Week 5 Glossary Terms:

Middle Childhood

(Paris et al., 2019)
Children in middle childhood go through tremendous changes in the growth and development of their brain. During this period of development children’s bodies are not only growing, but they are becoming more coordinated and physically capable. These children are more mindful of their greater abilities in school and are becoming more responsible for their health and diet. Some children may be challenged with physical or mental health concerns. It’s important to know what typical development looks like in order to identify and to help those that are struggling with health concerns.

Physical Development

Brain Development

(Lally & Valentine-French, 2022; Leon & West Hills Community College Lemoore, 2021)
The brain reaches its adult size at about age seven. Then between 10 and 12 years of age, the frontal lobes become more developed and improvements in logic, planning, and memory are evident (Van Der Molen & Molenaar, 1994). Children ages 7-11 are better able to plan and coordinate activity using both the left and right hemispheres of the brain, which control the development of emotions, physical abilities, and intellectual capabilities. The attention span also improves as the prefrontal cortex matures. The myelin also continues to develop and the a child's reaction time improves as well. Myelination improvement is one factor responsible for these growths.

From age 6–12, the nerve cells in the association areas of the brain. These areas are where sensory, motor, and intellectual functioning connect, becoming almost completely myelinated (Johnson, 2005). This myelination contributes to increases in information processing speed and the child’s reaction time. The hippocampus, which is responsible for transferring information from the short-term to long-term memory, also shows increases in myelination resulting in improvements in memory functioning (Rolls, 2000).

Changes in the brain during this age enable not only physical development, but also allow children to understand what others think of them and deal socially with the positive and negative consequences of that knowledge. Within this development period, children may struggle with mental health disorders or other health problems. As children are growing and becoming more capable, adults need to remember that children don’t grow physically in isolation. The development of their bodies isn't separate from the changes that are occurring socially, emotionally, and cognitively. Awareness and understanding of their other developmental domains and needs will support the child during these changes.

Physical Growth

Middle childhood spans the years between early childhood and adolescence, when children are approximately 6–11 years old. These children come in all shapes, sizes, heights, weights, abilities, and disabilities. Physical growth rates are generally slow and steady during these years. However, growth spurts do occur during middle to late childhood (Spreen et al., 1995). Typically, a child will gain about 5–7 pounds a year and grow about 2 inches per year. They also tend to slim down and gain muscle strength. As bones lengthen and broaden and muscles strengthen, many children want to engage in strenuous physical activity and can participate for longer periods of time. In addition, the rate of growth for the extremities is faster than for the trunk, which results in more adult-like proportions. Long-bone growth stretches muscles and ligaments, which results in many children experiencing growing pains, most particularly at night. (Polan & Taylor, 2003).

Children between ages six and nine show significant improvement in their abilities to perform motor skills. This development allows children to gain greater control over the movement of their bodies, mastering many gross and fine motor skills that are beyond younger children . Riding a bike that is bigger or running longer and farther is a big improvement in gross motor skills. Eye-hand coordination and fine motor skills allow for children to become better at writing and cutting. Sports and extracurricular activities may become a part of the lives of children during middle childhood due to their physical growth and capabilities.

Nutrition

A number of factors can influence children’s eating habits and attitudes toward food. Family environment, societal trends, taste preferences, and messages in the media all impact the emotions that children develop in relation to their diet. Television commercials can entice children to consume sugary products, fatty fast foods, excess calories, refined ingredients, and sodium. Therefore, it is critical that parents and caregivers direct children toward healthy choices (The Importance of Family Dinners, n.d.). 

Parents greatly impact their child’s nutritional choices. This time in a child’s life provides an opportunity for parents and other caregivers to reinforce good eating habits and introduce new foods into the diet, while remaining mindful of a child’s preferences. Parents should also serve as role models for their children, who will often mimic their behavior and eating habits. Parents must continue to help their school-aged child establish healthy eating habits and attitudes toward food. Their primary role is to bring a wide variety of health-promoting foods into the home, so that their children can make good eating choices (University of Hawai’i at Manoa Food Science & Human Nutrition Program, 2017).

Let’s think for a moment about what our parents and grandparents used to eat. What are some of the differences that you may have experienced as a child? One hundred years ago, as families sat down to dinner, they might have eaten boiled potatoes or corn, leafy vegetables such as cabbage or collards, fresh-baked bread, and, if they were fortunate, a small amount of beef or chicken. Young and old alike benefitted from a sound diet that packed a real nutritional punch. Times have changed. Many families today fill their dinner plates with fatty foods, such as French fries cooked in vegetable oil, a hamburger that contains several ounces of ground beef, a white-bread bun, and a single piece of lettuce and a slice or two of tomato as the only vegetables served with the meal.

Our diet has changed drastically as processed foods, which did not exist a century ago, and animal-based foods now account for a large percentage of our calories. What we eat is not the only thing that’s changed.  The amount that we consume has greatly increased as well, as plates and portion sizes have grown  larger. All of these choices impact our health, with short- and long-term consequences as we age. Possible effects in the short-term include excess weight gain and constipation. The possible long-term effects, primarily related to obesity, include the risk of cardiovascular disease, diabetes, hypertension, as well as other health and emotional problems for children. (Zimmerman & Snow, 2012).

During middle childhood, a healthy diet facilitates physical and mental development and helps maintain health and wellness. School-aged children experience steady, consistent growth, but at a slower rate than they did in early childhood. This slowed growth rate can have lasting a lasting impact if nutritional, caloric, and activity levels aren't adjusted in middle childhood. This can lead to excessive weight gain early in life and can lead to obesity into adolescence and adulthood (University of Hawai’i at Manoa Food Science & Human Nutrition Program, 2017).

Making sure that children have proper nutrients will allow for optimal growth and development. Look at the figure below to familiarize yourself with food and the place setting for healthy meals. One way to encourage children to eat healthy foods is to make meal and snack time fun and interesting. Parents should include children in food planning and preparation. Examples include selecting items while grocery shopping or helping to prepare part of a meal, like making a salad. At this time, parents can also educate children about kitchen safety. It might be helpful to cut sandwiches, meats, or pancakes into small or interesting shapes. In addition, parents should offer nutritious desserts, such as fresh fruits, instead of calorie-laden cookies, cakes, salty snacks, and ice cream. Studies show that children who eat family meals on a frequent basis consume more nutritious foods (The Importance of Family Dinners, n.d.).

Energy

(National Heart, Lung, and Blood Institute, 2014)
Children’s energy needs vary, depending on their growth and level of physical activity. Energy requirements also vary according to gender. Girls require 1,200–1,400 calories a day from age 2–8 and 1,400–1,800 for ages 9–13. Boys also need 1,200–1.400 calories daily from ages 4–8 but their daily caloric needs go up to 1,600–2,000 from ages 9–13. This range represents individual differences, including how active the child is.

Recommended intakes of macronutrients (protein, carbohydrates, and fats) and most micronutrients (vitamins and minerals) are higher relative to body size, compared with nutrient needs during adulthood. Therefore, children should be provided nutrient-dense food at meal-and snack-time. However, it is important not to overfeed children, as this can lead to childhood obesity, which is discussed in the next section.

