being studied. The theories of Freud, Erikson, Piaget, and Kohlberg are called stage theories. Stage theories or discontinuous development assume that developmental change often occurs in distinct stages that are qualitatively different from each other, and in a set, universal sequence. At each stage of development, children and adults have different qualities and characteristics. Thus, stage theorists assume development is more discontinuous. Others, such as the behaviorists, Vygotsky, and information processing theorists, assume development is a more slow and gradual process known as continuous development. For instance, they would see the adult as not possessing new skills, but more advanced skills that were already present in some form in the child. Brain development and environmental experiences contribute to the acquisition of more developed skills.

Figure 1.6 – The graph to the left shows three stages in the continuous growth of a tree. The graph to the right shows four distinct stages of development in the life cycle of a ladybug. 10

Active versus Passive

How much do you play a role in your own developmental path? Are you at the whim of your genetic inheritance or the environment that surrounds you? Some theorists see humans as playing a much more active role in their own development. Piaget, for instance believed that children actively explore their world and construct new ways of thinking to explain the things they experience. In contrast, many behaviorists view humans as being more passive in the developmental process. 11

How do we know so much about how we grow, develop, and learn? Let’s look at how that data is gathered through research

Research Methods

An important part of learning any science is having a basic knowledge of the techniques used in gathering information. The hallmark of scientific investigation is that of following a set of procedures designed to keep questioning or skepticism alive while describing, explaining, or testing any phenomenon. Some people are hesitant to trust academicians or researchers because they always seem to change their story. That, however, is exactly what science is all about; it involves continuously renewing our understanding of the subjects in question and an ongoing investigation of how and why events occur. Science is a vehicle for going on a never-ending journey. In the area of development, we have seen changes in recommendations for nutrition, in explanations of psychological states as people age, and in parenting advice. So think of learning about human development as a lifelong endeavor.

Take a moment to write down two things that you know about childhood. Now, how do you know? Chances are you know these things based on your own history (experiential reality) or based on what others have told you or cultural ideas (agreement reality) (Seccombe and Warner, 2004). There are several problems with personal inquiry. Read the following sentence aloud:

Paris in the

Are you sure that is what it said? Read it again:

If you read it differently the second time (adding the second “the”) you just experienced one of the problems with personal inquiry; that is, the tendency to see what we believe. Our assumptions very often guide our perceptions, consequently, when we believe something, we tend to see it even if it is not there. This problem may just be a result of cognitive ‘blinders’ or it may be part of a more conscious attempt to support our own views. Confirmation bias is the tendency to look for evidence that we are right and in so doing, we ignore contradictory evidence. Popper suggests that the distinction between that which is scientific and that which is unscientific is that science is falsifiable; scientific inquiry involves attempts to reject or refute a theory or set of assumptions (Thornton, 2005). Theory that cannot be falsified is not scientific. And much of what we do in personal inquiry involves drawing conclusions based on what we have personally experienced or validating our own experience by discussing what we think is true with others who share the same views.

Science offers a more systematic way to make comparisons guard against bias.

Scientific Methods

One method of scientific investigation involves the following steps:

• Determining a research question
• Reviewing previous studies addressing the topic in question (known as a literature review)
• Determining a method of gathering information
• Conducting the study
• Interpreting results
• Drawing conclusions; stating limitations of the study and suggestions for future research
• Making your findings available to others (both to share information and to have your work scrutinized by others)

Your findings can then be used by others as they explore the area of interest and through this process a literature or knowledge base is established. This model of scientific investigation presents research as a linear process guided by a specific research question. And it typically involves quantifying or using statistics to understand and report what has been studied. Many academic journals publish reports on studies conducted in this manner.

Another model of research referred to as qualitative research may involve steps such as these:

• Begin with a broad area of interest
• Gain entrance into a group to be researched
• Gather field notes about the setting, the people, the structure, the activities or other areas of interest
• Ask open ended, broad “grand tour” types of questions when interviewing subjects
• Modify research questions as study continues
• Note patterns or consistencies
• Explore new areas deemed important by the people being observed
• Report findings

In this type of research, theoretical ideas are “grounded” in the experiences of the participants. The researcher is the student and the people in the setting are the teachers as they inform the researcher of their world (Glazer & Strauss, 1967). Researchers are to be aware of their own biases and assumptions, acknowledge them and bracket them in efforts to keep them from limiting accuracy in reporting. Sometimes qualitative studies are used initially to explore a topic and more quantitative studies are used to test or explain what was first described.

Let’s look more closely at some techniques, or research methods, used to describe, explain, or evaluate. Each of these designs has strengths and weaknesses and is sometimes used in combination with other designs within a single study.

Observational Studies

Observational studies involve watching and recording the actions of participants. This may take place in the natural setting, such as observing children at play at a park, or behind a one-way glass while children are at play in a laboratory playroom. The researcher may follow a checklist and record the frequency and duration of events (perhaps how many conflicts occur among 2-year-olds) or may observe and record as much as possible about an event (such as observing children in a classroom and capturing the details about the room design and what the children and teachers are doing and saying). In general, observational studies have the strength of allowing the researcher to see how people behave rather than relying on self-report. What people do and what they say they do are often very different. A major weakness of observational studies is that they do not allow the researcher to explain causal relationships. Yet, observational studies are useful and widely used when studying children. Children tend to change their behavior when they know they are being watched (known as the Hawthorne effect) and may not survey well.

Experiments

Experiments are designed to test hypotheses (or specific statements about the relationship between variables) in a controlled setting in efforts to explain how certain factors or events produce outcomes. A variable is anything that changes in value. Concepts are operationalized or transformed into variables in research, which means that the researcher must specify exactly what is going to be measured in the study.

Three conditions must be met in order to establish cause and effect. Experimental designs are useful in meeting these conditions.

The independent and dependent variables must be related. In other words, when one is altered, the other changes in response. (The independent variable is something altered or introduced by the researcher. The dependent variable is the outcome or the factor affected by the introduction of the independent variable. For example, if we are looking at the impact of exercise on stress levels, the independent variable would be exercise; the dependent variable would be stress.)

The cause must come before the effect. Experiments involve measuring subjects on the dependent variable before exposing them to the independent variable (establishing a baseline). So we would measure the subjects’ level of stress before introducing exercise and then again after the exercise to see if there has been a change in stress levels. (Observational and survey research does not always allow us to look at the timing of these events, which makes understanding causality problematic with these designs.)

The cause must be isolated. The researcher must ensure that no outside, perhaps unknown variables are actually causing the effect we see. The experimental design helps make this possible. In an experiment, we would make sure that our subjects’ diets were held constant throughout the exercise program. Otherwise, diet might really be creating the change in stress level rather than exercise.

A basic experimental design involves beginning with a sample (or subset of a population) and randomly assigning subjects to one of two groups: the experimental group or the control group. The experimental group is the group that is going to be exposed to an independent variable or condition the researcher is introducing as a potential cause of an event. The control group is going to be used for comparison and is going to have the same experience as the experimental group but will not be exposed to the independent variable. After exposing the experimental group to the independent variable, the two groups are measured again to see if a change has occurred. If so, we are in a better position to suggest that the independent variable caused the change in the dependent variable.

The major advantage of the experimental design is that of helping to establish cause and effect relationships. A disadvantage of this design is the difficulty of translating much of what happens in a laboratory setting into real life.

Case Studies

Case studies involve exploring a single case or situation in great detail. Information may be gathered with the use of observation, interviews, testing, or other methods to uncover as much as possible about a person or situation. Case studies are helpful when investigating unusual situations such as brain trauma or children reared in isolation. And they are often used by clinicians who conduct case studies as part of their normal practice when gathering information about a client or patient coming in for treatment. Case studies can be used to explore areas about which little is known and can provide rich detail about situations or conditions. However, the findings from case studies cannot be generalized or applied to larger populations; this is because cases are not randomly selected and no control group is used for comparison.

Figure 1.7 – Illustrated poster from a classroom describing a case study. 12

Surveys are familiar to most people because they are so widely used. Surveys enhance accessibility to subjects because they can be conducted in person, over the phone, through the mail, or online. A survey involves asking a standard set of questions to a group of subjects. In a highly structured survey, subjects are forced to choose from a response set such as “strongly disagree, disagree, undecided, agree, strongly agree”; or “0, 1-5, 6-10, etc.” This is known as Likert Scale . Surveys are commonly used by sociologists, marketing researchers, political scientists, therapists, and others to gather information on many independent and dependent variables in a relatively short period of time. Surveys typically yield surface information on a wide variety of factors, but may not allow for in-depth understanding of human behavior.

Of course, surveys can be designed in a number of ways. They may include forced choice questions and semi-structured questions in which the researcher allows the respondent to describe or give details about certain events. One of the most difficult aspects of designing a good survey is wording questions in an unbiased way and asking the right questions so that respondents can give a clear response rather than choosing “undecided” each time. Knowing that 30% of respondents are undecided is of little use! So a lot of time and effort should be placed on the construction of survey items. One of the benefits of having forced choice items is that each response is coded so that the results can be quickly entered and analyzed using statistical software. Analysis takes much longer when respondents give lengthy responses that must be analyzed in a different way. Surveys are useful in examining stated values, attitudes, opinions, and reporting on practices. However, they are based on self-report or what people say they do rather than on observation and this can limit accuracy.

Developmental Designs

Developmental designs are techniques used in developmental research (and other areas as well). These techniques try to examine how age, cohort, gender, and social class impact development.

Longitudinal Research

Longitudinal research involves beginning with a group of people who may be of the same age and background, and measuring them repeatedly over a long period of time. One of the benefits of this type of research is that people can be followed through time and be compared with them when they were younger.

Figure 1.8 – A longitudinal research design. 13

A problem with this type of research is that it is very expensive and subjects may drop out over time. The Perry Preschool Project which began in 1962 is an example of a longitudinal study that continues to provide data on children’s development.

