MODULE 3.

1 Physical Development in Infancy

First Steps
Allan's parents were starting to get anxious. After 13 months, their son had yet to take his first
steps. Clearly, he was getting close. Allan was able to stand still for several moments unaided.
Clutching chairs and the sides of tables, he could shuffle his way around rooms. But as for
taking those first, momentous, solo stepsAllan just wasn't there yet.
Allan's older brother, Todd, had walked at 10 months. Allan's parents read stories online of
children walking at 9, 8, even 6 months old! Why, then, wasn't Allan walking on his own yet,
they wondered.
The anticipation was building. Allan's father kept his digital camera at the ready whenever
he was with his son, hoping to record Allan's milestone. Allan's mother frequently updated the
family blog, keeping friends and extended family alert to Allan's progress.
Finally, the moment came. One afternoon, Allan lurched away from a chair, took a
tottering stepthen another, and then another. He made it all the way across the room to
the opposite wall, laughing happily as he went. Allan's parents, who had been lucky enough to
witness the event, were overjoyed.
The reactions of Allans parents in the lead-up to their sons first steps, and their elation at the
steps themselves, were typical. Modern parents frequently scrutinize their children's behavior,
worrying over what they see as potential abnormalities (for the record, walking at 13 months is
entirely consistent with healthy childhood development) and celebrating i mportant milestones.
I n this module, we consider the nature of the astonishing physical development that occurs dur-
ing infancy, a period that starts at birth and continues until the second birthday. We begin by
discussing the pace of growth during infancy, noti ng obvious changes in height and weight as
well as less apparent changes in the nervous system. We also consider how infants quickly develop
increasingly stable patterns in such basic activities as sleeping, eating, and attending to the world.
Our discussion then turns to i nfants' thrilling gains i n motor devel opment as skills emerge
that eventually will allow an infant to roll over, take the first step, and pi ck up a cooki e crumb
from the fl oorski l l s that ultimately form the basis of later, even more compl ex behaviors. We
start with basic, geneti cal l y determi ned reflexes and consi der how even these may be modi fi ed
through experi ence. We also discuss the nature and ti mi ng of the devel opment of particular
physical skills, l ook at whether their emergence can be speeded up, and consi der the i mpor-
tance of early nutri ti on to their devel opment.
Finally, we explore how infants' senses develop. We investigate how sensory systems like
heari ng and vision operate, and how infants sort through the raw data from their sense organs
and transform it into meani ngful i nformati on.
Growth and Stability
L01 How does physical growth in the body and nervous system proceed during
infancy?
L02 How are the bodily systems integrated during infancy?
L03 What are the sleep patterns of infants?
The average newborn weighs just over 7 pounds, whi ch is less than the weight of the average
Thanksgi vi ng turkey. Its length is about 20 i nches, shorter than a l oaf of French bread. It is
helpless; i f left to fend for itself, it could not survive.
Yet after just a few years, the story is very different. Babies become much larger, they are
mobile, and they become increasingly independent. How does this growth happen? We can an-
swer this question first by describing the changes in weight and height that occur over the first two
years of life, and then by examining some of the principles that underlie and direct that growth.
Physical Development in Infancy l i Wj l i J I * ] 95
Physical Growth: The Rapid Advances of Infancy
I nfants grow at a rapi d pace over the fi rst two years of thei r lives (see Fi gure 3-1). By the age
of 5 months, the average i nfants bi rthwei ght has doubl ed to around 15 pounds. By the fi rst
bi rthday, the baby's wei ght has tri pl ed to about 22 pounds. A l though the pace of wei ght gai n
sl ows duri ng the second year, it still conti nues to i ncrease. By the end of hi s or her second
year, the average chi l d wei ghs around four ti mes as much as he or she di d at bi rth. Of course,
there i s a good deal of vari ati on among i nfants. Hei ght and wei ght measurements, whi ch are
taken regul arl y duri ng physi cal exams i n a baby's fi rst year, provi de a way to spot probl ems
i n devel opment.
The wei ght gai ns of i nfancy are matched by i ncreased l ength. By the end of the fi rst year,
the typi cal baby grows al most a foot and is about 30 i nches tall. By thei r second bi rthdays,
chi l dren average a hei ght of 3 feet.
Not all parts of an i nfant's body grow at the same rate. For i nstance, at bi rth the head ac-
counts for one-quarter of the newborn's enti re body si ze. Duri ng the fi rst two years of life, the
rest of the body begi ns to catch up. By the age of 2, the baby's head is onl y one-fi fth of i ts body
l ength, and by adul thood it is onl y one-ei ghth (see Fi gure 3-2).
There also are gender and ethni c di fferences i n wei ght and l ength. Gi rl s general l y are slightly
shorter and wei gh slightly less than boys, and these di fferences remai n throughout chi l dhood (and,
as we will see later i n the book, the disparities become consi derabl y greater duri ng adol escence).
Furthermore, Asi an i nfants tend to be slightly smal l er than North A meri can Caucasi an i nfants,
and Afri can A meri can i nfants tend to be slightly bi gger than North A meri can Caucasi an i nfants.
Four Principles of Growth. The di sproporti onatel y l arge size of i nfants' heads at bi rth is
an exampl e of one of four maj or pri nci pl es (summari zed i n Tabl e 3- 1) that govern growth.
The cephalocaudal principle states that growth fol l ows a di recti on and pattern that begi ns
wi th the head and upper body parts and then proceeds to the rest of the body. The cepha-
l ocaudal growth pri nci pl e means that we devel op vi sual abi l i ti es (l ocated i n the head) wel l
before we master the abi l i ty to wal k (cl oser to the end of the body).
The proximodistal principle states that devel opment proceeds f rom the center of the body
outward. The proxi modi stal pri nci pl e means that the trunk of the body grows before
the extremi ti es of the arms and l egs. Furthermore, the devel opment of the abi l i ty to use
Birth 1 yr. 2 yr.
Age
3 yr.
FIGURE 3-: Height and Weight Growth
Although the greatest increase in height and
weight occurs during the first year of life,
children continue to grow throughout infancy
and toddlerhood.
