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When researches examined the concept of connectedness. They looked at the violence among adolescents in inner cities and they tried to differentiate which kids are more prone to violence and which kids are less prone to violence. They couldn’t distinguish them because by economic class previous studies looked at rich kids, poor kids and so on and they found usually richer kids were less prone to violence than poor kids but in this set all these kids were poor so why are some being violent and some not child Development, preschooler, toddler, infant.
They found that the ones that tended not to be violent are the kids that were connected in some way to either their school, religion, family. There was something that made them feel grounded and connected and made a pretty strong case that this feeling of connectedness in adolescence is, in fact, a protective factor against risk. I mentioned social class with poverty, positive school experience and people who are planners tend to be
In general, these protective factors work together to protect against risk but there is a certain limit to how protective they can be and a number of studies show that if you have three or more risks – poor, raised by a single parent and asthmatic, chronic disease – all risk factors, virtually nothing can protect you. The rates of emotional disturbance and problems in kids with three or more risk factors is very, very high. A few kids will be resilient against that but if you look at them on a
One of the key core issues in child psychology is the attachment between the caregiving figure and the child. The people who did this work historically were Spitz and Bolbey. Very interesting, kind of primitive study. They found from the literature that children in very clean environments, raised in foundling homes, grew up retarded or died by age 1. Just to give you some sense of how dramatic this was in the 1880s and 1890s in Europe when children were moved for out of wedlock birth and but into foundling homes the death rate was 70% in year 1 and not because of poor conditions. In fact, conditions were cleaner and cleaner because the theory was that they were dying from infection and therefore they should have less human contact and fewer toys and cleaner surroundings. They were dying from infection but probably after they were depressed which made them vulnerable immunologically. The response to that was a vicious cycle of
Now Bolbey and Spitz also then looked at kids being raised in a prison environment. If you were a pregnant woman, criminal, you weren’t worthy of having your child raised in a foundling home, you had to raise the child yourself in prison. Those mothers acted like mothers. They played with the kids, they played with neighborhood toys. In fact, they thrived. In fact, in one little study, no child died in prison but they were dying in the much better foundling home. Based on those observations a number of dramatic changes were made, of course, in how children were raised in foster care and how
Bolbey sat in a hospital ward and observed infants being left by their mothers and fathers and how they reacted and from that observation came up with three stages – protest, despair and detachment. Protest is the first few hours and sometimes longer the child protesting their parent leaving. Despair is the quiet phase the child enters once they know their parent won’t return and detachment occurs because of repeated leavings. As you know in the 1940s there wasn’t too much you could do for children in hospitals. They stayed for long periods of time.
If they had a chronic disease you were admitted over and over, you met many different people. Those people developed a very rapid attachment style almost like a car salesman. Isn’t it interesting when you go and buy a car you feel like that person has known you for ten years within about 15 minutes? That’s detachment because after you buy the car they don’t know you anymore and that quality of relating is what Bolbey and Spitz were talking about.
Just to tell you it doesn’t only happen in car showrooms, children who have been repeatedly in foster care and been in foster home to foster home over the first three or four years of life have the same way of attaching. If you’ve had some experience, you can tell within minutes that a child has really not had a standard caretaking figure because of their detachment. I’m not making the claim that all car salesman were in foster care.
The term used for someone who has been truly deprived of a caretaking figure and has a serious problem with attachment in infancy, like if they were raised in a foundling home, is the term anaclitic depression and that’s the depression from lack of adequate contact with a caregiver.
Bolbey expanded this theory dramatically and in his series of books called Separation and Attachment makes the argument that separation anxiety may very well have a survival value. That a child who protests vigorously and gets the attention of their mother may have, in fact, been better protected from lions than a child who didn’t and therefore by natural selection we’ve selected for people who were vigorous protesters at attachment losses. He makes the point that maybe in addition to Freud’s view of sex and aggression as core instincts the third core instinct may be separation anxiety around being left and that those three core instincts are the ones that drive human behavior.