Cross-sectional Research

Cross-sectional research involves beginning with a sample that represents a cross-section of the population. Respondents who vary in age, gender, ethnicity, and social class might be asked to complete a survey about television program preferences or attitudes toward the use of the Internet. The attitudes of males and females could then be compared, as could attitudes based on age. In cross-sectional research, respondents are measured only once.

Figure 1.9 – A cross-sectional research design. 14

This method is much less expensive than longitudinal research but does not allow the researcher to distinguish between the impact of age and the cohort effect. Different attitudes about the use of technology, for example, might not be altered by a person’s biological age as much as their life experiences as members of a cohort.

Sequential Research

Sequential research involves combining aspects of the previous two techniques; beginning with a cross-sectional sample and measuring them through time.

Figure 1.10 – A sequential research design. 15

This is the perfect model for looking at age, gender, social class, and ethnicity. But the drawbacks of high costs and attrition are here as well. 16

Table 1 .1 – Advantages and Disadvantages of Different Research Designs 17

Consent and Ethics in Research

Research should, as much as possible, be based on participants’ freely volunteered informed consent. For minors, this also requires consent from their legal guardians. This implies a responsibility to explain fully and meaningfully to both the child and their guardians what the research is about and how it will be disseminated. Participants and their legal guardians should be aware of the research purpose and procedures, their right to refuse to participate; the extent to which confidentiality will be maintained; the potential uses to which the data might be put; the foreseeable risks and expected benefits; and that participants have the right to discontinue at any time.

But consent alone does not absolve the responsibility of researchers to anticipate and guard against potential harmful consequences for participants. 18 It is critical that researchers protect all rights of the participants including confidentiality.

Child development is a fascinating field of study – but care must be taken to ensure that researchers use appropriate methods to examine infant and child behavior, use the correct experimental design to answer their questions, and be aware of the special challenges that are part-and-parcel of developmental research. Hopefully, this information helped you develop an understanding of these various issues and to be ready to think more critically about research questions that interest you. There are so many interesting questions that remain to be examined by future generations of developmental scientists – maybe you will make one of the next big discoveries! 19

Another really important framework to use when trying to understand children’s development are theories of development. Let’s explore what theories are and introduce you to some major theories in child development.

Developmental Theories

What is a theory.

Students sometimes feel intimidated by theory; even the phrase, “Now we are going to look at some theories…” is met with blank stares and other indications that the audience is now lost. But theories are valuable tools for understanding human behavior; in fact they are proposed explanations for the “how” and “whys” of development. Have you ever wondered, “Why is my 3 year old so inquisitive?” or “Why are some fifth graders rejected by their classmates?” Theories can help explain these and other occurrences. Developmental theories offer explanations about how we develop, why we change over time and the kinds of influences that impact development.

A theory guides and helps us interpret research findings as well. It provides the researcher with a blueprint or model to be used to help piece together various studies. Think of theories as guidelines much like directions that come with an appliance or other object that requires assembly. The instructions can help one piece together smaller parts more easily than if trial and error are used.

Theories can be developed using induction in which a number of single cases are observed and after patterns or similarities are noted, the theorist develops ideas based on these examples. Established theories are then tested through research; however, not all theories are equally suited to scientific investigation.  Some theories are difficult to test but are still useful in stimulating debate or providing concepts that have practical application. Keep in mind that theories are not facts; they are guidelines for investigation and practice, and they gain credibility through research that fails to disprove them. 20

Let’s take a look at some key theories in Child Development.

Sigmund Freud’s Psychosexual Theory

We begin with the often controversial figure, Sigmund Freud (1856-1939). Freud has been a very influential figure in the area of development; his view of development and psychopathology dominated the field of psychiatry until the growth of behaviorism in the 1950s. His assumptions that personality forms during the first few years of life and that the ways in which parents or other caregivers interact with children have a long-lasting impact on children’s emotional states have guided parents, educators, clinicians, and policy-makers for many years. We have only recently begun to recognize that early childhood experiences do not always result in certain personality traits or emotional states. There is a growing body of literature addressing resilience in children who come from harsh backgrounds and yet develop without damaging emotional scars (O’Grady and Metz, 1987). Freud has stimulated an enormous amount of research and generated many ideas. Agreeing with Freud’s theory in its entirety is hardly necessary for appreciating the contribution he has made to the field of development.

Figure 1.11 – Sigmund Freud. 21

Freud’s theory of self suggests that there are three parts of the self.

The id is the part of the self that is inborn. It responds to biological urges without pause and is guided by the principle of pleasure: if it feels good, it is the thing to do. A newborn is all id. The newborn cries when hungry, defecates when the urge strikes.

The ego develops through interaction with others and is guided by logic or the reality principle. It has the ability to delay gratification. It knows that urges have to be managed. It mediates between the id and superego using logic and reality to calm the other parts of the self.

The superego represents society’s demands for its members. It is guided by a sense of guilt. Values, morals, and the conscience are all part of the superego.

The personality is thought to develop in response to the child’s ability to learn to manage biological urges. Parenting is important here. If the parent is either overly punitive or lax, the child may not progress to the next stage. Here is a brief introduction to Freud’s stages.

Table 1. 2 – Sigmund Freud’s Psychosexual Theory

Strengths and Weaknesses of Freud’s Theory

Freud’s theory has been heavily criticized for several reasons. One is that it is very difficult to test scientifically. How can parenting in infancy be traced to personality in adulthood? Are there other variables that might better explain development? The theory is also considered to be sexist in suggesting that women who do not accept an inferior position in society are somehow psychologically flawed. Freud focuses on the darker side of human nature and suggests that much of what determines our actions is unknown to us. So why do we study Freud? As mentioned above, despite the criticisms, Freud’s assumptions about the importance of early childhood experiences in shaping our psychological selves have found their way into child development, education, and parenting practices. Freud’s theory has heuristic value in providing a framework from which to elaborate and modify subsequent theories of development. Many later theories, particularly behaviorism and humanism, were challenges to Freud’s views. 22

Erik Erikson’s Psychosocial Theory

Now, let’s turn to a less controversial theorist, Erik Erikson. Erikson (1902-1994) suggested that our relationships and society’s expectations motivate much of our behavior in his theory of psychosocial development. Erikson was a student of Freud’s but emphasized the importance of the ego, or conscious thought, in determining our actions. In other words, he believed that we are not driven by unconscious urges. We know what motivates us and we consciously think about how to achieve our goals. He is considered the father of developmental psychology because his model gives us a guideline for the entire life span and suggests certain primary psychological and social concerns throughout life.

Figure 1.12 – Erik Erikson. 23

Erikson expanded on his Freud’s by emphasizing the importance of culture in parenting practices and motivations and adding three stages of adult development (Erikson, 1950; 1968). He believed that we are aware of what motivates us throughout life and the ego has greater importance in guiding our actions than does the id. We make conscious choices in life and these choices focus on meeting certain social and cultural needs rather than purely biological ones. Humans are motivated, for instance, by the need to feel that the world is a trustworthy place, that we are capable individuals, that we can make a contribution to society, and that we have lived a meaningful life. These are all psychosocial problems.

Erikson divided the lifespan into eight stages. In each stage, we have a major psychosocial task to accomplish or crisis to overcome.  Erikson believed that our personality continues to take shape throughout our lifespan as we face these challenges in living. Here is a brief overview of the eight stages:

Table 1. 3 – Erik Erikson’s Psychosocial Theory

These eight stages form a foundation for discussions on emotional and social development during the life span. Keep in mind, however, that these stages or crises can occur more than once. For instance, a person may struggle with a lack of trust beyond infancy under certain circumstances. Erikson’s theory has been criticized for focusing so heavily on stages and assuming that the completion of one stage is prerequisite for the next crisis of development. His theory also focuses on the social expectations that are found in certain cultures, but not in all. For instance, the idea that adolescence is a time of searching for identity might translate well in the middle-class culture of the United States, but not as well in cultures where the transition into adulthood coincides with puberty through rites of passage and where adult roles offer fewer choices. 24

Behaviorism

While Freud and Erikson looked at what was going on in the mind, behaviorism rejected any reference to mind and viewed overt and observable behavior as the proper subject matter of psychology. Through the scientific study of behavior, it was hoped that laws of learning could be derived that would promote the prediction and control of behavior. 25

Ivan Pavlov

Ivan Pavlov (1880-1937) was a Russian physiologist interested in studying digestion. As he recorded the amount of salivation his laboratory dogs produced as they ate, he noticed that they actually began to salivate before the food arrived as the researcher walked down the hall and toward the cage. “This,” he thought, “is not natural!” One would expect a dog to automatically salivate when food hit their palate, but BEFORE the food comes? Of course, what had happened was . . . you tell me. That’s right! The dogs knew that the food was coming because they had learned to associate the footsteps with the food. The key word here is “learned”. A learned response is called a “conditioned” response.

Figure 1.13 – Ivan Pavlov. 26

Pavlov began to experiment with this concept of classical conditioning . He began to ring a bell, for instance, prior to introducing the food. Sure enough, after making this connection several times, the dogs could be made to salivate to the sound of a bell. Once the bell had become an event to which the dogs had learned to salivate, it was called a conditioned stimulus . The act of salivating to a bell was a response that had also been learned, now termed in Pavlov’s jargon, a conditioned response. Notice that the response, salivation, is the same whether it is conditioned or unconditioned (unlearned or natural). What changed is the stimulus to which the dog salivates. One is natural (unconditioned) and one is learned (conditioned).

Let’s think about how classical conditioning is used on us. One of the most widespread applications of classical conditioning principles was brought to us by the psychologist, John B. Watson.

John B. Watson

John B. Watson (1878-1958) believed that most of our fears and other emotional responses are classically conditioned. He had gained a good deal of popularity in the 1920s with his expert advice on parenting offered to the public.

