Chapter 4: Early Childhood

Our discussion will now focus on the physical, cognitive and socioemotional development
during the ages from two to six, referred to as early childhood. Early childhood represents a time
period of continued rapid growth, especially in the areas of language and cognitive development.
Those in early childhood have more control over their emotions and begin to pursue a variety of
activities that reflect their personal interests. Parents continue to be very important in the child’s
development, but now teachers and peers exert an influence not seen with infants and toddlers.

Learning Objectives: Physical Development in Early Childhood

x Summarize the overall physical growth

x Describe the changes in brain maturation
x Describe the changes in sleep
x Summarize the changes in gross and motor skills
x Describe when a child is ready for toilet training
x Describe sexual development
x Identify nutritional concerns

Overall Physical Growth: Children between the ages Figure 4.1

of two and six years tend to grow about 3 inches in
height and gain about 4 to 5 pounds in weight each
year. Just as in infancy, growth occurs in spurts rather
than continually. According to the Centers for Disease
Control and Prevention (CDC, 2000) the average 2-
year-old weighs between 23 and 28 pounds and stands
between 33 and 35 inches tall. The average 6-year-old
weighs between 40 and 50 pounds and is about 44 to 47
inches in height. The 3-year-old is still very similar to a
toddler with a large head, large stomach, short arms and
legs. By the time the child reaches age 6, however, the
torso has lengthened, and body proportions have
become more like those of adults.

This growth rate is slower than that of infancy and is

accompanied by a reduced appetite between the ages of
2 and 6. This change can sometimes be surprising to
parents and lead to the development of poor eating
habits. However, children between the ages of 2 and 3 Source

need 1,000 to 1,400 calories, while children between

the ages of 4 and 8 need 1,200 to 2,000 calories (Mayo Clinic, 2016a).

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Brain Maturation

Brain weight: The brain is about 75 percent its adult weight by three years of age. By age 6, it is
at 95 percent its adult weight (Lenroot & Giedd, 2006). Myelination and the development of
dendrites continue to occur in the cortex and as it does, we see a corresponding change in what
the child is capable of doing. Greater development in the prefrontal cortex, the area of the brain
behind the forehead that helps us to think, strategize, and control attention and emotion, makes it
increasingly possible to inhibit emotional outbursts and understand how to play games.
Understanding the game, thinking ahead, and coordinating movement improve with practice and
myelination.

Growth in the Hemispheres and

Corpus Callosum: Between ages Figure 4.2 Corpus Callosum
3 and 6, the left hemisphere of the
brain grows dramatically. This
side of the brain or hemisphere is
typically involved in language
skills. The right hemisphere
continues to grow throughout
early childhood and is involved in
tasks that require spatial skills,
such as recognizing shapes and
patterns. The corpus callosum, a
dense band of fibers that connects
the two hemispheres of the brain,
contains approximately 200
million nerve fibers that connect
the hemispheres (Kolb &
Whishaw, 2011). The corpus Source

callosum is illustrated in Figure

4.2.

The corpus callosum is located a couple of inches below the longitudinal fissure, which runs the
length of the brain and separates the two cerebral hemispheres (Garrett, 2015). Because the two
hemispheres carry out different functions, they communicate with each other and integrate their
activities through the corpus callosum. Additionally, because incoming information is directed
toward one hemisphere, such as visual information from the left eye being directed to the right
hemisphere, the corpus callosum shares this information with the other hemisphere.

The corpus callosum undergoes a growth spurt between ages 3 and 6, and this results in
improved coordination between right and left hemisphere tasks. For example, in comparison to
other individuals, children younger than 6 demonstrate difficulty coordinating an Etch A Sketch
toy because their corpus callosum is not developed enough to integrate the movements of both
hands (Kalat, 2016).

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Motor Skill Development

Early childhood is the time period when most children acquire the
basic skills for locomotion, such as running, jumping, and Figure 4.3
skipping, and object control skills, such as throwing, catching, and
kicking (Clark, 1994). Children continue to improve their gross
motor skills as they run and jump. Fine motor skills are also being
refined in activities, such as pouring water into a container,
drawing, coloring, and buttoning coats and using scissors. Table
4.1 highlights some of the changes in motor skills during early
childhood between 2 and 5 years of age. The development of
greater coordination of muscles groups and finer precision can be
seen during this time period. Thus, average 2-year-olds may be
able to run with slightly better coordination than they managed as
a toddler, yet they would have difficulty peddling a tricycle,
something the typical 3-year-old can do. We see similar changes in
fine motor skills with 4-year-olds who no longer struggle to put on
their clothes, something they may have had problems with two Source
years earlier. Motor skills continue to develop into middle
childhood, but for those in early childhood, play that deliberately involves these skills is
emphasized.

Children’s Art: Children’s art highlights many developmental changes. Kellogg (1969) noted
that children’s drawings underwent several transformations. Starting with about 20 different
types of scribbles at age 2, children move on to experimenting with the placement of scribbles on
the page. By age 3 they are using the basic structure of scribbles to create shapes and are
beginning to combine these shapes to create more complex images. By 4 or 5 children are
creating images that are more recognizable representations of the world. These changes are a
function of improvement in motor skills, perceptual development, and cognitive understanding
of the world (Cote & Golbeck, 2007).
The drawing of tadpoles (see Figure: 4.4) is a pervasive
feature of young children’s drawings of self and others. Figure 4.4
Tadpoles emerge in children’s drawing at about the age
of 3 and have been observed in the drawings of young
children around the world (Gernhardt, Rubeling & Keller,
2015), but there are cultural variations in the size, number
of facial features, and emotional expressions displayed.
Gernhardt et al. found that children from Western
contexts (i.e., urban areas of Germany and Sweden) and
urban educated non-Western contexts (i.e., urban areas of
Turkey, Costa Rica and Estonia) drew larger images, Source
with more facial detail and more positive emotional
expressions, while those from non-Western rural contexts (i.e., rural areas of Cameroon and
India) depicted themselves as smaller, with less facial details and a more neutral emotional
expression. The authors suggest that cultural norms of non-Western traditionally rural cultures,

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which emphasize the social group rather than the individual, may be one of the factors for the
smaller size of the figures compared to the larger figures from children in the Western cultures
which emphasize the individual.

Table 4.1 Changes in Gross and Fine Motor Skills in Early Childhood
Gross Motor Skills Fine Motor Skills

Age 2 x Can kick a ball without losing x Able to turn a door knob
balance
x Can look through a book turning one page at
x Can pick up objects while standing, a time
without losing balance (This often
occurs by 15 months. It is a cause for x Can build a tower of 6 to 7 cubes
concern if not seen by 2 years).
x Able to put on simple clothes without help
x Can run with better coordination. (The child is often better at removing clothes
(May still have a wide stance). than putting them on).

Age 3 x Can briefly balance and hop on one x Can build a block tower of more than nine
foot cubes

x May walk up stairs with alternating x Can easily place small objects in a small
feet (without holding the rail) opening

x Can pedal a tricycle x Can copy a circle

x Can draw a person with 3 parts

x Can feed self easily

Age 4 x Shows improved balance x Can cut out a picture using scissors

x Hops on one foot without losing x Can draw a square

balance
x Manages a spoon and fork neatly while
x Throws a ball overhand with eating
coordination
x Puts on clothes properly

Age 5 x Has better coordination (getting the x Shows more skill with simple tools and
arms, legs, and body to work writing utensils
together)
x Can copy a triangle
x Skips, jumps, and hops with good
balance x Can use a knife to spread soft foods

x Stays balanced while standing on one

foot with eyes closed

Source: NIH: US National Library of Medicine

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Toilet Training

Figure: 4.5 Toilet training typically occurs during the first two years of early
childhood (24-36 months). Some children show interest by age 2,
but others may not be ready until months later. The average age for
girls to be toilet trained is 29 months and for boys it is 31 months,
and 98% of children are trained by 36 months (Boyse & Fitzgerald,
2010). The child’s age is not as important as his/her physical and
emotional readiness. If started too early, it might take longer to train
a child. If a child resists being trained, or it is not successful after a
few weeks, it is best to take a break and try again later. Most
children master daytime bladder control first, typically within two to
Source three months of consistent toilet training. However, nap and
nighttime training might take months or even years.
According to the Mayo Clinic (2016b) the following questions can help parents determine if a
child is ready for toilet training:
x Does your child seem interested in the potty chair or toilet, or in wearing underwear?
x Can your child understand and follow basic directions?
x Does your child complain about wet or dirty diapers?
x Does your child tell you through words, facial expressions or posture when he or she
needs to go?
x Does your child stay dry for periods of two hours or longer during the day?
x Can your child pull down his or her pants and pull them up again?
x Can your child sit on and rise from a potty chair? (p. 1)

Some children experience elimination disorders that may require intervention by the child’s
pediatrician or a trained mental health practitioner. Elimination disorders include: enuresis, or
the repeated voiding of urine into bed or clothes (involuntary or intentional) and encopresis, the
repeated passage of feces into inappropriate places (involuntary or intentional) (American
Psychiatric Association, 2022). The prevalence of enuresis is 5%-10% for 5-year-olds, 3%-5%
for 10-year-olds and approximately 1% for those 15 years of age or older. Around 1% of 5-year-
olds have encopresis, and it is more common in males than females.

Sleep
During early childhood, there is wide variation in the number of hours of sleep recommended per
day. For example, two-year-olds may still need 15-16 hours per day, while a six-year-old may
only need 7-8 hours. The National Sleep Foundation’s 2015 recommendations based on age are
listed in Figure 4.6.

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 Figure 4.6

Sexual Development in Early Childhood

Historically, children have been thought of as innocent or incapable of sexual arousal (Aries,
1962). Yet, the physical dimension of sexual arousal is present from birth. However, to associate
the elements of seduction, power, love, or lust that is part of the adult meanings of sexuality
would be inappropriate. Sexuality begins in childhood as a response to physical states and
sensation and cannot be interpreted as similar to that of adults in any way (Carroll, 2007).

Infancy: Boys and girls are capable of erections and vaginal lubrication even before birth
(Martinson, 1981). Arousal can signal overall physical contentment and stimulation that
accompanies feeding or warmth. Infants begin to explore their bodies and touch their genitals as
soon as they have the sufficient motor skills. This stimulation is for comfort or to relieve tension
rather than to reach orgasm (Carroll, 2007).

Early Childhood: Self-stimulation is common in early childhood for both boys and
girls. Curiosity about the body and about others’ bodies is a natural part of early childhood as
well. As children grow, they are more likely to show their genitals to siblings or peers, and to
take off their clothes and touch each other (Okami, Olmstead, & Abramson, 1997). Masturbation
is common for both boys and girls. Boys are often shown by other boys how to masturbate, but
girls tend to find out accidentally. Additionally, boys masturbate more often and touch
themselves more openly than do girls (Schwartz, 1999).

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Hopefully, parents respond to this without undue alarm and without making the child feel guilty
about their bodies. Instead, messages about what is going on and the appropriate time and place
for such activities help the child learn what is appropriate.

