DEVELOPMENTAL THEORIES Introduction: The period of growth and development extends throughout the life cycle; however, the

period in which the principal changes occur is from conception to the end of adolescence. It is important for the nurse to understand these early periods as well as the total life cycle of an individual to better understand the behaviour of parents and other adults who provide care for the child. Importance of Growth and Development: 1. To know what to expect of a particular child at any given age and at what age certain kinds of behaviour are likely to emerge in more mature forms. 2. To plan for nursing management and to help in formulating the plan for the total care of each child. 3. To better understand the reason for particular conditions and illnesses that occurs in various age groups. 4. To teach mothers and fathers how to observe and to use their knowledge so that they may help their children achieve optimal growth and development. Development: The development of children can be divided into several areas: intellectual, moral, emotional, sexual, social, language, speech and spiritual. In addition, as individuals mature they develop a body image and a life perspective. These divisions of development are arbitrary; they all usually progress together in the process of maturation and learning. Theories of Development: Many theories have been devised to study the development of children. The theories are: y y y y Intellectual Development: Jean Piaget Moral Development: Lawrence Kohlberg Emotional Development: Erik. H. Erikson Development of sexuality: Sigmund Freud

y Spiritual Development: James. W. Fowler. Types of Development: Intellectual Development (Jean Piaget) Piaget (1969) developed a theory of cognitive development from infancy through adolescence. The ability to understand develops in a predictable way. According to Piaget, cognitive ability, which makes understanding possible, develops in two major periods involving four stages- the Sensorimotor Stage, the Preoperational Stage, the Stage of Concrete Operations and the Stage of Formal Operations. These stages are not separate and distinct but rather are subdivisions of a continuous pattern of cognitive development. The first major period of cognitive development is shown as the Period of Sensorimotor Intelligence, covering the first stage of the cognitive developmental continuum, and the second is known as the Period of Conceptual Intelligence. including the other three stages. The first period is largely dominated by sensorimotor processes and the second by more abstract processes of reasoning and problem solving, in which the child is capable of using language and symbols. During the Sensorimotor stage of cognitive development, children begin to develop an understanding to themselves as separate and distinct from the environment, causality, time and space. This understanding comes from sensorimotor exploration. The sensorimotor stage extends from birth to the time when children are 2 years of age. The preoperational stage in cognitive development, which extends from 2 to 6 years of age, is the time when children are capable of using language and symbolic thinking. This is apparent in their imaginative play. It is a time of egocentric thinking in which children are unable to solve problems involving number concepts or classes of objects. The third stage in cognitive development- the stage of concrete operationsextends from the time children are 6 years of age until they are 11 to 12 years

old. At this time, the vague and nebulous concepts of the preschool years become concrete and specific. This enables children to begin to think deductively, to form concepts of space and time, and o categorizes objects. They are able to take the role of others and this leads to a greater understanding of reality. In the fourth and last stage of cognitive development- the stage of formal operations- which begins around the age of 11 to 12 years and extends onward. Children are capable of considering all possible ways of solving problems and are able to reason on the basis of hypothesis and propositions. As a result, they can look at problems from different points of view and can take many factors into consideration when solving problems. Childrens thinking then becomes more flexible and concrete, and they are able to combine information from a number of different sources. Moral Development (Lawrence Kohlberg and Carol Gilligan) Lawrence Kohlberg: Kohlberg (1969) developed a theory of moral development in levels that closely follow Piagets theory of cognitive development. Each level is further divided into separate stages. The preconventional level is based on external control as the child learns to conform to rules imposed by authority figures. y Stage I- punishment & obedience orientation: the childs behaviour is subject to external controls. In the first stage of this level the child is obedience and punishment oriented and the morality of an act is judged in terms of its physical consequences. y Stage II- instrumental relativist orientation: In the second stage of this level, children conform to social expectations to gain rewards. The conventional level involves identifying with significant others and conforming to their expectations. The person respects the values and ideals of family and friends, regardless of consequences.

