Toddelerhood

 

Recommended reading: K and S pg 37-39 

Objectives:

                1) The student will be able to describe the motor milestones of toddlerhood and the prerequisites for toilet training.

                2) The student will be able to describe the verbal milestones and when a formal speech assessment should be made to evaluate delays in language.

                3) The student will be able to compare and contrast the major developmental theories which address this period of development including, Piaget, Freud, Mahler and Erikson.

                4) The student will be able to define and describe practicing, rapprochement, social referencing, object constancy, transitional object, autonomy vs shame and doubt, associative and parallel play

                5) The student will be able to describe the time course for development of gender identity.

                6) The student will be able to describe the motor milestones for the preschool child

                7) The student will be able to describe and define pre-operational, egocentric, animistic, Magical thinking,  transductive reasoning

                8) The student will be able to describe the phallic phase of development and the origin of the super ego.

                9) The student will be able to describe the stage of intiative vs guilt and the oedipal/electra complex

 

The Toddler

The toddler period is remarkable for the transformation of an infant into a child.  Based-on what developmental milestones are attained, the toddler period extends from ~12-18 months to ~3 years.  This age is characterized by the child’s learning how to venture-out from ‘home base’ and explore his environment.  The infant starts-off this stage toddling and ends running, begins with one-word utterances and ends with basic sentences, and starts and ends in the “terrible twos” which are manifested in the child’s ambivalent struggle for autonomy.

Neurological

Motor Development By 18 months, infants can climb stairs, run awkwardly and throw a ball. By 24 months of age, most children can run well. Fine motor skills develop rapidly with improvements in eye-hand coordination.

Feeding and Toilet Training Dramatic decreases in appetite occur during this period due to decreased nutritional needs and increased interests in other activities. Parents who are overly concerned about this can create feeding problems by turning meals into power struggles. Toilet training usually begins between 18 and 30 months. Prerequisites for toilet training include the following: regularity of bladder and bowel function, the ability to sense bladder and rectal fullness, the ability to control the sphincter muscles, the psychological ability to delay, the wish to imitate adults and please parents, the ability to communicate the need to use the toilet, and the motor ability to walk, stoop, stand and remove clothing easily. Starting too early can lead to problems. Punitive and threatening measures should never be used. Most children establish control of urination during the day by age 2 1/2 and at night by age 3 1/2 to 4 years.  Nocturesis tends to be familial. Almost all children have achieved bowel control by age 4.

Cognitive

Communication and Language Development

It is during the toddler years that communication begins to be used to express cognition as well as sensory and emotional states.  During the period between 12-18 months, toddlers often make extensive use of jargon, unintelligible sounds resembling speech. By age 17-21 months speech is in telegraphic, two word sentences such as "Mommy, go". Children age 18-25 months have approximately a 50 word vocabulary, but understand probably ten times as many words, enabling them to process brief, clear statements. By age 24-36 months, vocabulary has increased to about 200 words. By age three, speech is usually in three word sentences. Stuttering is common and normal before age 3.

Although normal children vary in their language acquisition, an assessment is warranted if an 18-month-old uses no words or just "mama" or dada". An evaluation is warranted if a two-year-old is not putting two words together, or has a vocabulary of less than 20 words, or has speech which is unintelligible to the parents or does not understand commands or questions without gestures. Causes of delay may be deafness, aphasia, mental retardation, autism or developmental language disorder. The early identification of language delay is important so that treatment or remediation begins early.

The toddler years are a time of enormous acquisition and processing of novel stimuli.  Toddlers possess the capacity to hold objects in memory and are able to seek-out desired objects, as well as verbalize desires to parents.  However, the increased interest in the environment and the ability to explore in the absence of judgment or understanding of consequences put toddlers at extremely high risk for accidents. Parents must ensure safety while allowing exploration. Homes should be "child proofed" for safety and fragile objects protected so that struggles don't ensue between parent and child as a result of normal developmental exploration.