Source: Adapted from Cratty, B. J. (1979). PERCEPTUAL
AND MOTOR DEVELOPMENT IN INFANTS AND CHILDREN,
2e, pg. 222. Copyright 1979 Pearson Education, Inc.
Reprinted with permission of Pearson Education, Inc.
cephalocaudal principle the principle that growth
follows a pattern that begins with the head and
upper body parts and then proceeds down to the
rest of the body
proximodistal principle the principle that
development proceeds from the center of the body
outward
Newborn 2 Years 6 Years 12 Years 25 Years
Age
FIGURE 3-2 Decreasing Proportions
At birth, the head represents one-quarter of the neonate's body. By adulthood, the head is
only one-eighth the size of the body. Why is the neonate's head so large?
96 I nfancy
TABLE 3 -1 THE MAJOR PRINCIPLES GOVERNING GROWTH
Cephalocaudal Principle
Growth follows a pattern that
begins with the head and
upper body parts and then
proceeds to the rest of the
body. Based on Greek and
Latin roots meaning
"head-to-tail."
Proximodistal Principle
Development proceeds
from the center of the body
outward. Based on the Latin
words for "near" and "far."
Principle of Hierarchical Integration
Simple skills typically develop separately
and independently. Later they are
integrated into more complex skills.
Principle of the Independence of Systems
Different body systems grow at different rates.
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various parts of the body also follows the proxi modi stal principle. For i nstance, effective
use of the arms precedes the ability to use the hands.
The principle of hierarchical integration states that simple skills typically develop sepa-
rately and i ndependentl y but that these simple skills are integrated into more compl ex
ones. Thus, the relatively compl ex skill of grasping somethi ng in the hand cannot be mas-
tered until the developing infant learns how to control and i ntegratethe movements of
the individual fingers.
Finally, the principle of the independence of systems suggests that different body systems
grow at different rates. For i nstance, the patterns of growth for body size, the nervous
system, and sexual maturati on are quite different. -(watch on mydevelopmentlab.com
Physical Development in Infancy liWjliJI*] 101
SIDS: The Unant icipat ed Killer
o
o
o
1. 8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
1980 1982 1984 1986 1988 1990
For a ti ny percentage of i nfants, the rhythm of sl eep
is i nterrupted by a deadl y affl i cti on: sudden i nfant
death syndrome, or SI DS. Sudden infant death
syndrome (SIDS) is a di sorder i n whi ch seemi ngl y
heal thy i nfants di e i n thei r sl eep. Put to bed for a nap
or for the ni ght, an i nfant si mpl y never wakes up.
SI DS stri kes about 1 i n 1,000 i nfants i n the
Uni ted States each year. A l though it seems to occur
when the normal patterns of breathi ng duri ng sl eep
are i nterrupted, sci enti sts have been unabl e to di s-
cover why that mi ght happen. I t is cl ear that i nfants
don't smother or choke; they di e a peaceful death,
si mpl y ceasi ng to breathe.
Whi l e no rel i abl e means for preventi ng the syndrome has been found, the A mer i can
A cademy of Pedi atri cs now suggests that babi es sl eep on thei r backs rather than on thei r
si des or stomachscal l ed the back-to-sleep gui del i ne. I n addi ti on, they suggest that parents
consi der gi vi ng thei r babi es a paci fi er duri ng naps and bedti me (Task Force on Sudden
I nfant Death Syndrome, 2005).
The number of deaths f rom SI DS has decreased si gni fi cantl y si nce these gui del i nes were
devel oped (see Fi gure 3-6). Sti l l , SI DS is the l eadi ng cause of death i n chi l dren under the age
of 1 year (Dal ey, 2004; Bl ai r et al , 2006).
Many hypotheses have been suggested to expl ai n why i nfants di e f rom SI DS. These i n-
cl ude such probl ems as undi agnosed sl eep di sorders, suffocati on, nutri ti onal defi ci enci es,
probl ems wi th refl exes, brai nstem abnormal i ti es, and undi agnosed i l l ness. Sti l l , the actual
cause of SI DS remai ns el usi ve (Li psi tt, 2003; Machaal ani & Waters, 2008; K i nney & Thach,
2009; Mi tchel l , 2009; Duncan et al , 2010).
1992 1994
Year
1996 1998 2000 2002 2004
FIGURE 3-6 Declining Rates of SIDS
In the United States, SIDS rates have dropped dramatically as parents have become
more informed and put babies to sleep on their backs instead of their stomachs.
Source: American SIDS Institute, based on data from the Center for Disease Control and the National Center for
Health Statistics, 2004.
sudden infant death syndrome (SIDS) the
unexplained death of a seemingly healthy baby
102 I nfancy
Motor Development
L04 What are the major reflexes?
L05 What developmental tasks must be accomplished during infancy?
L06 What is the role of nutrition in physical development?
Suppose you were hi red by a geneti c engi neeri ng fi rm to redesi gn newborns and were charged
wi th repl aci ng the current versi on wi th a new, more mobi l e one. The first change you'd prob-
ably consi der i n carryi ng out this (l ucki l y fi cti ti ous) j ob woul d be i n the conformati on and
composi ti on of the baby's body.
The shape and proporti ons of newborn babi es are si mpl y not conduci ve to easy mobi l i ty.
Thei r heads are so large and heavy that young i nfants l ack the strength to raise them. Because
thei r l i mbs are short i n rel ati on to the rest of the body, thei r movements are further i mpeded.
Furthermore, thei r bodi es are mai nl y fat, wi th a l i mi ted amount of muscl e; the result is that
they l ack strength.
Fortunatel y, it doesn't take too l ong before i nfants begi n to devel op a remarkabl e amount
of mobi l i ty. I n fact, even at bi rth they have an extensi ve repertoi re of behavi oral possi bi l i ti es
brought about by i nnate refl exes, and thei r range of motor skills grows rapidly duri ng the first
two years of life.
