School Age, Adolescence, Special Issues of Development, and Adulthood

School Age, Adolescence, Special Issues of Development, and Adulthood
I. LATENCY OR SCHOOL AGE: 7–11 YEARS
A. Motor development.
The normal grade-school child, 7–11 years of age, engages in complex motor tasks (e.g., plays baseball, skips rope).
B. Social characteristics.
The school-age child:
1. Prefers to play with children of the same sex; typically avoids and is critical of those of the opposite sex.
2. Identifies with the parent of the same sex.
3. Has relationships with adults other than parents (e.g., teachers, group leaders).
4. Demonstrates little interest in psychosexual issues (sexual feelings are latent and will reappear at puberty).
5. Has internalized a moral sense of right and wrong (conscience) and understands how to follow rules.
6. School-age children and younger children are typically interviewed and examined by the doctor with the mother present.
C. Cognitive characteristics.
The school-age child:
1. Is industrious and organized (gathers collections of objects)
2. Has the capacity for logical thought and can determine that objects have more than one property (e.g., an object can be red and metal)
3. Understands the concepts of conservation and seriation; both are necessary for certain types of learning
a. Conservation involves the understanding that a quantity of a substance remains the same regardless of the size of the container or
shape it is in (e.g., two containers may contain the same amount of water even though one is a tall, thin tube and one is a sho rt, wide
bowl).
b. Seriation involves the ability to arrange objects in order with respect to their sizes or other qualities.
II. ADOLESCENCE: 11–20 YEARS
A. Early adolescence (11–14 years of age)
1. Puberty occurs in early adolescence and is marked by:
a. The development of secondary sex characteristics (Table 2-1) and increased skeletal growth
b. First menstruation (menarche) in girls, which on average occurs at 11–14 years of age
c. First ejaculation in boys, which on average occurs at 12–15 years of age
d. Cognitive maturation and formation of the personality
e. Sex drives, which are expressed through physical activity and masturbation (daily masturbation is normal)
2. Early adolescents show strong sensitivity to the opinions of peers but are generally obedient and unlikely to seriously challenge parental
authority.
3. Alterations in expected patterns of development (e.g., acne, obesity, late breast development in girls, nipple enlargement in boys
[usually temporary but may concern the boy and his parents]) may lead to psychological difficulties.

Tanner Stages of Sexual Development
1. Genitalia and associated structures are the same as in childhood; nipples (papillae) are slightly elevated in girls
2. Scant, straight pubic hair, testes enlarge, scrotum develops texture; slight elevation of breast tissue in girls
3. Pubic hair increases over the pubis and becomes curly, penis increases in length and testes enlarge
4. Penis increases in width, glans develops, scrotal skin darkens; areola rises above the rest of the breast in girls
5. Male and female genitalia are like adult; pubic hair now is also on thighs, areola is no longer elevated above the breast in girls


B. Middle adolescence (14–17 years of age)
1. Characteristics
a. There is great interest in gender roles, body image, and popularity.
b. Heterosexual crushes (love for an unattainable person such as a rock star) are common.
c. Homosexual experiences may occur. Although parents may become alarmed, such practicing is part of normal development.
d. Efforts to develop an identity by adopting current teen fashion in clothing and music, and preference for spending time with peers
over family are normal, but may lead to conflict with parents.
2. Risk-taking behavior
a. Readiness to challenge parental rules and feelings of omnipotence may result in risk-taking behavior (e.g., failure to use condoms,
driving too fast, smoking).
b. Education about obvious short-term benefits rather than references to long-term consequences of behavior is more likely to
decrease teenagers unwanted behavior. For example, to discourage smoking, telling teenagers that their teeth will stay white if
they don t
smoke, or that other teens find smoking disgusting, will be more helpful than telling them that they will avoid lung cancer in 30 year
C. Late adolescence (17–20 years of age)
1. Development
a. Older adolescents develop morals, ethics, self-control, and a realistic appraisal of their own abilities; they become concerned with
humanitarian issues and world problems.
b. Some adolescents, but not all, develop the ability for abstract reasoning (Piaget s stage of formal operations).
2. In the effort to form one s own identity, an identity crisis commonly develops.
a. If the identity crisis is not handled effectively, adolescents may experience role confusion in which they do not know where they
belong in the world.
b. Experiencing role confusion, the adolescent may display behavioral abnormalities D. Teenage sexuality
1. In the United States, first sexual intercourse occurs on average at 16 years of age; by 19 years of age, most men and women have had
sexual intercourse.
2. Fewer than half of all sexually active teenagers do not use contraceptives for reasons that include the conviction that they will not get
pregnant, lack of access to contraceptives, and lack of education about which methods are most effective.
3. Physicians may counsel minors (persons under 18 years of age) and provide them with contraceptives without parental knowledge or consent. They may also provide to minors treatment for sexually transmitted diseases, problems associated with pregnancy, and drug and
alcohol abuse (see Chapter 23).
4. Because of their potential sensitivity, issues involving sexuality and drug abuse, as well as issues concerning physical appe arance such as obesity, are typically discussed with teenagers without the parents present.

