Is A Little Learning Such A Dangerous Thing?

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Is A Little LearningSuch ADangerous Thing?
Sharing A Vision Conference Springfield, IL 1
October 2003
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The University of Chicago
Bennett L. Leventhal, M.D. Irving B. Harris
Professor of Child and Adolescent
Psychiatry Professor of Psychiatry and
Pediatrics Director, Child and Adolescent
Psychiatry Director, The Sonia Shankman
Orthogenic School Laboratory of Developmental
Neurosciences
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Is A Little LearningSuch ADangerous Thing?
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A little of what is being learned?

• A little who is learning?

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What is the basic goal of early learning?

• To enhance developmental outcomes

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Nature and Nurture

• Interdependent concepts (examples)
• Nonhuman primate studies
• Effects of abuse on human infants
• effect of nurture on nature
• Effects of autistic disorder on maternal-infant
  interaction
• effect of nature on nurture
• Additive or Synergistic when genetic parents
  raise child

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Basic Premise

• All considerations
• of all events in childhood
• (or in adulthood, for that matter),
• be they
• physiologic, psychological or experiential
• must take place
• in a
• developmental context

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Why Consider Development?
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What is Development?

• Longitudinal?
• Cross-Sectional?

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Development is a Process

• Individual and groups of characteristics and
  variables acting individually and together.

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Phases/Stages

• Characterized by most prominent signs of rapid
  development within a given developmental line
  during a given time
• Length of phase determined more by completion of
  a related set of changes within a developmental
  line than by number of months or years
• Should not be generally assumed that
  developmental tasks which are not most prominent
  are not developing or being used

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Critical period

• Development of a function takes place during a
  restricted time period relative to gestation
• If appropriate stimulation is not present at that
  time, development will be affected
• Example - Hubel and Wiesel - monocular
  deprivation of kittens during critical period of
  visual system development (environmental input
  and NMDA receptor dependent)

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Sensitive period

• Times during which loss of appropriate
  environmental stimulation may have adverse
  consequences, but which may be overridden by
  stimulation outside of a narrow window
• Example - abused or neglected children, who
  develop relatively normally after rehabilitation
  of parents' substance abuse, or after placement
  in a nurturing, structured adoptive home

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Normality (necessary concept)

• There is no normal race, gender, or sexual
  preference
• Normality must be defined in the context of each
  person's personal and cultural context
• For example, in Physical Diagnosis you won't be
  diagnosing your male patients as avaginal
• Concept around which one should constantly refine
  one's clinical judgment as a physician

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Examples of normal as average not being healthy

• Although most children in Israel or the
  Palestinian territories may have experienced
  violence, it does not make it a healthy experience

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Is Successful Development

• NATURAL?
• or
• LEARNED?

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What is Successful Development?

• The optimal use of individual and environmental
  factors to reach the highest possible level of
  adaptive functioning

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Individual Characteristics

• Genetics
• Appearance
• Size
• Attractive/Dysmorphic
• Intelligence
• Social Skills
• Personality
• Temperament

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Developmental Lines
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Development - Longitudinal

• Developmental Lines
• Physical/Gross Fine Motor
• Cognitive
• Language
• Psychosexual
• Interpersonal/psychosocial
• Affective
• Moral
• Spiritual

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Longitudinal Models

• Social
• Freud
• Mahler Separation-Individuation
• Erikson - Psychosocial
• Piaget - Cognitive
• Language
• Motor
• Kohut Object Relations
• Kohlberg Moral
• Others

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Social Stages of Development

• 0-12 months - Infancy
• 12 36 months - Toddler
• 36 60 months - Preschool
• 7 12 years - School Age
• 12 18 years - Adolescence
• 18 ?25 years Young Adulthood
• 25 ?65 years - Adulthood
• 65 years - Older Adulthood

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Language

• 6 months Coos, smiles, reaches
• 12 months - First words
• 18 months - Increasing words
• 24 months 2-3 word sentences
• 36 months - 3 word phrases
• 8 years - Knows person, place, time

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Gross Motor

• Roll over at 4 mo.
• 4 months roll over
• 6 months - Sit unassisted
• 12-15 months - Walk unassisted
• 30 months - run
• 36 months - Stairs one step/foot, Ride tricycle
• 6-7 years - Ride bicycle