Reflexes: Our Inborn Physical Skills
When her father pressed 3-day-ol d Chri sti na's pal m wi th his finger, she responded by tightly
wi ndi ng her smal l fist around his fi nger and graspi ng it. When he moved his fi nger upward,
she hel d on so tightly that it seemed he mi ght be able to lift her compl etel y off her cri b fl oor.
LEARNING OBJECTIVES |
Physical Development in Infancy l i Wj l i J I * ] 103
TABLE 3 -3 SOME BASIC REFLEXES IN INFANTS
Reflex
Rooting reflex
Stepping reflex
Swimming reflex
Mora reflex
Babinski reflex
Startle reflex
Eye-blink reflex
Sucking reflex
Gag reflex
Approximate Age
of Disappearance
3 weeks
2 months
4-6 months
6 months
8-12 months
Remains in different form
Remains
Remains
Remains
Description
Neonate's tendency to turn its head toward things that touch
its cheek.
Movement of legs when held upright with feet touching
the floor.
Infant's tendency to paddle and kick in a sort of swimming
motion when lying face down in a body of water.
Activated when support for the neck and head is suddenly
removed. The arms of the infant are thrust outward and then
appear to grasp onto something.
An infant fans out its toes in response to a stroke on the
outside of its foot.
An infant, in response to a sudden noise, flings out arms,
arches its back, and spreads its fingers.
Rapid shutting and opening of eye on exposure to direct light.
Infant's tendency to suck at things that touch its lips.
An infant's reflex to clear its throat.
Possible Function
Food intake
Prepares infants for independent
locomotion
Avoidance of danger
Similar to primate's protection
from falling
Unknown
Protection
Protection of eye from direct light
Food intake
Prevents choking
The Basic Reflexes. I n fact, her father was right: Chri sti na probabl y could have been lifted
in this way The reason for her resolute grip was activation of one of the dozens of reflexes with
whi ch infants are born. Reflexes are unl earned, organized, i nvol untary responses that occur
automati cal l y in the presence of certai n stimuli. Newborns enter the world with a repertoire
of reflexive behavi oral patterns that help them adapt to their new surroundi ngs and serve to
protect them. ^>-| watch on mydevelopmentlab.com
As we can see from the list of reflexes in Table 3-3, many reflexes clearly represent behavi or
that has survival value, helping to ensure the wel l -bei ng of the infant. For i nstance, the swim-
ming reflex makes a baby who is lying face down in a body of water paddle and ki ck in a sort
of swi mmi ng moti on. The obvious consequence of such behavi or is to help the baby move
from danger and survive until a caregiver can come to its rescue. Similarly, the eye-blink reflex
seems designed to protect the eye from too much direct light, whi ch mi ght damage the retina.
Given the protective value of many reflexes, it mi ght seem benefi ci al for them to remai n
with us for our entire lives. I n fact, some do: The eye-bl i nk reflex remai ns functi onal through-
out the full life span. On the other hand, quite a few reflexes, such as the swi mmi ng reflex,
disappear after a few months. Why shoul d this be the case?
Researchers who focus on evol uti onary expl anati ons of devel opment attribute the gradual
disappearance of reflexes to the i ncrease in vol untary control over behavi or that occurs as
infants become more able to control their muscl es. I n addition, it may be that reflexes form
the foundati on for future, more compl ex behaviors. As these more i ntri cate behaviors become
well learned, they encompass the earlier reflexes. Finally, it is possible that reflexes stimulate
parts of the brai n responsible for more compl ex behaviors, helping them develop (Mykl ebust
& Gottl i eb, 1993; Zelazo, 1998; Lipsitt, 2003).
Ethnic and Cultural Differences and Similarities in Reflexes. Although reflexes are,
by definition, genetically determi ned and universal throughout all infants, there are actu-
ally some cultural variations in the ways they are displayed. For i nstance, consi der the Moro
reflex whi ch is activated when support for the neck and head is suddenl y removed. The Moro
reflex consists of the i nfants arms thrusti ng outward and then appearing to seek to grasp
onto somethi ng. Most scientists feel that the Moro reflex represents a leftover response that
we humans have i nheri ted from our nonhuman ancestors. The Moro reflex is an extremel y
2 Watch on mydevelopmentIab.com
y
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reflexes unlearned, organized involuntary
responses that occur automatically in the presence
of certain stimuli
104 I nf ancy
Infants showing (a) the rooting reflex, (b) the startle reflex, and (c) the Babinski reflex.
useful behavi or for monkey babi es, who travel about by cl i ngi ng to thei r mothers' backs. I f
they l ose thei r gri p, they fall down unl ess they are abl e to grasp qui ckl y onto thei r mother's
f urusi ng a Moro-l i ke refl ex (Prechtl , 1982; Zafei ri ou, 2004).
The Mor o refl ex is f ound i n all humans, but it appears wi th si gni fi cantl y di fferent vi gor i n
di fferent chi l dren. Some di fferences refl ect cul tural and ethni c vari ati ons (Freedman, 1979).
For i nstance, Caucasi an i nfants show a pronounced response to si tuati ons that produce the
Mor o refl ex. Not onl y do they fl i ng out thei r arms, but they al so cry and respond i n a gener-
al l y agi tated manner. I n contrast, Navajo babi es react to the same si tuati on much mor e cal ml y.
Thei r arms do not fl ai l out as much, and they cry onl y rarely.
TABLE 3-4 MILESTONES OF FINE
MOTOR DEVELOPMENT
Age (months) Skill
3 Opens hand prominently
3 Grasps rattle
8 Grasps with thumb and finger
11 Holds crayon adaptively
14 Builds tower of two cubes
16 Places pegs in board
24 Imitates strokes on paper
33 Copies circle
Source: From Frankenburg, W. K., Dodds, J., Archer,
P, Shapiro, H., and Brunsneck, B., The Denver II:
A Major Revision and Restandardlzatlon of the
Denver Developmental Screening Test, Pediatrics,
89, pp. 91-97, 1992. Reprinted with permission
from Dr. William K. Frankenburg.