There have been attempts to measure attachment and as you can imagine that’s a very difficult thing to do but a child psychiatrist named Mary Ainsworth created a set of situations where children were left by their mother in a certain pattern, a certain sequence and that’s called the Ainsworth Strain Situation. You may see it on a test or in a article and that’s a different way of classifying or measuring how children react when their parents leave. There’s certainly a secure way of acting, an insecure, an anxious way of reacting and those are classified for research purposes. They don’t want to test whether they’re all true but at least there was one approach to standardizing attachment measure.
The last point I want to make under attachment is the famous Harlow monkey experiment where Harlow raised monkeys in different attachment formats. Once he raised a number of monkeys where they were in total isolation and those monkeys were frank but crazy. I don’t want to get too technical. Then he raised another group of monkeys only with peers and those monkeys were not crazy but those monkeys looked like character disorders. As a matter of fact, they didn’t know how to groom, they didn’t know how to mate, they didn’t know how to have intercourse, they didn’t know how to relate. They were characterologically limited monkeys.
At the end of the experiment, he took those monkeys and put them in the zoo with a normal monkey colony and things happen. One was that these monkeys elicited other monkeys to take care of them and a group of monkeys developed, there were monkey therapists, and their job was to get those character disordered monkeys to behave and they did by constantly correcting them. "This is the way you groom. This is the way you screw around. This is the way you eat. Come on. Behave." It took them six months of 24 hour effort to get those character disordered monkeys to become part of the colony and to mate and they did. So there’s hope even if you’re raised in very difficult circumstances.
So that’s the attachment approach model development. The next model which moves a little bit more into sort of the core structures that are built in is the ethological model. I’m not going to spend much time on this except to note that this is where the term critical period comes from. It comes from the work of Lorenz where Lorenz discovered that if you hatch goslings and you expose them to a mother at a certain period, about six or twelve hours depending on what species, at that moment they are ready to attach. In fact, when Conrad Lorenz exposed them to himself, to his tush, at that time, the little goslings followed Conrad Lorenz like he was their mother and from that came the notion of bonding, that there was a period of time in an animal’s life where "you see it, you follow it".
That became a big theory in pediatrics because they tried to get infants, newborns exposed to their mothers just at birth because they thought if they were exposed just at birth, "bang" they would bond like glue and it would work and they tried to do followup studies and so on.
It’s interesting, as anybody knows who’s tried to train a dog, that period for goslings may be six to twelve hours but when do you housebreak a dog? Maybe you start at six or eight weeks and you go for twelve weeks. There may be a core of attachment or a sensitive period where we are more open and more flexible and more plastic but even children who are taken from war situations at 18 months or 2 years where you think it’s well past their post bonding period but, in fact, if they’re put in a stable environment can be indistinguishable from children raised by a single caregiver. They can attach, they can have an intimate relationship and so forth even after rather horrendous beginnings. So I want to mention the concept but I don’t want to put too much weight on it as a core unit issue.
Moving a little bit more towards the interactional environment is this notion of temperament. Chester and Thomas were child psychiatrists, and they did the first longitudinal study of children in the 1950s and early ‘60s where they tried to see what children were like. They did the study in reaction to the criticism of analysts that parents caused all problems and they said, "Gee, if we looked at kids at three weeks or four weeks of age, could we find some patterns that would be relevant? If they are, how do we blame the parents?" Because it’s hard to imagine that a neurosis would influence the behavior of a four week old or eight week old.
They defined nine temperaments that I’ve listed for you: rhythmicity, approach withdrawal, mood, threshold. I’ll define a couple of them. Rhythmicity is regularity of hunger and going to the bathroom, for example. Approach withdrawal is the initial reaction a child has to a new situation. Threshold is how much it takes for a child to get activated or excited. Distractible is obvious. Persistence is how long the child stays in the state. Intensity and adaptability.