Figure 1.14 – John B. Watson. 27

He tried to demonstrate the power of classical conditioning with his famous experiment with an 18 month old boy named “Little Albert”. Watson sat Albert down and introduced a variety of seemingly scary objects to him: a burning piece of newspaper, a white rat, etc. But Albert remained curious and reached for all of these things. Watson knew that one of our only inborn fears is the fear of loud noises so he proceeded to make a loud noise each time he introduced one of Albert’s favorites, a white rat. After hearing the loud noise several times paired with the rat, Albert soon came to fear the rat and began to cry when it was introduced. Watson filmed this experiment for posterity and used it to demonstrate that he could help parents achieve any outcomes they desired, if they would only follow his advice. Watson wrote columns in newspapers and in magazines and gained a lot of popularity among parents eager to apply science to household order.

Operant conditioning, on the other hand, looks at the way the consequences of a behavior increase or decrease the likelihood of a behavior occurring again. So let’s look at this a bit more.

B.F. Skinner and Operant Conditioning

B. F. Skinner (1904-1990), who brought us the principles of operant conditioning, suggested that reinforcement is a more effective means of encouraging a behavior than is criticism or punishment. By focusing on strengthening desirable behavior, we have a greater impact than if we emphasize what is undesirable. Reinforcement is anything that an organism desires and is motivated to obtain.

Figure 1.15 – B. F. Skinner. 28

A reinforcer is something that encourages or promotes a behavior. Some things are natural rewards. They are considered intrinsic or primary because their value is easily understood. Think of what kinds of things babies or animals such as puppies find rewarding.

Extrinsic or secondary reinforcers are things that have a value not immediately understood. Their value is indirect. They can be traded in for what is ultimately desired.

The use of positive reinforcement involves adding something to a situation in order to encourage a behavior. For example, if I give a child a cookie for cleaning a room, the addition of the cookie makes cleaning more likely in the future. Think of ways in which you positively reinforce others.

Negative reinforcement occurs when taking something unpleasant away from a situation encourages behavior. For example, I have an alarm clock that makes a very unpleasant, loud sound when it goes off in the morning. As a result, I get up and turn it off. By removing the noise, I am reinforced for getting up. How do you negatively reinforce others?

Punishment is an effort to stop a behavior. It means to follow an action with something unpleasant or painful. Punishment is often less effective than reinforcement for several reasons. It doesn’t indicate the desired behavior, it may result in suppressing rather than stopping a behavior, (in other words, the person may not do what is being punished when you’re around, but may do it often when you leave), and a focus on punishment can result in not noticing when the person does well.

Not all behaviors are learned through association or reinforcement. Many of the things we do are learned by watching others. This is addressed in social learning theory.

Social Learning Theory

Albert Bandura (1925-) is a leading contributor to social learning theory. He calls our attention to the ways in which many of our actions are not learned through conditioning; rather, they are learned by watching others (1977). Young children frequently learn behaviors through imitation

Figure 1.16 – Albert Bandura. 29

Sometimes, particularly when we do not know what else to do, we learn by modeling or copying the behavior of others. A kindergartner on his or her first day of school might eagerly look at how others are acting and try to act the same way to fit in more quickly. Adolescents struggling with their identity rely heavily on their peers to act as role-models. Sometimes we do things because we’ve seen it pay off for someone else. They were operantly conditioned, but we engage in the behavior because we hope it will pay off for us as well. This is referred to as vicarious reinforcement (Bandura, Ross and Ross, 1963).

Bandura (1986) suggests that there is interplay between the environment and the individual. We are not just the product of our surroundings, rather we influence our surroundings. Parents not only influence their child’s environment, perhaps intentionally through the use of reinforcement, etc., but children influence parents as well. Parents may respond differently with their first child than with their fourth. Perhaps they try to be the perfect parents with their firstborn, but by the time their last child comes along they have very different expectations both of themselves and their child. Our environment creates us and we create our environment. 30

Theories also explore cognitive development and how mental processes change over time.

Jean Piaget’s Theory of Cognitive Development

Jean Piaget (1896-1980) is one of the most influential cognitive theorists. Piaget was inspired to explore children’s ability to think and reason by watching his own children’s development. He was one of the first to recognize and map out the ways in which children’s thought differs from that of adults. His interest in this area began when he was asked to test the IQ of children and began to notice that there was a pattern in their wrong answers. He believed that children’s intellectual skills change over time through maturation. Children of differing ages interpret the world differently.

Figure 1.17 – Jean Piaget. 32

Piaget believed our desire to understand the world comes from a need for cognitive equilibrium . This is an agreement or balance between what we sense in the outside world and what we know in our minds. If we experience something that we cannot understand, we try to restore the balance by either changing our thoughts or by altering the experience to fit into what we do understand. Perhaps you meet someone who is very different from anyone you know. How do you make sense of this person? You might use them to establish a new category of people in your mind or you might think about how they are similar to someone else.

A schema or schemes are categories of knowledge. They are like mental boxes of concepts. A child has to learn many concepts. They may have a scheme for “under” and “soft” or “running” and “sour”. All of these are schema. Our efforts to understand the world around us lead us to develop new schema and to modify old ones.

One way to make sense of new experiences is to focus on how they are similar to what we already know. This is assimilation . So the person we meet who is very different may be understood as being “sort of like my brother” or “his voice sounds a lot like yours.” Or a new food may be assimilated when we determine that it tastes like chicken!

Another way to make sense of the world is to change our mind. We can make a cognitive accommodation to this new experience by adding new schema. This food is unlike anything I’ve tasted before. I now have a new category of foods that are bitter-sweet in flavor, for instance. This is  accommodation . Do you accommodate or assimilate more frequently? Children accommodate more frequently as they build new schema. Adults tend to look for similarity in their experience and assimilate. They may be less inclined to think “outside the box.”

Piaget suggested different ways of understanding that are associated with maturation. He divided this into four stages:

Table 1.4 – Jean Piaget’s Theory of Cognitive Development

Criticisms of Piaget’s Theory

Piaget has been criticized for overemphasizing the role that physical maturation plays in cognitive development and in underestimating the role that culture and interaction (or experience) plays in cognitive development. Looking across cultures reveals considerable variation in what children are able to do at various ages. Piaget may have underestimated what children are capable of given the right circumstances. 33

Lev Vygotsky’s Sociocultural Theory

Lev Vygotsky (1896-1934) was a Russian psychologist who wrote in the early 1900s but whose work was discovered in the United States in the 1960s but became more widely known in the 1980s. Vygotsky differed with Piaget in that he believed that a person not only has a set of abilities, but also a set of potential abilities that can be realized if given the proper guidance from others. His sociocultural theory emphasizes the importance of culture and interaction in the development of cognitive abilities. He believed that through guided participation known as scaffolding, with a teacher or capable peer, a child can learn cognitive skills within a certain range known as the zone of proximal development . 34 His belief was that development occurred first through children’s immediate social interactions, and then moved to the individual level as they began to internalize their learning. 35

Figure 1.18- Lev Vygotsky. 36

Have you ever taught a child to perform a task? Maybe it was brushing their teeth or preparing food. Chances are you spoke to them and described what you were doing while you demonstrated the skill and let them work along with you all through the process. You gave them assistance when they seemed to need it, but once they knew what to do-you stood back and let them go. This is scaffolding and can be seen demonstrated throughout the world. This approach to teaching has also been adopted by educators. Rather than assessing students on what they are doing, they should be understood in terms of what they are capable of doing with the proper guidance. You can see how Vygotsky would be very popular with modern day educators. 37

Comparing Piaget and Vygotsky

Vygotsky concentrated more on the child’s immediate social and cultural environment and his or her interactions with adults and peers. While Piaget saw the child as actively discovering the world through individual interactions with it, Vygotsky saw the child as more of an apprentice, learning through a social environment of others who had more experience and were sensitive to the child’s needs and abilities. 38

Like Vygotsky’s, Bronfenbrenner looked at the social influences on learning and development.

Urie Bronfenbrenner’s Ecological Systems Model

Urie Bronfenbrenner (1917-2005) offers us one of the most comprehensive theories of human development. Bronfenbrenner studied Freud, Erikson, Piaget, and learning theorists and believed that all of those theories could be enhanced by adding the dimension of context. What is being taught and how society interprets situations depends on who is involved in the life of a child and on when and where a child lives.

Figure 1.19 – Urie Bronfenbrenner. 39

Bronfenbrenner’s ecological systems model explains the direct and indirect influences on an individual’s development.

Table 1.5 – Urie Bronfenbrenner’s Ecological Systems Model

For example, in order to understand a student in math, we can’t simply look at that individual and what challenges they face directly with the subject. We have to look at the interactions that occur between teacher and child. Perhaps the teacher needs to make modifications as well. The teacher may be responding to regulations made by the school, such as new expectations for students in math or constraints on time that interfere with the teacher’s ability to instruct. These new demands may be a response to national efforts to promote math and science deemed important by political leaders in response to relations with other countries at a particular time in history.

Figure 1.20 – Bronfenbrenner’s ecological systems theory. 40

Bronfenbrenner’s ecological systems model challenges us to go beyond the individual if we want to understand human development and promote improvements. 41

In this chapter we looked at:

underlying principles of development

the five periods of development

three issues in development

Various methods of research

important theories that help us understand development

Next, we are going to be examining where we all started with conception, heredity, and prenatal development.

Child Growth and Development Copyright © by Jean Zaar is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Principles of Child Development and Learning and Implications That Inform Practice

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NAEYC’s guidelines and recommendations for developmentally appropriate practice are based on the following nine principles and their implications for early childhood education professional practice. These principles reflect an extensive research base that is only partially referenced here. 13  Because these principles are interrelated, this linear list does not fully represent their overall complexity.

Development and learning are dynamic processes that reflect the complex interplay between a child’s biological characteristics and the environment, each shaping the other as well as future patterns of growth.