Childhood Obesity

(Sahoo et al., 2015)
Childhood obesity is a complex health issue. It occurs when a child is well above the normal or healthy weight for his or her age and height. Childhood obesity is a serious problem in the United States, putting children at risk for poor health. In 2015–2016, 13.9 percent of two-to-five-year-olds were obese. Where people live can affect their ability to make healthy choices. Obesity disproportionately affects children from low-income families.

Causes of Obesity

The causes of excess weight gain in young people are similar to those in adults, including factors such as a person’s behavior and genetics. Behaviors that influence excess weight gain include:

• Eating high calorie, low-nutrient foods

• Not getting enough physical exercise

• Sedentary activities (such as watching television or other screen devices)

• Medication use

• Sleep routines

Consequences of Obesity

The consequences of childhood obesity are both immediate and long term. It can affect physical as well as social and emotional well-being.

Immediate Health Risks:

• High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD).

• Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes.

• Breathing problems, such as asthma and sleep apnea.

• Joint problems and musculoskeletal discomfort.

• Fatty liver disease, gallstones, and gastro-esophageal reflux (in other words, heartburn).

Childhood obesity is also related to:

• Psychological problems such as anxiety and depression.

• Low self-esteem and lower self-reported quality of life.

• Social problems such as bullying and stigma.

Future Health Risks:

• Children who have obesity are more likely to become adults with obesity.11 Adult obesity is associated with increased risk of a number of serious health conditions including heart disease, type 2 diabetes, and cancer.

• If children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe.

Being Overweight and Obesity in Children

(Lally & Valentine-French, 2022; Overstreet & Lumen Learning, 2017)
Excess weight and obesity in children is associated with a variety of medical conditions including high blood pressure, insulin resistance, inflammation, depression, and lower academic achievement (Lu, 2016). Being overweight has also been linked to impaired brain functioning, which includes deficits in executive functioning, working memory, mental flexibility, and decision making (Liang et al., 2014). Children who ate more saturated fats performed worse on relational memory tasks, while eating a diet high in omega-3 fatty acids promoted relational memory skills (Davidson, 2014). Using animal studies, Davidson et al., (2013) found that large amounts of processed sugars and saturated fat weakened the blood-brain barrier, especially in the hippocampus (Davidson et al., 2013). This can make the brain more vulnerable to harmful substances that can impair its functioning. Another important executive functioning skill is controlling impulses and delaying gratification. Children who are overweight show less inhibitory control than normal weight children, which may make it more difficult for them to avoid unhealthy foods (Lu, 2016). Overall, being overweight as a child increases the risk for cognitive decline as one ages.

The current measurement for determining excess weight is the Body Mass Index (BMI) which expresses the relationship of height to weight. According to the Centers for Disease Control and Prevention (CDC), childrens whose BMI is at or above the 85th percentile for their age are considered overweight, while children who are at or above the 95th percentile are considered obese (Lu, 2016). In 2011–2012 approximately 8.4 percent of 2–5 year-olds were considered overweight or obese, and 17.7 percent of 6–11 year-olds were overweight or obese (Fryar et al., 2015, pp. 2011–2012).

Obesity Rates for Children

About 16–33 percent of American children are obese (Centers for Disease Control and Prevention, 2022). This is defined as being at least 20 percent over their ideal weight. The percentage of obesity in school-aged children has increased substantially since the 1960s and has in fact doubled since the 1980s. This is true in part because of the introduction of a steady diet of television and other sedentary activities. In addition, we have come to emphasize high fat, fast foods as a culture. Pizza, hamburgers, chicken nuggets, and lunchables with soda have replaced more nutritious foods as staples. The decreased participation in school physical education and youth sports is just another of many factors that has led to an increase in children being overweight or obese.

Being Overweight Can Be a Lifelong Struggle

A growing concern is the lack of recognition from parents that children are overweight or obese. Katz referred to this as “oblivobesity” (Katz, 2015). Black found that parents in the United Kingdom (UK) only recognized their children as obese when they were above the 99.7th percentile while the official cut-off for obesity is at the 85th percentile (Black et al., 2015). Oude Luttikhuis surveyed 439 parents and found that 75% of parents of overweight children said the child had a normal weight and 50% of parents of obese children said the child had a normal weight (Oude Luttikhuis et al., 2010). For these parents, overweight was considered normal and obesity was considered normal or a little heavy. Doolen reported on several studies from the United Kingdom, Australia, Italy, and the United States, and in all locations parents were more likely to misperceive their children’s weight (Doolen et al., 2009). Black concluded that as the average weight of children rises, what parents consider normal also rises. If parents cannot identify if their children are overweight they will not be able to intervene and assist their children with proper weight management. An added concern is that the children themselves are not accurately identifying if they are overweight. In a United States sample of 8–15 year-olds, more than 80 percent of overweight boys and 70 percent of overweight girls misperceived their weight as normal (Sarafrazi et al., 2014, pp. 2005–2012). Also noted was that as the socioeconomic status of the children rose, the frequency of these misconceptions decreased. It appeared that families with more resources were more conscious of what defines a healthy weight.

Results of Childhood Obesity

Children who are overweight tend to be rejected, ridiculed, teased and bullied by others (Smith et al., 2018). This can certainly be damaging to their self-image and popularity. In addition, obese children run the risk of suffering orthopedic problems such as knee injuries, and they have an increased risk of heart disease and stroke in adulthood (Lu, 2016). It is hard for a child who is obese to become a non-obese adult. In addition, the number of cases of pediatric diabetes has risen dramatically in recent years.

Behavioral interventions, including training children to overcome impulsive behavior, are being researched to help overweight children (Lu, 2016). Practicing inhibition has been shown to strengthen the ability to resist unhealthy foods. Parents can help their overweight children the best when they are warm and supportive without using shame or guilt. They can also act like the child’s frontal lobe until it is developed by helping them make correct food choices and praising their efforts (Liang et al., 2014). Research also shows that exercise, especially aerobic exercise, can help improve cognitive functioning in overweight children (Lu, 2016). Parents should take caution against emphasizing diet alone to avoid the development of any obsession about dieting that can lead to eating disorders. Instead, increasing a child's activity level is most helpful.

Dieting is not really the answer. If you diet, your basal metabolic rate tends to decrease thereby making the body burn even fewer calories in order to maintain the weight. Increased activity is much more effective in lowering the weight and improving the child’s health and psychological well-being. Exercise reduces stress and being an overweight child, subjected to the ridicule of others, can certainly be stressful. Parents should take caution against emphasizing diet alone to avoid the development of any obsession about dieting that can lead to eating disorders as teens. Again, helping children make healthy food choices and increasing physical activity will help prevent childhood obesity.

Cognitive Development

Piaget’s Theory of Cognitive Development

Concrete Operational Thought

(Spielman et al., 2020)
As children continue into elementary school, they develop the ability to represent ideas and events more flexibly and logically. Their rules of thinking still seem very basic by adult standards and usually operate unconsciously, but they allow children to solve problems more systematically than before, and therefore be successful with many academic tasks. In the concrete operational stage, for example, a child may unconsciously follow the rule: “If nothing is added or taken away, then the amount of something stays the same.” This simple principle helps children understand certain arithmetic tasks, such as adding or subtracting zero from a number, as well as certain classroom science experiments, such as ones involving judgments of amounts of liquids when mixed. Piaget called this period the concrete operational stage because children mentally operate on concrete objects and events.