Nutritional Concerns
In addition to those in early childhood having a smaller appetite, their parents may notice a
general reticence to try new foods, or a preference for certain foods, often served or eaten in a
particular way. Some of these changes can be traced back to the “just right” (or just-so)
phenomenon that is common in early childhood. Many young children desire consistency and
may be upset if there are even slight changes to their daily routines. They may like to line up
their toys or other objects or place them in symmetric patterns. They may arrange the objects
until they feel “just right”. Many young children have a set bedtime ritual and a strong
preference for certain clothes, toys or games. All these tendencies tend to wane as children
approach middle childhood, and the familiarity of such ritualistic behaviors seem to bring a sense
of security and general reduction in childhood fears and anxiety (Evans et al., 1999; Evans &
Leckman, 2015).

Malnutrition due to insufficient food is not

Figure 4.7 Nutritious Lunch common in developed nations, like the
United States, yet many children lack a
balanced diet. Added sugars and solid fats
contribute to 40% of daily calories for
children and teens in the US. Approximately
half of these empty calories come from six
sources: soda, fruit drinks, dairy desserts,
grain desserts, pizza, and whole milk (CDC,
2015). Caregivers need to keep in mind that
they are setting up taste preferences at this
age. Young children who grow accustomed
to high fat, very sweet and salty flavors may
have trouble eating foods that have subtler
Source
flavors, such as fruits and
vegetables. Consider the following advice
(See Box 4.1) about establishing eating patterns for years to come (Rice, 1997). Notice that
keeping mealtime pleasant, providing sound nutrition and not engaging in power struggles over
food are the main goals:

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 Box 4.1
Tips for Establishing Healthy Eating Patterns

Recognize that appetite varies. Children may eat well at one meal and have no appetite at
another. Rather than seeing this as a problem, it may help to realize that appetites do
vary. Continue to provide good nutrition, but do not worry excessively if the child does not
eat at a particular meal.

Keep it pleasant. This tip is designed to help caregivers create a positive atmosphere during
mealtime. Mealtimes should not be the time for arguments or expressing tensions. You do not
want the child to have painful memories of mealtimes together or have nervous stomachs and
problems eating and digesting food due to stress.

No short order chefs. While it is fine to prepare foods that children enjoy, preparing a
different meal for each child or family member sets up an unrealistic expectation from
others. Children probably do best when they are hungry, and a meal is ready. Limiting snacks
rather than allowing children to “graze” can help create an appetite for what is being served.

Limit choices. If you give your young child choices, make sure that you give them one or
two specific choices rather than asking “What would you like for lunch?” If given an open
choice, children may change their minds or ask for something that is not available or
appropriate.

Serve balanced meals. This tip encourages caregivers to serve balanced meals. A box of
macaroni and cheese is not a balanced meal. Meals prepared at home tend to have better
nutritional value than fast food or frozen dinners. Prepared foods tend to be higher in fat and
sugar content, as these ingredients enhance taste and profit margin because fresh food is often
costlier and less profitable. However, preparing fresh food at home is not costly. It does,
however, require more activity. Preparing meals and including the children in kitchen chores
can provide a fun and memorable experience.

Do not bribe. Bribing a child to eat vegetables by promising desert is not a good idea. The
child will likely find a way to get the desert without eating the vegetables (by whining or
fidgeting, perhaps, until the caregiver gives in). In addition, bribery teaches the child that
some foods are better than others. Children tend to naturally enjoy a variety of foods until
they are taught that some are considered less desirable than others. Most important is not to
force your child to eat or fight over eating food.

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 Learning Objectives: Cognitive Development in Early Childhood

x Describe Piaget’s preoperational stage and the characteristics of preoperational

thought
x Summarize the challenges to Piaget’s theory
x Describe Vygotsky’s theory of cognitive development
x Describe Information processing research on attention and memory
x Describe the views of the neo-Piagetians
x Describe theory-theory and the development of theory of mind
x Describe the developmental changes in language
x Describe the various types of early childhood education
x Describe the characteristics of autism

Early childhood is a time of pretending, blending fact and fiction, and learning to think of the
world using language. As young children move away from needing to touch, feel, and hear about
the world, they begin learning basic principles about how the world works. Concepts such as
tomorrow, time, size, distance and fact vs. fiction are not easy to grasp at this age, but these tasks
are all part of cognitive development during early childhood.

Piaget’s Preoperational Stage

Piaget’s stage that coincides with early childhood is the preoperational stage. According to
Piaget, this stage occurs from the age of 2 to 7 years. In the preoperational stage, children use
symbols to represent words, images, and ideas, which is why children in this stage engage in
pretend play. A child’s arms might become airplane wings as she zooms around the room, or a
child with a stick might become a brave knight with a sword. Children also begin to use
language in the preoperational stage, but they cannot understand adult logic or mentally
manipulate information. The term operational refers to logical manipulation of information, so
children at this stage are considered pre-operational. Children’s logic is based on their own
personal knowledge of the world so far, rather than on conventional knowledge.

The preoperational period is divided into two stages: The symbolic function substage occurs
between 2 and 4 years of age and is characterized by the child being able to mentally represent an
object that is not present and a dependence on perception in problem solving. The intuitive
thought substage, lasting from 4 to 7 years, is marked by greater dependence on intuitive thinking
rather than just perception (Thomas, 1979). This implies that children think automatically
without using evidence. At this stage, children ask many questions as they attempt to understand
the world around them using immature reasoning. Let us examine some of Piaget’s assertions
about children’s cognitive abilities at this age.

126
 Figure 4. 8 Pretend Play: Pretending is a favorite activity
at this time. A toy has qualities beyond the
way it was designed to function and can now
be used to stand for a character or object
unlike anything originally intended. A teddy
bear, for example, can be a baby or the queen
of a faraway land. Piaget believed that
children’s pretend play helped children
solidify new schemata they were developing
cognitively. This play, then, reflected changes
in their conceptions or thoughts. However,
children also learn as they pretend and
experiment. Their play does not simply
Source represent what they have learned (Berk,
2007).

Egocentrism: Egocentrism in early childhood refers to the tendency of young children not to be
able to take the perspective of others, and instead the child thinks that everyone sees, thinks, and
feels just as they do. Egocentric children are not able to infer the perspective of other people and
instead attribute their own perspective to situations. For example, ten-year-old Keiko’s birthday
is coming up, so her mom takes 3-year-old Kenny to the toy store to choose a present for his
sister. He selects an Iron Man action figure for her, thinking that if he likes the toy, his sister will
too.

Piaget’s classic experiment on egocentrism involved showing Figure 4.9 “What does
children a three-dimensional model of a mountain and asking
Dolly see?”
them to describe what a doll that is looking at the mountain
from a different angle might see (see Figure 4.9). Children
tend to choose a picture that represents their own, rather than
the doll’s view. By age 7 children are less self-centered.
However, even younger children when speaking to others tend
to use different sentence structures and vocabulary when
addressing a younger child or an older adult. This indicates
some awareness of the views of others.

Conservation Errors: Conservation refers to the ability to

Source
recognize that moving or rearranging matter does not change
the quantity. Using Kenny and Keiko again, dad gave a slice of pizza to 10-year-old Keiko and
another slice to 3-year-old Kenny. Kenny’s pizza slice was cut into five pieces, so Kenny told his
sister that he got more pizza than she did. Kenny did not understand that cutting the pizza into smaller
pieces did not increase the overall amount. This was because Kenny exhibited centration or focused on
only one characteristic of an object to the exclusion of others. Kenny focused on the five pieces of pizza to
his sister’s one piece even though the total amount was the same. Keiko was able to consider several
characteristics of an object than just one. Because children have not developed this understanding of
conservation, they cannot perform mental operations.

127
The classic Piagetian experiment
associated with conservation involves Figure 4.10 Conservation of Liquid. Does
liquid (Crain, 2005). As seen in Figure pouring liquid in a tall, narrow container make it
4.10, the child is shown two glasses have more?
(as shown in a) which are filled to the
same level and asked if they have the
same amount. Usually the child
agrees they have the same amount.
The experimenter then pours the liquid
in one glass to a taller and thinner
glass (as shown in b). The child is
again asked if the two glasses have the
same amount of liquid. The
preoperational child will typically say
the taller glass now has more liquid because it is taller (as shown in c). The child has centrated
on the height of the glass and fails to conserve.

Classification Errors: Preoperational children have difficulty understanding that an object can
be classified in more than one way. For example, if shown three white buttons and four black
buttons and asked whether there are more black buttons or buttons, the child is likely to respond
that there are more black buttons. They do not consider the general class of buttons. Because
young children lack these general classes, their reasoning is typically transductive, that is,
making faulty inferences from one specific example to another. For example, Piaget’s daughter
Lucienne stated she had not had her nap, therefore it was not afternoon. She did not understand
that afternoons are a time period and her nap was just one of many events that occurred in the
afternoon (Crain, 2005). As the child’s vocabulary improves and more schemata are developed,
the ability to classify objects improves.

Animism: Animism refers to attributing life-like qualities to objects. The cup is alive, the chair
that falls down and hits the child’s ankle is mean, and the toys need to stay home because they
are tired. Cartoons frequently show objects that appear alive and take on lifelike qualities.
Young children do seem to think that objects that move may be alive, but after age three, they
seldom refer to objects as being alive (Berk, 2007).

Critique of Piaget: Similar to the critique of the sensorimotor period, several psychologists
have attempted to show that Piaget also underestimated the intellectual capabilities of the
preoperational child. For example, children’s specific experiences can influence when they are
able to conserve. Children of pottery makers in Mexican villages know that reshaping clay does
not change the amount of clay at much younger ages than children who do not have similar
experiences (Price-Williams et al., 1969). Crain (2005) indicated that preoperational children can
think rationally on mathematical and scientific tasks, and they are not as egocentric as Piaget
implied. Research on Theory of Mind (discussed later in the chapter) has demonstrated that
children overcome egocentrism by 4 or 5 years of age, which is sooner than Piaget indicated.

128
Vygotsky’s Sociocultural Theory of Cognitive Development

Figure 4.11 Lev Vygotsky Lev Vygotsky (1896-1934) was a Russian psychologist who
argued that culture has a major impact on a child’s cognitive
development. Piaget and Gesell believed development
stemmed directly from the child, and although Vygotsky
acknowledged intrinsic development, he argued that it is the
language, writings, and concepts arising from the culture that
elicit the highest level of cognitive thinking (Crain, 2005). He
believed that the social interactions with adults and more
learned peers can facilitate a child’s potential for learning.
Without this interpersonal instruction, he believed children’s
minds would not advance very far as their knowledge would
be based only on their own discoveries. Some of Vygotsky’s
key concepts are described below.