Advances in neuroscience over the last two decades have provided new insights regarding the processes of early brain development and their long-term implications for development and learning. The findings provide robust evidence supporting the importance of high-quality early learning experiences for young children for promoting children’s lifelong success.

Neural connections in the brain—which are the basis for all thought, communication, and learning—are established most rapidly in early childhood. 14  The processes of forming new neural connections and pruning the neural connections that are not used continue throughout a person’s lifespan but are most consequential in the first three years. 15  When adults are sensitive and respond to an infant’s babble, cry, or gesture, they directly support the development of neural connections that lay the foundation for children’s communication and social skills, including self-regulation. These “serve and return” interactions shape the brain’s architecture. 16  They also help educators and others “tune in” to the infant and better respond to the infant’s wants and needs.

The interplay of biology and environment, present at birth, continues through the preschool years and primary grades (kindergarten through grade 3). This has particular implications for children who experience adversity. In infancy, for example, a persistent lack of responsive care results in the infant experiencing chronic stress that may negatively impact brain development and may delay or impair the development of essential systems and abilities, including thinking, learning, and memory, as well as the immune system and the ability to cope with stress. 17  Living in persistent poverty can also generate chronic stress that negatively affects the development of brain areas associated with cognitive and self-regulatory functions. 18

No group is monolithic, and data specific to communities provides a deeper understanding of children’s experiences and outcomes. It is important to recognize that although children of all races and ethnicities experience poverty and other adverse childhood experiences (ACEs), Black and Latino/a children, as well as children in refugee and immigrant families, children in some Asian-American families, and children in Native American families, have been found to be more likely to experience ACEs than White non-Latino/a and other Asian-American populations of children, 19  reflecting a history of systemic inequities. 20  Moreover, racism itself must be recognized not only for its immediate and obvious impacts on children, but also for its long-term negative impacts, in which the repetitive trauma created by racism can predispose individuals to chronic disease. 21  It should be noted that these stressors and trauma affect adults as well as children, including family members and early childhood educators themselves, who, despite their skills and importance, often earn wages that place them into poverty.

Some children appear to be more susceptible than others to the effects of environmental influence—both positive and negative—reflecting individual differences at play. For children facing adverse circumstances, including trauma, the buffering effects of caring, consistent relationships—with family and other community members but also in high-quality early childhood programs—are also important to note. 22  This emerging science emphasizes the critical importance of early childhood educators in providing consistent, responsive, sensitive care and education to promote children’s development and learning across the full birth-through-8 age span. The negative impacts of chronic stress and other adverse experiences can be overcome. High-quality early childhood education contributes substantially to children’s resilience and healthy development.

All domains of child development—physical development, cognitive development, social and emotional development, and linguistic development (including bilingual or multilingual development), as well as approaches to learning—are important; each domain both supports and is supported by the others.

Early childhood educators are responsible for fostering children’s development and learning in all these domains as well as in general learning competencies and executive functioning, which include attention, working memory, self-regulation, reasoning, problem solving, and approaches to learning. There is considerable overlap and interaction across these domains and competencies. For example, sound nutrition, physical activity, and sufficient sleep all promote children’s abilities to engage in social interactions that, in turn, stimulate cognitive growth. Children who experience predictable, responsive relationships and responsive interactions with adults also tend to demonstrate improved general learning competencies and executive functioning. 23

Changes in one domain often impact other areas and highlight each area’s importance. For example, as children begin to crawl or walk, they gain new possibilities for exploring the world. This mobility in turn affects both their cognitive development and their ability to satisfy their curiosity, underscoring the importance of adaptations for children with disabilities that limit their mobility. Likewise, language development influences a child’s ability to participate in social interaction with adults and other children; such interactions, in turn, support further language development as well as further social, emotional, and cognitive development. Science is clear that children can learn multiple languages as easily as one, given adequate exposure and practice, and this process brings cognitive advantages. 24  In groups in which children speak different home languages, educators may not be able to speak each language, but they can value and support maintaining all languages. 25

A growing body of work demonstrates relationships between social, emotional, executive function, and cognitive competencies 26  as well as the importance of movement and physical activity. 27  These areas of learning are mutually reinforcing and all are critical in educating young children across birth through age 8. Intentional teaching strategies, including, and particularly, play (both self-directed and guided), address each domain. Kindergartens and grades 1-3 tend to be considered elementary or primary education, and, as such, may have increasingly prioritized cognitive learning at the expense of physical, social, emotional, and linguistic development. But integrating cognitive, emotional, social, interpersonal skills and self-regulatory competencies better prepares children for more challenging academic content and learning experiences. 28  In brief, the knowledge base documents the importance of a comprehensive curriculum and the interrelatedness of the developmental domains for all young children’s well-being and success.

Play promotes joyful learning that fosters self-regulation, language, cognitive and social competencies as well as content knowledge across disciplines. Play is essential for all children, birth through age 8.

Play (e.g., self-directed, guided, solitary, parallel, social, cooperative, onlooker, object, fantasy, physical, constructive, and games with rules) is the central teaching practice that facilitates young children’s development and learning. Play develops young children’s symbolic and imaginative thinking, peer relationships, language (English and/or additional languages), physical development, and problem-solving skills. All young children need daily, sustained opportunities for play, both indoors and outdoors. Play helps children develop large-motor and fine-motor physical competence, explore and make sense of their world, interact with others, express and control their emotions, develop symbolic and problem-solving abilities, and practice emerging skills. Consistently, studies find clear links between play and foundational capacities such as working memory, self-regulation, oral language abilities, social skills, and success in school. 29

Indeed, play embodies the characteristics of effective development and learning described in principles 4 and 5—active, meaningful engagement driven by children’s choices. Researchers studying the pedagogy of play have identified three key components: choice (the children’s decisions to engage in play, as well as decisions about its direction and its continuation), wonder (children’s continued engagement as they explore, gather information, test hypotheses, and make meaning), and delight (the joy and laughter associated with the pleasure of the activity, making discoveries, and achieving new things). 30  Play also typically involves social interaction with peers and/or adults.

Although adults can be play partners (for example, playing peekaboo with an infant) or play facilitators (by making a suggestion to extend the activity in a certain way), the more that the adult directs an activity or interaction, the less likely it will be perceived as play by the child. When planning learning environments and activities, educators may find it helpful to consider a continuum ranging from children’s self-directed play to direct instruction. 31  Neither end of the continuum is effective by itself in creating a high-quality early childhood program. Effective, developmentally-appropriate practice does not mean simply letting children play in the absence of a planned learning environment, nor does it mean predominantly offering direct instruction. In the middle of the continuum is guided play. Educators create learning environments that reflect children’s interests; they provide sustained time and opportunities for children to engage in self-directed play (individually and in small groups). Educators also strategically make comments and suggestions and ask questions to help move children toward a learning goal, even as children continue to lead the activity. 32

Guided play gives educators opportunities to use children’s interests and creations to introduce new vocabulary and concepts, model complex language, and provide children with multiple opportunities to use words in context in children’s home languages as well as in English. These meaningful and engaging experiences help children—including those in kindergarten and the primary grades—build knowledge and vocabulary across subject areas and in purposeful contexts (which is more effective than memorization of word lists). 33

Despite evidence that supports the value of play, not all children are afforded the opportunity to play, a reality which disproportionately affects Black and Latino/a children. 34  Play is often viewed as being at odds with the demands of formal schooling, especially for children growing up in under-resourced communities. 35  In fact, the highly didactic, highly controlling curriculum found in many kindergarten and primary grades, with its narrow focus on test-focused skill development, is unlikely to be engaging or meaningful for children; it is also unlikely to build the broad knowledge and vocabulary needed for reading comprehension in later grades. Instead, the lesson children are likely to learn is that they are not valued thinkers or successful learners in school. For example, studies suggest that students who are taught math primarily through memorization and rote learning are more than a year behind those who have been taught by relating math concepts to their existing knowledge and reflecting on their own understanding. 36

Even if not called play, cross-curricular and collaborative approaches such as project-based learning, inquiry learning, or making and tinkering share characteristics of playful learning. 37  Giving children autonomy and agency in how they approach problems, make hypotheses, and explore potential solutions with others promotes deeper learning and improves executive functioning. 38  In sum, self-directed play, guided play, and playful learning, skillfully supported by early childhood educators, build academic language, deepen conceptual development, and support reflective and intentional approaches to learning—all of which add up to effective strategies for long-term success.

Although general progressions of development and learning can be identified, variations due to cultural contexts, experiences, and individual differences must also be considered.

A pervasive characteristic of development is that children’s functioning, including their play, becomes increasingly complex—in language, cognition, social interaction, physical movement, problem solving, and virtually every other aspect. Increased organization and memory capacity of the developing brain make it possible for children to combine simple routines into more complex strategies with age. 39  Despite these predictable changes in all domains, the ways that these changes are demonstrated and the meanings attached to them will vary in different cultural and linguistic contexts. For example, in some cultures, children may be encouraged to satisfy their growing curiosity by moving independently to explore the environment; in other cultures, children may be socialized to seek answers to queries within structured activities created for them by adults. 40  In addition, all children learn language through their social interactions, but there are important distinctions in the process for monolingual, bilingual, and multilingual children. 41  Rather than assuming that the process typical of monolingual children is the norm against which others ought to be judged, it is important for educators to recognize the differences as variations in strengths (rather than deficits) and to support them appropriately. 42

Development and learning also occur at varying rates from child to child and at uneven rates across different areas for each child. Children’s demonstrated abilities and skills are often fluid and may vary from day to day based on individual or contextual factors. For example, because children are still developing the ability to direct their attention, a distraction in the environment may result in a child successfully completing a puzzle one day but not the next. In addition, some regression in observed skills is common before new developments are fully achieved. 43  For all of these reasons, the notion of “stages” of development has limited utility; a more helpful concept may be to think of waves of development that allow for considerable overlap without rigid boundaries. 44

Children are active learners from birth, constantly taking in and organizing information to create meaning through their relationships, their interactions with their environment, and their overall experiences.