(Lally & Valentine-French, 2022)
The concrete operational stage is the third stage in Piaget's theory of cognitive development. This stage takes place around 7–11 years of age, and is characterized by the development of organized and rational thinking. Piaget considered the concrete stage a major turning point in the child's cognitive development because it marks the beginning of logical or operational thought (Piaget, 1954). The child is now mature enough to use logical thought or operations (in other words, rules) but can only apply logic to physical objects (hence concrete operational). Children gain the abilities of conservation (number, area, volume, and orientation) and reversibility.

Let’s look at the following cognitive skills that children typically master during Piaget’s concrete operational stage.

Seriation: Arranging items along a quantitative dimension, such as length or weight, in a methodical way is demonstrated by a concrete operational child. For example, they can methodically arrange a series of different-sized sticks in order by length, while younger children approach a similar task in a haphazard way.

Classification: As children's experiences and vocabularies grow, they build schema and are able to organize objects in many different ways. They also understand classification hierarchies and can arrange objects into a variety of classes and subclasses.

Reversibility: The child learns that some things that have been changed can be returned to their original state. Water can be frozen and then thawed to become liquid again. But eggs cannot be unscrambled. Arithmetic operations are reversible as well: 2 + 3 = 5 and 5 – 3 = 2. Many of these cognitive skills are incorporated into the school's curriculum through mathematical problems and worksheets about which situations are reversible or irreversible.

Conservation: An example of the preoperational child’s thinking; if you were to fill a tall beaker with 8 ounces of water this child would think that it was more than a short, wide bowl filled with 8 ounces of water. Concrete operational children can understand the concept of conservation, which means that changing one quality (in this example, height or water level) can be compensated for by changes in another quality (width). Consequently, there is the same amount of water in each container, although one is taller and narrower and the other is shorter and wider.

Decentration: Concrete operational children no longer focus on only one dimension of any object (such as the height of the glass) and instead consider the changes in other dimensions too (such as the width of the glass). This allows for conservation to occur.

Identity: One feature of concrete operational thought is the understanding that objects have qualities that do not change even if the object is altered in some way. For instance, mass of an object does not change by rearranging it. A piece of chalk is still chalk even when the piece is broken in two. 

Transitivity: Being able to understand how objects are related to one another is referred to as transitivity, or transitive inference. This means that if one understands that a dog is a mammal, and that a boxer is a dog, then a boxer must be a mammal.

Language Development

Vocabulary

(Lally & Valentine-French, 2022)

One of the reasons that children can classify objects in so many ways is that they have acquired a vocabulary to do so. By fifth grade, a child’s vocabulary has grown to 40,000 words. It grows at the rate of 20 words per day, a rate that exceeds that of preschoolers. This language explosion, however, differs from that of preschoolers because it is facilitated by associating new words with those already known (fast-mapping) and because it is accompanied by a more sophisticated understanding of the meanings of a word.

A child in middle childhood can also think of objects in less literal ways. For example, if asked for the first word that comes to mind when one hears the word “pizza”, the preschooler is likely to say “eat” or some word that describes what is done with a pizza. However, the school-aged child is more likely to place pizza in the appropriate category and say “food” or “carbohydrate”.

This sophistication of vocabulary is also evidenced in the fact that school-aged children are able to tell jokes and delight in doing so. They may use jokes that involve plays on words such as knock-knock jokes or jokes with punchlines. Preschoolers do not understand plays on words and rely on telling jokes that are literal or slapstick such as “A man fell down in the mud! Isn’t that funny?”

Grammar and Flexibility

School-aged children can also learn new grammar rules with more flexibility. While preschoolers are likely to be reluctant to give up saying “I goed there”, school-aged children will learn this rather quickly along with other rules of grammar. While the preschool years might be a good time to learn a second language (being able to understand and speak the language), the school years may be the best time to be taught a second language (the rules of grammar).

Information Processing: Learning, Memory, and Problem Solving

During middle and late childhood children make strides in several areas of cognitive function including the capacity of working memory, their ability to pay attention, and their use of memory strategies. Both changes in the brain and experience foster these abilities.

In this section, we will look at how children process information, think, and learn. This allows them to increase their ability to learn and remember due to an improvement in the ways they attend to, store information, and problem solve.

The capacity of working memory expands during middle and late childhood. Research has suggested that both an increase in processing speed and the ability to inhibit irrelevant information from entering memory are contributing to the greater efficiency of working memory during this age (de Ribaupierre, 2002). Changes in myelination and synaptic pruning in the cortex are likely behind the increase in processing speed and ability to filter out irrelevant stimuli (Kail et al., 2013). 

As noted above, the ability to inhibit irrelevant information improves during this age group, with there being a sharp improvement in selective attention from age six into adolescence (Vakil et al., 2008). Children also improve in their ability to shift their attention between tasks or different features of a task (Carlson et al., 2013). A younger child who is asked to sort objects into piles based on type of object, car versus animal, or color of object, red versus blue, would likely have no trouble doing so. But if you ask them to switch from sorting based on type to now having them sort based on color, they would struggle because this requires them to suppress the prior sorting rule. An older child has less difficulty making the switch, meaning there is greater flexibility in their intentional skills. These changes in attention and working memory contribute to children having more strategic approaches to challenging tasks.

Bjorklund describes a developmental progression in the acquisition and use of memory strategies (Bjorklund, 2005). Such strategies are often lacking in younger children, but increase in frequency as children progress through elementary school. Examples of memory strategies include rehearsing information you wish to recall, visualizing and organizing information, creating rhymes—such as “i before e except after c”—or inventing acronyms, such as “roygbiv” to remember the colors of the rainbow. Schneider reported  a steady increase in the use of memory strategies from ages six to ten in their longitudinal study. Moreover, by age ten many children were using two or more memory strategies to help them recall information. Schneider and colleagues found that there were considerable individual differences at each age in the use of strategies, and that children who utilized more strategies had better memory performance than their peers of the same age (Schneider et al., 2009).

Cognitive Processes

As children enter school and learn more about the world, they develop categories for concepts and learn more efficient strategies for storing and retrieving information. One significant reason is that they continue to have more experiences on which to tie new information. In other words, their knowledge base, knowledge in particular areas that makes learning new information easier, expands (Berger, 2014).

Metacognition refers to the knowledge we have about our own thinking and our ability to use this awareness to regulate our cognitive processes (Bruning et al., 2004). Children in this developmental stage also have a better understanding of how well they are performing a task and the level of difficulty of a task. As they become more realistic about their abilities, they can adapt studying strategies to meet those needs. Young children spend as much time on an unimportant aspect of a problem as they do on the main point, while older children start to learn to prioritize and gauge what is significant and what is not. As a result, they develop metacognition.