Source Zone of Proximal Development and Scaffolding:

Vygotsky’s best-known concept is the zone of proximal
development (ZPD). Vygotsky stated that children should be taught in the ZPD, which occurs
when they can almost perform a task, but not quite on their own without assistance. With the
right kind of teaching, however, they can accomplish it successfully. A good teacher identifies a
child’s ZPD and helps the child stretch beyond it. Then the adult (teacher) gradually withdraws
support until the child can then perform the task unaided. Researchers have applied the metaphor
of scaffolds (the temporary platforms on which construction workers stand) to this way of
teaching. Scaffolding is the temporary support that parents or teachers give a child to do a task.

Private Speech: Do you ever talk to yourself? Why? Chances are, this occurs when you are
struggling with a problem, trying to remember something, or feel very emotional about a
situation. Children talk to themselves too. Piaget interpreted this as egocentric speech or speech
that is focused on the child and does not include another’s point of view.

Vygotsky, however, believed that children talk to Figure 4.12 Children talk to
themselves in order to solve problems or clarify themselves to better problem solve
thoughts. As children learn to think in words, they do
so aloud before eventually closing their lips and
engaging in private speech or inner speech.

Thinking out loud eventually becomes thought

accompanied by internal speech and talking to oneself
becomes a practice only engaged in when we are
trying to learn something or remember
something. This inner speech is not as elaborate as
the speech we use when communicating with others
(Vygotsky, 1962). Source

129
Contrast with Piaget: Piaget was highly critical of teacher-directed instruction believing that
teachers who take control of the child’s learning place the child into a passive role (Crain, 2005).
Further, teachers may present abstract ideas without the child’s true understanding, and instead
they just repeat back what they heard. Piaget believed children must be given opportunities to
discover concepts on their own. As previously stated, Vygotsky did not believe children could
reach a higher cognitive level without instruction from more learned individuals. Who is
correct? Both theories certainly contribute to our understanding of how children learn.

Information Processing
Information processing researchers have focused on several issues in cognitive development for
this age group, including improvements in attention skills, changes in the capacity and the
emergence of executive functions in working memory. Additionally, in early childhood memory
strategies, memory accuracy, and autobiographical memory emerge. Early childhood is seen by
many researchers as a crucial time period in memory development (Posner & Rothbart, 2007).

Attention
Changes in attention have been described by many as the key to changes in human memory
(Nelson & Fivush, 2004; Posner & Rothbart, 2007). However, attention is not a unified
function; it is comprised of sub-processes. The ability to switch our focus between tasks or
external stimuli is called divided attention or multitasking. This is separate from our ability to
focus on a single task or stimulus, while ignoring distracting information, called selective
attention. Different from these is sustained attention, or the ability to stay on task for long
periods of time. Moreover, we also have attention processes that influence our behavior and
enable us to inhibit a habitual or dominant response, and others that enable us to distract
ourselves when upset or frustrated.

Figure 4.13 These children Divided Attention: Young children (age 3-4) have
will experience difficulty considerable difficulties in dividing their attention
focusing on anything except between two tasks, and often perform at levels equivalent
playing to our closest relative, the chimpanzee, but by age five
they have surpassed the chimp (Hermann et al., 2015;
Hermann & Tomasello, 2015). Despite these
improvements, 5-year-olds continue to perform below the
level of school-age children, adolescents, and adults.
Selective Attention: Children’s ability with selective
attention tasks improve as they age. However, this ability
is also greatly influenced by the child’s temperament
(Rothbart & Rueda, 2005), the complexity of the stimulus
or task (Porporino et al., 2004), and along with whether
the stimuli are visual or auditory (Guy et al., 2013). Guy
et al. found that children’s ability to selectively attend to
Source visual information outpaced that of auditory stimuli. This
may explain why young children are not able to hear the
130
voice of the teacher over the cacophony of sounds in the typical preschool classroom (Jones et
al., 2015). Jones and his colleagues found that 4 to 7-year-olds could not filter out background
noise, especially when its frequencies were close in sound to the target sound. In comparison, 8
to 11-year-old older children often performed similar to adults.
Sustained Attention: Most measures of sustained attention typically ask children to spend
several minutes focusing on one task, while waiting for an infrequent event, while there are
multiple distractors for several minutes. Berwid et al. (2005) asked children between the ages of
3 and 7 to push a button whenever a “target” image was displayed, but they had to refrain from
pushing the button when a non-target image was shown. The younger the child, the more
difficulty he or she had maintaining their attention.

Memory

Based on studies of adults, people with amnesia, and neurological research on memory,
researchers have proposed several “types” of memory (see Figure 4.14). Sensory memory (also
called the sensory register) is the first stage of the memory system, and it stores sensory input in
its raw form for a very brief duration; essentially long enough for the brain to register and start
processing the information. Studies of auditory sensory memory have found that the sensory
memory trace for the characteristics of a tone last about one second in 2-year-olds, two seconds
in 3-year-olds, more than two seconds in 4-year-olds and three to five seconds in 6-year-olds
(Glass et al., 2008). Other researchers have found that young children hold sounds for a shorter
duration than do older children and adults, and that this deficit is not due to attentional
differences between these age groups but reflect differences in the performance of the sensory
memory system (Gomes et al., 1999).

Figure 4.14

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The second stage of the memory system is called short-term or working memory. Working
memory is the component of memory in which current conscious mental activity occurs.
Working memory often requires conscious effort and adequate use of attention to function
effectively. As you read earlier, children in this age group struggle with many aspects of
attention, and this greatly diminishes their ability to consciously juggle several pieces of
information in memory. The capacity of working memory, that is the amount of information
someone can hold in consciousness, is smaller in young children than in older children and adults
(Galotti, 2018). The typical adult and teenager can hold a 7-digit number active in their short-
term memory. The typical 5-year-old can hold only a 4-digit number active. This means that the
more complex a mental task is, the less efficient a younger child will be in paying attention to,
and actively processing, information in order to complete the task.
Changes in attention and the working memory system also involve changes in executive
function. Executive function (EF) refers to self-regulatory processes, such as the ability to
inhibit a behavior or cognitive flexibility, that enable adaptive responses to new situations or to
reach a specific goal. Executive function skills gradually emerge during early childhood and
continue to develop throughout childhood and adolescence. Like many cognitive changes, brain
maturation, especially the prefrontal cortex, along with experience influence the development of
executive function skills. Children show higher executive function skills when parents are warm
and responsive, use scaffolding when the child is trying to solve a problem, and provide
cognitively stimulating environments (Fay-Stammbach et al., 2014). For instance, scaffolding
was positively correlated with greater cognitive flexibility at age two and inhibitory control at
age four (Bibok et al., 2009).
Older children and adults use mental strategies to aid their memory performance. For instance,
simple rote rehearsal may be used to commit information to memory. Young children often do
not rehearse unless reminded to do so, and when they do rehearse, they often fail to use
clustering rehearsal. In clustering rehearsal, the person rehearses previous material while
adding in additional information. If a list of words is read out loud to you, you are likely to
rehearse each word as you hear it along with any previous words you were given. Young
children will repeat each word they hear, but often fail to repeat the prior words in the list. In a
longitudinal study of 102 kindergarten children by Schneider et al. (2009), the majority of
children used no strategy to remember information, a finding that was consistent with previous
research. As a result, their memory performance was poor when compared to their abilities as
they aged and started to use more effective memory strategies.
The third component in memory is long-term memory, which is also known as permanent
memory. A basic division of long-term memory is between declarative and non-declarative
memory. Declarative memories, sometimes referred to as explicit memories, are memories for
facts or events that we can consciously recollect. Non-declarative memories, sometimes
referred to as implicit memories, are typically automated skills that do not require conscious
recollection. Remembering that you have an exam next week would be an example of a
declarative memory. In contrast, knowing how to walk so you can get to the classroom or how
to hold a pencil to write would be examples of non-declarative memories. Declarative memory
is further divided into semantic and episodic memory. Semantic memories are memories for
facts and knowledge that are not tied to a timeline, while episodic memories are tied to specific
events in time.

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 Figure 4.15 How long will A component of episodic memory is autobiographical
these children remember memory, or our personal narrative. As you may recall in
their trip to Disneyland? Chapter 3, the concept of infantile amnesia was introduced.
Adults rarely remember events from the first few years of
life. In other words, we lack autobiographical memories
from our experiences as an infant, toddler and very young
preschooler. Several factors contribute to the emergence of
autobiographical memory, including brain maturation,
improvements in language, opportunities to talk about
experiences with parents and others, the development of
theory of mind, and a representation of “self” (Nelson &
Fivush, 2004). Two-year-olds do remember fragments of
personal experiences, but these are rarely coherent accounts
of past events (Nelson & Ross, 1980). Between 2 and 2 ½
years of age children can provide more information about
past experiences. However, these recollections require
considerable prodding by adults (Nelson & Fivush, 2004).
Over the next few years, children will form more detailed
Source autobiographical memories and engage in more reflection of
the past.

Neo-Piagetians
As previously discussed, Piaget’s theory has been criticized on many fronts, and updates to
reflect more current research have been provided by the Neo-Piagetians, or those theorists who
provide “new” interpretations of Piaget’s theory. Morra et al. (2008) reviewed Neo-Piagetian
theories, which were first presented in the 1970s, and identified how these “new” theories
combined Piagetian concepts with those found in Information Processing. Similar to Piaget’s
theory, Neo-Piagetian theories believe in constructivism, assume cognitive development can be
separated into different stages with qualitatively different characteristics, and advocate that
children’s thinking becomes more complex in advanced stages. Unlike Piaget, Neo-Piagetians
believe that aspects of information processing change the complexity of each stage, not logic as
determined by Piaget.

Neo-Piagetians propose that working memory capacity is affected by biological maturation, and
therefore restricts young children’s ability to acquire complex thinking and reasoning skills.
Increases in working memory performance and cognitive skills development coincide with the
timing of several neurodevelopmental processes. These include myelination, axonal and
synaptic pruning, changes in cerebral metabolism, and changes in brain activity (Morra et al.,
2008). Myelination especially occurs in waves between birth and adolescence, and the degree of
myelination in particular areas explains the increasing efficiency of certain skills. Therefore,
brain maturation, which occurs in spurts, affects how and when cognitive skills develop.
Additionally, all Neo-Piagetian theories support that experience and learning interact with
biological maturation in shaping cognitive development.

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Children’s Understanding of the World
Both Piaget and Vygotsky believed that children actively try to understand the world around
them, referred to as constructivism. However, Piaget is identified as a cognitive
constructivitst, which focuses on independent learning, while Vygotsky is a social constrctivist
relying on social interactions for learning. More recently developmentalists have added to this
understanding by examining how children organize information and develop their own theories
about the world.

Theory-Theory is the tendency of

children to generate theories to Figure 4.16
explain everything they encounter.
This concept implies that humans
are naturally inclined to find
reasons and generate explanations
for why things occur. Children
frequently ask question about what
they see or hear around them.
When the answers provided do not
satisfy their curiosity or are too
complicated for them to understand,
they generate their own theories. In
much the same way that scientists
construct and revise their theories, Source
children do the same with their
intuitions about the world as they
encounter new experiences (Gopnik & Wellman, 2012). One of the theories they start to generate
in early childhood centers on the mental states; both their own and those of others.