y Stage III- good boy- good girl orientation: in this stage, the child conforms to rules to win the approval of others and to maintain good relations with them. y Stage IV- law & order orientation: in the second stage of this level, children believe that if the social group accepts rules as appropriate for all group members, they should conform to them to avoid social disapproval. The post conventional level involves moral judgement that is rational and internalized into ones standards or values.  Stage V- social contact, utilitarian orientation: In the first stage of this level, the child believes that there should be flexibility on moral beliefs that make it possible to modify and change moral standards if it proves advantageous to the group members as a whole.  Stage VI- universal ethical principle orientation: in the second stage of this level, people conform to both social standards and to internalized ideals to avoid self- condemnation rather than to avoid social disapproval. It is morality based on respect for others rather than on personal desires. Faith Development (James Fowler): Fowler (1981) produced a developmental theory of the spiritual identity of humans, based on the work of Piaget, Kohlberg and Erikson. He describes faith as follows: Faith is not always religious in its content or context faith is a persons or groups way of moving into the force field of life. It is our way of finding coherence in and giving meaning to the multiple forces and relations that make up our lives. Faith is a persons way of seeing him or herself in relation in relation to others against a background of shared meanings and purpose. Faith therefore is not necessarily religious, but it comprises the reasons one finds life worth living. Fowlers theory consists of a prestage and six stages of faith development. The prestage called undifferentiated faith, trust, courage, hope and love compete

with threats of abandonment and inconsistencies in the infants environment. The strength of faith in this stage is based on the infants relationship with the primary caregiver. The stages are as follows: y Stage I- Intuitive- projective faith: Most typical of the 3 to 7 year old child. Children imitate religious gestures and behaviours of others, primarily their parents. They take on their parents attitudes toward religious or moral beliefs without a thorough understanding of them. Imagination in this stage leads to long-lived images and feelings that they must question and reintegrate in later stages. y Stage II- Mythical-literal faith: Predominates in the school-aged child, who is having more social interaction. Stories represent religious and moral beliefs, and the child accepts the existence of a deity. y Stage III- Synthetic- conventional faith: The characteristic stage for many adolescents. As the person experiences increasing demands from work, school, family and peers, the basis for identity becomes more complex. the person begins to question life-guiding values or religious practices in an attempt to stabilize his or her own identity. y Stage IV- Individuative-reflective faith: This is crucial for older adolescents and young adults because they become responsible for their own commitments, beliefs and attitudes. Many adults do not develop to this stage and for some people, it does not emerge until they are in their 30s or 40s. y Stage V- Conjunctive faith: Integrates other viewpoints about faith into ones understanding of truth. y Stage VI- Universalizing faith: Involves making tangible the values of absolute love and justice for humankind. The faith relationship is characterized by total trust in the principle of actively being in relation to others in whom we invest commitment, belief, love, risk and hope and in the existence of the future, regardless of what religion or image of faith involved.

Psycho Sexual Theory (Sigmund Freud): Freud described a series of developmental stages through which all people must pass. o Oral Stage (ages 0-18 months). The infants pleasures center on gratification by using the mouth for sucking and satisfying hunger. o Anal Stage (ages 8 months - 4 years). This stage begins when neuromuscular control is developed to allow control of the anal sphincter. Toilet training is a crucial issue that requires delayed gratification as the child compromises between enjoyment of bowel function and limits set by social expectations. Negativism and Temper Tantrums: During the toddler period the child begins to separate self from the primary caregiver, usually the mother. This begins the attempts to achieve autonomy. At the same time, the toddler exhibits negativism, the propensity to do the opposite of that which is requested or of what ones normal desires would suggest. For e.g. when the toddler is offered ice cream, the immediate response may be No though the ice cream is eaten quickly. The child exerts power as an individual through negativism over these family members. Negativism is a behavioural manifestation of frustration when the toddler cannot express autonomy. Four developmental steps in response to frustration may be described as: 1. The 8-month olds anxiety in response to strangers is a form of passive refusal to comply with the wishes of others. The infants response to parental no is passive acceptance at this age. 2. During the toddler period this passive acceptance to frustration shifts to achieve physical aggression or resistance such as

making the body rigid, breath holding, biting, kicking, throwing objects, hitting, crying and full- blown severe temper tantrums. 3. As the older toddler and early preschool child learn to verbalize, the physical aggression is replaced by verbal aggression, the forceful NO! 4. The final step in the response to frustration is the utilization of socially acceptable behaviour using alternative means, bargaining and the achievement of alternative goals. Social cooperation is achieved. Ritualism: Ritualism, repetitive acts performed to relieve anxiety, provides a way for the toddler to maintain sameness and stability in a sometimes confusing world. Rituals can help the child feel secure in the face of uncertainty. It occurs between the ages of 18-4 yrs. E.g. Child while taking bath will place the towel in the way they want and keep it in that way always, while eating would place the bib in a particular manner only, and sleeping may carry a favourite security object to bed always. Ambivalence: Ambivalence is the simultaneous existence of conflicting attitudes of love and hate toward the same object, typical of the toddlers struggle to achieve autonomy. It is usually observed in the relationship of the toddler with the primary caregiver. o Phallic Stage (ages 3- 7 years). The child has increased interest in gender differences, his or her own gender, and conflict and resolution of that conflict with the parent of the same sex (named the Oedipus complex in boys and the Electra complex in girls, based on feelings of intimate sexual possessiveness for the opposite- sex parent). Curiosity about the genitals and masturbation increase.