Critical thinking, or a detailed examination of beliefs, courses of action, and evidence, involves teaching children how to think. The purpose of critical thinking is to evaluate information in ways that help us make informed decisions. Critical thinking involves better understanding a problem through gathering, evaluating, and selecting information, and also by considering many possible solutions. (Ennis, 1987) identified several skills useful in critical thinking. These include analyzing arguments, clarifying information, judging the credibility of a source, making value judgments, and deciding on an action. Metacognition is essential to critical thinking because it allows us to reflect on the information as we make decisions. Children differ in their cognitive process and these differences predict both their readiness for school, academic performance, and testing in school (Prebler et al., 2013). 

Developmental Disorders and Learning Disabilities

(Maricopa Open Digital Press, 2024)
Children’s cognitive and social skills are evaluated as they enter and progress through school. Sometimes this evaluation indicates that a child needs special assistance with language or in learning how to interact with others. Evaluation and diagnosis of a child can be the first step in helping provide the child with the type of instruction and resources needed. But diagnosis and labeling also have social implications. It is important to consider that children can be misdiagnosed and that once a child has received a diagnostic label, the child, teachers, and family members may tend to interpret the actions of the child through that label. The label can also influence the child’s self-concept. Consider, for example, a child who is misdiagnosed as learning disabled. That child may expect to have difficulties in school and lack of confidence because of these expectations. This is a self-fulfilling prophecy, or tendency to act in such a way as to make what you predict will happen come true. This calls our attention to the power that labels can have when they are not accurately applied.

It is also important to consider that children’s difficulties can change over time. A child who has problems in school may improve later or live under circumstances as an adult where the problem (such as a delay in math skills or reading skills) is no longer relevant. That person will still have a label as learning disabled. It should be recognized that the distinction between abnormal and normal behavior is not always clear; some abnormal behavior in children is fairly common. Misdiagnosis may be more of a concern when evaluating learning difficulties than in cases of autism spectrum disorder where unusual behaviors are clear and consistent.

Keeping these cautionary considerations in mind, let’s turn our attention to some developmental and learning difficulties.

Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. The estimate published by the (Centers for Disease Control and Prevention, 2023b)3 is that about 1 out of every 59 children in the United States has been diagnosed with autism spectrum disorder (ASD), which covers a wide variety of ranges in ability, from those with milder forms (formerly known as Asperger’s Syndrome) to more severe deficits in communication.

A person with autism has difficulty with and a lack of interest in learning language. An autistic child may respond to a question by repeating the question or might rarely speak. Sometimes autistic children learn more difficult words before simple words or can complete complicated tasks before they can complete easier ones. The person often has difficulty reading social cues such as the meanings of nonverbal gestures, like a wave of the hand or the emotion associated with a frown. Intense sensitivity to touch or visual stimulation may also be experienced. Autistic children often have poor social skills and cannot communicate with or empathize with others emotionally. People with autism often view the world differently and learn differently than people who do not have autism. Autistic children tend to prefer routines and patterns and become upset when routines are altered. For example, moving the furniture or changing the daily schedule can be very upsetting.

Many children with ASD are not identified until they reach school age, although our ability to diagnose children earlier continues to improve. In the 2017–2018 school year, about 710,000 children on the spectrum received special education through the public schools. These disorders are found in all racial and ethnic groups and are more common in boys than in girls. All these disorders are marked by difficulty in social interactions, problems in various areas of communication, and difficulty altering patterns or daily routines. There is no single cause of ASD and the causes of these disorders are to a large extent, unknown. In cases involving identical twins, if one twin has autism, the other is also autistic about 75 percent of the time. Rubella, fragile X syndrome, and PKU that have been untreated are some medical conditions associated with risks of autism.

Some individuals benefit from medications that alleviate some of the symptoms of ASD, but the most effective treatments involve behavioral intervention and teaching techniques used to promote the development of language and social skills. Children also excel when they are in structured learning environments that accommodate the needs of children on the spectrum. 

Impaired Theory of Mind in Individuals with Autism

People with autism or an autism spectrum disorder (ASD) typically show an impaired ability to recognize other people’s minds. Under the DSM-5, a manual used by health care professionals to diagnose mental disorders, autism is characterized by persistent deficits in social communication and interaction across multiple contexts and restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, typically before age three, and lead to clinically significant functional impairment. Symptoms may include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with unusual objects.

About half of parents of children with ASD notice their child’s unusual behaviors by age 18 months, and about four-fifths notice by age 24 months, but often a diagnosis comes later, and individual cases vary significantly. Typical early signs of autism include:

• No babbling by 12 months.

• No gesturing (pointing, waving, and so on) by 12 months.

• No single words by 16 months.

• No two-word (spontaneous, not just echolalic) phrases by 24 months.

• Loss of  language or social skills at any age.

Children with ASD experience difficulties explaining and predicting other people’s behavior, leading to problems in social communication and interaction. Children who are diagnosed with an autistic spectrum disorder usually develop the theory of mind more slowly than other children and continue to have difficulties with it throughout their lives.

The Sally-Anne test is performed to test whether someone lacks the theory of mind. The child sees the following story: Sally and Anne are playing. Sally puts her ball into a basket and leaves the room. While Sally is gone, Anne moves the ball from the basket to the box. Now Sally returns. The question is: where will Sally look for her ball? The test is passed if the child correctly assumes that Sally will look in the basket. The test is failed if the child thinks that Sally will look in the box. Children younger than four and older children with autism will generally say that Sally will look in the box.

Learning Disabilities

What is a learning disability? If a child is mentally disabled, that child is typically slow in all areas of learning. However, a child with a learning disability has problems in a specific area or with a specific task or type of activity related to education. A learning difficulty refers to a deficit in a child’s ability to perform an expected academic skill (Berger, 2005). These difficulties are identified in school because this is when children’s academic abilities are being tested, compared, and measured. Consequently, once academic testing is no longer essential in that person’s life (as when they are working rather than going to school) these disabilities may no longer be noticed or relevant, depending on the person’s job and the extent of the disability.

Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in the area of reading. This diagnosis is used for a number of reading difficulties. For example, the child may reverse letters, have difficulty reading from left to right, or have problems associating letters with sounds. Dyslexia appears to be rooted in some neurological problems involving the parts of the brain active in recognizing letters, verbally responding, or being able to manipulate sounds (International Dyslexia Association, 2024). Treatment typically involves altering teaching methods to accommodate the person’s particular problematic area.

Attention deficit hyperactivity disorder (ADHD) is considered a neurological and behavioral disorder in which a person has difficulty staying on task, screening out distractions, and inhibiting behavioral outbursts. The most commonly recommended treatment involves the use of medication, structuring the classroom environment to keep distractions at a minimum, tutoring, and teaching parents how to set limits and encourage age-appropriate behavior (Centers for Disease Control and Prevention, 2023a). Some people say that the term attention deficit is a misnomer because people who suffer from ADHD actually have great difficulty tuning things out. They are bombarded with information and their brains are trying to pay attention to everything. They do not have a deficit of attention; they are trying to pay attention to too many things at once, so everything suffers.

Recent research suggests that several brain structures may be implicated in ADHD. These studies have mainly focused on the frontal lobe and prefrontal cortex. Some studies suggest that the frontal lobe is underdeveloped in children and adults with ADHD. The frontal lobe is involved in executive function, attention, planning, impulse control, motivation, and decision-making. In some cases the development is delayed, but catches up to expected standards by adulthood; in other cases, the frontal lobe never fully develops.