Motor Development in Infancy: Landmarks of Physical Achievement
Probabl y no physi cal changes are mor e obvi ousand mor e eagerl y anti ci patedthan the
i ncreasi ng array of motor ski l l s that babi es acqui re duri ng i nfancy. Most parents can r emem-
ber thei r child's fi rst steps wi th a sense of pri de and awe at how qui ckl y she or he changed f rom
a hel pl ess i nfant, unabl e even to rol l over, i nto a person who coul d navi gate qui te effecti vel y
i n the worl d.
Gross Motor Skills. Even though the motor ski l l s of newbor n i nfants are not terri bl y
sophi sti cated, at l east compared wi th attai nments that wi l l soon appear, young i nfants sti l l
are abl e to accompl i sh some ki nds of movement. For i nstance, when pl aced on thei r stom-
achs they wi ggl e thei r arms and l egs and may try to lift thei r heavy heads. As thei r strength
i ncreases, they are abl e to push hard enough agai nst the surface on whi ch they are resti ng to
propel thei r bodi es i n di fferent di recti ons. They often end up movi ng backwards rather than
forwards, but by the age of 6 months they become rather accompl i shed at movi ng themsel ves
i n parti cul ar di recti ons. These i ni ti al efforts are the forerunners of crawl i ng, i n whi ch babi es
coordi nate the moti ons of thei r arms and l egs and propel themsel ves forward. Crawl i ng
appears typi cal l y between 8 and 10 months. (Fi gure 3-7 provi des a summar y of some of the
mi l estones of nor mal motor devel opment.)
Wal ki ng comes later. At around the age of 9 months, most i nfants are abl e to wal k by sup-
porti ng themsel ves on furni ture, and hal f of all i nfants can wal k wel l by the end of thei r fi rst
year of life.
At the same ti me i nfants are l earni ng to move around, they are perfecti ng the abi l i ty to
remai n i n a stati onary si tti ng posi ti on. At fi rst, babi es cannot remai n seated upri ght wi thout
support. But they qui ckl y master thi s ability, and most are abl e to sit wi thout support by the
age of 6 months.
Fine Motor skills. As i nfants are perfecti ng thei r gross motor ski l l s, such as si tti ng upri ght
and wal ki ng, they are al so maki ng advances i n thei r fi ne motor ski l l s (see Tabl e 3-4). For
i nstance, by the age of 3 months, i nfants show some abi l i ty to coordi nate the movements of
thei r l i mbs.
Furthermore, al though i nfants are bor n wi th a rudi mentary abi l i ty to reach toward an
object, thi s abi l i ty is nei ther very sophi sti cated nor very accurate, and it di sappears around
Physical Development in Infancy liWjliJI*] 105
3.2 months:
roiling over
3.3 months:
grasping rattle
5.9 months:
sitting without
support
7.2 months:
standing while
holding on
8.2 months:
grasping with thumb
and finger
16.6 months:
walking up steps
23.8 months:
jumping in place
11.5 months:
standing
alone well
12.3 months:
walking well
14.8 months:
building tower
of two cubes
FIGURE 3-7 Milestones of Motor Development
Fifty percent of children are able to perform each skill at the month indicated in the figure. However, the
specific timing at which each skill appears varies widely. For example, one-quarter of children are able to walk
well at 11.1 months; by 14.9 months, 90 percent of children are walking well. Is knowledge of such average
benchmarks helpful or harmful to parents?
Source: Adapted from Frankenburg et al., 1992.
the age of 4 weeks. A di fferent, mor e preci se, f orm of reachi ng reappears at 4 months. I t takes
some ti me for i nfants to coordi nate successful graspi ng after they reach out, but i n fai rl y short
order they are abl e to reach out and hol d onto an object of i nterest (Cl axton, Keen, & McCarty,
2003; Cl axton, McCarty, & Keen, 2009; Gri ssmer et al , 2010).
The sophi sti cati on of fi ne motor ski l l s conti nues to grow. By the age of 11 months, i nfants
are abl e to pi ck up off the ground objects as smal l as marbl essomethi ng caregi vers need to
be concerned about, si nce the next pl ace such objects often go is the mouth. By the ti me they
are 2 years ol d, chi l dren can careful l y hol d a cup, bri ng it to thei r l i ps, and take a dri nk wi thout
spi l l i ng a drop.
Graspi ng, l i ke other motor advances, fol l ows a sequenti al devel opmental pattern i n whi ch
si mpl e ski l l s are combi ned i nto mor e sophi sti cated ones. For exampl e, i nfants fi rst begi n pi ck-
i ng thi ngs up wi th thei r whol e hand. A s they get ol der, they use a pincer grasp, where thumb
and i ndex fi nger meet to f orm a ci rcl e. The pi ncer grasp al l ows for consi derabl y more preci se
motor control (Barrett & Needham, 2008).
Developmental Norms: Comparing the I ndividual to the Group. Keep in mind that
the ti mi ng of the mi l estones i n motor devel opment that we have been di scussi ng is based on
norms. Norms represent the average perf ormance of a l arge sampl e of chi l dren of a gi ven age.
They permi t compari sons between a parti cul ar chi l d's perf ormance on a parti cul ar behavi or
and the average perf ormance of the chi l dren i n the nor m sampl e.
For i nstance, one of the most wi del y used techni ques to determi ne i nfants' normati ve
standi ng i s the Brazelton Neonatal Behavioral Assessment Scale (NBAS), a measure desi gned
to determi ne i nfants' neurol ogi cal and behavi oral responses to thei r envi ronment.
Taki ng about 30 mi nutes to admi ni ster, the N BA S i ncl udes 27 separate categori es of re-
sponses that consti tute four general aspects of i nfants' behavi or: i nteracti ons wi th others (such
as al ertness and cuddl i ness), motor behavi or, physi ol ogi cal control (such as the abi l i ty to be
soothed after bei ng upset), and responses to stress (Brazel ton, 1973, 1990; Davi s & Emory,
1995; Canal s et al , 2003).
norms the average performance of a large sample
of children of a given age
Brazelton Neonatal Behavioral Assessment Scale
(NBAS) a measure designed to determine infants'
neurological and behavioral responses to their
environment
P
106 I nfancy
Cultural influences affect the rate of the
development of motor skills.