Piaget referred to the toddler and pre-school years as the pre-operational years; a time when the child has attained the understanding of object permanence but not conservation.  We will discuss this in more detail later.

Psychosocial

Anal Stage

Freud felt that at ~18 months, the child enters the anal stage, which continues until toilet training is complete.  Freud observed that this age is notable for the struggle of wills between the mother and child.  He felt that this stage is characterized by sadism, initially in the act of defecation, but progressively in the infant’s control of the parents by choosing when and where to defecate.  The sense of ‘me’ and ‘not-me’ developed through the process of conscious defecation and subsequent disposal of the waste.  Freud felt that those whose parents were overly aggressive in toilet-training them would develop harsh, overly-demanding personalities characterized as compulsively neat, rigid, domineering, and pedantic (the anal personality).  Obviously, Freud’s comments in this regard elicited quite a bit of debate and, being so broad, are difficult to prove or disprove.  The important observation is that there is a struggle for control during this stage was noted by Freud and was studied in more detail by others.

Object Relations

During the first 4 months of the second year, Mahler observed that the securely attached toddler is consumed with practicing the requisite skills for true separation from the caregiver (as he has been since the 7th month).  The toddler displays social referencing (looking to caregiver for clues as to how to respond to novel stimuli) but also exhibiting autonomous ego functions in the immediate vicinity of the caregiver (restraint in the presence of the potential restrainer).  Object permanence is solidifying in this time and allows for the child to carry an internal representation of the caregiver; however, the toddler must frequently return to the mother to refresh his internal representation of her.

From the 16th to 24th months, the toddler struggles with rapprochement.  This struggle is characterized by the child’s ambivalent attempts to be independent while wanting to be with the caregiver (pushes-away when held, pulls-close when left).  The toddler’s self-image is completely dependent on primary caregiver.  Interestingly, the transition between rapprochement and object constancy is largely dependent on the toddler’s learning to trust the caregiver.  This is the stage at which many children benefit from the presence of a transitional object, which provides concrete comfort for the child in the absence of the caregiver.  This is also the beginning of the “terrible twos” during which the toddler struggles for psychological autonomy and separateness from the parents. This is often seen in the form of negativity and tantrums.

Object Constancy occurs during the third year as the toddler begins to consolidate his internal representation of caregiver as “good” and trustworthy, even when left.  The child is also able to extend this trust to other adults identified as “OK” by mom or dad.  During this stage, object permanence has truly solidified and the child develops stable inner representations of parents and parenting functions (they usually know what they should do, even if they don’t always do it).  The psychological skill, which Mahler refers to as ‘object constancy,’ requires the prior acquisition of the cognitive skill, which Piaget refers to as ‘object permanence.’

Erik Erikson described the essential psychosocial dilemma of the toddler years Autonomy vs. Shame and Doubt.  This essentially describes the result of a child proceeding through the Object Constancy phase as described by Mahler and emerging with an internalized sense of right and wrong which is predominantly reinforced by parental expectations.  The converse of this is a child unable to reliably predict his caregiver’s response to various behaviors, resulting in persistent self-doubt and shame at his inability to behave in a manner consistent with their expectations.  This can result from parenting that is predominantly inconsistent with essentially random positive and negative reinforcement patterns.  

It is also important to note that some degree of negativism is essential in the child's development of a sense of autonomy.  The negativism ranges from the child saying “no” to the child throwing a ‘temper tantrum.’  The manner in which parents handle these tantrums can be extremely important in terms of how the child will handle emotions. Parents should be firm but sympathetic, never rewarding tantrums and not taking the negativism as a personal affront. The child's feeling should be acknowledged and the child should be given choices as much as possible.   In general, positive reinforcement should be given with an effusive, positive affect (smiling, “oh, what a good job you did!”) while negative reinforcement and/or punishment should be initiated with a neutral, not angry, affect (“now you must go to time-out”).  Corporal punishment is particularly problematic for toddlers as they have great difficulty understanding why they can be hit but are not allowed to hit (social referencing) and base their own behaviors on what they observe in others.  The benefit of “Time Out” is that children can give themselves this when they feel overwhelmed and are taught to step-back from conflict instead of to respond with violence. 