Theory of mind refers to the ability to think about other people’s thoughts. This mental mind
reading helps humans to understand and predict the reactions of others, thus playing a crucial
role in social development. One common method for determining if a child has reached this
mental milestone is the false belief task. The research began with a clever experiment by
Wimmer and Perner (1983), who tested whether children can pass a false-belief test (see Figure
4.17). The child is shown a picture story of Sally, who puts her ball in a basket and leaves the
room. While Sally is out of the room, Anne comes along and takes the ball from the basket and
puts it inside a box. The child is then asked where Sally thinks the ball is located when she
comes back to the room. Is she going to look first in the box or in the basket? The right answer is
that she will look in the basket, because that is where she put it and thinks it is; but we have to
infer this false belief against our own better knowledge that the ball is in the box. This is very
difficult for children before the age of four because of the cognitive effort it takes. Three-year-
olds have difficulty distinguishing between what they once thought was true and what they now
know to be true. They feel confident that what they know now is what they have always known
(Birch & Bloom, 2003). Even adults need to think through this task (Epley et al., 2004). To be
successful at solving this type of task the child must separate what he or she “knows” to be true
from what someone else might “think” is true.

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In Piagetian terms, children must give up a Figure 4. 17
tendency toward egocentrism. The child must
also understand that what guides people’s
actions and responses are what they believe
rather than what is reality. In other words,
people can mistakenly believe things that are
false and will act based on this false knowledge.
Consequently, prior to age four children are
rarely successful at solving such a task
(Wellman et al., 2001).

Researchers examining the development of

theory of mind have been concerned by the
overemphasis on the mastery of false belief as
the primary measure of whether a child has
attained theory of mind. Two-year-olds
understand the diversity of desires, yet as noted
earlier it is not until age four or five that
children grasp false belief, and often not until
middle childhood do they understand that
people may hide how they really feel. In part,
because children in early childhood have
difficulty hiding how they really feel. Wellman
and his colleagues (Wellman et al., 2006)
suggest that theory of mind is comprised of a
number of components, each with its own
developmental timeline (see Table 4.2).

Those in early childhood in the US, Australia,

and Germany develop theory of mind in the
sequence outlined in Table 4.2. Yet, Chinese Source
and Iranian preschoolers acquire knowledge
access before diverse beliefs (Shahaeian et al., 2011). Shahaeian and colleagues suggested that
cultural differences in child-rearing may account for this reversal. Parents in collectivistic
cultures, such as China and Iran, emphasize conformity to the family and cultural values, greater
respect for elders, and the acquisition of knowledge and academic skills more than they do
autonomy and social skills (Frank et al., 2010). This could reduce the degree of familial conflict
of opinions expressed in the family. In contrast, individualistic cultures encourage children to
think for themselves and assert their own opinion, and this could increase the risk of conflict in
beliefs being expressed by family members. As a result, children in individualistic cultures
would acquire insight into the question of diversity of belief earlier, while children in
collectivistic cultures would acquire knowledge access earlier in the sequence. The role of
conflict in aiding the development of theory of mind may account for the earlier age of onset of
an understanding of false belief in children with siblings, especially older siblings (McAlister &
Petersen, 2007; Perner et al., 1994).

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 Table 4.2 Components of Theory of Mind

Component Description
Diverse-desires Understanding that two people may have different desires
regarding the same object.
Diverse-beliefs Understanding that two people may hold different beliefs
about an object.
Knowledge access Understanding that people may or may not have access to
(knowledge/ignorance) information.
False belief Understanding that someone might hold a belief based on
false information.
Hidden emotion Understanding that people may not always express their
true emotions.

This awareness of the existence of theory of mind is part of social intelligence, such as
recognizing that others can think differently about situations. It helps us to be self-conscious or
aware that others can think of us in different ways and it helps us to be able to be understanding
or be empathic toward others. Moreover, this mind reading ability helps us to anticipate and
predict people’s actions. The awareness of the mental states of others is important for
communication and social skills.

Language Development
Vocabulary growth: A child’s vocabulary expands between the ages of two to six from about
200 words to over 10,000 words. This “vocabulary spurt” typically involves 10-20 new words
per week and is accomplished through a process called fast-mapping. Words are easily learned
by making connections between new words and concepts already known. The parts of speech that
are learned depend on the language and what is emphasized. Children speaking verb-friendly
languages, such as Chinese and Japanese, learn verbs more readily, while those speaking English
tend to learn nouns more readily. However, those learning less verb-friendly languages, such as
English, seem to need assistance in grammar to master the use of verbs (Imai et al., 2008).

Literal meanings: Children can repeat words and phrases after having heard them only once or
twice, but they do not always understand the meaning of the words or phrases. This is especially
true of expressions or figures of speech which are taken literally. For example, a classroom full
of preschoolers hears the teacher say, “Wow! That was a piece of cake!” The children began
asking “Cake? Where is my cake? I want cake!”

Overregularization: Children learn rules of grammar as they learn language but may apply
these rules inappropriately at first. For instance, a child learns to add “ed” to the end of a word to
indicate past tense. Then form a sentence such as “I goed there. I doed that.” This is typical at
ages two and three. They will soon learn new words such as “went” and “did” to be used in
those situations.

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The impact of training: Remember Vygotsky and the Zone of Proximal Development?
Children can be assisted in learning language by others who listen attentively, model more
accurate pronunciations and encourage elaboration. The child exclaims, “I’m goed there!” and
the adult responds, “You went there? Say, ‘I went there.’ Where did you go?” Children may be
ripe for language as Chomsky suggests, but active participation in helping them learn is
important for language development as well. The process of scaffolding is one in which the
guide provides needed assistance to the child as a new skill is learned.

Bilingualism
Although monolingual speakers often do not realize it, the majority of children around the world
are Bilingual, meaning that they understand and use two languages (Meyers-Sutton, 2005).
Even in the United States, which is a relatively monolingual society, more than 60 million people
(21%) speak a language other than English at home (Camarota & Zeigler, 2014; Ryan, 2013).
Children who are dual language learners are one of the fastest growing populations in the United
States (Hammer et al., 2014). They make up nearly 30% of children enrolled in early childhood
programs, like Head Start. By the time they enter school, they are very heterogeneous in their
language and literacy skills, with some children showing delays in being proficient in either one
or both languages (Hammer et al., 2014). Hoff (2018) reports language competency is
dependent on the quantity, quality, and opportunity to use a language. Dual language learners
may hear the same number of words and phrases (quantity) overall, as do monolingual children,
but it is split between two languages (Hoff, 2018). Thus, in any single language they may be
exposed to fewer words. They will show higher expressive and receptive skills in the language
they come to hear the most.

In addition, the quality of the languages spoken to the child may differ in bilingual versus
monolingual families. Place and Hoff (2016) found that for many immigrant children in the
United States, most of the English heard was spoken by a non-native speaker of the language.
Finally, many children in bilingual households will sometimes avoid using the family’s heritage
language in favor of the majority language (DeHouwer, 2007, Hoff, 2018). A common pattern in
Spanish-English homes, is for the parents to speak to the child in Spanish, but for the child to
respond in English. As a result, children may show little difference in the receptive skills
between English and Spanish, but better expressive skills in English (Hoff, 2018).

There are several studies that have documented the advantages of learning more than one
language in childhood for cognitive executive function skills. Bilingual children consistently
outperform monolinguals on measures of inhibitory control, such as ignoring irrelevant
information (Bialystok et al., 2005). Studies also reveal an advantage for bilingual children on
measures of verbal working memory (Kaushanskaya et al., 2014; Yoo & Kaushanskaya, 2012)
and non-verbal working memory (Bialystok, 2011). However, it has been reported that among
lower SES populations the working memory advantage is not always found (Bonifacci et al.,
2011).

There is also considerable research to show that being bilingual, either as a child or an adult,
leads to greater efficiency in the word learning process. Monolingual children are strongly
influenced by the mutual-exclusivity bias, the assumption that an object has only a single name

137
(Kaushanskaya et al., 2014). For example, a child who has previously learned the word car, may
be confused when this object is referred to as an automobile or sedan. Research shows that
monolingual children find it easier to learn the name of a new object, than acquiring a new name
for a previously labelled object. In contrast, bilingual children and adults show little difficulty
with either task (Kaushanskaya & Marian, 2009). This finding may be explained by the
experience bilinguals have in translating between languages when referring to familiar objects.

Preschool
Providing universal preschool has become an important lobbying point for federal, state, and
local leaders throughout our country. In his 2013 State of the Union address, President Obama
called upon congress to provide high quality preschool for all children. He continued to support
universal preschool in his legislative agenda, and in December 2014 the President convened
state and local policymakers for the White House Summit on Early Education (White House
Press Secretary, 2014). However, universal preschool covering all four-year olds in the
country would require significant funding. Further, how effective preschools are in preparing
children for elementary school, and what constitutes high quality preschool have been debated.
To set criteria for designation as a high-quality preschool, the National Association for the
Education of Young Children (NAEYC) identifies 10 standards (NAEYC, 2016). These
include:

x Positive relationships among all children and adults are promoted.

x A curriculum that supports learning and development in social, emotional, physical,
language, and cognitive areas.
x Teaching approaches that are developmentally, culturally and linguistically appropriate.
x Assessment of children’s progress to provide information on learning and development.
x The health and nutrition of children are promoted, while they are protected from illness
and injury.
x Teachers possess the educational qualifications, knowledge, and commitment to promote
children’s learning.
x Collaborative relationships with families are established and maintained.
x Relationships with agencies and institutions in the children’s communities are established
to support the program’s goals.
x The indoor and outdoor physical environments are safe and well-maintained.
x Leadership and management personnel are well qualified, effective, and maintain
licensure status with the applicable state agency.
Parents should review preschool programs using the NAEYC criteria as a guide and template for
asking questions that will assist them in choosing the best program for their child. Selecting the
right preschool is also difficult because there are so many types of preschools available. Zachry
(2013) identified Montessori, Waldorf, Reggio Emilia, High Scope, Parent Co-Ops and Bank
Street as types of preschool programs that focus on children learning through discovery.
Teachers act as guides and create activities based on the child’s developmental level.

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Head Start: For children who live in Figure 4.18 Four Year Old Head Start Students
poverty, Head Start has been
providing preschool education since
1965 when it was begun by President
Lyndon Johnson as part of his war on
poverty. It currently serves nearly
one million children and annually
costs approximately 7.5 billion
dollars (United States Department of
Health and Human Services, 2015).
However, concerns about the
effectiveness of Head Start have been
ongoing since the program began.
Armor (2015) reviewed existing
research on Head Start and found
there were no lasting gains, and the Source
average child in Head Start had not
learned more than children who did not receive preschool education.

A 2015 report evaluating the effectiveness of Head Start comes from the What Works
Clearinghouse. The What Works Clearinghouse identifies research that provides reliable
evidence of the effectiveness of programs and practices in education and is managed by the
Institute of Education Services for the United States Department of Education. After reviewing
90 studies on the effectiveness of Head Start, only one study was deemed scientifically
acceptable and this study showed disappointing results (Barshay, 2015). This study showed that
3-and 4-year-old children in Head Start received “potentially positive effects” on general reading
achievement, but no noticeable effects on math achievement and social-emotional development.