E. Teenage pregnancy
1. Teenage pregnancy is a social problem in the United States. Although the birth rate and abortion rate in American teenagers are
currently decreasing, in 2000, teenagers gave birth to approximately 470,000 infants (8,500 of these infants were born to mothers under
15 years of age) and had about 500,000 abortions.
2. Abortion is legal in the United States. However, in many states, minors must obtain parental consent for abortion.
3. Factors predisposing adolescent girls to pregnancy include depression, poor school achievement, and having divorced parents.
4. Pregnant teenagers are at high risk for obstetric complications because they are less likely to get prenatal care, and because they are
physically immature.
III. SPECIAL ISSUES IN CHILD DEVELOPMENT
A. Illness and death in childhood and adolescence.
A child s reaction to illness and death is closely associated with the child s developmental stage.
1. During the toddler years (15 months–21??2 years) hospitalized children fear separation from the parent more than they fear bodily harm,
pain, or death.
2. During the preschool years (21??2–6 years) the child s greatest fear when hospitalized is of bodily harm.
3. School-age children (7–11 years of age) cope relatively well with hospitalization. Thus, this is the best age to perform elective surgery.
4. Ill adolescents may challenge the authority of doctors and nurses and resist being different from peers. Both of these factors can result in
lack of adherence to medical advice.
5. A child with an ill sibling or parent may respond by acting badly at school or home (use of the defense mechanism of "acting out"
B. Adoption
1. An adoptive parent is a person who voluntarily becomes the legal parent of a child who is not his or her genetic offspring.
2. Adopted children, particularly those adopted after infancy, may be at increased risk for behavioral problems in childhood and adolescence.
3. Children should be told by their parents that they are adopted at the earliest age possible to avoid the chance of others telling them first.
C. Mental retardation
(also referred to as intellectual and/or developmental disability)
1. Etiology
a. The most common genetic causes of mental retardation are Down syndrome and fragile X syndrome.
b. Other causes include metabolic factors affecting the mother or fetus, prenatal and postnatal infection (e.g., rubella), and maternal
substance abuse; many cases of mental retardation are of unknown etiology.
2. Mildly (IQ of 50–69) and moderately (IQ of 35–49) mentally retarded children and adolescents commonly know they are handicapped (see
Chapter 8). Because of this, they may become frustrated and socially withdrawn. They may have poor self-esteem because it is difficult
for them to communicate and compete with peers.
3. The Vineland Social Maturity Scale (see Chapter 8) can be used to evaluate social skills and skills for daily living in mentally retarded and
other challenged individuals.
4. Avoidance of pregnancy in adults with mental retardation can become an issue, particularly in residential social settings (e.g., summer
camp). Long-acting, reversible contraceptive methods such as subcutaneous progesterone implants can be particularly useful for these
individuals.
IV. Early Adulthood: 20–40 Years
A. Characteristics
1. At about 30 years of age, there is a period of reappraisal of one s life.
2. The adult s role in society is defined, physical development peaks, and the adult becomes independent.
B. Responsibilities and relationships
1. The development of an intimate (e.g., close, sexual) relationship with another person occurs.
2. According to Erikson, this is the stage of intimacy versus isolation; if the individual does not develop the ability to sustain an intimate
relationship by this stage of life, he or she may experience emotional isolation in the future.
3. By 30 years of age, most Americans are married and have children.
4. During their middle 30s, many women alter their lifestyles by returning to work or school or by resuming their careers.
V. MIDDLE ADULTHOOD: 40–65 YEARS
A. Characteristics.
The person in middle adulthood possesses more power and authority than at other life stages.
B. Responsibilities.
The individual either maintains a continued sense of productivity or develops a sense of emptiness (Erikson s stage of generativity versus
stagnation).
C. Relationships
1. Seventy to eighty percent of men in their middle 40s or early 50s exhibit a midlife crisis. This may lead to
a. A change in profession or lifestyle
b. Infidelity, separation, or divorce
c. Increased use of alcohol or drugs
d. Depression
2. Midlife crisis is associated with an awareness of one s own aging and death and severe or unexpected lifestyle changes (e.g., death of
a spouse, loss of a job, serious illness).
D. Climacterium
is the change in physiologic function that occurs during midlife.
1. In men, decreased muscle strength, physical endurance, and sexual performance (see Chapter 18) occur in midlife.
2. In women, menopause occurs.
a. The ovaries stop functioning, and menstruation stops in the late forties or early fifties.
b. Absence of menstruation for 1 year defines the end of menopause. To avoid unwanted pregnancy, contraceptive measures should be
used until at least 1 year following the last missed menstrual period.
c. Most women experience menopause with relatively few physical or psychological problems.
d. Vasomotor instability, called hot flashes or flushes, is a common physical problem seen in women in all countries and cultural
groups and may continue for years. While estrogen or estrogen/progesterone replacement therapy can relieve this symptom, use of
such therapy has decreased because it is associated with increased risk of uterine and breast cancer.