Al though the norms provided by scales such as the NBAS are useful in maki ng broad
generalizations about the ti mi ng of various behavi ors and skills, they must be i nterpreted
with caution. Because norms are averages, they mask substantial individual differences in
the ti mes when chi l dren attain various achi evements.
Norms are useful onl y to the extent that they are based on data from a large, heteroge-
neous, culturally diverse sample of children. Unfortunately, many of the norms on whi ch
devel opmental researchers have traditionally relied have been based on groups of infants
who are predomi nantl y Caucasi an and from the middle and upper soci oeconomi c strata
(e.g., Gesell, 1946). The reason: Much of the research was conducted on college campuses,
using the chi l dren of graduate students and faculty.
Thi s l i mi tati on woul d not be critical i f no differences existed in the ti mi ng of devel-
opment in chi l dren from different cultural, racial, and soci al groups. But they do. For
example, as a group, Afri can Ameri can babies show more rapid motor devel opment than
Caucasi an babies throughout infancy. Moreover, there are significant variations related
to cultural factors, as we discuss next (Werner, 1972; Keefer et al., 1991; Gartstei n et al.,
2003; de Oni s et al , 2007).
Nut rit ion in Infancy: Fueling Motor Development
Rosa sighed as she sat down to nurse the babyagain. She had fed 4-week-old Juan about every
hour today, and he still seemed hungry. Some days, it seemed like all she did was breastfeed her baby.
"Well, he must begoing through a growth spurt," she decided, as she settled into her favorite rocking
chair and put the baby to her nipple.
The rapid physical growth that occurs during i nfancy is fueled by the nutri ents that i n-
fants receive. Wi thout proper nutri ti on, infants cannot reach their physical potential, and
they may suffer cognitive and soci al consequences as well (Tanner & Fi nn-Stevenson,
2002; Costel l o et al , 2003; Gregory, 2005).
Cultural Dimensions
Motor Development Across Cultures
Among the Ache people, who live in the rain forest of South America,
infants face an early life of physical restriction. Because the Ache lead
a nomadic existence, living in a series of tiny camps in the rain forest,
open space is at a premium. Consequently, for the first few years of life,
infants spend nearly all their time in direct physical contact with their
mothers. Even when they are not physically touching their mothers,
they are permitted to venture no more than a few feet away.
Infants among the Kipsigis people, who live in a more open envi-
ronment in rural Kenya, Africa, lead quite a different existence. Their
lives are filled with activity and exercise. Parents seek to teach their
children to sit up, stand, and walk from the earliest days of infancy. For
example, very young infants are placed in shallow holes in the ground
designed to keep them in an upright position. Parents begin to teach
their children to walk starting at the eighth week of life. The infants are
held with their feet touching the ground, and they are pushed forward.
Clearly, the infants in these two societies lead very different lives
(Super, 1976; Kaplan & Dove, 1987). But do the relative lack of early
motor stimulation for Ache infants and the efforts of the Kipsigis to
encourage motor development really make a difference?
The answer is both yes and no. It's yes, in that Ache infants tend
to show delayed motor development, relative both to Kipsigis infants
and to children raised in Western societies. Although their social abili-
ties are no different, Ache children tend to begin walking at around
23 months, about a year later than the typical child in the United
States. In contrast, Kipsigis children, who are encouraged in their
motor development, learn to sit up and walk several weeks earlier, on
average, than U.S. children.
In the long run, however, the differences between Ache, Kipsigis,
and Western children disappear. By late childhood, about age 6, there
is no evidence of differences in general, overall motor skills among
Ache, Kipsigis, and Western children.
As we see with the Ache and Kipsigis babies, variations in the tim-
ing of motor skills seem to depend in part on parental expectations
of what is the "appropriate" schedule for the emergence of specific
skills. For instance, one study examined the motor skills of infants
who lived in a single city in England, but whose mothers varied in
ethnic origin. In the research, English, Jamaican, and Indian mothers'
expectations were first assessed regarding several markers of their
infants' motor skills. The Jamaican mothers expected their infants to
sit and walk significantly earlier than the English and Indian mothers,
and the actual emergence of these activities was in line with their
expectations. The source of the Jamaican infants' earlier mastery
seemed to lie in the treatment of the children by their parents. For
instance, Jamaican mothers gave their children practice in stepping
quite early in infancy (Hopkins & Westra, 1989, 1990).
In sum, cultural factors help determine the time at which specific
motor skills appear. Activities that are an intrinsic part of a culture
are more apt to be purposely taught to infants in that culture, lead-
ing to the potential of their earlier emergence (Nugent, Lester, &
Brazelton, 1989).
Cognitive Development in Infancy
The Roots of Language
L013 How do children learn to use language?
L014 How do infants influence adults' language?
127
LEARNING OBJ ECTIVES
Vicki and Dominic were engaged in a friendly competition over whose name would be thefirst word
their baby, Maura, said. "Say 'mama,'" Vicki would coo before handing Maura over to Dominic for
a diaper change. Grinning, he would take her and coax, "No, say 'daddy.'" Both parents ended up
losingand winningwhen Maura's first word sounded more like "baba," and seemed to refer to
her bottle.
Mama. No. Cookie. Dad. Jo. Most parents can remember their baby's first word, and no wonder.
I ts an exci ti ng moment, this emergence of a skill that is, arguably, uni que to human beings.
But those initial words are just the first and most obvious mani festati ons of language.
Many months earlier, infants began to understand the language used by others to make sense
of the world around them. How does this linguistic ability develop? What is the pattern and
sequence of language development? And how does the use of language transform the cogni -
tive world of infants and their parents? We consider these questions, and others, as we address
the devel opment of language during the first years of life.
The Fundamentals of Language: From Sounds t o Symbols
Language, the systematic, meani ngful arrangement of symbol s, provides the basis for com-
muni cati on. But it does more than this: It is closely tied to the way we thi nk and understand
the world. It enables us to reflect on people and objects and to convey our thoughts to others.