Nonexperimental designs are a significant problem in determining the effectiveness of Head

Start programs because a control group is needed to show group differences that would
demonstrate educational benefits. Because of ethical reasons, low income children are usually
provided with some type of pre-school programming in an alternative setting. Additionally, head
Start programs are different depending on the location, and these differences include the length
of the day or qualification of the teachers. Lastly, testing young children is difficult and strongly
dependent on their language skills and comfort level with an evaluator (Barshay, 2015).

Autism Spectrum Disorder

A greater discussion on disorders affecting children and special educational services to assist
them will occur in Chapter 5. However, because characteristics of autism spectrum disorder
must be present in the early developmental period, as established by the DSM-5-TR (American
Psychiatric Association, 2022), this disorder will be presented here. So, what exactly is an
autism spectrum disorder?

Autism spectrum disorder is probably the most misunderstood and puzzling of the
neurodevelopmental disorders. Children with this disorder show signs of significant
disturbances in three main areas: (a) deficits in social interaction, (b) deficits in

139
communication, and (c) repetitive patterns of behavior or interests. These disturbances
appear early in life and cause serious impairments in functioning (American Psychiatric
Association, 2022). The child with autism spectrum disorder might exhibit deficits in social
interaction by not initiating conversations with other children or turning their head away when
spoken to. These children do not make eye contact with others and seem to prefer playing
alone rather than with others. In a certain sense, it is almost as though these individuals live in
a personal and isolated social world which others are simply not privy to or able to penetrate.
Communication deficits can range from a complete lack of speech, to one-word responses
(e.g., saying “Yes” or “No” when replying to questions or statements that require additional
elaboration), to echoed speech (e.g., parroting what another person says, either immediately
or several hours or even days later), and to difficulty maintaining a conversation because of
an inability to reciprocate others’ comments. These deficits can also include problems in
using and understanding nonverbal cues (e.g., facial expressions, gestures, and postures) that
facilitate normal communication.

Repetitive patterns of behavior or interests can be exhibited a number of ways. The child
might engage in stereotyped, repetitive movements (rocking, head-banging, or repeatedly
dropping an object and then picking it up), or she might show great distress at small
changes in routine or the environment. For example, the child might throw a temper tantrum
if an object is not in its proper place or if a regularly-scheduled activity is rescheduled. In
some cases, the person with autism spectrum disorder might show highly restricted and
fixated interests that appear to be abnormal in their intensity. For instance, the child might
learn and memorize every detail about something even though doing so serves no apparent
purpose. Importantly, autism spectrum disorder is not the same thing as intellectual disability,
although these two conditions can occur together. The DSM-5-TR specifies that the
symptoms of autism spectrum disorder are not caused or explained by intellectual disability.

Figure 4.19 Dr. Temple The qualifier “spectrum” in autism spectrum disorder
Grandin, an advocate for is used to indicate that individuals with the disorder
individuals with autism can show a range, or spectrum, of symptoms that
vary in their magnitude and severity: Some severe,
others less severe. The previous edition of the DSM
included a diagnosis of Asperger’s disorder, generally
recognized as a less severe form of autistim spectrum
disorder. Individuals diagnosed with Asperger’s
disorder were described as having average or high
intelligence and a strong vocabulary, but exhibiting
impairments in social interaction and social
communication, such as talking only about their special
interests (Wing et al., 2011). However, because research
has failed to demonstrate that Asperger’s disorder
Source
differs from autism spectrum disorder, the DSM-5-TR
does not include it. Some individuals with autism
spectrum disorder, particularly those with better language and intellectual skills, can live
and work independently as adults. However, most do not because the symptoms cause serious
impairment in many aspects of life (APA, 2022).

140
To determine current prevalence rates, the Autism and Developmental Disabilities Monitoring
(ADDM) Network provides estimates of the prevalence of autism spectrum disorders among 8-
year-old children who reside within 11 ADM sites in the United States, including Arizona,
Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina,
Tennessee, and Wisconsin (Baio et al., 2018). For 2014 (most recent data), estimates indicated
that nearly 1 in 59 children in the United States has autism spectrum disorder, and the disorder is
4 times more common in boys (1 out of 38) than girls (1 out of 152).

Rates of autistim spectrum disorder have increased dramatically since the 1980s. For example,
California saw an increase of 273% in reported cases from 1987 through 1998 (Byrd, 2002).
Between 2000 and 2008, the rate of autism diagnoses in the United States increased 78% (CDC,
2012) and between 2000 and 2014 the rate increased 150% (Baio et al., 2018). Although it is
difficult to interpret this increase, it is possible that the rise in prevalence is the result of the
broadening of the diagnosis, increased efforts to identify cases in the community, and greater
awareness and acceptance of the diagnosis. In addition, mental health professionals are now
more knowledgeable about autism spectrum disorder and are better equipped to make the
diagnosis, even in subtle cases (Novella, 2008).

The exact causes of autism spectrum disorder remain unknown despite massive research
efforts over the last two decades (Meek, Lemery-Chalfant, Jahromi, & Valiente, 2013). Autism
appears to be strongly influenced by genetics, as identical twins show concordance rates of 60%–
90%, whereas concordance rates for fraternal twins and siblings are 5%–10% (Autism Genome
Project Consortium, 2007). Many different genes and gene mutations have been implicated in
autism (Meek et al., 2013). Among the genes involved are those important in the formation of
synaptic circuits that facilitate communication between different areas of the brain (Gauthier
et al., 2011). A number of environmental factors are also thought to be associated with
increased risk for autism spectrum disorder, at least in part, because they contribute to new
mutations. These factors include exposure to pollutants, such as plant emissions and mercury,
urban versus rural residence, and vitamin D deficiency (Kinney et al., 2009).

A recent Swedish study looking at the records of over one million children born between 1973
and 2014 found that exposure to prenatal infections increased the risk for autism spectrum
disorders (al-Haddad et al., 2019). Children born to mothers with an infection during pregnancy
has a 79% increased risk of autism. Infections included: sepsis, flu, pneumonia, meningitis,
encephalitis, an infection of the placental tissues or kidneys, or a urinary tract infection. One
possible reason for the autism diagnosis is that the fetal brain is extremely vulnerable to damage
from infections and inflammation. These results highlighted the importance of pregnant
women receiving a flu vaccination and avoiding any infections during pregnancy.

There is no scientific evidence that a link exists between autism and vaccinations (Hughes,
2007). Indeed, a recent study compared the vaccination histories of 256 children with autism
spectrum disorder with that of 752 control children across three time periods during their first
two years of life (birth to 3 months, birth to 7 months, and birth to 2 years) (DeStefano et al.,
2013). At the time of the study, the children were between 6 and 13 years old, and their prior
vaccination records were obtained. Because vaccines contain immunogens (substances that
fight infections), the investigators examined medical records to see how many immunogens

141
children received to determine if those children who received more immunogens were at
greater risk for developing autism spectrum disorder. The results of this study clearly
demonstrated that the quantity of immunogens from vaccines received during the first two
years of life were not at all related to the development of autism spectrum disorder.

Learning Objectives: Psychosocial Development in Early Childhood

x Describe Erikson’s third stage of initiative vs. guilt

x Describe the changes in self-concept and self-esteem
x Describe children’s understanding of others
x Describe emotional regulation and delayed gratification
x Describe young children’s understanding of morality
x Summarize the main theories of gender development
x Explain the terms transgender, gender dysphoria, and intersex
x Describe the major parenting styles and their consequences for children
x Describe the role of siblings in children’s development
x Summarize the types of play in which children engage
x Describe the influence of the media on young children’s social development

Erikson: Initiative vs. Guilt

The trust and autonomy of previous stages develop into a desire to take initiative or to think of
ideas and initiative action (Erikson, 1982). Children may want to build a fort with the cushions
from the living room couch or open a lemonade stand in the driveway or make a zoo with their
stuffed animals and issue tickets to those who want to come. Or they may just want to get
themselves ready for bed without any assistance. To reinforce taking initiative, caregivers should
offer praise for the child’s efforts and avoid being critical of messes or mistakes. Placing
pictures of drawings on the refrigerator, purchasing mud pies for dinner, and admiring towers of
legos will facilitate the child’s sense of initiative.

Self-Concept and Self-Esteem

Early childhood is a time of forming an initial sense of self. Self-concept is our self-description
according to various categories, such as our external and internal qualities. In contrast, self-
esteem is an evaluative judgment about who we are. The emergence of cognitive skills in this
age group results in improved perceptions of the self. If asked to describe yourself to others you
would likely provide some physical descriptors, group affiliation, personality traits, behavioral
quirks, values, and beliefs. When researchers ask young children the same open-ended question,
the children provide physical descriptors, preferred activities, and favorite possessions. Thus, a
three-year-old might describe herself as a three years-old girl with red hair, who likes to play
with legos. This focus on external qualities is referred to as the categorical self.
However, even children as young as three know there is more to themselves than these external

142
characteristics. Harter and Pike (1984) challenged the method of measuring personality with an
open-ended question as they felt that language limitations were hindering the ability of young
children to express their self-knowledge. They suggested a change to the method of measuring
self-concept in young children, whereby researchers provide statements that ask whether
something is true of the child (e.g., “I like to boss people around”, “I am grumpy most of the
time”). Consistent with Harter and Pike’s suspicions, those in early childhood answer these
statements in an internally consistent manner, especially after the age of four (Goodvin et al.,
2008) and often give similar responses to what others (parents and teachers) say about the child
(Brown et al., 2008; Colwell & Lindsey, 2003).

Young children tend to have a generally positive self-

image. This optimism is often the result of a lack of Figure 4.20
social comparison when making self-evaluations
(Ruble et al., 1980), and with comparison between
what the child once could do to what they can do
now (Kemple, 1995). However, this does not mean
that preschool children are exempt from negative
self-evaluations. Preschool children with insecure
attachments to their caregivers tend to have lower
self-esteem at age four (Goodvin et al., 2008).
Maternal negative affect was also found by Goodwin Source
and her colleagues to produce more negative self-
evaluations in preschool children.

Self-Control
Self-control is not a single phenomenon but is multi-facetted. It includes response initiation,
the ability to not initiate a behavior before you have evaluated all the information, response
inhibition, the ability to stop a behavior that has already begun, and delayed gratification, the
ability to hold out for a larger reward by forgoing a smaller immediate reward (Dougherty et al.,
2005). It is in early childhood that we see the start of self-control, a process that takes many
years to fully develop. In the now classic “Marshmallow Test” (Mischel et al., 1972) children are
confronted with the choice of a small immediate reward (a marshmallow) and a larger delayed
reward (more marshmallows). Walter Mischel and his colleagues over the years have found that
the ability to delay gratification at the age of four predicted better academic performance and
health later in life (Mischel, et al., 2011). Self-control is related to executive function, discussed
earlier in the chapter. As executive function improves, children become less impulsive (Traverso
et al., 2015).