In general, ADHD is treated with stimulants. While this may seem counterintuitive (why give a hyperactive child a stimulant?), it makes a lot of sense when you understand the neurological processes involved. There are two ways that stimulants may work to help people with ADHD focus. Some researchers have found that the stimulants activate the underdeveloped parts of the brain (prefrontal cortex and frontal lobe) thereby making these brain areas function more as they should. This allows the child or adult to focus properly. Other researchers suspect that the stimulants affect the way the neurotransmitters function in these brain areas, leading to better function in those areas.

There is still a lot of controversy about medicating children with ADHD. While there is clear evidence that medication works to control the negative effects of ADHD, there are also negative side effects that must be dealt with including problems sleeping, changes in appetite, headaches, and more. Further, the long-term effects of medicating young children are not well understood. For these reasons, many parents prefer an intervention that does not involve medication. The most common non-pharmaceutical intervention for ADHD is cognitive behavioral therapy (CBT). CBT works by helping children to become aware of their thought processes, and then to learn to change those thought processes to be more beneficial or positive. CBT can also help by educating parents about ways to help their children learn about self-control and discipline. There is good evidence that CBT is effective in treating ADHD. Indeed, in some studies, children treated with CBT have better long-term outcomes than children treated with medication. Some studies show that a combination of medication and CBT is most beneficial because the medication helps with behavior change more quickly, allowing for the child to learn through CBT more quickly. The CBT then helps with longer-term behavior change so that the child can stop taking medications and deal effectively with their ADHD symptoms based on what they have learned through CBT.

Psychosocial Development

Lawrence Kohlberg’s Stages of Moral Development

Kohlberg built on the work of Piaget and was interested in finding out how our moral reasoning changes as we get older (Kohlberg, 1963). He wanted to find out how people decide what is right and what is wrong. Just as Piaget believed that children’s cognitive development follows specific Patterns, Kohlberg argued that we learn our moral values through active thinking and reasoning, and that moral development follows a series of stages (Kohlberg, 1984, p. 84). Kohlberg's six stages are generally organized into three levels of moral reasons. To study moral development, Kohlberg looked at how children (and adults) respond to moral dilemmas. One of Kohlberg’s best known moral dilemmas is the Heinz dilemma:

In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make but the druggist was charging ten times what the drug cost him to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman’s husband, Heinz, went to everyone he knew to borrow the money but he could only get together about $1,000, about half of what the drug cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: “No, I discovered the drug and I’m going to make money from it.” Heinz got desperate and broke into the man’s store to steal the drug for his wife. Should the husband have done that? (Spielman et al., 2020).

Level One - Preconventional Morality

In stage one, moral reasoning is based on concepts of punishment. The child believes that if the consequence for an action is punishment, then the action was wrong. In the second stage, the child bases their thinking on self-interest and reward, "You scratch my back, I'll scratch yours". The youngest subjects seemed to answer based on what would happen to the man as a result of the act. For example, they might say the man should not break into the pharmacy because the pharmacist might find him and beat him. Or they might say that the man should break in and steal the drug and his wife will give him a big kiss. Right or wrong, both decisions were based on what would physically happen to the man as a result of the act. This is a self-centered approach to moral decision-making. He called this superficial understanding of right and wrong preconventional morality. Preconventional morality focuses on self-interest. Punishment is avoided and rewards are sought. Adults can also fall into these stages, particularly when they are under pressure.

Level Two - Conventional Morality

Those tested who based their answers on what other people would think of the man as a result of his act were placed in Level Two. For instance, they might say he should break into the store, and everyone would think he was a good husband, or he should not because it is against the law. In either case, right and wrong is determined by what other people think. In stage three, the person wants to please others. At stage four, the person acknowledges the importance of social norms or laws and wants to be a good member of the group or society. A good decision is one that gains the approval of others or one that complies with the law. This he called conventional morality. People care about the effect of their actions on others. Some older children, adolescents, and adults use this reasoning.

Level Three, post conventional morality, is not included because it focuses on adolescence and adulthood. However, it is in the table below if you’d like an overview of Level Three - Stages 5 and 6.

Lawrence Kohlberg’s Levels of Moral Reasoning:

Although research has supported Kohlberg’s idea that moral reasoning changes from an early emphasis on punishment and social rules and regulations to an emphasis on more general ethical principles, as with Piaget’s approach, Kohlberg’s stage model is probably too simple. For one, people may use higher levels of reasoning for some types of problems but revert to lower levels in situations where doing so is more consistent with their goals or beliefs (Rest, 1979). Second, it has been argued that the stage model is particularly appropriate for Western, rather than non-Western samples, in which allegiance to social norms, such as respect for authority, may be particularly important (Haidt, 2001). In addition, there is frequently little correlation between how we score on the moral stages and how we behave in real life. Perhaps the most important critique of Kohlberg’s theory is that it may describe the moral development of males better than it describes that of females (Jaffee & Hyde, 2000).

Family Forms

The sociology of the family examines the family as an institution and a unit of socialization. Sociological studies of the family look at demographic characteristics of the family members: family size, age, ethnicity and gender of its members, social class of the family, the economic level and mobility of the family, professions of its members, and the education levels of the family members.

Currently, one of the biggest issues that sociologists study are the changing roles of family members. Often, each member is restricted by the gender roles of the traditional family. These roles, such as the father as the breadwinner and the mother as the homemaker, are declining. Now, the mother is often the supplementary provider while retaining the responsibilities of child rearing. In this scenario, females' role in the labor force is compatible with the demands of the traditional family. Sociology studies have examined the adaptation of males' role to caregiver as well as provider. The gender roles are becoming increasingly interwoven and various other family forms are becoming more common.

Here is a list of some of the diverse types of families:

Families Without Children

Singlehood family contains a person who is not married or in a common law relationship. He or She may share a relationship with a partner but lead a single lifestyle. Couples that are childless are often overlooked in the discussion of families.

Families with One Parent

A single parent family usually refers to a parent who has most of the day-to-day responsibilities in the raising of the child or children, who are not living with a spouse or partner, or who is not married. The dominant caregiver is the parent with whom the children reside for the majority of the time; if the parents are separated or divorced, children live with their custodial parent and have visitation with their noncustodial parent. In general Western society, following a separation a child will end up with the primary caregiver, usually the mother, and a secondary caregiver, usually the father.

Single parent by choice families refer to a family that a single person builds by choice. These families can be built with the use of assisted reproductive technology and donor gametes (sperm and/or egg) or embryos, surrogacy, foster or kinship care, and adoption.

Two Parent Families

The nuclear family is often referred to as the traditional family structure. It includes two married parents and children. While common in industrialized cultures (such as the US), it is not actually the most common type of family worldwide (Tsaneda, 2020).

Cohabitation is an arrangement where two people who are not married live together in an relationship, particularly an emotionally and/or sexually intimate one, on a long-term or permanent basis. Today, cohabitation is a common pattern among people in the Western world. More than two-thirds of married couples in the U.S. say that they lived together before getting married.