Language has several formal characteri sti cs that must be mastered as linguistic compe-
tence is developed. They include:
Phonology. Phonol ogy refers to the basic sounds of language, called phonemes, that can
be combi ned to produce words and sentences. For i nstance, the "a" i n "mat" and the "a"
in "mate" represent two different phonemes in Engl i sh. Al though Engl i sh employs just
40 phonemes to create every word in the language, other languages have as many as
85 phonemesand some as few as 15 (Akmaji an, Demers, & Harni sh, 1984).
Morphemes. A morpheme is the smallest language unit that has meani ng. Some mor-
phemes are compl ete words, while others add i nformati on necessary for i nterpreti ng a
word, such as the endings "-s" for plural and "-ed" for past tense.
Semantics. Semanti cs are the rules that govern the meani ng of words and sentences. As
their knowledge of semanti cs develops, chi l dren are able to understand the subtle distinc-
tion between "Ellie was hit by a bal l " (an answer to the questi on of why Ellie doesn't want
to play catch) and "A ball hit Ellie" (used to announce the current situation).
I n consi deri ng the devel opment of language, we need to distinguish between linguistic
comprehension, the understandi ng of speech, and linguistic production, the use of language
to communi cate. One principle underlies the relationship between the two: Comprehensi on
precedes producti on. An 18-month-ol d may be able to understand a compl ex series of direc-
tions ("Pi ck up your coat from the fl oor and put it on the chair by the fireplace") but may not
yet have strung more than two words together when speaki ng for herself. Throughout infancy,
comprehensi on also outpaces producti on. For example, during infancy, comprehensi on of
words expands at a rate of 22 new words a month, while producti on of words i ncreases at a
rate of about 9 new words a month, once talking begi ns (Ti ncoff & J usczyk, 1999; Rescorl a,
Alley, & Chri sti ne, 2001; Cattani, 2010) (see Fi gure 3-13).
Early Sounds and Communication. Spend 24 hours with even a very young infant and you
will hear a variety of sounds: cooi ng, crying, gurgling, murmuri ng, and assorted types of other
noises. These sounds, although not meani ngful in themselves, play an i mportant role in linguis-
tic development, paving the way for true language (Bl oom, 1993; O'Grady & Ai tchi son, 2005).
Although we tend to think of language
in terms of the production of words and
then groups of words, infants can begin to
communicate linguistically well before they
say their first word.
language the systematic, meaningful arrangement
of symbols, which provides the basis for
communication
128 I nf ancy
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Average Age in Months
Uses first pronoun, phrase, sentence
Uses two words in combination
Says five words or more
Says first word
Two syllables with repetition of first: "ma-ma,"
Clear vocalization of several syllables
Babbling
Cooing
One syllable
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Understands two prepositions: "in," "under"
Repeats things said
Names a picture in a book: "dog"
Understands a simple question
Understands a prohibition
Responds to simple commands
Understands gestures and responds to "bye-bye"
Discriminates between friendly and angry talking
Vocalizes to social stimulation
Responds and attends to speaking voice
28
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Average Age in Months
FIGURE 3-13 Comprehension Precedes Production
Throughout infancy, the comprehension of speech precedes the production of speech.
Source: Adapted from Bornstein & Lamb, 1992a.
Prelinguistic communication is communi cati on through sounds, faci al expressi ons, ges-
tures, i mi tati on, and other nonl i ngui sti c means. When a father responds to hi s daughter's "ah"
wi th an "ah" of hi s own, and then the daughter repeats the sound, and the father responds
once agai n, they are engaged i n prel i ngui sti c communi cati on. Cl earl y, the "ah" sound has no
parti cul ar meani ng. However, its repeti ti on, whi ch mi mi cs the gi ve-and-take of conversati on,
teaches the i nfant somethi ng about turn-taki ng and the back-and-f orth of communi cati on
(Reddy, 1999).
The most obvi ous mani festati on of prel i ngui sti c communi cati on is babbl i ng. Babbling,
maki ng speechl i ke but meani ngl ess sounds, starts at the age of 2 or 3 months and conti nues
unti l around the age of 1 year. When they babbl e, i nfants repeat the same vowel sound over
and over, changi ng the pi tch f rom hi gh to l ow (as i n "ee-ee-ee," repeated at di fferent pi tches).
After the age of 5 months, the sounds of babbl i ng begi n to expand, refl ecti ng the addi ti on of
consonants (such as "bee-bee-bee-bee").
Babbl i ng i s a uni versal phenomenon, accompl i shed i n the same way throughout all cul -
tures. Whi l e they are babbl i ng, i nfants spontaneousl y produce all of the sounds f ound i n every
l anguage, not just the l anguage they hear peopl e around them speaki ng.
Babbl i ng typi cal l y fol l ows a progressi on f rom si mpl e to mor e compl ex sounds. A l though
exposure to the sounds of a parti cul ar l anguage does not seem to i nfl uence babbl i ng i ni ti al l y,
eventual l y experi ence does make a di fference. By the age of 6 months, babbl i ng refl ects the
sounds of the l anguage to whi ch i nfants are exposed. The di fference is so noti ceabl e that even
untrai ned l i steners can di sti ngui sh between babbl i ng i nfants who have been rai sed i n cul tures
i n whi ch French, Arabi c, or Cantonese l anguages are spoken. Furthermore, the speed at whi ch
i nfants begi n homi ng i n on thei r own l anguage is rel ated to the speed of l ater l anguage de-
vel opment (Bl ake & Boysson-Bardi es, 1992; Whal en, Levi tt, & Gol dstei n, 2007; Lee, Davi s, &
MacNei l age, 2010).
babbling making speechlike but meaningless First Words. When a mother and father fi rst hear thei r chi l d say "Mama" or "Dada," or
sounds / even "baba," as i n the case of Maura, the baby descri bed earl i er i n thi s secti on, it is hard to be
1
Cognitive Development in Infancy 129
Sunt
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anything but delighted. But their initial enthusi asm may be dampened a bit when they find
that the same sound is used to ask for a cooki e, a doll, and a ratty old blanket.
