Critical issues in development

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When one takes a closer look at how children develop, one cannot help but be amazed at the complexities of the process. Children the world over start using words around their first birthday, and within a couple of years more they are talking in complex sentences using complicated ideas. The contrast between the language development of most children and the minority who suffer a severe mental handicap is devastating. Likewise, blind children start to smile at the same time as sighted children; deaf children start to use a similar range of phonemes; children in Japan, France, and the United Kingdom all start uttering the same range of sounds only to have them narrowed down to those they need in their native language—with the later consequence that they may not even be able to discriminate some of the unused sounds, let alone incorporate them when learning a foreign language. The broad developmental trajectory seems very similar across cultural groups, but particular children do not always follow the average in a smooth, predictable way.

Rutter and Rutter(14) drew attention to a number of issues that need to be considered when trying to understand developmental processes. Clinicians are understandably focused on trying to make sense of cases where something has gone wrong in development. Mostly in child psychiatry, abnormal behaviours of children are quantitatively rather than qualitatively different from normal. Disorders following brain damage or genetic/chromosomal abnormalities and many involving very severe degrees of mental handicap, including infantile autism, are increasingly recognized as being qualitatively different. Most of the other disorders seen in child and adolescent mental health services are probably best viewed as deviations lying at the extreme of a continuum. But why do some children break down under stress while others do not? Why are some more resilient than others? What factors protect children against environmental and social stressors? Is it really the case that severe depression in late adolescence is just the extreme end of a continuum ranging from happiness through sadness to suicidality? In order to tackle these issues, it is necessary to clarify some of the concepts of development.

1. One should not assume that the same mechanisms underlie both normal and abnormal development.

2. A biological perspective is necessary to understand human development fully. The brain is clearly the most important organ concerned—the genetic inheritance, insults during critical periods of brain growth, and hormonal changes all have considerable influence on how children develop.

3. One has to expect both continuities and discontinuities in development. At times, continuities are intrinsic to the particular process as in language development; at other times, continuities—as in academic attainment—are in large part influenced by continuities imposed by the social environment. Parents concerned about education influence the choice of schools and provide support for learning.

4. The timing of an experience is as important as its nature. The brain is most vulnerable to insult when it is developing most rapidly, at and shortly after birth. Severe disruptions in caretaking have their greatest effects from around 9 months to 2 or 3 years. Before then, the infant does not show the same quality of selective attachments; after language is well established, the child can better hold the memory of a loved one, and that may act as a protection against the separation.

5. Children are active creatures. Not only do they call out responses from others, but as they develop cognitively and linguistically, they actively seek to make sense of their world. They appraise threat from others, even if they do not always get it right. When they are involved in a major catastrophe, their 'assumptive world'(!5> can be literally turned upside down and they take a long time to reconstruct the world as a safe place. The way the child interprets experience will come to determine in part how similar experiences are responded to in the future.

6. 'Continuity may be heterotypic as well as homotypic.' (14> The brilliant idea developed in the New York Longitudinal Study (1.6) of temperament was that rather than seeking evidence for predictability and continuity in particular infant behaviours across times when behaviour was developing rapidly, the investigators looked instead at how a variety of topographically different behaviours were expressed, and found considerable continuities in such aspects as regularity of functions, strength of response, and predominant reaction to new stimuli. Thus, they adduced evidence of temperamental characteristics that were independent of the specific behaviours shown, and, moreover, these temperamental characteristics proved to be predictive of later behaviour and adjustment. (16>

7. Both risk and protective factors, and the interactions between them, must be considered. Not all apparently adverse experiences are necessarily wholly bad for healthy development. In the same way that exposure to a virus or infection can boost resistance to infection, so exposure to mild stressors may boost resistance to other stressful experiences later. In part, this is the basis for stress inoculation therapy. (17> Some would argue that young children should have practice in separating from parents under enjoyable conditions so that in the event of a sudden, unexpected, or traumatic separation being necessary, the effects of experience will be mitigated.

8. As noted earlier, continuities may arise indirectly in that the way parents or society in general support attainment and in turn entry to the job market. The moderately high correlations between early attainment and later earning power are thereby in part determined and supported environmentally.

9. Similarly, the achievement of a particular behaviour may set in motion a chain of events. It is important to understand the processes underlying such a sequence. Too often studies are short-term and cross-sectional in nature and despite being aware of the pitfall of confusing correlation with causality, investigators remain prone to identifying a correlate as being a causal agent. For example, in the early days of studies of reading difficulties, it was noted that poor readers did badly on tests of visual perception. It was assumed that they therefore had a visual perceptual deficit and generations of poor readers were subjected to hours of mindless tracing of lines and walking along benches. The end result was that they performed better on the particular visual-perceptual test but they were no better at reading! A different experimental design was needed to demonstrate causal relationships between psychological processes and poor reading,1,» and when that was understood, the way was open for better remedial work based on a proper understanding of causal mechanisms.

This can also be viewed as an error in confusing a risk indicator with a risk process. Thirty years ago, studies of the dehumanizing effects of institutionalization on adults and children(19> found that poor living conditions and 'block treatment' of residents were related to a greater risk of behavioural and emotional problems. In one set of studies, a good indicator of block treatment was whether patients had their own toothbrushes. Clearly, providing individual toothbrushes to all would not make much difference if all the other aspects of institutionalization remained in force. A fuller understanding of the process of institutionalization is needed in order to be able to develop more humane care that improves development.

These critical issues demonstrate just how complicated the relationship between nature, experience, and development can be. But human beings are indeed very complicated, and so a proper appreciation of all these factors is needed in order to be able to understand how a particular child reached a particular point in development, to be able to predict what the future may hold for a child, and to be able to develop rational interventions that have a hope of making a real difference to children's lives.

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