Theories of Development

Child development was widely studied in the 20th century. A general understanding of the common theories can enrich the clinician's relationship with young patients. Most researchers in child development believe that developmental outcomes are a product of intrinsic child factors, including genetic potential and temperament, and extrinsic environmental factors, such as intrauterine, infectious, traumatic, chemical, and sociocultural factors (Vaughan and Litt, 1992). The relative weights of each of these factors vary considerably among persons, thus frustrating the attempts of researchers to develop a formula for predicting developmental outcome for any individual person.

A clinician who is familiar with the key elements of theoretic models can develop expertise in applying them appropriately to meet the needs of countless clinical scenarios. For example, a physician might use Erikson's theory of psychosocial stages to explain to a vexed parent of a 2-year-old that the child's constant temper tantrums represent a normal expression of the child's need to exert autonomy over the environment. In the next room, the physician might refer to Piaget's concept of concrete operational thought to explain why a 10-year-old might not be capable of considering remote consequences of present actions (e.g., "If I don't study for my science test, I might not meet my goal of becoming an astronaut").

Features of the most widely accepted developmental theories are found in many pediatric references (Dixon and Stein, 2000). A summary of the salient features of each theory and potential clinical applications is presented in Table 23-5.

Erikson's psychosocial stages theory is particularly relevant (Table 23-6). According to his theory, at each discrete life stage, persons are confronted with a crisis requiring integration of personal needs with sociocultural demands. Successful integration of needs and development indicates normal adaptation. A practitioner who is familiar with these stages can counsel families about the emotional needs of children at different ages and explain the appropriateness of challenging but normal childhood behavior.

The concept of temperament is also clinically relevant for primary care. Temperament is a set of consistent, inborn characteristics that influence how people interact with and learn from their environment (Thomas et al., 1968). The person's temperament characteristics are innate to his or her personality. Three basic temperament profiles based on nine separate infant characteristics are outlined in Table 23-7. These are broad generalizations, and not all infants fit easily into one of these three categories.

Each family's personal value system influences their reaction to a child of a particular temperament. For example, a highly competitive, athletically oriented family may view high-energy, high-intensity characteristics more positively than a family who values studiousness. Qualities such as introversion or extroversion are often based on characteristics of temperament and are not modified readily by the environment. In a family in whom "goodness of fit" between individual members' temperaments does not exist, knowledge of the inborn nature of temperament can help the family accept a child's unique characteristics. Anticipatory guidance can then focus on achieving a better relationship between family and child.

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