Gay and lesbian couples with children have same-sex families. While now recognized legally in the United States, discrimination against same-sex families is not uncommon. According to the American Academy of Pediatrics, there is “ample evidence to show that children raised by same-gender parents fare as well as those raised by heterosexual parents. More than 25 years of research have documented that there is no relationship between parents' sexual orientation and any measure of a child's emotional, psychosocial, and behavioral adjustment. Conscientious and nurturing adults, whether they are men or women, heterosexual or homosexual, can be excellent parents. The rights, benefits, and protections of civil marriage can further strengthen these families” (Wikipedia, 2024a).

Blended families describe families with mixed parents: one or both parents remarried, bringing children of the former family into the new family (Wikipedia, The Free Encyclopedia., 2024). Blended families are complex in a number of ways that can pose unique challenges to those who seek to form successful stepfamily relationships (Visher & Visherf, 1985). These families are also referred to as stepfamilies.

Families That Include Additional Adults

Extended families include three generations, grandparents, parents, and children. This is the most common type of family worldwide (Tsaneda, 2020).

Families by choice are relatively newly recognized. The term was popularized by the LGBTQ+ community to describe a family not recognized by the legal system. It may include adopted children, live-in partners, kin of each member of the household, and close friends. Increasingly family by choice is being practiced by those who see benefit to including people beyond blood relatives in their families (Tsaneda, 2020).

While most families in the US are monogamous, some families have more than two married parents. These families are polygamous (Wikipedia, The Free Encyclopedia., 2024). Polygamy is illegal in all 50 states, but legal in other parts of the world (Wikipedia, 2024b).

Additional Forms of Families

Kinship families are those in which the full-time care, nurturing, and protection of a child is provided by relatives, members of their Tribe or clan, godparents, stepparents, or other adults who have a family relationship with a child. When children cannot be cared for by their parents, research finds benefits to kinship care (Child Welfare Information Gateway, 2024).

When a person assumes the parenting of another, usually a child, from that person's biological or legal parents or parents this creates adoptive families. Legal adoption permanently transfers all rights and responsibilities and is intended to affect a permanent change in status and, as such, requires societal recognition, either through legal or religious sanction. As introduced in

Chapter 3, adoption can be done privately, through an agency, or through foster care and in the U.S. or from abroad. Adoptions can be closed (no contact with birth or biological families or open, with different degrees of contact with birth or biological families). Couples, both opposite and same-sex, and single parents can adopt (although not all agencies and foreign countries will work with unmarried, single, or same-sex intended parents) (Wikipedia, 2024c).

When parents are not of the same ethnicity, they build interracial families. Until the decision in Loving versus Virginia in 1969, this was not legal in the U.S. There are other parts of the world where marrying someone outside of your race (or social class) has legal and social ramifications (Wikipedia, 2024d). These families may experience issues unique to each individual family’s culture.

Changes in Families - Divorce

The tasks of families listed above are functions that can be fulfilled in a variety of family types, not just intact, two-parent households. Harmony and stability can be achieved in many family forms and when it is disrupted through divorce, efforts to blend families, or any other circumstances, the child suffers (Hetherington & Kelly, 2003). Changes continue to happen, but for children they are especially vulnerable. Divorce and how it impacts children depends on how the caregivers handle the divorce as well as how they support the emotional needs of the child.

Divorce

A lot of attention has been given to the impact of divorce on the life of children. The assumption has been that divorce has a strong, negative impact on the child and that single-parent families are deficient in some way. However, 75–80 percent of children and adults who experience divorce suffer no long-term effects (Hetherington & Kelly, 2003). An objective view of divorce, repartnering, and remarriage indicates that divorce, remarriage, and life in stepfamilies can have a variety of effects (Carter et al., 2019).

Factors Affecting the Impact of Divorce

(Overstreet & Lumen Learning, 2017)
As you look at the consequences (both pros and cons) of divorce and remarriage on children, keep these family functions in mind. Some negative consequences are a result of financial hardship rather than divorce per se (Drexler & Gross, 2005). Some positive consequences reflect improvements in meeting these functions. For instance, we have learned that a positive self-esteem comes in part from a belief in the self and one’s abilities rather than merely being complimented by others. In single-parent homes, children may be given more opportunity to discover their own abilities and gain independence that fosters self-esteem. If divorce leads to fighting between the parents and the child is included in these arguments, their self-esteem may suffer.

The impact of divorce on children depends on a number of factors. The degree of conflict prior to the divorce plays a role. If the divorce means a reduction in tensions, the child may feel relief. If the parents have kept their conflicts hidden, the announcement of a divorce can come as a shock and be met with enormous resentment. Another factor that has a great impact on the child concerns financial hardships they may suffer, especially if financial support is inadequate. Another difficult situation for children of divorce is the position they are put into if the parents continue to argue and fight, especially if they bring the children into those arguments.

In roughly the first year following divorce, children may exhibit some of these short-term effects:

1. Grief over losses suffered: The child will grieve the loss of the parent they no longer see as frequently. The child may also grieve about other family members that are no longer available. Grief sometimes comes in the form of sadness but it can also be experienced as anger or withdrawal. Older children may feel depressed.

2. Reduced standard of living: Very often, divorce means a change in the amount of money coming into the household. Children experience new constraints on spending or entertainment. School-aged children, especially, may notice that they can no longer have toys, clothing, or other items to which they’ve grown accustomed. It may mean that there is less eating out or being unable to afford cable television, and so on. The custodial parent may experience stress at not being able to rely on child support payments or having the same level of income as before. This can affect decisions regarding healthcare, vacations, rents, mortgages, and other expenditures. Stress can result in less happiness and relaxation in the home. The parent who has to take on more work may also be less available to the children.

3. Adjusting to transitions: Children may also have to adjust to other changes accompanying a divorce. The divorce might mean moving to a new home and changing schools or friends. It might mean leaving a neighborhood that has meant a lot to them as well.

Here are some long-term effects that go beyond the first year following divorce:

1. Economic and occupational status: One of the most commonly cited long-term effects of divorce is that children of divorce may have lower levels of education or occupational status. This may be a consequence of lower income and resources for funding education rather than to divorce per se. In those households where economic hardship does not occur, there may be no impact on economic status (Drexler & Gross, 2005).

2. Improved relationships with the custodial parent (usually the mother): Most children of divorce lead happy, well-adjusted lives and develop stronger, positive relationships with their custodial parent (Seccombe & Warner, 2004). Others have also found that relationships between mothers and children become closer and stronger (Guttmann, 1993) and suggest that greater equality and less rigid parenting is beneficial after divorce (Stewart et al., 1997).

3. Greater emotional independence in sons: Drexler And Gross note that sons who are raised only by mothers develop an emotional sensitivity to others that is beneficial in relationships (Drexler & Gross, 2005).

4. Feeling more anxious in their own love relationships: Children of divorce may feel more anxious about their own relationships as adults. This may reflect a fear of divorce if things go wrong, or it may be a result of setting higher expectations for their own relationships.

5. Adjustment of the custodial parent: Furstenberg and Cherlin believe that the primary factor influencing the way that children adjust to divorce is the way the custodial parent adjusts to the divorce (Furstenberg & Cherlin, 1991). If that parent is adjusting well, the children will benefit. This may explain a good deal of the variation we find in children of divorce. 