They identified a cluster of traits that would make a child pretty easy to take care of and actually my first son, David, was an "easy" child. He was rhythmical. He knew when he was hungry. He knew he was going to sleep. He approached situations positively. His mood was upbeat. It took a fair amount to get him excited. He was fairly persistent in tasks. His reactions were not too intense if he got upset and if we changed planes he was adaptable. Kind of nice. At that point, I was a child psychiatrist pediatrician, my wife was a nurse, we had an easy child, we thought, "Man, are we good parents." He is now at Boston College Law School. He’s happy.
Then we had our second child, Abe, and Abe was classically what Chester and Thomas called a difficult child. He never knew what he wanted whenever he wanted it. His first reaction was to withdraw and say no. His mood was generally negative. "Do you want to go to the park?" "No." "Do you want to go home?" "No." "Do you want to go to sleep?" "No." "Are you hungry?" "No. Threshold. A pin could drop. My wife used to have to walk with a stroller to get him to take a nap. If she hit a stop sign, if the stroller stopped moving, he woke up and could not be consoled. Very persistent. Once he got pissed, he was pissed a long time. Intense and not very adaptable and we worked like hell to adjust our lives to Abe. He is now doing very well in prep school and a wonderful kid but it was an enormous effort and we felt like total failures. Thank God we had David first because I would have given up child psychiatry.
A key parameter that tells you the impact of either a difficult child or an easy child is not a neurotic parent but how well the child’s temperament fits with the parent’s temperament. So if you have a parent who is very orderly and a child who is not disturbed but does not fit that order, you can have some great friction. This model is very important in helping pediatricians doing some counseling that was nonpsychiatric but a little bit supportive to parents that the temperament of the baby and their own style could become more integrated in a more positive way and we get this very nice concept of goodness of fit.
Fortunately most of these temperamental traits are not stable. By the age of three or four this model breaks down because children become too complex and there’s no consistency between anti-rhythmicity at age one and rhythmicity at age 15. So those things don’t work except for approach withdrawal. The work of Beiderman and originally of Kagen showed that there is a shyness factor and that kids who are shy at about 2 also tend to be shy at age 4 or 5 but there may, and you’ll hear about this more in the course, be related to anxiety and panic disorders so there may be a continuum. There may be a genetic connection to those things. Interestingly, even in the shy children after 20 minutes of sort of being used to the situation they’re in, they’re indistinguishable from children who don’t have this shyness factor unless it’s part of a psychiatric disorder but at least it’s stable.
One of my soccer players is Olivia. She’s a quiet little girl who’s a church mouse. She was like that at 2, she was like that at 4, she was like that at 11. On the other hand, once she’s comfortable on a team she’s a tiger. She is an excellent wing and is not shy at all but her initial reaction is kind of withdrawn and shy and that’s the temperamental trait.
Another interactive kind of developmental model is cognitive development by Piaget. The underlying principle of Piaget’s contribution is this notion of stages and that’s obviously a key issue in child development. Kids go through certain stages of development. Piaget defined a stage as organizing a principle, a concept and that concept has the same order anywhere for any child in any culture and you have to sort of go through that particular set of concepts before you can move to the next set of concepts.
Piaget felt that children innately have a need to function. They have a need to meet the environment and try to understand it and he called that equilibration. The child faces a door they can’t open and they have to figure out "How can I open it?" They try to apply what they’ve learned in the past. They try to mix different techniques they’ve used and they try to figure out how to open the door and that’s equilibration.
Piaget noted four major stages. Sensory motor, birth to age 2 and this is where the notion of object permanence comes into play. If you take a coin and you move it through space in front of a three month old they’ll follow it but after awhile they’ll lose interest. If the coin disappears they won’t hunt for it. At an older age, they will keep tracking it. At about 9 or 10 months, if you put the coin in one hand and they see you move it to the other hand, they’ll track the movement. If they see the coin in the other hand at around 12 months they’ll go to that hand and look for it and by 18 months if you put the coin in one hand and you take it to the other and they don’t even see it move, they’ll still know it’s in the other hand.