Fi rst words generally are spoken somewhere around the age of 10 to 14 months, but may
occur as early as 9 months. Once an i nfant starts to produce words, vocabul ary i ncreases at
a rapid rate. By the age of 15 months, the average child has a vocabul ary of ten words and
methodi cal l y expands until the one-word stage of language devel opment ends at around 18
months. Once that happens, a sudden spurt in vocabul ary occurs. I n just a short peri oda
few weeks somewhere between 16 and 24 months of agethere is an expl osi on of language,
in whi ch a child's vocabul ary typically i ncreases from 50 to 400 words (Gl ei tman & Landau,
1994; Fernal d et al 1998; Nazzi & Bertonci ni , 2003; McMurray, Aslin, & Toscano, 2009).
The first words in children's early vocabul ari es typically regard objects and thi ngs, both
ani mate and i nani mate. Most often they refer to peopl e or objects who constantl y appear
and disappear ("Mama"), to ani mal s ("ki tty"), or to temporary states ("wet"). These first
words are often holophrases, one-word utterances that stand for a whol e phrase, whose
meani ng depends on the parti cul ar context in whi ch they are used. For i nstance, a young-
ster may use the phrase "ma" to mean, dependi ng on the context, "I want to be pi cked up
by Mom" or "I want somethi ng to eat, Mom" or "Where's Mom?" (Dromi , 1987; O'Grady &
Ai tchi son, 2005).
Culture has an effect on the type of first words spoken. For example, unlike North
Ameri can Engl i sh-speaki ng infants, who are more apt to use nouns initially, Chi nese
Mandari n-speaki ng infants use more verbs than nouns. On the other hand, by the age of
20 months, there are remarkabl e cross-cul tural similarities in the types of words spoken. For
example, a compari son of 20-month-ol ds in Argenti na, Bel gi um, France, I srael, Italy, and the
Republ i c of Korea found that children's vocabul ari es in every culture contai ned greater pro-
porti ons of nouns than other classes of words (Tardif, 1996; Bornstei n et al., 2004).
First Sentences. When Aaron was 19 months old, he heard his mother comi ng up the back
steps, as she did every day just before dinner. Aaron turned to his father and distinctly said,
"Ma come." I n stri ngi ng those two words together, Aaron took a giant step i n his language
development.
The explosive i ncrease i n vocabul ary that comes at around 18 months is accompani ed
by another accompl i shment: the l i nki ng together of i ndi vi dual words i nto sentences that
convey a single thought. Al though there is a good deal of vari abi l i ty i n the ti me at whi ch
chi l dren first create two-word phrases, it is general l y around 8 to 12 months after they say
their first word.
The linguistic advance represented by two-word combi nati ons is i mportant because
the linkage not onl y provides labels for things in the worl d but also i ndi cates the relations
between them. For i nstance, the combi nati on may declare somethi ng about possessi on
("Mama key") or recurrent events ("Dog bark"). I nterestingly, most early sentences don't
represent demands or even necessari l y requi re a response. I nstead, they are often merel y
comments and observati ons about events occurri ng in the child's worl d (Halliday, 1975;
O'Grady & Ai tchi son, 2005).
Two-year-ol ds using two-word combi nati ons tend to empl oy particular sequences that
are similar to the ways in whi ch adult sentences are constructed. For i nstance, sentences in
Engl i sh typically follow a pattern in whi ch the subject of the sentence comes first, followed
by the verb, and then the object ("J osh threw the bal l "). Children's speech most often uses a
similar order, although not all the words are initially included. Consequentl y, a child mi ght say
"J osh threw" or "J osh ball" to indicate the same thought. What is significant is that the order
is typically not "threw J osh" or "bal l J osh," but rather the usual order of English, whi ch makes
the utterance much easier for an Engl i sh speaker to comprehend (Brown, 1973; Hi rsh-Pasek
& Mi chni ck-Gol i nkoff, 1995; Masataka, 2003).
Al though the creati on of two-word sentences represents an advance, the language used by
chi l dren still is by no means adultlike. As we've just seen, 2-year-ol ds tend to leave out words
that aren't critical to the message, similar to the way we mi ght write a telegram for whi ch we
were paying by the word. For that reason, their talk is often called telegraphic speech. Rather
than saying, "I showed you the book," a child using telegraphic speech mi ght say, "I show
book." "I am drawing a dog" mi ght become "Drawi ng dog" (see Table 3-8).
By the age of 2, most children use two-word
phrases, such as "ball play."
holophrases one-word utterances that stand for
a whole phrase, the meaning of which depends on
the particular context in which they are used
telegraphic speech speech in which words not
critical to the message are left out
130 I nf ancy
TABLE 3 -8 CHILDREN'S IMITATION OF SENTENCES SHOWING DECLINE OF TELEGRAPHIC SPEECH
Eve, 25.5 Months Adam, 28.5 Months Helen, 30 Months Ian, 31.5 Months Jimmy, 32 Months June, 35.5 Months
1 showed you the book. 1 show book. (1 show) book. C 1 show you the book. C Show you the book.
1 am very tall. (My) tall. 1 (very) tall. 1 very tall. I'm very tall. Very tall. 1 very tall.
It goes in a big box. Big box. Big box. In big box. It goes in the box. C C
1 am drawing a dog. Drawing dog. 1 draw dog. 1 drawing dog. Dog. C C
1 will read the book. Read book. 1 will read book. 1 read the book. 1 read the book. C C
1 can see a cow. See cow. 1 want see cow. C Cow. C C
1 will do that again. Do-again. 1 will that again. 1 do that. 1 again. C C
C =correct imitation.
Source: Adapted from R. Brown & C. Fraser, 1963.
Infant-directed speech includes the use of short, simple sentences and is said in a pitch that is higher than that used with older children
and adults.
underextension the overly restrictive use of words,
common among children just mastering spoken
language
overextension the overly broad use of words,
overgenerallzing their meaning
Earl y l anguage has other characteri sti cs that di fferenti ate it f rom the l anguage used by
adul ts. For i nstance, consi der Sarah, who refers to the bl anket she sl eeps wi th as "bl anki e."
When her A unt Ethel gi ves her a new bl anket, Sarah refuses to cal l the new one a "bl anki e,"
restri cti ng the word to her ori gi nal bl anket.