Families are the most important part of 6–11 year-old life. However, peers and friendships become more important to the child in middle childhood.

Friendships, Peers, and Peer Groups

(Overstreet & Lumen Learning, 2017)
Parent-child relationships are not the only significant relationships in a child’s life. Friendships take on new importance as judges of one’s worth, competence, and attractiveness. Friendships provide the opportunity for learning social skills such as how to communicate with others and how to negotiate differences. Children get ideas from one another about how to perform certain tasks, how to gain popularity, what to wear, say, listen to, and how to act. This society of children marks a transition from a life focused on the family to a life concerned with peers. Peers play a key role in a child’s self-esteem at this age as any parent who has tried to console a rejected child will tell you. No matter how complementary and encouraging the parent may be, being rejected by friends can only be remedied by renewed acceptance.

Children’s conceptualization of what makes someone a friend changes from a more egocentric understanding to one based on mutual trust and commitment. Both Bigelow (1977) and Selman (1980) believe that these changes are linked to advances in cognitive development (Bigelow, 1977; Selman, 1980). Bigelow and La Gaipa (1975) outline three stages to children’s conceptualization of friendship (Bigelow & La Gaipa, 1975).

Three Stages to Children’s Conceptualization of Friendship:

(Lally & Valentine-French, 2022)
Friendships are very important for children. The social interaction with another child who is similar in age, skills, and knowledge provokes the development of many social skills that are valuable for the rest of life (Bukowski et al., 2013). In these relationships, children learn how to initiate and maintain social interactions with other children. They learn skills for managing conflict, such as turn-taking, compromise, and bargaining. Play also involves the mutual, sometimes complex coordination of goals, actions, and understanding. Through these experiences, children develop friendships that provide sources of security and support in addition to support provided by their parents.

Five Stages of Friendship from Early Childhood through Adulthood

(Lally & Valentine-French, 2022)
Selman (1980) outlines five stages of friendship from early childhood through to adulthood.

In stage 0, momentary physical interaction, a friend is someone who you are playing with. Selman notes that this is typical of children between the ages of three and six. These early friendships are based more on circumstances (for example, a neighbor) than on genuine similarities.

In stage 1, one-way assistance, a friend is someone who does nice things for you, such as saving you a seat on the school bus or sharing a toy. However, children in this stage do not always think about what they are contributing to the relationships. Nonetheless, having a friend is important and children will put up with a not so nice person just to have a friend. Children as young as five and as old as nine may be in this stage.

In stage 2, fair-weather cooperation, children are concerned with fairness and reciprocity.  A friend is someone who returns a favor. In this stage, if a child does something nice for a friend there is an expectation that the friend will do something nice for them at the first available opportunity. When this fails to happen, a child may break off the friendship. Selman found that some children as young as seven and as old as twelve are in this stage.

In stage 3, intimate and mutual sharing, which is typically between the ages of eight and fifteen, a friend is someone who you can tell things you would tell no one else. Children and teens in this stage no longer keep score, and do things for a friend because they genuinely care for the person. If a friendship dissolves in this stage it is usually due to a violation of trust. However, children in this stage do expect their friend to share similar interests and viewpoints and may take it as a betrayal if a friend likes someone they do not.

In stage 4, autonomous interdependence, a friend is someone who accepts you and you accept them. . In this stage children, teens, and adults accept and even appreciate differences between themselves and their friends. They are also not as possessive, so they are less likely to feel threatened if their friends have other relationships or interests. Children are typically twelve or older in this stage.

Peer Groups

Peer relationships can be challenging as well as supportive (Rubin et al., 2011)). Being accepted by other children is an important source of affirmation and self-esteem, but peer rejection can foreshadow later behavior problems (especially when children are rejected due to aggressive behavior). With increasing age, children confront the challenges of bullying, peer victimization, and conformity pressures. Social comparison with peers is an important means by which children evaluate their skills, knowledge, and personal qualities, but it may cause them to feel that they do not measure up well against others. For example, a boy who is not athletic may feel unworthy of his football-playing peers and revert to shy behavior, isolating himself and avoiding conversation. Conversely, an athlete who doesn’t understand Shakespeare may feel embarrassed and avoid reading altogether.

Also, with the approach of adolescence, peer relationships become focused on psychological intimacy, involving personal disclosure, vulnerability, and loyalty (or its betrayal), which significantly affect a child’s outlook on the world. Each of these aspects of peer relationships require developing very different social and emotional skills than those that emerge in parent-child relationships. They also illustrate the many ways that peer relationships influence the growth of personality and self-concept.

Peer Relationships

Most children want to be liked and accepted by their friends. Some popular children are nice and have good social skills. These popular-prosocial children tend to do well in school and are cooperative and friendly. Popular-antisocial children may gain popularity by acting tough or spreading rumors about others (Cillessen & Mayeux, 2004). Rejected children are sometimes excluded because they are shy and withdrawn. The withdrawn-rejected children are easy targets for bullies because they are unlikely to retaliate when belittled (Boulton, 1999). Other rejected children are ostracized because they are aggressive, loud, and confrontational. The aggressive-rejected children may be acting out of a feeling of insecurity. Unfortunately, their fear of rejection only leads to behavior that brings further rejection from other children. Children who are not accepted are more likely to experience conflict, lack confidence, and have trouble adjusting. Unfortunately for rejected children, their fear of rejection only leads to behavior that brings further rejection from other children. Children who are not accepted are more likely to experience conflict, lack confidence, and trouble adjusting (Klima & Repetti, 2008); (Schwartz et al., 2015).

Aggression, Antisocial Behavior, Bullies, & Victims

Aggression and Antisocial Behavior

Aggression may be physical, verbal, or emotional. Aggression is activated in large part by the amygdala and regulated by the prefrontal cortex. Testosterone is associated with increased aggression in both males and females. Aggression is also caused by negative experiences and emotions, including frustration, pain, and heat. As predicted by principles of observational learning, research evidence makes it very clear that, on average, people who watch violent behavior become more aggressive. Early, antisocial behavior leads to befriending others who also engage in antisocial behavior, which only perpetuates the downward cycle of aggression and wrongful acts (Barkan, 2007).

Bullying and Victims

According to Stopbullying.gov (2016), a federal government website managed by the U.S. Department of Health & Human Services, bullying is defined as unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance. Furthermore, the aggressive behavior happens more than once or has the potential to be repeated. There are different types of bullying, including verbal bullying, which is saying or writing mean things, teasing, name-calling, taunting, threatening, or making inappropriate sexual comments. Social bullying, also referred to as relational bullying, involves spreading rumors, purposefully excluding someone from a group, or embarrassing someone on purpose. Physical bullying involves hurting a person’s body or possessions.

A more recent form of bullying is cyberbullying, which involves electronic technology. Examples of cyberbullying include sending mean text messages or emails, creating fake profiles, and posting embarrassing pictures, videos, or rumors on social networking sites. Children who experience cyberbullying have a harder time getting away from the behavior because it can occur any time of day and without being in the presence of others (Smith et al., 2018). 