Even as infants, children are capable of highly complex thinking. 45  Using information they gather through their interactions with people and things as well as their observations of the world around them, they quickly create sophisticated theories to build their conceptual understanding. They recognize patterns and make predictions that they then apply to new situations. Infants appear particularly attuned to adults as sources of information, underscoring the importance of consistent, responsive caregiving to support the formation of relationships. 46  Cultural variations can be seen in these interactions, with implications for later development and learning. For example, in some cultures, children are socialized to quietly observe members of the adult community and to learn by pitching in (often through mimicking the adults’ behaviors). 47  In other cultures, adults make a point of getting a child’s attention to encourage one-on-one interactions. Children socialized to learn through observing may quietly watch others without asking for help, while those socialized to expect direct interaction may find it difficult to maintain focus without frequent adult engagement.

Throughout the early childhood years, young children continue to construct knowledge and make meaning through their interactions with adults and peers, through active exploration and play, and through their observations of people and things in the world around them. Educators recognize the importance of their role in creating a rich, play-based learning environment that encourages the development of knowledge (including vocabulary) and skills across all domains. Educators understand that children’s current abilities are largely the result of the experiences—the opportunities to learn—that children have had. As such, children with disabilities (or with the potential for a disability) have capacity to learn; they need educators who do not label them or isolate them from their peers and who are prepared to work with them and their families to develop that potential.

In addition to learning language and concepts about the physical phenomena in the world around them, children learn powerful lessons about social dynamics as they observe the interactions that educators have with them and other children as well as peer interactions. Well before age 5, most young children have rudimentary definitions of their own and others’ social identities that can include awareness of and biases regarding gender and race. 48

Early childhood educators need to understand the importance of creating a learning environment that helps children develop social identities which do not privilege one group over another. They must also be aware of the potential for implicit bias that may prejudice their interactions with children of various social identities. 49  Educators must also recognize that their nonverbal signals may influence children’s attitudes toward their peers. For example, one recent study found that children will think a child who receives more positive nonverbal signals from a teacher is perceived as a “better” or “smarter” reader than a child who receives more negative nonverbal signals, regardless of that child’s actual reading performance. 50

Children’s motivation to learn is increased when their learning environment fosters their sense of belonging, purpose, and agency. Curricula and teaching methods build on each child’s assets by connecting their experiences in the school or learning environment to their home and community settings.

This principle is drawn from the influential report How People Learn II and is supported by a growing body of research that affirms principles espoused more than 100 years ago by John Dewey. 51  The sense of belonging requires both physical and psychological safety. Seeing connections with home and community can be a powerful signal for children’s establishing psychological safety; conversely, when there are few signs of connection for children, their psychological safety is jeopardized. It is important for children to see people who look like them across levels of authority, to hear and see their home language in the learning environment, and to have learning experiences that are both culturally and linguistically affirming and responsive. 52

Equally important is encouraging each child’s sense of agency. Opportunities for agency—that is, the ability to make and act upon choices about what activities one will engage in and how those activities will proceed—must be widely available for all children, not limited as a reward after completing other tasks or only offered to high-achieving students. Ultimately, motivation is a personal decision based on the learner’s determination of meaningfulness, interest, and engagement. 53  Educators can promote children’s agency and help them feel motivated by engaging them in challenging yet achievable tasks that build on their interests and that they recognize as meaningful and purposeful to their lives. Studies have found that some children are denied opportunities to exercise agency because they are mistakenly deemed unable to do so. 54  For educators, supporting a child’s agency can be especially challenging when they do not speak the same language as the child or are not able to understand a child’s attempts to express solutions or preferences. In these cases, nonverbal cues and/or technology-assistive tools may be helpful as the educator also works to address the communication barrier.

As noted earlier regarding brain development, children’s feelings of safety and security are essential for the development of higher-order thinking skills, so fostering that sense of belonging is essentially a brain-building activity. Beginning in infancy, educators who follow children’s lead in noticing their interests and responding with an appropriate action and conversation (including noting when interest wanes) are helping children develop self-confidence and an understanding that their actions make a difference. Educators can involve children in choosing or creating learning experiences that are meaningful to them, helping them establish and achieve challenging goals, and reflecting on their experiences and their learning. Educators can also intentionally build bridges between children’s interests and the subject matter knowledge that will serve as the foundation for learning in later grades.

Children learn in an integrated fashion that cuts across academic disciplines or subject areas. Because the foundations of subject area knowledge are established in early childhood, educators need subject-area knowledge, an understanding of the learning progressions within each subject area, and pedagogical knowledge about teaching each subject area’s content effectively.

Based on their knowledge of what is meaningful and engaging to each child, educators design the learning environment and its activities to promote subject area knowledge across all content areas as well as across all domains of development. Educators use their knowledge of learning progressions for different subjects, their understanding of common conceptions and misconceptions at different points on the progressions, and their pedagogical knowledge about each subject area to develop learning activities that offer challenging but achievable goals for children that are also meaningful and engaging. These activities will look very different for infants and toddlers than for second- and third-graders and from one community of learners to another, given variations in culture and context. Across all levels and settings, educators can help children observe and, over time, reflect about phenomena in the world around them, gain vocabulary, and build their conceptual understanding of the content of subjects across all disciplines.

Recognizing the value of the academic disciplines, an interdisciplinary approach that considers multiple areas together is typically more meaningful than teaching content areas separately. This requires going beyond superficial connections. It means “making rich connections among domain and subject areas, but allowing each to retain its core conceptual, procedural, and epistemological structures.” 55  It is, therefore, important that educators have a good understanding of the core structures (concepts and language) for all the academic subject areas so that they can communicate them in appropriate ways to children.

Educators shape children’s conceptual development through their use of language. For example, labeling objects helps young children form conceptual categories; statements conveyed as generic descriptions about a category are especially salient to young children and, once learned, can be resistant to change. 56  It is also important for educators to monitor their language for potential bias. For example, educators who frequently refer to “boys” and “girls” rather than “children” emphasize binary gender distinctions that exclude some children. Educators can also encourage children’s continued exploration and discovery through the words they use. For example, when given an object, children are more likely to engage in creative explorations of that object when they are provided with more open-ended guidance versus when they are given specific information about what the object was designed to do.

From infancy through age 8, proactively building children’s conceptual and factual knowledge, including academic vocabulary, is essential because knowledge is the primary driver of comprehension. The more children (and adults) know, the better their listening comprehension and, later, reading comprehension. By building knowledge of the world in early childhood, educators are laying the foundation that is critical for all future learning. 57  All subject matter can be taught in ways that are meaningful and engaging for each child. 58  The notion that young children are not ready for academic subject matter is a misunderstanding of developmentally appropriate practice.

Development and learning advance when children are challenged to achieve at a level just beyond their current mastery and when they have many opportunities to reflect on and practice newly acquired skills.

Human beings, especially young children, are motivated to understand or do what is just beyond their current understanding or mastery. Drawing upon the strengths and resources each child and family brings, early childhood educators create a rich learning environment that stimulates that motivation and helps to extend each child’s current skills, abilities, and interests. They make use of strategies to promote children’s undertaking and mastering of new and progressively more advanced challenges. They also recognize the potential for implicit bias to lead to lowered expectations, especially for children of color, 59  and actively work to avoid such bias.

Educators contribute significantly to the child’s development by providing the support or assistance that allows the child to succeed at a task that is just beyond their current level of skill or understanding. This includes emotional support as well as strategies such as pointing out salient details or providing other cues that can help children make connections to previous knowledge and experiences. 60  As children make this stretch to a new level in a supportive context, they can go on to use the skill independently and in a variety of contexts, laying the foundation for the next challenge. Provision of such support, or scaffolding, is a key feature of effective teaching. Pairing children can be an effective way to support peer learning in which children with different abilities can scaffold each other. 61

Children need to feel successful in new tasks a significant proportion of the time to promote their motivation and persistence. 62  Confronted by repeated failure, most children will simply stop trying. Repeated opportunities to practice and consolidate new skills and concepts are also essential for children to reach the threshold of mastery at which they can go on to use this knowledge or skill, applying it in new situations. Play (especially in intentionally designed environments with carefully selected materials) provides young children with opportunities to engage in this type of practice.

Educators foster learning for a group of children by setting challenging, achievable goals for each child, building on the combined funds of knowledge and cultural assets of the children in the group. Providing the right amount and type of scaffolding requires general knowledge of child development and learning, including familiarity with the paths and sequences that children are known to follow in specific skills, concepts, and abilities. Also essential is deep knowledge of each child, based on what the teacher has learned from close observation and from the family about the individual child’s interests, skills, and abilities and about practices of importance to the family. Both sets of knowledge are critical to matching curriculum and teaching experiences to each child’s emerging competencies in ways that are challenging but not frustrating.

Encouraging children to reflect on their experiences and learning and to revisit concepts over time is also an important strategy for educators. The curriculum should provide both breadth and depth with multiple opportunities to revisit concepts and experiences, rather than rapidly progressing through a wide but shallow set of experiences. Picture books and other learning materials that depict communities and situations relevant to children’s lives can be useful starting points for such reflection. Group projects with documentation, including photos, videos, child artwork and representations, child dictations, and/or children’s writing, are also important tools for encouraging reflection and for revisiting concepts over time. 63

Tiered intervention approaches can be helpful in identifying children who might benefit from additional instruction or support. 64  These approaches, often in collaboration with early childhood special educators and early interventionists, are most effective when they are implemented in a way that is continuous, flexible, dynamic, and focused on the range of critical skills and proficiencies children need to develop and to enable their full participation in the classroom/group community.

Used responsibly and intentionally, technology and interactive media can be valuable tools for supporting children’s development and learning.

