Introduction

'The child is father to the man.' This saying seems so obviously true that it may surprise some people that it needs to be analysed and certain assumptions inherent in it need to be challenged if psychiatric practice across the lifespan is to be properly informed by findings from developmental psychology. This chapter examines different conceptualizations of children and childhood through the ages and the ideas and theoretical models that have shaped popular, as well as professional, views on how children develop. It notes that there are no overarching theories of child development, but rather a potpourri of smaller models, most of which address disparate aspects of development.

Developmental psychology is not just about charting the norms of development, although knowledge of such is essential in all clinical practice. Rather, there are many issues that need to be critically examined in trying to understand how individuals develop. Taking a 'developmental perspective' is about integrating this knowledge and understanding the patient's presenting problems within such a framework.

The significance that the clinician will place on a particular piece of behaviour will depend not only on the child's sociocultural background, but also on the child's developmental age. Cox and Rutter(1) note four reasons for taking a developmental perspective.

1. Children behave differently at different ages. The clinician must be familiar with the range of behaviours and their age-appropriateness in separating the normal from the abnormal. For instance, simple consonant substitutions are widespread in the speech of preschool children, but indicate some delay or deviation in the speech of teenagers.

2. Many aspects of behaviour can be viewed as progressing through a normal sequence. Admittedly, discrete stages are overemphasized by stage theorists such as Freud, Piaget, and Bowlby, whereas the continuities in development are more emphasized by social learning theorists such as Staats, Bijou, and Baer. Either way, an understanding of the normal sequences and ages permits a judgement as to whether the child has deviated in his or her development.

3. Different stages of development are associated with different stresses and different developmental tasks. Bladder and bowel training are normally achieved between the ages of 2 and 4 years. Major stresses on the child or the family at the time may interfere with the achievement of proper bladder and bowel control. Mood swings are very common in adolescence, making it difficult to diagnose the severity of depression at this stage. (23)

4. An understanding of the processes that underlie both normal and abnormal development will help in the understanding of how the problems have arisen. (4) Such an historical perspective can help explain to the parents why a particular problem developed, as well as give possible clues for future programmes for prevention. A major implication of this for clinical practice is that it is always necessary to obtain a good account of the child's developmental history.

5. A better understanding of the processes underlying a child's development will lead to far better interventions and prevention. Once we have a better understanding of the distal and proximal causes of behaviour, better targeted interventions will follow.

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