Those at Risk for Bullying

Bullying can happen to anyone but some students are at an increased risk for being bullied, including lesbian, gay, bisexual, transgendered (LGBTQ+) youth, those with disabilities, and those who are socially isolated. Additionally, those who are perceived as different, weak, less popular, overweight, or having low self-esteem have a higher likelihood of being bullied.

Those Who are More Likely to Bully

Bullies are often thought of as having low self-esteem, and bully others to feel better about themselves. Although this can occur, many bullies in fact have high levels of self-esteem. They possess considerable popularity and social power and have well-connected peer relationships. They do not lack self-esteem, and instead lack empathy for others. They like to dominate or be in charge of others.

Bullied Children

Unfortunately, most children do not let adults know that they are being bullied. Some fear retaliation from the bully, while others are too embarrassed to ask for help. Those who are socially isolated may not know who to ask for help or believe that no one would care or assist them if they did ask for assistance. Consequently, it is important for parents and teachers to know the warning signs that may indicate a child is being bullied. These include: unexplainable injuries, lost or destroyed possessions, changes in eating or sleeping patterns, declining school grades, not wanting to go to school, loss of friends, decreased self-esteem and/or self-destructive behaviors.

Childhood Stress and Development

(Maricopa Open Digital Press, 2024)
What is the impact of stress on child development? The answer to that question is complex and depends on several factors including the number of stressors, the duration of stress, and the child’s ability to cope with stress.

Children experience different types of stressors that manifest in various ways. Normal, everyday stress can provide an opportunity for young children to build coping skills and poses little risk to development. Even long-lasting stressful events, such as changing schools or losing a loved one, can be managed fairly well.

Some experts have theorized that there is a point where prolonged or excessive stress becomes harmful and can lead to serious health effects. When stress builds up in early childhood, neurobiological factors are affected; levels of the stress hormone cortisol exceed normal ranges. Due in part to the biological consequences of excessive cortisol, children can develop physical, emotional, and social symptoms. Physical conditions include cardiovascular problems, skin conditions, susceptibility to viruses, headaches, or stomach aches in young children. Emotionally, children may become anxious or depressed, violent, or feel overwhelmed. Socially, they may become withdrawn, act out towards others, or develop new behavioral ticks such as biting nails or picking at skin.

Types of Stress

Researchers have proposed three distinct types of responses to stress in young children: positive, tolerable, and toxic. Positive stress (also called eustress) is necessary and promotes resilience, or the ability to function competently under threat. Such stress arises from brief, mild to moderate stressful experiences, buffered by the presence of a caring adult who can help the child cope with the stressor. This type of stress causes minor, temporary physiological, and hormonal changes in the young child such as an increase in heart rate and a change in hormone cortisol levels. The first day of school, a family wedding, or making new friends are all examples of positive stressors. Tolerable stress comes from adverse experiences that are more intense in nature but short-lived and can usually be overcome. Some examples of tolerable stressors are family disruptions, accidents, or the death of a loved one. The body’s stress response is more intensely activated due to severe stressors; however, the response is still adaptive and temporary.

Toxic stress is a term coined by pediatrician Jack P. Shonkoff of the Center on the Developing Child at Harvard University to refer to chronic, excessive stress that exceeds a child’s ability to cope, especially in the absence of supportive caregiving from adults (Shonkoff et al., 2012). Extreme, long-lasting stress in the absence of supportive relationships to buffer the effects of a heightened stress response can damage and weaken bodily and brain systems, leading to diminished physical and mental health throughout a person’s lifetime. Exposure to such toxic stress can result in the stress response system becoming more highly sensitized to stressful events, producing increased wear and tear on physical systems through over-activation of the body’s stress response. This wear and tear increases the later risk of various physical and mental illnesses.

Consequences of Toxic Stress

Children who experience toxic stress or live in extremely stressful situations of abuse over long periods can suffer long-lasting effects. The midbrain or limbic system structures, such as the hippocampus and amygdala, can be vulnerable to prolonged stress (Middlebrooks & Audage, 2008). High stress hormone cortisol levels can reduce the hippocampus’s size and affect a child’s memory abilities. Stress hormones can also reduce immunity to disease. If the brain is exposed to long periods of severe stress, it can develop a low threshold, making a child hypersensitive to stress in the future.

With chronic toxic stress, children undergo long term hyper-arousal of brain stem activity. This includes increased heart rate, blood pressure, and arousal states. These children may experience a change in brain chemistry, which leads to hyperactivity and anxiety. It is evident that chronic stress in a young child’s life can create significant physical, emotional, psychological, social, and behavioral changes; however, the effects of stress can be minimized if the child has the support of caring adults.

Coping with Stress

Stress is encountered in four different stages. In the first stage, stress usually causes alarm. Next, in the second or appraisal stage, the child attempts to find meaning from the event. Stage three consists of children seeking out coping strategies. Lastly, in stage four, children execute one or more of the coping strategies. However, children with a lower tolerance for stressors are more susceptible to alarm and find a broader array of events to be stressful. These children often experience chronic or toxic stress.

Some recommendations to help children manage stressful situations include:

• Preparing children for everyday stressful situations, such as traveling to new places or going to the doctor. For example, talk to children about the experience to help them understand that it is okay to be stressed and scared.

• Keeping communication open. This includes making sure that the child feels comfortable talking to a person. This may include being in a comfortable space, such as their bedroom, where they feel safe. The comfort level of the child is important because if a child is not comfortable or feels forced to speak, they may not open up at all.

• Spending time together as a family so that no one’s feelings go unseen ensures that a child knows that their feelings are valued and should be expressed in healthy ways.

• Modeling healthy and successful coping mechanisms (such as walking).

• Encouraging children to express themselves creatively as an outlet or to help others to understand what is stressing the child. Some healthy outlets for stress-relief include sports or running, writing, reading, art, as well as playing musical instruments.

• Teaching children to act and think positively when faced with a situation to manage the stress before it becomes overwhelming.

• Providing a safe and healthy home and environment for children.

• Providing children with proper nutrition and attention.

• Ensuring children are not exposed to substance abuse or violence. When a healthy environment is provided, children are more likely to be emotionally and physically healthy.

Trauma in Childhood

Childhood trauma is referred to in academic literature as adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma, including neglect, abandonment, sexual abuse, physical abuse, parent or sibling treated violently, separation or incarceration of parents, or having a parent with a mental illness. These events have profound psychological, physiological, and sociological impacts and can negatively affect health and well-being.

Kaiser Permanente and the Centers for Disease Control and Prevention’s 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy self-destructive behaviors, risk of violence or re-victimization, chronic health conditions, low life potential, and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs (Felitti et al., 1998).

References

Barkan, S. E. (2007). Sociology: Brief Edition. Unnamed Publisher. https://2012books.lardbucket.org/books/sociology-brief-edition-v1.0/index.html

Berger, K. S. (2005). The Developing Person Through the Life Span. (6. ed). Worth Publ.

Berger, K. S. (2014). The developing person through the life span (Ninth edition). Worth Publishers.

Bigelow, B. J. (1977). Children’s Friendship Expectations: A Cognitive-Developmental Study. Child Development, 48(1), 246. https://doi.org/10.2307/1128905

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