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Fine Motor

• 4 weeks hands fisted
• 6 months - Grasps cube
• 18 months - Tower of 3 cubes
• 3 years - Draws circle
• 4 years - Draws square

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Development - Cross-sectional

• Observation of human development at a given time
• Domains are interdependent
• Quality of integration of domains is important
• The "whole" child or adult is subject of study
• Pro and con See forest well, but trees not as
  clear

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Cross-Sectional Development
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Prenatal Development

• Almost all neurons born before 11 weeks
  gestation
• Almost all cell migration complete by 16 weeks
  gestation
• Drug exposures, most commonly alcohol and
  nicotine lead to later behavioral problems
  (dose-related)

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Prenatal Development

• Nutrition important during prenatal development
• Full-term or near-full term developmental failure
  is mostly due to hypoxia and related to CNS
  bleeding when birth excessively premature
• However, outcomes progressively improving with
  advances in neonatal care

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Post-natal Development

• When does it really begin?
• At delivery?
• In utero, near delivery?

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Post-natal Development

• Physiological homeostasis is main goal
• Key first step is feeding, which requires
  adequate muscle tone for sucking

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Post-natal Development

• First 2 months social life largely bilateral
• Parental functioning is important
• Goodness of fit
• Support systems
• Time after birth is a sensitive period for
  developing attachment between caregivers and the
  infant

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Post-natal Development

• Bonding vs Attachment
• Bonding
• Lorenz
• like imprinting
• a critical period
• Attachment
• Bilateral
• Complex behavioral interaction
• Begins at birth

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2-4 months

• 2 month social smile is very overdue for
  first-time parents up all night with frequently
  crying infants
• Parents begin to more reliably read subtle cues
  and patterns of child (e.g. communication of
  hunger vs. needing a diaper change
• 4 months - rolling over increases the risk for
  falls
• Interest in objects in environment
• Color
• movement

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4-6 Months

• Rolling over at 4 months to sitting up unassisted
  at 6 months
• Child develops more three dimensional view of
  their world but mobility limited
• By 6 months, children are relatively social
  without much fear of strangers

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6-9 Months

• Emergence of normative separation anxiety and
  stranger wariness
• Children become more mobile although not usually
  walking
• Creeping
• Crawling
• Pulling up and standing
• For most children sleep and eating schedules are
  relatively organized

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9-12 Months

• Exciting time with development of single words
  starting with dada (then mama) and with many
  other single words by 12 months
• Development of walking from assisted to
  unassisted typically by 12 months
• Increasing need for child-proofing (although this
  should occur prenatally)

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12-18 Months

• Generally a time in which child is in love with
  the world enjoying new mobility and its freedom
• Object permanence by 12 months
• Joint attention by 12 months (will follow a point
  by a parent to attend to something other than the
  parent and child, just because of interest to the
  parent)

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18-36 Month-olds

• 18-36 months - anal period (psychosexual),
  autonomy vs. shame and doubt (psychosocial),
  separation-individuation
• reorganization of nervous system (pruning in
  primary sensory cortex)

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18-36 Months

• Terrible twos
• Parental response important
• Child struggles to be soothed by parent without
  feeling smothered
• Voracious appetite for learning and trying new
  things
• Language
• 2-3 word phrases -gtshort sentences

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18-36 Months

• Ambivalent struggle over autonomy, because child
  still needs parent
• Parent has to set limits where necessary (esp.
  safety issues)
• Parent has to help child find a way out of
  unsolvable conflicts (provide child with
  easy-to-understand choices)
• Parent has to be secure enough not to have to try
  to win the power struggles

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36-48 Months

• Emergence of focus on more complex relationships
  and enjoyment of developing skills without
  focusing on autonomy
• Begin to directly play with other children but
  play is often parallel
• Language plays a role in play
• Can speak in full thoughts sentences
• Many, but not all children enter nursery school
• Independence associated with bowel control end
  of traditional anal period

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Four year-olds

• Has mastered toileting, although accidents not
  uncommon, especially through the night
• Rapid increase in social interest and competence
• Nursery school (common, but not compulsory)
• Conflicts over autonomy are not most prominent
  conflict, but persist as a concern
• Fundamentals of spoken language mastered can
  tell a story and share feelings but still
  concrete