During this age, the child has a growing understanding of emotions and the ability to deal with them verbally. Common fears of toddlers include loud noises, animals, the dark and separation. Fears of the bathtub and toilet are common due to the toddler's inability to judge relative sizes and determine that they could not actually fit down the drain (a skill that they obtain with conservation).

 

Gender Identity

Gender identity is generally seen about 18 months and is often established by 24 to 30 months. Usually by age 4 absolute integration of gender identity is seen. It develops through a complex interaction of physiologic and environmental factors. Cultural factors are extremely important for the development of gender role behavior. Adults tend to treat boys and girls differently from birth. Boys are handled more roughly. Mothers talk more to girls. Different toys are offered to boys and girls usually beginning in the second year. Fathers pay more attention to boys and by age two boys show a preference for their fathers.

 

Social Development

Social development refers to interaction with non-caregivers.  Parallel play occurs in the first half of the third year, which is solitary play conducted in pairs. Over the next six months, children begin to establish associative play, which is doing the same thing side by side but not interacting. Toddler play includes imitating previously observed behaviors, practicing various fine and gross motor skills, and seeking-out novel stimuli; usually with more interest in the process than the product.

 

Early Childhood or Preschool

Having successfully gained the requisite skills to confidently explore as toddlers, pre-school-age children spend their time interacting with their environment.  Initially, their interactions are largely assimilative

Neurological

Motor Development

 Most three-year-olds can stand on one foot, jump, run smoothly and climb stairs using alternating feet. A three-year-old can usually ride a tricycle. Four-year-olds can climb on a jungle gym and throw overhand. Five-year-olds can skip and hop on one foot. Handedness is usually expressed by age five.

A three-year-old can build a tower of 9 or 10 blocks. By age 4 most children can button and lace, feed themselves neatly, pour from a pitcher and dress and wash themselves. Drawing ability progress from copying a circle at three years, to copying a cross and drawing a simple man with head, legs and eyes at four years. The five-year-old can copy a square and draw a recognizable man with basic body parts, eyes, nose, mouth, arms, legs and feet.

 

Cognitive

 

Speech and Language

The development of language in the pre-schooler is extremely important because it permits mastery of negative feelings by putting them into words rather than acting upon them, yielding better impulse control and the ability to delay gratification. The normal decrease in aggression that occurs between 3 and 4 years is related to the increasing language skills. Three- to six-year-olds develop vocabulary at an amazing rate of nine new words a day. Three-year- olds ask constant questions, just for the sake of talking. The four-year-old's articulation may be immature, but their speech should be largely intelligible. They should speak in several word sentences. By the age of 5, articulation should be clear and correct and all the essential rules of grammar are understood. Differences in syntax between the six-year-old and the adult should be minimal in ordinary conversation. During this period, language development may be ahead of the ability to understand concepts.

Piaget's pre-operational stage of intellectual development extends from approximately 1 to 7 years of age, including the toddler period and early childhood. The thinking of this stage is characterized by a magical, illogical, intuitive view of the world in which the relationship of objects in space and time is not understood and cause and effect is not clear. The child is unable to deal with more than one dimension or recognize that a person or thing conserves its identity when it undergoes minor variations in appearance. Problem solving is by trial and error rather than planned strategies.

Figure 1 poses a question difficult for pre-operational children to answer, namely, will either, neither or both groups of eggs fit into their respective row of egg cups as shown in the top picture?