Young children live in a digital era in which technology and interactive media are pervasive. Given rapid changes in the types and uses of new media, the knowledge base of their effects on children’s development and learning continues to grow and shift. Emerging evidence suggests a number of cautions, including concerns about negative associations between excessive screen time and childhood obesity as well as negative impacts on toddlers’ performance on measures of fine motor, communication, and social skills. 65  There is no evidence that development is enhanced when children younger than age 2 independently use devices with screen media. 66  Keeping these cautions in mind, technology and interactive media can help to support developmentally appropriate practice. For example, technology and interactive media can facilitate communication between families, children, and teachers. It can also support learning, comprehension, and communication across language differences and provide adaptations that support inclusion of children with disabilities. The use of digital media can facilitate reflection through documentation and formative assessment by children, educators, and families. The use of media can also provide isolated children (for example, children with health problems that prevent them from participating in group settings or those with less well-developed social skills) with opportunities to engage effectively with peers. 67

Effective uses of technology and media by children are active, hands-on, engaging, and empowering; give children control; provide adaptive scaffolds to help each child progress in skills development at their individual pace; and are used as one of many options to support children’s learning. Technology and interactive media should expand children’s access to new content and new skills; they should not replace opportunities for real, hands-on experiences. 68  When truly integrated, uses of technology and media become normal and transparent—the child or the educator is focused on the activity or exploration itself, not the technology. Readers are encouraged to review the NAEYC/Fred Rogers Center  position statement on the use of technology  for more information on this topic.

View the full list of endnotes.

Developmentally Appropriate Practice (DAP) Position Statement

Child Development Basics

Children with special health care needs are especially at risk. Learn more

Physical Developmental Delays: What to look for

Healthy Development

The early years of a child’s life are very important for their health and development. Healthy development means that children of all abilities, including those with special health care needs, are able to grow up where their social, emotional and educational needs are met. Having a safe and loving home and spending time with family―playing, singing, reading, and talking―are very important. Proper nutrition, exercise, and sleep also can make a big difference.

Effective Parenting Practices

Parenting takes many different forms. However, some positive parenting practices work well across diverse families and in diverse settings when providing the care that children need to be happy and healthy, and to grow and develop well. A comprehensive report looked at the evidence in scientific publications for what works, and found these key ways that parents can support their child’s healthy development:

• Responding to children in a predictable way
• Showing warmth and sensitivity
• Having routines and household rules
• Sharing books and talking with children
• Supporting health and safety
• Using appropriate discipline without harshness

Parents who use these practices can help their child stay healthy, be safe, and be successful in many areas—emotional, behavioral, cognitive , and social. Read more about the report here.

Positive Parenting Tips

Get parenting, health, and safety tips for children from birth through 17 years of age

Easy-to-use, interactive web tools for children and teens to deal with thoughts and feelings in a healthy way.

Developmental Milestones

Skills such as taking a first step, smiling for the first time, and waving “bye-bye” are called developmental milestones . Children reach milestones in how they play, learn, speak, behave, and move (for example, crawling and walking).

Children develop at their own pace, so it’s impossible to tell exactly when a child will learn a given skill. However, the developmental milestones give a general idea of the changes to expect as a child gets older.

As a parent, you know your child best. If your child is not meeting the milestones for their age, or if you think there could be a problem with your child’s development, talk with your child’s doctor and share your concerns. Don’t wait.

Developmental Monitoring and Screening

Parents, grandparents, early childhood providers, and other caregivers can participate in developmental monitoring , which observes how your child grows and changes over time and whether your child meets the typical developmental milestones in playing, learning, speaking, behaving, and moving.

Developmental screening takes a closer look at how your child is developing. A missed milestone could be a sign of a problem, so when you take your child to a well visit, the doctor, nurse, or another specialist might give your child a brief test, or you will complete a questionnaire about your child.

If the screening tool identifies an area of concern, a formal developmental evaluation may be needed, where a trained specialist takes an in-depth look at a child’s development.

If a child has a developmental delay, it is important to get help as soon as possible. When a developmental delay is not found early, children must wait to get the help they need to do well in social and educational settings.

Learn more about developmental monitoring and screening

If You’re Concerned

If your child is not meeting the milestones for their age, or you are concerned about your child’s development, talk with your child’s doctor and share your concerns. Don’t wait!

Learn more about what to do if you’re concerned

More Information

• “Learn the Signs. Act Early.” | CDC
• Normal growth and development
• Preschoolers
• School age children
• Adolescents

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Encyclopedia of Quality of Life and Well-Being Research pp 1735–1739 Cite as

Early Childhood Development (ECD)

• Nazeem Muhajarine 3  
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Child development is a multifaceted, integral, and continual process of change in which children become able to handle ever more complex levels of moving, thinking, feeling, and relating to others. (Inter-American Development Bank, 1999 )

Early childhood development , generally used to describe the time from conception to age 8, is increasingly recognized as the most crucial period of development and is the focus of this entry.

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Emergence of the field.

In the last decades of the twentieth century, a rapidly expanding body of research in the neurobiological, behavioral, and social sciences documented the tremendous importance of optimal growth and development in the early years, not only for the individual’s later health and success but for the well-being of society. At the same time, it was becoming clear that the conditions for most children around the world fell far short of what science recommended (Shonkoff & Phillips, 2000). Even as many around the world enjoyed...

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Muhajarine, N. (2014). Early Childhood Development (ECD). In: Michalos, A.C. (eds) Encyclopedia of Quality of Life and Well-Being Research. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0753-5_320

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Early childhood development, for every child, early moments matter..

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Science shows that life is a story for which the beginning sets the tone. That makes the early years of childhood a time of great opportunity, but also great risk. 

Children’s brains are built, moment by moment, as they interact with their environments. In the first few years of life, more than one million neural connections are formed each second – a pace never repeated again. The quality of a child’s early experiences makes a critical difference as their brains develop, providing either strong or weak foundations for learning, health and behaviour throughout life.

In the first few years of life, more than one million neural connections are formed each second – a pace never repeated again. 

Early childhood offers a critical window of opportunity to shape the trajectory of a child’s holistic development and build a foundation for their future. For children to achieve their full potential, as is their human right , they need health care and nutrition, protection from harm and a sense of security, opportunities for early learning, and responsive caregiving – like talking, singing and playing – with parents and caregivers who love them. All of this is needed to nourish developing brains and fuel growing bodies. 

For many millions of the world’s most disadvantaged children – including children living in poverty or affected by conflict and crisis, children on the move, children belonging to communities facing discrimination, and children with disabilities – we are often missing this window of opportunity.  

Millions of children are not receiving the nutrition or health care they need, growing up exposed to violence, polluted environments and extreme stress. They miss out on opportunities to learn and are deprived of the stimulation that their developing brains need to thrive. Their parents and caregivers struggle to get the time, resources and services necessary to provide their children with nurturing care in these contexts.  

When children miss out on this once-in-a-lifetime opportunity, they pay the price in lost potential – dying before they have a chance to grow up, or going through life with poor physical and mental health; struggling to learn and, later, to earn a living. And we all pay the price. Failing to give children the best start in life perpetuates cycles of poverty and disadvantage that can span generations, undermining the strength and stability of our societies. 

Explore topics in early childhood development

When we give children the best start in life, the benefits are huge, for every child and for the societies we share. Providing early childhood development (ECD) interventions to all young children and families is one of the most powerful and cost-effective equalizers we have at our disposal, to ensure that the most vulnerable children can reach their full potential.

Support for parenting

Because parents and caregivers are the most important providers of nurturing care in early childhood, UNICEF works to ensure they have the time, resources and services they need to provide it. We offer information and resources directly to parents , and also work with service providers and employers to offer support for parenting, from family-friendly workplaces and childcare, to child benefits for families and support for caregivers’ well-being.

Support to governments and partners

Promoting children’s optimal development involves coordinated efforts across health, nutrition, education, child protection and social protection systems, and beyond. UNICEF works with governments, businesses, civil society and academia to strengthen these systems so that children receive the services required for their developmental needs – and to make sure that the institutions that shape the lives of children and families work together to create a supportive environment for them. 

Early childhood development in emergencies

For young children in humanitarian and fragile settings, access to ECD services is a matter of life and death. UNICEF advocates with governments, donors and other partners to ensure that ECD is treated – and funded – as a priority in all humanitarian action, including in protracted crises. We also work with partners to provide essential ECD services – from health and nutrition to play and early learning opportunities – to meet the needs of children and caregivers during emergencies. 

Tracking early childhood development

Data and evidence on ECD are essential to identifying the children at greatest risk of not achieving their full potential, improving and targeting services, and making the case for adequate investments in young children and their families. UNICEF works with governments and other partners to monitor ECD and create measurement tools that help close the gaps in our knowledge of young children’s development. 

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Crane Center For Early Childhood Research and Policy

The Crane Center for Early Childhood Research and Policy is a multidisciplinary research center conducting research related to children’s learning and well-being, and seeking to impact early childhood policy and practice.

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CRANE RESEARCH FORUM RECAP – Shared Parental Responsiveness and Child Development Among Families with Low Income

Dr. Joyce Lee , assistant professor of social work at The Ohio State University and director of the Child and Family Wellbeing Laboratory, discussed how preschoolers’ behavior and receptive language development are affected by shared parental responsiveness in low-income households.

Responsive relationships are important in young children’s early development, but the ways in which fathers and mothers work together as a system — as well as the role of shared parental responsiveness in child development — are not well understood. In this presentation, Dr. Joyce Lee discussed findings on the effects of shared parental responsiveness between fathers and mothers in low-income households on preschoolers’ developmental outcomes. The specific developmental outcomes studied include children’s behavior problems, prosocial behaviors and receptive language.