By 18 months to 2 years, a very nice example of this is if a ball rolls under the sofa. The 1 year old to 15-month-old will go and point to where the ball entered under the sofa because they’ll think that’s where the ball is. At about 2, they’ll go point where the ball exits the sofa. So they’ll be able to know that the ball still exists and they’ll make a geometric diagram of the floor under the sofa and they’ll know the angle of entry and the angle of exit and they’ll note the angle of exit. That’s the end of the sensory motor stage.
Preoperational stage is second which is mainly the use of language and if you want to get into this there’s also a whole set of oral development which I won’t go into unless somebody asks a question that relates to Piaget’s developmental stages. Concrete operations are about 7 to adolescence and that deals with weights, rules, sports rules and measures. Boys especially can get quite locked into rules at this age.
Just as a vignette, we used to have a little basketball court in the backyard. Where the tar and the dirt met, you know, black tar, black dirt. If the ball hit the tar it was inbounds, if the ball hit the dirt it was out of bounds. That’s a fine distinction in the driveway and especially boys will fight endlessly as to whether the ball hit the tar or hit the dirt.
Carol Gilligan said girls will react somewhat differently. If there’s a real big fight at the playground around tar versus dirt, the guys will just argue and argue and argue and finally continue to play. The girls would say, "I didn’t really want to play basketball that much anyway." and will stay in the group. Social affiliation is more important than if the ball was in bounds or out of bounds. I’ll let you choose which model is more attractive.
At early adolescence you have formal operations and that’s being able to conceptualize and you get the essays in high school, "How is this character and that character alike?" Even though they’re in totally different situations they were both heroic and they were both sad. They conceptualize something and can work with it.
The major risk of Piaget is that in our society we distort it. It’s led to some major toy industries. Creative play things and all those kinds of things, we’re taking Piaget concepts, putting them into toys and they’re trying to sell them to us so we can accelerate the learning process. One of Piaget’s points was this is a normal sequence that happens at its own evolving rate. You can’t really do anything to accelerate it. The natural events in the environment – pots, pans, doors – these are the issues that kids deal with and having specialized toys doesn’t help or doesn’t hurt.
The worst element of this is, I guess some of you may have heard of the book called The Hurried Child, where we take a lot of stuff and throw it at kids. So we feel that if we get them into first grade earlier or into soccer earlier, into toys earlier and so forth we’re really going to accelerate their normal array of cognitive development which hasn’t been shown to be true.
The last developmental model I want to spend a couple of minutes on is psychodynamic and I just want to go over it from a structural point of view. Obviously the critical organizing principle is the role of the unconscious. That there are built-in structures that the unconscious meets and has to deal with.
Anna Freud gave us the notion of a set order of defenses. One of the key defenses relevant to child development is regression. Usually a child will have to regress a little bit either under stress or facing a new challenge. My fourth child, Hannah Rose, who is now 6, is very independent, athletic, terrific little girl but the first day of school, maybe she doesn’t want to get out of bed early and maybe she crawls in at 5 o’clock in the morning and says, "Gee, you know, I had a bad dream. How about if I hang out here for a little bit." She needs a little more cuddling and she gets her new clothes on and then as she’s ready she marches off and acted independently. That’s regression and the classic phrase for it was "regression in the service of the ego". She had to kind of get a little extra support and act a little bit younger so she could face a new task.
Anna Freud gave us a very important core concept called developmental lines and those were the same structures that evolved over time as the child got older from playing with your fingers at four to six months, beginning to play with toys, to abstracting those toys into games and rules, then into schoolwork and then into a job. A second key developmental line was from dependency, obviously, complete on the caregiver parent to autonomy and there’s obviously each step along the way from dependency to self reliance and autonomy.
Psychodynamic development really can be broken down into two or three different approaches. One emphasizes the ego, one emphasizes object relationships or relationships with other and third is narcissistic development. I’ve listed for you the key stages of ego development and, again, that was worked on by Margaret Maurer where she created an experimental situation where infants and parents and toddlers and parents interacted and then she tried to make some observations about how the ego of the toddler evolved.
