Contexts and development

As in all aspects of child psychiatry, a developmental perspective is crucial when considering environmental risks. Key sources of environmental influence change with age, and the meaning and impact of events will vary with the child's stage of cognitive, emotional, and social development. In infancy and early childhood, the family is the central source of environmental influences, charged as it is in most societies with prime responsibility for the care, nurture, and socialization of the young. As children develop, so their social worlds expand; childcare and school settings take on increased importance, as do relationships with friends and peers. Throughout, each of these proximal contexts is shaped by influences from the wider culture and society. Any comprehensive assessment of a child's environment needs to take each of these types and levels of influence into account.

In addition, children's responses to adversity vary in important ways with their age and developmental stage. Separations from caregivers, for example, may cause relatively little distress in the first 6 months of life, before specific attachments have been formed, or after about 4 years, when children's cognitive competencies enable them to cope more successfully—provided they are adequately prepared. Cognitive development also affects responses to bereavement. Before 4 to 5 years of age, children do not have a full concept of death as being permanent. As a result, very young children respond to bereavement as they would to any distressing separation, and the grief reactions more typical of adult bereavement do not emerge until later in development. The major biological and social changes of adolescence highlight other developmental issues. Sensitivity to life events and stressors may alter in adolescence, and the impact of normative events such as changing schools varies with pubertal stage. Examples of this kind could easily be multiplied. As they emphasize, the impact of environmental adversities always needs to be examined in the light of a child's specific developmental stage.

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