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Four year-olds

• Conflicts over autonomy are not most prominent
  conflict, but persist as a concern

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Four year-olds

• Identify self by gender
• Gender roles become stereotypic
• Internal forces
• child feels how they behave is who they are
• insecurity leads to conformity
• External forces

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Four year-old

• Learning basic rules of right and wrong
• Mastery of aggressive impulses often more
  difficult for boys than girls
• ? due to less well developed social competence in
  boys (cant separate out nature from nurture
  here) vs. preference for aggressive behavior

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Four year-old

• Triadic relationships are emergent domain
• (present before, but diadic relationships often
  dominate scene earlier)
• Competition more prominent
• Often competition with same sex parent and less
  conflictual relationships with opposite sex parent

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Five year-old

• Kindergarten
• Pre-academic skills
• early reading
• writing currently enhanced by inventive
  spelling - idea is to encourage expression
  without constraint of spelling rules and details
  for which child not ready
• early reading, mostly by sight identification

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Five-year old - Academic

• early math skills - especially geometric and
  functional
• Counting and alphabet usually solid
• Early adding, but subtraction not typical

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Five year-old

• social skills further developing
• most children can contain their violence in
  classroom at this point
• disorders of activity and violence such as ADHD
  and conduct disorder often first diagnosed

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Five year-old

• Continence typical, even at bedtime
• Failure to establish continence first diagnosed
• Enuresis - daytime or more commonly nocturnal
  wetting
• usually spontaneously remits by adolescence
• Encopresis - daytime or nighttime defecation
• if regular symptomatic of constipation or
  emotional conflicts, particularly re autonomy

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Interactional Models
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Interactional Models - Example

• Rutter's study (England) of effects of
  coeducational schooling on girls with early
  puberty
• adverse effect of coeducation only for low
  socioeconomic status (SES) girls (increased risk
  for delinquency (conduct disorder)

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Interactional Model - Example

• Low birthweight (prematurity) and SES
• 1500 - 2500 g range, low birthweight leads to
  decreased cognitive capacity only in low SES
  group
• below 1500 g SES less important than birthweight
  for cognitive outcome
• lt 1500 g maternal risk behavior for prematurity
  at higher rates in low SES groups

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MediatorsandModifiers
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Socioeconomic Status (SES)

• A generalizable risk factor
• Not to be equated with African-American,
  Asian-American, Appalachian, Liverpoolian
• Each society differs in generalizable effects of
  race, gender, sexual preference on SES
• There are NO generalizable effects of race, part
  of world, part of country, gender, sexual
  preference on any of the developmental lines
  listed above or on risk for psychopathology which
  are independent of SES effects

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Strengths

• Resilience

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Strengths/Resilience

• Too often we overlook strengths when considering
  health or overlook context when considering
  extent of stressors
• Many children grow up healthy even under
  traumatic experiences
• Chronic trauma usually more problematic than
  acute trauma, largely due to the absence of care
  correlated with chronic trauma

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Is Impairment an indicator of Developmental
Failure?Inadequate Strengths or Resilience?
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Can We Create Strength?

• What Fosters Resilience?

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Principles of Mental Healthin Early Childhood

• Centrality of early parent-child relationship
• Development as transactional process
• Intergenerational influences
• Development in context
• Multiple pathways
• Adaptation

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Socioemotional Milestones in Young Children

• Social reciprocity ( 3-6 mos.)
• Attachment ( 6-12 mos.)
• Exploration/mastery (12-18 mos.)
• Individuation (18-30 mos.)
• Self-control (30-54 mos.)
• Cooperative play (30-54 mos.)
• Empathy (30-54 mos.)