I’ve listed the stages for you. I won’t go through them in detail because of time. The neatest one and really a nice example is the second one called hatching and the example of that is if you’re in an elevator and you’re with a three or four month old they seem to totally relate to the parent and sort of sit in a direct one to one way. By around six, seven, eight months and the baby’s on the parent’s shoulder, they’ll begin to look around and they will begin to reach or begin to watch the numbers. The classic term for it is differentiation, the colloquial term is hatching. It’s almost like they’re just growing out of an egg to gaze at the world and that’s kind of a feel for the model.
In terms of object relations, I just want to say that there are a couple of key words that you may see. Obviously the key person in this area was Winnicott. I won’t go over the words. Good enough and holding, I’m sure you know about, but one of the key phrases that he added was transitional object. What a transitional object is is the mental object or probably more classically the piece of blanket or the doll that a child will use which is special and that special thing Winnicott thought represented the mother as the infant developed autonomy and separated from the mother.
Of my kids, two out of four had them. Dave had one he cared about a lot until age 5. Abe, the difficult one, he had a blanket that he held onto life and death until age 9. Life and death. It was shredded piece of yuck but it was critical to him. Isaiah who’s now 10 and Hannah couldn’t care less but the theory would be that they had something in their psyche that held them together. Abe had something that really held him together.
One of the last areas I want to just touch about in development for a minute is narcissistic development. That’s been an area that although it’s been emphasized a lot in narcissistic characters through our literature really nobody’s spent much time talking about narcissistic development as a pure developmental line like they have in ego or psychodynamic.
There is a healthy narcissism and I’ve tried to give you some characteristics of healthy narcissism. Aggressive impulses that do not upset the confidence or esteem of parents and one of the key clinical questions I ask in narcissistic development is, "Do you play fun?" Does the child play fun. It’s interesting in healthy families where narcissism and autonomy of a child is tolerated there is a lot of fun in splash fights and play fights. Nobody really gets hurt. The limits aren’t crossed. The boundaries are fine and people have a lot of fun. In families where this is more of an issue somebody gets hurt, sometimes the kid, sometimes the aggression on the parent in punishment and it gets into a whole big mess.
Autonomy is not experienced as an attack. The child can make their own accomplishments at their own pace. They own their own feelings. They own their own successes. They’re not rushed and it doesn’t feel like a loss for the parents. This is a dramatic issue in Newton’s soccer where for some reason the parents never played soccer when they were growing up. This is of tremendous importance to the parents and where the child’s success is really the extension of the parent’s or the child’s failure is the loss for the parents and that’s where the narcissistic line kind of gets crossed from normal to not normal.
There are two integrative models. What I’ve done up until now is talk about all these separate pieces, attachment, morphology, temperament, cognition, psychodynamic and obviously we’re only talking about one child so this is not eight different tracks but it’s all integrated into one. The newest model which is a few years old is the Interpersonal World of the Infant Body by Daniel Stern where he talks about the self being the organizer of principle, the integrator of all these different developmental approaches and I’ve outlined for you the different pieces of his model.
The major sections are the sense of self, an emergent self from 0 to 2 months, a core self from 2 to 6 months, a subjective self from 7 to 15 months. The phrases I like the best there are 2 to 6 months "self agency". That the child it’s like hatching. The beginning of a sense that they themselves are an agent and the subjective self at 7 to 15 months where the use of words allows them to have a new sense of self. "Juice." There’s some connection to the parent but it’s in connection with their own autonomy.
The classic integrative model is still Erickson’s and it’s still spoken about a great deal and that is also a stage theory where there are eight ages, actually his wife defined a ninth, of development. Each one is a stage. Each one has its own organizing principle.
The first is basic trust and mistrust and I put in bold for you the first paragraph of this stage. What’s interesting about the first paragraph and I’m just