Gender
Another important dimension of the self is the sense of self as male or female. Preschool aged
children become increasingly interested in finding out the differences between boys and girls,
both physically and in terms of what activities are acceptable for each. While two-year-olds can
identify some differences and learn whether they are boys or girls, preschoolers become more

143
interested in what it means to be male or female. Gender is the cultural, social and
psychological meanings associated with masculinity and feminity (Spears Brown & Jewell,
2018). A person’s sense of self as a member of a particular gender is known as gender identity.
The development of gender identity appears to be due to an interaction among biological, social
and representational influences (Ruble et al., 2006). Gender roles, or the expectations
associated with being male or female, are learned in one’s culture throughout childhood and into
adulthood.

Gender socialization focuses on what young children Figure 4.21 Gender Roles
learn about gender from society, including parents, peers,
media, religious institutions, schools, and public policies.
Children learn about what is acceptable for females and
males early, and in fact, this socialization may even begin
the moment a parent learns that a child is on the
way. Knowing the sex of the child can conjure up images
of the child’s behavior, appearance, and potential on the
part of a parent, and this stereotyping continues to guide
perception through life. Consider parents of newborns,
shown a 7-pound, 20-inch baby, wrapped in blue (a color
designating males) describe the child as tough, strong, and
angry when crying. Shown the same infant in pink (a
color used in the United States for baby girls), these
parents are likely to describe the baby as pretty, delicate,
and frustrated when crying (Maccoby & Jacklin,
1987). Female infants are held more, talked to more
frequently and given direct eye contact, while male infant
interactions are often mediated through a toy or activity. Source

As they age, sons are given tasks that take them outside the house and that have to be performed
only on occasion, while girls are more likely to be given chores inside the home, such as
cleaning or cooking that are performed daily. Sons are encouraged to think for themselves when
they encounter problems and daughters are more likely to be given assistance, even when they
are working on an answer. Parents also talk to their children differently according to their
gender. For example, parents talk to sons more in detail about science, and they discuss numbers
and counting twice as often than with daughters (Chang et al., 2011). How are these beliefs about
behaviors and expectations based on gender transmitted to children?

Theories of Gender Development

One theory of gender development in children is social learning theory, which argues that
behavior is learned through observation, modeling, reinforcement, and punishment (Bandura,
1997). Children are rewarded and reinforced for behaving in concordance with gender roles that
have been presented to them since birth and punished for breaking gender roles. In addition,
social learning theory states that children learn many of their gender roles by modeling the
behavior of adults and older children and, in doing so, develop ideas about what behaviors are
appropriate for each gender. Cognitive social learning theory also emphasizes reinforcement,

144
punishment, and imitation, but adds cognitive processes. These processes include attention, self-
regulation, and self-efficacy. Once children learn the significance of gender, they regulate their
own behavior based on internalized gender norms (Bussey & Bandura, 1999).

Another theory is that children develop their own conceptions of the attributes associated with
maleness or femaleness, which is referred to as gender schema theory (Bem, 1981). Once
children have identified with a particular gender, they seek out information about gender traits,
behaviors, and roles. This theory is more constructivist as children are actively acquiring their
gender. For example, friends discuss what is acceptable for boys and girls, and popularity may
be based on what is considered ideal behavior for their gender.

Developmental intergroup theory states that many of our gender stereotypes are so strong
because we emphasize gender so much in culture (Bigler & Liben, 2007). Developmental
intergroup theory postulates that adults’ heavy focus on gender leads children to pay attention to
gender as a key source of information about themselves and others, to seek out any possible
gender differences, and to form rigid stereotypes based on gender that are subsequently difficult
to change.

Transgender Children

Many young children do not conform to the gender roles modeled by the culture and even push
back against assigned roles. However, a small percentage of children actively reject the toys,
clothing, and anatomy of their assigned sex and state they prefer the toys, clothing and anatomy
of the opposite sex. Approximately 0.3 percent of the United States population identify as
transgender or identifying with the gender opposite their natal sex (Olson & Gülgöz, 2018).
Some of these children may experience gender dysphoria, or a marked incongruence between
one’s assigned gender and their experienced/expressed gender (American Psychiatric
Association, 2022). However, other children do not experience discomfort regarding their gender
identity. Transgender adults have stated that they identified with the opposite gender as soon as
they began talking (Russo, 2016).
Current research is now looking at those young children who identify as transgender and have
socially transitioned. In 2013, a longitudinal study following 300 socially transitioned
transgender children between the ages of 3 and 12 began (Olson & Gülgöz, 2018). Socially
transitioned transgender children identify with the gender opposite than the one assigned at birth,
and they change their appearance and pronouns to reflect their gender identity. Findings from
the study indicated that the gender development of these socially transitioned children looked
similar to the gender development of cisgender children, or those whose gender and sex
assignment at birth matched. These socially transitioned transgender children exhibited similar
gender preferences and gender identities as their gender matched peers. Further, these children
who were living everyday according to their gender identity and were supported by their
families, exhibited positive mental health.

Some individuals who identify as transgender are intersex; that is born with either an absence or
some combination of male and female reproductive organs, sex hormones, or sex chromosomes
(Jarne & Auld, 2006). In humans, intersex individuals make up more than 150 million people, or

145
about two percent of the world’s population (Blackless et al., 2000). There are dozens of intersex
conditions, and intersex individuals demonstrate the diverse variations of biological sex. Some
examples of intersex conditions include:

x Turner syndrome or the absence of, or an imperfect, second X chromosome

x Congenital adrenal hyperplasia or a genetic disorder caused by an increased
production of androgens
x Androgen insensitivity syndrome or when a person has one X and one Y chromosome,
but is resistant to the male hormones or androgens

Greater attention to the rights of children born intersex is occurring in the medical field, and
intersex children and their parents should work closely with specialists to ensure these children
develop positive gender identities.

How much does gender matter for children: Starting at birth, children learn the social
meanings of gender from adults and their culture. Gender roles and expectations are especially
portrayed in children’s toys, books, commercials, video games, movies, television shows and
music (Khorr, 2017). Therefore, when children make choices regarding their gender
identification, expression, and behavior that may be contrary to gender stereotypes, it is
important that they feel supported by the caring adults in their lives. This support allows children
to feel valued, resilient, and develop a secure sense of self (American Academy of Pediatricians,
2015).

Parenting Styles
Relationships between parents and children continue to play a significant role in children’s
development during early childhood. As children mature, parent-child relationships naturally
change. Preschool and grade-school children are more capable, have their own preferences, and
sometimes refuse or seek to compromise with parental expectations. This can lead to greater
parent-child conflict, and how conflict is managed by parents further shapes the quality of
parent-child relationships.

Baumrind (1971) identified a model of parenting Figure 4.22 Authoritative Parenting

that focuses on the level of control/ expectations that
parents have regarding their children and how
warm/responsive they are. This model resulted in
four parenting styles. In general, children develop
greater competence and self-confidence when
parents have high, but reasonable expectations for
children’s behavior, communicate well with them,
are warm, loving and responsive, and use reasoning,
rather than coercion as preferred responses to
children’s misbehavior. This kind of parenting style
has been described as authoritative (Baumrind,
Source
2013). Authoritative parents are supportive and
show interest in their kids’ activities but are not

146
overbearing and allow them to make constructive mistakes. Parents allow negotiation where
appropriate, and consequently this type of parenting is considered more democratic.

Authoritarian is the traditional model of parenting in which parents make the rules and
children are expected to be obedient. Baumrind suggests that authoritarian parents tend to place
maturity demands on their children that are unreasonably high and tend to be aloof and
distant. Consequently, children reared in this way may fear rather than respect their parents and,
because their parents do not allow discussion, may take out their frustrations on safer targets-
perhaps as bullies toward peers.

Permissive parenting involves holding expectations of children that are below what could be
reasonably expected from them. Children are allowed to make their own rules and determine
their own activities. Parents are warm and communicative but provide little structure for their
children. Children fail to learn self-discipline and may feel somewhat insecure because they do
not know the limits.

Uninvolved parents are disengaged from their children. They do not make demands on their
children and are non-responsive. These children can suffer in school and in their relationships
with their peers (Gecas & Self, 1991).

Keep in mind that most parents do not follow any model completely. Real people tend to fall
somewhere in between these styles. Sometimes parenting styles change from one child to the
next or in times when the parent has more or less time and energy for parenting. Parenting styles
can also be affected by concerns the parent has in other areas of his or her life. For example,
parenting styles tend to become more authoritarian when parents are tired and perhaps more
authoritative when they are more energetic. Sometimes parents seem to change their parenting
approach when others are around, maybe because they become more self-conscious as parents or
are concerned with giving others the impression that they are a “tough” parent or an “easy-
going” parent. Additionally, parenting styles may reflect the type of parenting someone saw
modeled while growing up. See Table 4.3 for Baumrind’s parenting style descriptions.

Table 4.3 Comparison of Four Parenting Styles

147
Culture: The impact of culture and class cannot be ignored when examining parenting
styles. The model of parenting described above assumes that the authoritative style is the best
because this style is designed to help the parent raise a child who is independent, self-reliant and
responsible. These are qualities favored in “individualistic” cultures such as the United States,
particularly by the middle class. However, in “collectivistic” cultures such as China or Korea,
being obedient and compliant are favored behaviors. Authoritarian parenting has been used
historically and reflects cultural need for children to do as they are told. African-American,
Hispanic and Asian parents tend to be more authoritarian than non-Hispanic whites. In societies
where family members’ cooperation is necessary for survival, rearing children who are
independent and who strive to be on their own makes no sense. However, in an economy based
on being mobile in order to find jobs and where one’s earnings are based on education, raising a
child to be independent is very important.

In a classic study on social class and parenting styles, Kohn (1977) explains that parents tend to
emphasize qualities that are needed for their own survival when parenting their children.
Working class parents are rewarded for being obedient, reliable, and honest in their jobs. They
are not paid to be independent or to question the management; rather, they move up and are
considered good employees if they show up on time, do their work as they are told, and can be
counted on by their employers. Consequently, these parents reward honesty and obedience in
their children. Middle class parents who work as professionals are rewarded for taking initiative,
being self-directed, and assertive in their jobs. They are required to get the job done without
being told exactly what to do. They are asked to be innovative and to work independently. These
parents encourage their children to have those qualities as well by rewarding independence and
self-reliance. Parenting styles can reflect many elements of culture.

Spanking
Spanking is often thought of as a rite of passage for children, and this method of discipline
continues to be endorsed by the majority of parents (Smith, 2012). Just how effective is
spanking, however, and are there any negative consequences? After reviewing the research,
Smith (2012) states “many studies have shown that physical punishment, including spanking,
hitting and other means of causing pain, can lead to increased aggression, antisocial behavior,
physical injury and mental health problems for children” (p. 60). Gershoff, (2008) reviewed
decades of research and recommended that parents and caregivers make every effort to avoid
physical punishment and called for the banning of physical discipline in all U.S. schools.