Dr. Lee’s research aims to promote child welfare and family strengthening through preventing child maltreatment, supporting positive parenting and promoting the health of children in foster care. Her work is intended to inform child welfare policies and practices to improve children’s health outcomes and strengthen children’s relationships with their family members.

– Read the research brief written by Dr. Lee on this work.

– Check out the full research article for a more in-depth look at the research behind Dr. Lee’s presentation.

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How Being an “Oops Baby” Shapes Development

It's important that your child knows unplanned doesn't mean unloved

Yolanda Renteria, LPC, is a licensed therapist, somatic practitioner, national certified counselor, adjunct faculty professor, speaker specializing in the treatment of trauma and intergenerational trauma.

Verywell Mind / Getty Images

Understanding Child Development

Factors influencing child development, parental perception and oops baby development, emotional and social development, cognitive development.

• Strategies for Supporting Children's Development

Babies resulting from unplanned or unwanted pregnancies are sometimes referred to as “oops babies,” and they’re more common than you might think. According to research from the Guttmacher Institute published in January 2019, 45% of pregnancies in the US are unintended, with 58% of these resulting in birth.

Being an “oops baby” can have an impact on development as a child and adolescent, even when the parents of these babies want them once they find out about the pregnancy. There are a number of reasons for this, but there are also plenty of ways to support children who may have been unplanned in their development.

Child development can be best understood when broken down into a series of stages. Children can develop at different paces, so the stages should be taken as a guide rather than a rule, but are nonetheless a useful indicator. 

Patricia Britto, DEdPsy

Parents’ attentiveness to their children’s emotions is essential when fostering their emotional development and well-being.

There’s the newborn stage, from birth to around three months, which is followed by the infant stage, until around 12-18 months. Children will then enter the toddler stage until they’re around three years old, followed by the preschool stage, until around four. Early childhood is often considered to last until a child is around seven, while middle childhood is considered to last from seven to around 11 or 12. This is followed by adolescence, which often corresponds to puberty and the teenage years. 

Jean Piaget’s theory of cognitive development largely echoes these stages, too, as can be seen below:

• Sensorimotor stage: Birth to 2 years 
• Preoperational stage: Ages 2 to 7 
• Concrete operational stage: Ages 7 to 11 
• Formal operational stage: Ages 12 and up

When it comes to child development—particularly in the earlier stages—the relationships and bonds the child forms with their caregivers are crucial. When these bonds aren’t there, or are disrupted, the effects can remain into adulthood.

When a child doesn’t form a secure attachment to their primary caregivers, they may find it more difficult to form healthy relationships growing up, develop behavioral or mental health conditions, and display attachment issues as they grow up.

There are lots of factors that can influence child development , from genetics to the attitudes and behaviors of a child’s caregivers to things like nutrition and the socioeconomic position of their family—they all contribute. Some factors, however, play a larger role than others:

• Genetics: This isn’t something we have a lot of control over. From our hair and eye color to more complex aspects of us like our physical and mental abilities, many parts of us are influenced by genetics. But while we can’t control our genetics, we can make plans to rectify any limitations they might give us through lifestyle changes, for example.
• Environmental factors: Our surroundings influence our development as children, from our geographic location in a literal sense to our emotional surroundings. The development of a child who grows up surrounded by affection and attention is likely to be different from the development of a child who grows up being ignored and neglected.
• Parental attitudes and behaviors: Parents have a huge influence on their children’s development, and their attitudes and behaviors can really impact it. This might relate to the cultural interests a parent has and shares with their child, or the interest a parent takes in their child, for example.

Although research on unplanned pregnancies is still very new, attachment theory explains the importance of safe connection with attachment figures in early development.

Jennie Lannette Bedsworth, MSW LCSW

It's not how a child begins that defines their future, but rather the care and nurturing they receive along the way.

“How a parent views their children is significant,” explains Patricia Britto , DEdPsy, an HCPC-registered educational psychologist. “Every child or young person 25 and under needs at least one adult who thinks they are priceless and provides unconditional love. Parents’ attentiveness to their children’s emotions is essential when fostering their emotional development and well-being.”

Feeling unwanted or unloved can have a negative impact on development and on mental health. Research has linked feeling unloved to adolescent depression, for example.

According to Dr Britto, “Children and young people who have been told that their birth status is unplanned can likely feel unwanted, which can be associated with attachment insecurity —anxiety and avoidance.”

She explains that telling children and young people that they were unplanned can have a negative impact on the relationship with their parents both in the short term and into adulthood.

Children can worry that their parents don’t love them as much, or develop a fear of abandonment, which may in terms impact how they interact with their parents—and form relationships more generally—going forward. “For example,” she continues, “Some children and young people may struggle to trust their parents and be more sensitive to rejection.”

She advises that, if parents do tell their children that they were unplanned, they should consider how they do so. ”A nurturing approach is likely to result in a more favorable outcome than an abrupt one,” she says.

It’s not so much that being unplanned in itself will affect a child’s emotional and social development, but a child who is unplanned may be more likely to have less interaction with their parents and witness violence between parents. They are also less likely to be breastfed, for example, which can also affect development. Unplanned children may have lower self-esteem as adolescents resulting from poorer parent-child relationships too.

There’s not a lot of evidence suggesting that being unplanned results in negative cognitive development or affects academic outcomes. That said, should children who are unplanned go on to experience abuse and neglect, this is much more likely to affect their cognitive development.

“Children who have experienced neglect or abuse may struggle to sustain their focus to ask and process learning information and could be more passive in the classroom rather than active,” says Dr Britto.

And, there’s evidence that children who were unplanned are more likely to have problems with conduct and attention from the ages of around seven to nine.

However, there can be longer-term effects. Jennie Lannette Bedsworth , MSW LCSW, a licensed clinical social worker and behavioral therapist, says that an unplanned pregnancy can add stress on to a family and this might have knock-on effects on cognitive development: “Financial and emotional pressures could make it harder to provide the stable environment kids need in those early years. We also know that long-term stress isn't good for anyone's health.”

Strategies for Supporting Children's Development

Fortunately, there are strategies for supporting your child's development whether they were planned or not.

In terms of emotional development, Dr Britto recommends educating children about their emotions, and labeling emotions when their children present them. She also advises showing empathy toward your children no matter what the circumstances are, and pausing to self-regulate before identifying their children’s emotions, to make co-regulation easier.

“Co-regulation is a strategy to help children learn how to return to a calm state when triggered by stressors such as sensory inputs and stressful events with support and direction from an adult,” she explains. “For example, parents may sit with their children in moments of distress and wait until they are calm before they solve problems. They also offer tips such as taking deep breaths, drinking a sip of water, moving to another scenery, and engaging in mindfulness.”

External factors can help you support your child’s development, too. Bedsworth says that when children who were unplanned do well, this can often be down to things like strong family ties, support systems and resources, good healthcare, parental guidance, and policies allowing parents time off after birth.

She recommends seeking help from professionals if you think you need it, too: “Therapy, home visits, and support groups—connecting with even one of these can provide relief during challenging times.”

Probably the most important factor is parents working through their emotions—whether it's disappointment, sadness, anger—from having an unplanned pregnancy so they can connect emotionally with their child.

Keep in Mind

Bedsworth says, “With a solid network behind them, families dealing with an unplanned pregnancy can absolutely emerge happy and healthy. It's not how a child begins that defines their future, but rather the care and nurturing they receive along the way."

She explains that “countless children from unplanned pregnancies thrive with loving, committed parents.” While being an ‘oops baby’ certainly can have an impact on a child’s development, it’s not the be-all and end-all. What’s more important is the child’s life and the child’s upbringing, not whether or not they came from a planned pregnancy.

Zhou HY, Zhu WQ, Xiao WY, Huang YT, Ju K, Zheng H, Yan C. Feeling unloved is the most robust sign of adolescent depression linking to family communication patterns . J Res Adolesc. 2023 Jun;33(2):418-430. doi: 10.1111/jora.12813

Nelson J, O’Brien M. Does an unplanned pregnancy have long-term implications for mother-child relationships?   J Fam Issues . 2012;33(4):506-526. doi:10.1177/0192513X11420820

Drexel University College of Medicine. Unwanted Pregnancies: Outcomes For Children .

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What Cass review says about surge in children seeking gender services

Report finds particularly complex factors may explain surge in birth-registered females referred to NHS Gids

In 2009 the NHS’s gender identity development service (Gids) saw fewer than 50 children a year. Since then, demand increased a hundredfold, with more than 5,000 seeking help in 2021-22.

In her review of gender services , Dr Hilary Cass said there had been a “dramatic increase” in presentations to gender clinics in the last decade, in particular by birth-registered females. In 2009, Gids treated 15 girls. By 2016, that figure had risen to 1,071.

“There has been a significant change in the population of young people over the last 10 to 15 years,” Cass told BBC Radio 4’s Today programme on Wednesday.

“So about 15 years ago, the service was seeing perhaps 50 predominantly birth registered boys in childhood. And over the last 10 years or so it’s switched to over 3,000 young people, and it’s mainly birth-registered girls presenting in early teens … often with quite complex additional problems.”

There is no single explanation for the increase in prevalence of gender incongruence or the specific rise in birth-registered females referred to Gids, her review concluded.

But it says various factors may explain the increase in predominantly birth-registered females presenting to gender services in early adolescence:

Social media and the internet

Generation Z and Generation Alpha (those born since 2010) have grown up with “unprecedented” online lives, the report says. This has huge advantages, but also brings risks and challenges.

Greater access to the internet has given children and young people learning resources “but it has also made them vulnerable to new dangers”, according to the review.

“Biology hasn’t changed and adult biology hasn’t changed in the last few years,” Cass said this week. “So it’s not that that’s changed things.

“I don’t think that young people today are being exposed to more abuse, or trauma or so on, than previous generations. We do have to think very seriously about the impact of social media.”

The report says girls spend more hours using social media than boys. A study cited by Cass found 43% of girls used social media for three or more hours a day, compared with 22% of boys.