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Infant Characteristics

• State regulation
• Soothability
• Predictability
• Temperament
• Robustness
• Interest in Exploration
• Social Responsiveness

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Infant Risk Factors

• Difficult temperament
• Low birthweight
• Prenatal exposure to substances
• Gender
• Developmental delay
• Physical health problems

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Parenting
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Parenting

• Biological
• Social
• Child-rearing

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Parenting

• Preparation
• Biology
• Maturity
• Modeling
• Formal Education

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Parenting

• Planning
• Unplanned
• Planned
• Partnerships
• Alone
• Mother-father
• Other models

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Parenting Risk Factors

• Young age at first birth
• History of maltreatment/deprivation
• Maternal depression
• domestic violence/marital discord
• multiple, closely spaced births
• social isolation
• poverty

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Parenting

• Goodness of Fit
• Individual characteristics of each parent
• Parent-to-parent
• Parents to child
• Parents to extended family
• Child to extended family
• Parents to community
• Child to Community

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Dyadic Processes

• Reciprocity
• Emotional engagement
• Synchrony
• Goodness of fit
• attachment

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Parent-Child Contributions to Relationship
Processes

• PARENT
• Emotional availability
• Sensitivity
• Predictability
• Flexibility
• Psychological resources

• CHILD
• Social responsiveness
• Readability
• Regularity
• Adaptability
• Developmental functioning

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Responsive Parenting

• Read cues accurately
• Interpret appropriately
• Respond contingently
• Awareness/responsiveness to childs changing
  developmental needs
• Attunement to childs emotional state
• Packaging stimulation

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Responsive Parenting with Toddlers and
Preschoolers

• Emotional availability
• Autonomy support
• Joint negotiation
• Consistent limit-setting
• Flexibility
• Labelling of emotions
• Fostering verbal problem-solving

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Discipline

• Authoritarian
• vs
• Authoritative

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How Young Children Learn To Control Their Behavior

• Developmental advances
• Structure and routine
• Parental guidance and modeling
• Experience of manageable challenge and mastery
• Experience of social problem-solving and
  negotiation of conflict

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Child Risk Factors for Developing Behavior
Problems

• Genetic
• Prenatal substance exposure
• cognitive and language delays
• Temperament reactive, low adaptability, social
  wariness, fussy/irritable

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Family Contributors to Young Childrens Behavior
Problems

• Exposure to violence
• Low parental supervision/monitoring
• Inconsistent, ineffective discipline
• Unresponsive Parenting
• Absence of proactive adult input in learning to
  manage feelings, tolerate frustration and persist

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Supporting Healthy Emotional Development in Young
Children

• Providing safe, secure, consistent environments
• Fostering exploration and curiousity
• Building trusting relationships
• Nurturing families
• Helping children know their place
• Engendering hope
• Fostering development of adaptive skills

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Interventions for Young Children

• Behavioral
• Psychotherapeutic
• Psychopharmacologic
• AND
• Educational

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A few lessons before closing
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Provide an appropriate structure

• Activity should be qualitatively and
  qualitatively appropriate

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Provide rules

• Not too many
• Make them simple and reasonable

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Somethings are hard to teach

• They still must be taught so that the child at
  least has an accurate understanding of the facts

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Talk is cheap

• But, it is better than not talking at all and
  conversing is even better

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Be developmentally sensitive

• Too much too soon can be as problematic as too
  little too late

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Might is not always right

• But, it is still important to understand
  differences in adult and child roles and how that
  impacts learning

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Personal resources do make a difference

• Despite our wishes to the contrary we all have
  limits

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We all get angry and frustrated, at least once in
a while

• Managing frustration is at least as important as
  managing stress

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Experience does make a difference

• Not all experiences are good but there are
  usually ways to make them have some positive value

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Fostering successful development is never easy

• The absence of frustration and failure means that
  you either
• Did not try hard enough
• Or
• You are a liar

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Dont ever under estimate the power of modeling

• Both Positive and Negative

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Timing isnt everything

• But, time well spent is pretty important

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Honesty is best policy

• Always tell the truth but being brutally frank is
  not necessary

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Good behavior in the absence of complete
comprehension can be good

• And, it may even be adaptive

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What you see is not always what you get

• Blind reliance on or exposure to the media can be
  dangerous

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Biology is not necessarily destiny

• Some biological factors can be modified by
  experience

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The competent, consistent and developmentally
appropriate control of the child is never wrong!

• And, contrary to popular opinion, it neither
  limits development nor inhibits creativity

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Dreaming is good

• It is better to have a dream dashed then to have
  never dreamed at all

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Is A Little LearningSuch ADangerous Thing?
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I hoped you learned a little
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I hope that

• You did not feel endangered

AND
You are not dangerous