Figure 2 poses the conservation dilemma, namely, will the empty container marked B in the second row accommodate all the fluid in container A or C, A only, C only, or neither, based on the information supplied by the upper picture?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1

 

 

               

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2

Pre-operational children are egocentric, relating everything to themselves. Piaget felt that the child was unaware of the point of view of the listener or even aware that the listener had a different point of view. More recent work has shown that 4-year-olds speak differently to 2-year-olds than they do to adults, indicating an awareness of the listener's ability to understand. Young children are animistic, believing that all events can be explained by the action of some human-like agency or force. Their reasoning is transductive, attributing causality to juxtaposition in time and space. For example, "I haven't had my nap so it isn't afternoon." Magical thinking, the belief that words, thoughts, and wishes can cause events in the real world, is typical of children in the pre-operational stage.

Psychosocial Development

Moral development

Three- to six-year-olds believe in imminent justice and the inevitability of punishment. Consequences determine whether an action is good or bad. Guilt is determined solely by the amount of damage, not the intent or motivation (“an eye for an eye”). A child who spills a whole container of milk while trying to help set the table is judged as more guilty than a child who spills a drop of ink while playing with a pen that he has been forbidden to touch. Young children are absolute in their judgement of right and wrong. The inability to see simultaneous positive and negative aspects of the same person or event is normal in early childhood though pathological in adulthood.

 

Affective and Emotional Development

Imaginary companions are common in the 3-6 year range. This phenomenon is most often seen in creative children of above average intelligence. The companion may serve as scapegoat, playmate or protector. By 10 years of age, the imaginary companion is usually given up. Children can distinguish dreams from reality by about 5 years of age. Nightmares are common, often involving monsters that may be a projection of anger at parents.

 

Phallic Stage

Freud thought that at the age of three, the child entered the phallic stage, during which the primary erogenous zone is the penis or clitoris.  Freud noted that the child begins to look for outside love objects and to experience jealousy when thwarted.  Many 3-6 years olds show exaggerated "romantic" behavior toward the parent of the opposite sex, coupled with disinterest or rivalry with the same sex parent. Freud described this as the Oedipus (Electra) complex, resolved when the child learns that he cannot have the opposite sex parent and identifies with the same sex parent. In a more general sense, the child learns that he cannot have everything he wants and must conform to societal rules. Freud felt the super-ego developed out of the resolution of the Oedipus complex.  It is important to note the usefulness of the concept of super-ego; with a super-ego, the child carries around an internal representation of what is expected or ’right,’ but is able to choose to do otherwise.

 

Social Development

Empathy begins to emerge around three years of age but is frequently overwhelmed by the child’s egocentricity.  Four-year-olds are able to engage in cooperative or small-group play. They are sometimes able to share, but are often bossy and have difficulty understanding the feelings of other children. By age 5, most children can engage in the planning and execution of group projects and participate in dramatic play. Empathy continues to develop with subsequent ability to provide leadership. Aggressive children tend to be rejected by their peers. Early rejection by peers is a strong predictor of later psychopathology.

Play during early childhood allows children to gain a sense of control in scenarios where they have been passively acted upon, such as a medical procedure. In play they take an active role. Play is also used to discharge aggressive impulses. The play of preschoolers is often very aggressive. Play also is used to develop a mastery of both skills and emotions and to prepare for adult roles.

Erickson felt that the primary conflict of pre-schoolers (ages 3-5) was Initiative vs. Guilt.  At first glance, this might seem indistinguishable from Autonomy vs. Shame and Doubt; however, they are not at all the same.  Autonomy in a society depends on one’s own behavioral constraints being more restrictive than society’s.  Initiative is the process of setting one’s own tasks and/or discovering novel approaches to pre-existing tasks.  The child with initiative behaves appropriately and comes-up with his or her own activities.  Guilt arises when the caregiver refuses to relinquish the planning of certain activities to the child and remains inflexible (even if consistent).  For this reason, it is imperative that children be allowed imaginative play and given tasks that they are allowed to solve on their own.  One can easily see the usefulness of the concept of ‘super-ego’ in learning to develop social skills.