o Latency Stage (ages 7- 12 years). This stage marks the transition to adult sexuality or the genital stage during adolescence. Increasing sex role identification with the parent of the same sex prepares the child for adult roles and relationships. o Genital Stage (ages 12- 20 years). At this stage, sexual interest can be expressed in overt sexual relationships. Sexual pressures and conflicts typically cause turmoil as the adolescent makes adjustments in relationships. Psycho social Theory (Erik Erikson): Eriksons (1963) developmental theory was based on Freuds work but was expanded to include cultural and social influences in addition biologic processes. Erikson identified eight stages that progress from birth to old age and death. Each stage is characterized by a developmental crisis to be mastered, with possible successful or unsuccessful resolution of the crisis. Unsuccessful resolution at any one stage may delay progress through the next stage. But mastery can occur later. The stages are as follows: y Trust versus Mistrust (Infancy). The infant learns to rely on caregivers to meet basic needs of warmth, food and comfort, forming trust in others. Mistrust is the result of inconsistent, inadequate or unsafe care. y Autonomy versus Shame and Doubt (Toddler, ages 1-3 years). As motor and language skills develop, the toddler learns from the environment and gains independence through encouragement from parents to feed, dress and toilet self. If the parents are overprotective or have expectations that are too high, shame and doubt as well as feelings of inadequacy may develop in the child. y Initiative versus Guilt (Preschool, ages 4-6 years). Confidence gained as a toddler allows the preschooler to take the initiative in learning, so that the child actively seeks out new experiences and explores the how and why of

activities. If the child experiences and learning, guilt results, and the child becomes hesitant to attempt more challenging skills in motor or language development. y Industry versus Inferiority (School aged children). Focusing on the end result of achievements, the school- aged child gains pleasure from finishing projects and receiving recognition for accomplishments. If the child is not accepted by peers or cannot meet parental expectations, a feeling of inferiority and lack of self- worth may develop. y Identity versus Role confusion (Adolescence). As many changes occur in his or her body, the adolescence is in transition from childhood to adulthood. Hormonal changes produce secondary sex characteristics and mood swings. Trying on roles and even rebellion are considered normal behaviours as the adolescent acquires a sense of who he or she is and what direction he or she will take in life. Role confusion occurs when the adolescent is unable to establish identity and a sense of direction. y Intimacy versus Isolation (Young adulthood). The tasks for the young adult are to unite self-identity with identities of friends and to make commitments to others. Fear of such commitments results in isolation and loneliness. y Generativity versus Stagnation (Middle adulthood). The middle adult years are a time of concern for the next generation as well as involvement with family, friends and community. There is a desire to make a contribution to the world. If this task is not met, stagnation results, and the person becomes self- absorbed and obsessed with her or his own needs or regresses to an earlier level of coping. y Ego integrity versus Despair (Later adulthood). As one enters the older years, reminiscence about life events provides a sense of fulfillment and purpose. If one believes that ones life has been a series of failures or missed directions, a sense of despair may prevail.

Summary: Today we have seen the meaning of development, the importance of growth and development and the various development theories related to growth and development of the child. Conclusion: The nurses primary role understands the childs position in the process, being aware of expectations in terms of functional health, and recognizing functional health problems related to development. The nurse can also help parents to achieve a positive attitude toward the growth and development of their children and can provide adequate and consistent guidance for them. Bibliography: y Textbook of Pediatric Nursing Dorothy R Marlow. Barbara A Redding: 6th Edition; Elsevier Publications; Pg.no173- 195. y Fundamentals of Nursing; The Art & Science of Nursing Care; Carol Taylor, Carol Lillis, Priscilla LeMone; 4th Edition; Lippincott Publications; Pg.No: 117-169 y Fundamentals of Nursing; Human Health& Function; Ruth. F.Craven, Constance.J.Hirnle; 4th Edition; Lippincott Publications; Pg.No: 281-291 y Child Health Nursing; Care of the Child & Family; Adele Pellittri; 1999; Lippincott Publications; Pg.No: 60-72. y Maternal & Child Health Nursing; Care of the Childbearing & Childbearing Family; 3rd Edition; Lippincott Publications; Pg.No: 180182. y Child Development; Elizabeth H Hurlock; 6th Edition; Tata McGraw- Hill Publishing Company Limited; Pg. No: 353-355,385- 390