In a longitudinal study that followed more than 1500 families from 20 U.S. cities, parents’
reports of spanking were assessed at ages three and five (MacKenzie et al., 2013). Measures of
externalizing behavior and receptive vocabulary were assessed at age nine. Results indicated
that those children who were spanked at least twice a week by their mothers scored 2.66 points
higher on a measure of aggression and rule-breaking than those who were never spanked.
Additionally, those who were spanked less, still scored 1.17 points higher than those never
spanked. When fathers did the spanking, those spanked at least two times per week scored 5.7
points lower on a vocabulary test than those never spanked. This study revealed the negative
cognitive effects of spanking in addition to the increase in aggressive behavior.

148
Internationally, physical discipline is increasingly being viewed as a violation of children’s
human rights. According to Save the Children (2019), 46 countries have banned the use of
physical punishment, and the United Nations Committee on the Rights of the Child (2014) called
physical punishment “legalized violence against children” and advocated that physical
punishment be eliminated in all settings.

Many alternatives to spanking are advocated by child development specialists and include:
x Praising and modeling appropriate behavior
x Providing time-outs for inappropriate behavior
x Giving choices
x Helping the child identify emotions and learning to calm down
x Ignoring small annoyances
x Withdrawing privileges

Sibling Relationships

Figure 4.23 Siblings spend a considerable amount of time with each

other and offer a unique relationship that is not found
with same-age peers or with adults. Siblings play an
important role in the development of social skills.
Cooperative and pretend play interactions between
younger and older siblings can teach empathy, sharing,
and cooperation (Pike et al., 2005), as well as, negotiation
and conflict resolution (Abuhatoum & Howe, 2013).
However, the quality of sibling relationships is often
mediated by the quality of the parent-child relationship
Source:
and the psychological adjustment of the child (Pike et al.,
2005). For instance, more negative interactions between
siblings have been reported in families where parents had poor patterns of communication with
their children (Brody et al., 1994). Children who have emotional and behavioral problems are
also more likely to have negative interactions with their siblings. However, the psychological
adjustment of the child can sometimes be a reflection of the parent-child relationship. Thus,
when examining the quality of sibling interactions, it is often difficult to tease out the separate
effect of adjustment from the effect of the parent-child relationship.

While parents want positive interactions between their children, conflicts are going to arise, and
some confrontations can be the impetus for growth in children’s social and cognitive skills. The
sources of conflict between siblings often depend on their respective ages. Dunn and Munn
(1987) revealed that over half of all sibling conflicts in early childhood were disputes about
property rights. By middle childhood this starts shifting toward control over social situation,
such as what games to play, disagreements about facts or opinions, or rude behavior (Howe et
al., 2002). Researchers have also found that the strategies children use to deal with conflict
change with age, but this is also tempered by the nature of the conflict. Abuhatoum and Howe
(2013) found that coercive strategies (e.g., threats) were preferred when the dispute centered on
property rights, while reasoning was more likely to be used by older siblings and in disputes
regarding control over the social situation. However, younger siblings also use reasoning,

149
frequently bringing up the concern of legitimacy (e.g., “You’re not the boss”) when in conflict
with an older sibling. This is a very common strategy used by younger siblings and is possibly
an adaptive strategy in order for younger siblings to assert their autonomy (Abuhatoum & Howe,
2013). A number of researchers have found that children who can use non-coercive strategies
are more likely to have a successful resolution, whereby a compromise is reached and neither
child feels slighted (Ram & Ross, 2008; Abuhatoum & Howe, 2013). Not surprisingly, friendly
relationships with siblings often lead to more positive interactions with peers. The reverse is also
true. A child can also learn to get along with a sibling, with, as the song says, “a little help from
my friends” (Kramer & Gottman, 1992).

Play
Freud saw play as a means for children to release Figure 4.24 Which type of play are
pent-up emotions and to deal with emotionally these two boys engaging in?
distressing situations in a more secure environment.
Vygotsky and Piaget saw play as a way of children
developing their intellectual abilities (Dyer &
Moneta, 2006). All three theorists saw play as
providing positive outcomes for children. Parten
(1932) observed two to five-year-old children and
noted six types of play: Three labeled as non-social
play (unoccupied, solitary, and onlooker) and three
categorized as social play (parallel, associative, and
cooperative). Table 4.4 describes each type of play. Source

Younger children engage in non-social play more

than those older; by age five associative and cooperative play are the most common forms of
play (Dyer & Moneta, 2006).

Table 4.4 Parten’s Classification of Types of Play in Preschool Children

Category Description
Unoccupied Play Children’s behavior seems more random and without a specific
goal. This is the least common form of play.
Solitary Play Children play by themselves, do not interact with others, nor are
they engaging in similar activities as the children around them.
Onlooker Play Children are observing other children playing. They may comment
on the activities and even make suggestions but will not directly
join the play.
Parallel Play Children play alongside each other, using similar toys, but do not
directly act with each other.
Associative Play Children will interact with each other and share toys but are not
working toward a common goal.
Cooperative Play Children are interacting to achieve a common goal. Children may
take on different tasks to reach that goal.

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Box 4.2 Imaginary Companions

An intriguing occurrence in early childhood is the

emergence of imaginary companions. Figure 4.25
Researchers differ in how they define what
qualifies as an imaginary companion. Some
studies include only invisible characters that the
child refers to in conversation or plays with for an
extended period of time. Other researchers also
include objects that the child personifies, such as
a stuffed toy or doll, or characters the child
impersonates every day. Estimates of the number
of children who have imaginary companions
varies greatly (from as little as 6% to as high as
65%) depending on what is included in the
definition (Gleason et al., 2000).
Source
Little is known about why children create
imaginary companions, and more than half of all
companions have no obvious trigger in the child’s life (Masih, 1978). Imaginary companions are
sometimes based on real people, characters from stories, or simply names the child has heard (Gleason,
et. al., 2000). Imaginary companions often change over time. In their study, Gleason et al. (2000)
found that 40% of the imaginary companions of the children they studied changed, such as developing
superpowers, switching age, gender, or even dying, and 68% of the characteristics of the companion
were acquired over time. This could reflect greater complexity in the child’s “creation” over time
and/or a greater willingness to talk about their imaginary playmates.

In addition, research suggests that contrary to the assumption that children with imaginary companions
are compensating for poor social skills, several studies have found that these children are very sociable
(Mauro, 1991; Singer & Singer, 1990; Gleason, 2002). However, studies have reported that children
with imaginary companions are more likely to be first-borns or only-children (Masih, 1978; Gleason et
al., 2000, Gleason, 2002). Although not all research has found a link between birth order and the
incidence of imaginary playmates (Manosevitz et al., 1973). Moreover, some studies have found little
or no difference in the presence of imaginary companions and parental divorce (Gleason et al., 2000),
number of people in the home, or the amount of time children are spending with real playmates (Masih,
1978; Gleason & Hohmann, 2006).

Do children treat real friends differently? The answer appears to be not really. Young children view
their relationship with their imaginary companion to be as supportive and nurturing as with their real
friends. Gleason has suggested that this might suggest that children form a schema of what is a friend
and use this same schema in their interactions with both types of friends (Gleason, et al., 2000;
Gleason, 2002; Gleason & Hohmann, 2006).

151
 Children and the Media
Children view far more television today than in the
Figure 4.26 1960s; so much that they have been referred to as
Generation M for Media. Almost all American
families have at least one TV set, and half own
three or more (Nielsen Company, 2009). For
children age six and under, two-thirds watch
television every day, usually for two hours
(Rideout & Hamel, 2006). Even when involved in
other activities, such as playing, there is often a
television on nearby (Christakis, 2009; Kirkorian
et al., 2009). Research has consistently shown that
too much television adversely affects children’s
behavior, health, and achievement (Gentile &
Source
Walsh, 2002; Robinson et al., 2001). Young
children are less able to focus on active, hands-on
play while the television is on, and background TV can negatively affect cognitive and language
development as well as be linked to attention problems later in childhood (Schmidt et al., 2008;
Courage et al., 2010).

An additional concern is the amount of screen time children are getting with smart mobile
devices. While most parents believe that their young children use mobile devices for a variety of
activities, the children report that they typically use them to play games (Chiong & Schuler,
2010). Studies have reported that young children who have two or more hours per day using
mobile devices show more externalizing behaviors (aggression, tantrums) and inattention
(Tamana, et al., 2019), shorter sleep durations and a higher risk of behavioral problems (Wu,
2017), and fail to meet developmental milestones in fine and gross motor skills, language, and
problem-solving (Madigan et al., 2019).

Based on research findings, the AAP (2016) suggests that prior to the age of two children should
be engaged in hands-on exploration and social interaction with the real world, rather than the
virtual one. The immaturity of the cognitive functions in infants and toddlers make it difficult
for them to learn from digital media as effectively as they can from caregivers. For instance, it is
often not until 24 months of age that children can learn new words from live-video chatting
(Kirkorian et al., 2016). Between the ages of 2 and 5 the AAP (2016) suggests that children
should be limited to no more than one hour per day of high-quality programs that are co-viewed
with a caregiver to help children to understand what they are viewing. The AAP also strongly
suggest that parents should avoid using mobile media to soothe their children. The concern is
that using media as a strategy to distract or soothe the child may make it difficult for parents to
limit the child’s use of the devices and may inhibit children’s ability to self-regulate their own
emotions.

152
Child Care

In 2018, about 71.5% of mothers of school-aged and 65.1% Figure 4.27 U.S.
percent of mothers of preschool aged children in the United
Mothers’ Time Spent in
States worked outside the home (Bureau of Labor Statistics,
2019). Since more women have been entering the workplace, Child Care 1965-2012
there has been a concern that families do not spend as much time
with their children. This, however, is not true. The Economist
Data Team (2017) analyzed data from of ten countries (United
States, Britain, Canada, France, Germany, Denmark, Italy,
Netherlands, Slovenia and Spain) and estimated that the average
mother spent 54 minutes a day caring for children in 1965, but
104 minutes in 2012. Only mothers in France spent less time in
2012 than in 1965. Men continue to do less than women at 59
minutes per day in 2012, but they provided more care than in
1965 when they averaged only 16 minutes a day. However, Source
differences were found between working-class and middle-class
mothers. In 1965 mothers with and without a university education spent about the same amount
of time on child care. By 2012 the more educated ones were spending half an hour more per
day. See Figure 4.27 for the difference between mothers in the United States who were
university educated (dark blue line) and those who were non-university educated (light blue
line).

To evaluate how early child care affects children’s development, the National Institute of Child
Health and Human Development (2006) conducted a longitudinal study. This study is considered
the most comprehensive child care study to date, and it began in 1991 when the children were
one month of age. The study included an economically and ethnically diverse group of 1364
children assessed from 10 sites around the country. By design the study involved single parents,
minority backgrounds, and differing formal education levels. Child care was defined as “any
care provided on a regular basis by someone other than the child’s mother” (p. 4). A regular
basis included more than 10 hours per week. Child care arrangements included: Care from the
father or another relative, care from a caregiver not related to the child in the child’s home, small
group care in the caregiver’s home, and center-based care.