A systematic review highlighted by the Cass report found that use of social media was associated with body image concerns. Numerous other studies cited by the report implicate smartphone and social media use in mental distress and suicidality among young people, particularly girls.

All showed a clear dose-response relationship: the more hours spent online, the greater the effect.

Peer and socio-cultural influence

The report suggests that although the impact of societal influences on a child’s gender expression remains unclear, it’s clear that the influences of a child’s peers are “very powerful during adolescence”.

Although the report does not specifically state that girls are affected by social and cultural influences, such as peer pressure, more than boys, and so too their gender expression, other evidence has suggested this is the case.

Several studies have implied that girls are more affected by peer pressure than boys, and are more likely to develop a negative body image during adolescence.

Another societal influence that the report references as possibly having an impact on a young person’s gender expression includes information on gender dysmorphia and gender expression found online.

More specifically, a focus group of gender-questioning young people and their parents who spoke to the review said that they often found online information “that describes normal adolescent discomfort as a possible sign of being trans and that particular influencers have had a substantial impact on their child’s beliefs and understanding of their gender”.

One gender-questioning young person is quoted in the report affirming this view, saying a “lot of trans people make YouTube videos, which I think is a major informational source for a lot of people, and that’s mainly where I get my information from, not so much professional services”.

The report also stated that according to another focus group of gender-questioning young people, they often found it difficult to find “trusted sources of information, favouring lived experience social media accounts over mainstream news outlets”.

Greater societal acceptance of transgender identities has allowed young people to come out easily, the review found. It suggests that the increased numbers now reflect the true prevalence of gender incongruence in society.

Dangerous online influencers

Cass said her review team received reports of gender-questioning children being urged to hide things from their parents. “We haven’t done a comprehensive search but certainly when we were told about particular influencers, I followed some of those up,” Cass said. “Some of them give them very unbalanced information.

“And some [young people] were told that parents would not understand, so that they had to actively separate from their parents or distance their parents. All the evidence shows that that family support is really key to people’s wellbeing. So there was really some dangerous influencing going on.”

Cass says the influencers “are legion” but declined to identify any specially.

Mental health

The striking increase in young people presenting with gender dysphoria should be seen within the context of increasing rates of poor mental health and emotional distress among the broader adolescent population, particularly among girls, the Cass report found.

There has been a substantial increase in rates of mental health problems in children and young people, with increased anxiety and depression being most evident in teenage girls, UK national surveys between 1999 and 2017 show.

The Cass review found that there was a “marked increase” in young women aged between 16 and 24 presenting with anxiety, depression and self-harm. Some conditions – for example, eating disorders – have increased more than others, particularly in girls and young women.

Studies of rates of self-harm have shown similar increases. For example, the report says there was an almost 70% increase in girls aged between 13 and 16 presenting with self-harm. This was not seen in boys, the review noted.

“The increase in presentations to gender clinics has to some degree paralleled this deterioration in child and adolescent mental health,” the report says. “Mental health problems have risen in both boys and girls, but have been most striking in girls and young women.”

Girls were also more likely to have low self-esteem (12.8% versus 8.9% of boys), according to a study cited by the Cass review. They were also more likely to be unhappy with their appearance (15.4% versus 11.8% of boys).

Changes in concepts of gender and sexuality

The report states that the relationship between sexuality and gender identity is “complex and contested”, and that although a trans identity does not necessarily determine a person’s sexuality, it was “important to consider the relationship between sexual identity and gender identity given that sexuality contributes to a person’s sense of identity, and both may be fluid during adolescence”.

The report cites a 2016 research paper from Gids that looked at sexual orientation in 57% (97) of a clinic sample of patients over 12 years of age for whom this information was available.

Of the birth-registered females, 68% were attracted to females, 21% were bisexual, 9% were attracted to males and 2% were asexual. Of the birth-registered males, 42% were attracted to males, 39% were bisexual and 19% were attracted to females.

The report goes on to say that it is “common in adolescence to experience same-sex attraction and not to conform to gender stereotypes. In making sense of these feelings young people are now having to navigate an increasingly complex interplay between sex and gender.”

On the relationship between sexual orientation and gender identity, the review concludes that it “is an area that warrants better exploration and understanding”.

The report also stated that it had received several reports from parents of birth-registered females “that their child had been through a period of trans identification before recognising that they were cisgender same-sex attracted”.

• Transgender
• Children's health
• Young people

More on this story

Veteran trans campaigner: ‘Cass review has potential for positive change’

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‘This isn’t how good scientific debate happens’: academics on culture of fear in gender medicine research

Five thousand children with gender-related distress awaiting NHS care in England

Ban on children’s puberty blockers to be enforced in private sector in England

Adult transgender clinics in England face inquiry into patient care

‘Children are being used as a football’: Hilary Cass on her review of gender identity services

Thousands of children unsure of gender identity ‘let down by NHS’, report finds

Review of gender services has major implications for mental health services

What are the key findings of the NHS gender identity review?

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What the U.K.’s explosive Cass Review means for gender medicine in the U.S.

The report is a gauntlet thrown down to the biden administration and organizations supporting controversial treatments for children.

By Valerie Hudson

A 388-page bomb just dropped in the U.K., and reverberations will be felt around the world. The long-awaited final Cass Review — commissioned by the National Health Service on gender-related medical treatment — has just been published. Dr. Hilary Cass, the author of this independent review, is one of Britain’s preeminent pediatricians and formerly the president of the Royal College of Paediatrics and Child Health.

The Cass Review is painstaking in its detail and comprehensive in its scope. Its findings have already caused the U.K.’s Council for Psychotherapy to cease its advocacy for an uncritically affirming stance for those with gender dysphoria. In anticipation of the final report, last month the U.K. banned the NHS from providing puberty blockers, cross-sex hormones or surgery to minors. A law prohibiting private clinics from offering these practices is also in the works.

What does the Cass Review say?

Overall, it finds the evidence for the use of puberty blockers and cross-sex hormones as treatment for gender dysphoria to be quite weak.

With regard to puberty blockers, the review “found no evidence that puberty blockers improve body image or dysphoria, and very limited evidence for positive mental health outcomes, which without a control group could be due to placebo effect or concomitant psychological support.”

Additionally, the use of puberty blockers was not only associated with significant loss in bone density, but the review found evidence that “brain maturation may be temporarily or permanently disrupted by the use of puberty blockers, which could have a significant impact on the young person’s ability to make complex risk-laden decisions, as well as having possible longer-term neuropsychological consequences.”

The effects of puberty blockers may not, then, be reversible. In fact, the review notes, “given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/ feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.”

With regard to the use of cross-sex hormones, similar conclusions are reached: “There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow up. No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility. Uncertainty remains about the outcomes for height/growth, cardiometabolic and bone health.”

Noting the lack of evidence as to benefits and harms, the author concludes that it is unethical to prescribe these medications to anyone under the age of 18, and possibly unethical to prescribe them to anyone younger than their mid-20s, when full executive reasoning has been achieved.

Proponents of gender-altering medical treatment have argued that treatment lowers the risk of suicide among gender dysphoric young people but Cass does not find this to be the case. The report says: “[I]t is well established that children and young people with gender dysphoria are at increased risk of suicide, but suicide risk appears to be comparable to other young people with a similar range of mental health and psychosocial challenges. Some clinicians feel under pressure to support a medical pathway based on widespread reporting that gender-affirming treatment reduces suicide risk. This conclusion was not supported by the systematic review. In summary, the evidence does not adequately support the claim that gender-affirming treatment reduces suicide risk.”

Given no real evidence of any improvement with use of puberty blockers and cross-sex hormones in gender dysphoric children, and given the clear gaps in the research literature, the review concludes that there can be no informed consent on the part of either parents or patients to this treatment. Without the possibility of informed consent, it is patently unethical for doctors to prescribe such treatments.

The Cass Review also weighs in on the issue of social transition, which has been a source of conflict between schools and parents in the U.K.

While U.K. schools are prepared to socially transition a child — and to do so without informing parents — the Cass Review asserts that social transition is consequential, especially for younger children. The review notes, “sex of rearing seems to have some influence on eventual gender outcome, and it is possible that social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence. For this reason, a more cautious approach needs to be taken for children than for adolescents.” For this reason, the U.K. government has recently issued guidance to stop schools from socially transitioning children.

The concept of “conversion therapy” also needs to be rethought, according to the Cass Review. Given the significantly higher rate of mental health comorbidities of gender dysphoric children compared to controls, it is important that mental health professionals be allowed to investigate whether a child’s gender dysphoria may be relieved through psychological interventions. Proposed bans on “conversion therapy” might stifle such needed therapy.

Furthermore, the review insists that detransitioning support also be provided by the NHS since, according to Cass, the number of detransitioners appears to be increasing.

All in all, the Cass Review is an important achievement. It will be the foundation for an almost 180-degree turn in how the National Health Service treats gender dysphoric children. It is also a massive repudiation of the care guidelines put forward by WPATH, the World Professional Association of Transgender Healthcare. The guidelines have been unjustifiably influential given their “lack [of] developmental rigour,” as the review politely puts it.

But the report represents more, at least to Americans. It is a gauntlet thrown down to U.S. professional organizations, such as the American Medical Association, the American Academy of Pediatrics and the American Psychological Association, all of which have uncritically adopted the clearly unethical WPATH approach. It is also a gauntlet thrown down to the Biden administration, which has followed suit.

With the publication of the Cass Review, American institutions must rethink their approach to the treatment of gender dysphoric children. That approach is now clearly seen to be wrong, and can no longer be ethically justified.

I’m planning on mailing a copy of the review to the U.S. Department of Health and Human Services, care of Dr. Rachel Levine.

Valerie M. Hudson is a university distinguished professor at the Bush School of Government and Public Service at Texas A&M University and a Deseret News contributor. Her views are her own.