Overall results indicated that children cared for by their mothers did not develop differently than
those who were cared for by others. Parents and family characteristics were stronger predictors
of child development than child care facilities. Specifically, greater cognitive, language and
social competence were demonstrated when parents were more educated, had higher incomes,
and provided emotionally supportive and cognitively enriched home environments. When
comparing higher quality child care with lower quality child care differences were noted. Higher
quality care, as measured by adult-to-child ratios, group size, and caregivers’ educational and
training levels, resulted in higher cognitive performance, better language comprehension and
production, and higher levels of school readiness. Lower quality care predicted more behavioral
problems and poorer cognitive, language, and school readiness.

153
 Figure 4.28 The higher the teacher to child ratio, the
more time the teacher has for
involvement with the children and the
less stressed the teacher may be so that
the interactions can be more relaxed,
stimulating and positive. The more
children there are in a program, the less
desirable the program as well. This is
because the center may be more rigid in
rules and structure to accommodate the
large number of children in the
facility. The physical environment
should be colorful, stimulating, clean,
and safe. The philosophy of the
organization and the curriculum
Source available should be child-centered,
positive, and stimulating. Providers
should be trained in early childhood education as well. A majority of states do not require
training for their child care providers. While formal education is not required for a person to
provide a warm, loving relationship to a child, knowledge of a child’s development is useful for
addressing their social, emotional, and cognitive needs in an effective way.

By working toward improving the quality of childcare and increasing family-friendly workplace
policies, such as more flexible scheduling and childcare facilities at places of employment, we
can accommodate families with smaller children and relieve parents of the stress sometimes
associated with managing work and family life.

Child Abuse
The Child Abuse Prevention and Treatment Act (United States Department of Health and Human
Services, 2013) defines Child Abuse and Neglect as: Any recent act or failure to act on the part
of a parent or caretaker which results in death, serious physical or emotional harm, sexual
abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious
harm (p. viii). Each state has its own definition of child abuse based on the federal law, and most
states recognize four major types of maltreatment: neglect, physical abuse, psychological
maltreatment, and sexual abuse. Each of the forms of child maltreatment may be identified alone,
but they can occur in combination.

Victims of Child Abuse: According to the United States Department of Health and Human
Services (HHS) (2019), during 2017 (the most recent year data has been collected) Child
Protective Services (CPS) agencies received an estimated 4.1 million referrals for abuse
involving approximately 7.5 million children. This is a rate of 31.8 per 1,000 children in the
national population. Professionals made 65.7% of alleged child abuse and neglect reports, and
they included law enforcement (18.3%), educational (19.4%) and social services personnel
(11.7%). Nonprofessionals, such as friends, neighbors, and relatives, submitted 17.3% of the
reports. Approximately 3.5 million children were the subjects of at least one report.

154
Victims in their first year of life had the highest rate of victimization (25.3 per 1,000 children of
the same age). The majority of victims consisted of three ethnicities: White (44.6%), Hispanic
(22.3%), and African-American (20.7%). The greatest percentages of children suffered from
neglect (74.9%) and physical abuse (18.3%), although a child may have suffered from multiple
forms of maltreatment. In 2017 an estimated 1,720 children died from abuse and neglect, and
71.8% of all child fatalities were younger than 3 years old. Boys had a higher child fatality rate
(2.68 per 100,000 boys), while girls died of abuse and neglect at a rate of 2.02 per 100,000 girls.
More than 88% of child fatalities were comprised of White (41.9%), African-American (31.5%),
and Hispanic (15.1%) victims (HHS, 2019).

Sexual Abuse: Childhood sexual abuse is defined as any sexual contact between a child and an
adult or a much older child. Incest refers to sexual contact between a child and family
members. In each of these cases, the child is exploited by an older person without regard for the
child's developmental immaturity and inability to understand the sexual behavior (Steele,
1986). Research estimates that 1 out of 4 girls and 1 out of 10 boys have been sexually abused
(Valente, 2005). The median age for sexual abuse is 8 or 9 years for both boys and girls
(Finkelhorn et al., 1990). Most boys and girls are sexually abused by a male. Although rates of
sexual abuse are higher for girls than for boys, boys may be less likely to report abuse because of
the cultural expectation that boys should be able to take care of themselves and because of the
stigma attached to homosexual encounters (Finkelhorn et al., 1990). Girls are more likely to be
abused by family member and boys by strangers. Sexual abuse can create feelings of self-blame,
betrayal, shame and guilt (Valente, 2005). Sexual abuse is particularly damaging when the
perpetrator is someone the child trusts and may lead to depression, anxiety, problems with
intimacy, and suicide (Valente, 2005).
Stress on Young Children: Children experience different types of stressors. Normal, everyday
stress can provide an opportunity for young children to build coping skills and poses little risk to
development. Even more long-lasting stressful events, such as changing schools or losing a
loved one, can be managed fairly well. Children who experience toxic stress or who live in
extremely stressful situations of abuse over long periods of time can suffer long-lasting
effects. The structures in the midbrain or limbic system, such as the hippocampus and amygdala,
can be vulnerable to prolonged stress during early childhood (Middlebrooks & Audage,
2008). High levels of the stress hormone cortisol can reduce the size of the hippocampus and
affect the child's memory abilities. Stress hormones can also reduce immunity to disease. The
brain exposed to long periods of severe stress can develop a low threshold making the child
hypersensitive to stress in the future.

Adverse Childhood Experiences (ACEs)

The toxic stress that young children endure can have a significant impact on their later lives.
According to Merrick, Ford, Ports, and Guinn (2018), the foundation for lifelong health and
well-being is created in childhood, as positive experiences strengthen biological systems while
adverse experiences can increase mortality and morbidity. All types of abuse, neglect, and other
potentially traumatic experiences that occur before the age of 18 are referred to as adverse
childhood experiences (ACEs) (CDC, 2019). ACEs have been linked to risky behaviors,
chronic health conditions, low life potential and early death, and as the number of ACEs
increase, so does the risk for these results.

155
 Figure 4.29

Source

When a child experiences strong, frequent, and/or prolonged adversity without adequate adult
support, the child’s stress response systems can be activated and disrupt the development of the
brain and other organ systems (Harvard University, 2019). Further, ACEs can increase the risk
for stress-related disease and cognitive impairment, well into the adult years. Felitti et al. (1998)
found that those who had experienced four or more ACEs compared to those who had
experienced none, had increased health risks for alcoholism, drug abuse, depression, suicide
attempt, increase in smoking, poor self-rated health, more sexually transmitted diseases, an
increase in physical inactivity and severe obesity. More ACEs showed an increased relationship
to the presence of adult diseases including heart disease, cancer, chronic lung disease, skeletal
fractures, and liver disease. Overall, those with multiple ACEs were likely to have multiple
health risk factors later in life.

156
 Figure 4.30 How ACES Affect Children and Adults

Source

Some groups have been found to be at a greater risk for experiencing ACEs. Merrick et al.
(2018) reviewed the results from the 2011-2014 Behavioral Risk Factor Surveillance System,
which included an ACE module consisting of questions adapted from the Centers for Disease
Control and Prevention. Each question was collapsed into one of the eight ACE categories:
physical abuse, emotional abuse, sexual abuse, household mental illness, household substance
use, household domestic violence, incarcerated household member, and parental separation or
divorce. The results indicated that 25% of the sample had been exposed to three or more ACEs,
and although ACEs were found across all demographic groups, those who identified as Black,
multiracial, lesbian/gay/bisexual, having less than a high school education, being low income,
and unemployed experienced significantly higher ACE exposure. Assisting families and
providing children with supportive and responsive adults can help prevent the negative effects of
ACEs.

157
Separating Families at the United States Figure 4.31 Children in a Detention Center
Border: Thousands of children were
separated from their parents beginning in
April 2018 as they approached the United
States border by Immigration and Custom
Enforcement (ICE). Children were placed in
separate facilities from their parents when
they were being processed, and they were not
told when they would be reunited. When
enduring stressful situations, separation from
one’s parents can be extremely detrimental to
a child (Society for Research in Child
Development (SRCD), 2018). Parental
separations affect children’s stress
management systems by changing how the
Source
body responds to stress. Long-term stress
can disrupt brain functioning, cognitive
skills, emotional processing, and physiological health. When exposed to stress, children
typically look to their parents for support and care, and parents can reduce children’s stress.
These separated children were already under extreme stress escaping their previous homes, and
then were separated from the individuals who could support them through this process.
Stress from parent separation places children at a higher risk for anxiety, depression, PTSD,
lower IQ, obesity, impaired immune system functioning, and medical conditions (SRCD, 2018).
Even after being reunited, children can experience attachment issues, poorer self-esteem, and
physical and psychological health difficulties. As they age, they continue to exhibit an increased
risk for mental health problems, problems in social interactions, difficulty with adult
attachments, poorer stress management, and an increased risk for death. The American
Psychological Association (2019) opposes policies that separate families given the negative
outcomes suffered by children.

COVID-19: Impact on Early Childhood

Prevalence and MIS-C: Since the start of the pandemic, children make up approximately 14%
of COVID-19 cases (American Academy of Pediatrics (AAP), 2021). Most children with
COVID-19 have mild or no symptoms (CDC, 2021). However, children with underlying
conditions such as asthma or other chronic lung diseases, diabetes, sickle cell, heart disease since
birth, a suppressed immune system, obesity, genetics, neurologic, or metabolic conditions are
more likely to experience a severe illness from COVID-19 infection (CDC, 2021). The
symptoms of COVID-19 in children are similar to those in adults and can often look like other
common illnesses such as colds, strep throat, or allergies. However, a rare but more serious
condition can emerge in children with the virus called Kawasaki disease-like
multisystem inflammatory syndrome (MIS-C). MIS-C in children “is a condition where
different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes,
or gastrointestinal organs” (CDC, 2021, para 1). At present, it is not known why some children
with COVID-19 are likely to have this severe reaction, while others do not. The COVID-19

158
mortality rate for children infected with the virus is extremely low, nationally about .01%, and
children make up .06% of all COVID-19 deaths (AAP, 2021).

Adverse Childhood Experiences (ACES): COVID-19 has resulted in social isolation, parental
job loss, school closures, and other stressors that increase the development of ACES or worsen
their impact (Sanders, 2020). Children are especially susceptible to family stressors, such as job,
food, and housing insecurity, which are linked to ACES. Bryant et al. (2020) reported the rise in
child abuse and intimate partner violence, as family members were trapped with their abuser
during the pandemic. Parental mental health issues and increased substance use have also been
noted. Further, COVID-19 has especially affected low-income and ethnic minority children, who
were already at greater risk for the development of ACES, placing them at increased risk for
physical and mental health conditions. Both Sanders (2020) and Bryant et al. (2020) recommend
that pediatric health care providers regularly assess for ACES, and address the short-term and
long-term consequences on affected youth.

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