Sarahs i nabi l i ty to general i ze the l abel of "bl anki e" to bl ankets i n general i s an exampl e of
underextension, usi ng words too restri cti vel y, whi ch is common among chi l dren just master-
i ng spoken l anguage. Underextensi on occurs when l anguage novi ces thi nk that a word refers
to a speci fi c i nstance of a concept, i nstead of to all exampl es of the concept (Capl an & Barr,
1989; Masataka, 2003).
As i nfants like Sarah grow more adept wi th l anguage, the opposi te phenomenon someti mes
occurs. I n overextension, words are used too broadl y, overgeneral i zi ng thei r meani ng. For ex-
ampl e, when Sarah refers to buses, trucks, and tractors as "cars," she is gui l ty of overextensi on,
maki ng the assumpti on that any object wi th wheel s must be a car. A l though overextensi on
Cognitive Development in Infancy 131
reflects speech errors, it also shows that advances are occurri ng in the child's thought processes:
The child is begi nni ng to develop general mental categories and concepts (J ohnson & Eilers,
1998; McDonough, 2002).
I nfants also show individual differences in the style of language they use. For example,
some use a referential style, in whi ch language is used pri mari l y to label objects. Others tend
to use an expressive style, in whi ch language is used pri mari l y to express feelings and needs
about onesel f and others (Bates et al., 1994; Nel son, 1996). Language styles reflect, in part,
cultural factors. For example, mothers in the Uni ted States label objects more frequentl y than
do J apanese mothers, encouragi ng a more referential style of speech. I n contrast, mothers in
J apan are more apt to speak about soci al i nteracti ons, encouragi ng a more expressive style of
speech (Fernal d & Mori kawa, 1993).
The Origins of Language Development
The i mmense strides in language devel opment during the preschool years raise a fundamental
question: How does profi ci ency in language come about? Linguists are deeply divided on how
to answer this questi on.
Learning Theory Approaches: Language as a Learned Skill. One view of language
devel opment emphasizes the basic principles of learning. Accordi ng to the learning theory
approach, language acquisition follows the basic laws of rei nforcement and condi ti oni ng
discussed in Modul e 1.2 (Skinner, 1957). For i nstance, a child who articulates the word "da"
may be hugged and praised by her father, who jumps to the concl usi on that she is referri ng
to hi m. Thi s reacti on rei nforces the child, who is more likely to repeat the word. I n sum, the
l earni ng theory perspective on language acqui si ti on suggests that chi l dren learn to speak by
bei ng rewarded for maki ng sounds that approximate speech. Through the process of shaping,
language becomes more and more similar to adult speech.
There's a probl em, though, with the l earni ng theory approach. It doesn't seem to ad-
equately explain how chi l dren acquire the rules of language as readily as they do. For i nstance,
young chi l dren are rei nforced when they make errors. Parents are apt to be just as responsive
i f their child says, "Why the dog won't eat?" as they are i f the child phrases the question more
correctl y ("Why won't the dog eat?"). Both forms of the question are understood correctly, and
both elicit the same response; rei nforcement is provided for both correct and i ncorrect lan-
guage usage. Under such ci rcumstances, l earni ng theory is hard-put to explain how chi l dren
learn to speak properly.
Chi l dren are also able to move beyond speci fi c utterances they have heard, and produce
novel phrases, sentences, and constructi ons, an ability that also cannot be explained by l earn-
i ng theory. Furthermore, chi l dren can apply linguistic rules to nonsense words. I n one study,
4-year-ol d chi l dren heard the nonsense verb "to pilk" in the sentence "the bear is pilking the
horse." Later, when asked what was happeni ng to the horse, they responded by placing the
nonsense verb in the correct tense and voice: "He's getting pilked by the bear."
Nativist Approaches: Language as an I nnate Skill. Such conceptual difficulties with
the l earni ng theory approach have led to the devel opment of an al ternati ve, champi oned by
the l i ngui st Noam Chomsky and known as the nati vi st approach (1968, 1978, 1991, 1999,
2005). The nativist approach argues that there is a geneti cal l y determi ned, i nnate mecha-
ni sm that di rects the devel opment of l anguage. Accordi ng to Chomsky, peopl e are born
wi th an i nnate capaci ty to use l anguage, whi ch emerges, more or less automati cal l y, due to
maturati on.
Chomsky's analysis of different languages suggests that all the world's languages share a
similar underl yi ng structure, whi ch he calls universal grammar. I n this view, the human brai n
is wi red with a neural system called the language-acquisition device (LAD), that both permi ts
the understandi ng of language structure and provides a set of strategies and techni ques for
l earni ng the particular characteri sti cs of the language to whi ch a child is exposed. I n this view,
language is uni quel y human, made possible by a geneti c predisposition to both comprehend
and produce words and sentences (Lidz & Gl ei tman, 2004; Stromswol d, 2006; Boeckx, 2010;
Lieven & Stoll, 2010).
referential style a style of language use in which
language is used primarily to label objects
expressive style a style of language use in which
language is used primarily to express feelings and
needs about oneself and others
learningtheory approach the theory that
language acquisition follows the basic laws of
reinforcement and conditioning
nativist approach the theory that a genetically
determined, innate mechanism directs language
development
universal grammar Noam Chomsky's theory that
all the world's languages share a similar underlying
structure
language-acquisition device (LAD) a neural
system of the brain hypothesized to permit
understanding of language
132 I nfancy
F IGURE 3 14 Infant's Speech
Processing
This fMRI scan of a 3-month-old infant
shows speech processing activity similar
to that of an adult, suggesting there may
be an evolutionary basis to language.
Source: Dehaene-Lambertz, Hertz-Pannier, &
Dubois, 2006.
Support for Chomsky's nativist approach comes from recent findings identifying a
speci fi c gene related to speech producti on. Further support comes from research show-
ing that language processi ng i n infants involves brai n structures similar to those in adult
speech processi ng, suggesting an evol uti onary basis to language (Wade, 2001; Monaco, 2005;
Dehaene-Lambertz, Hertz-Panni er, & Duboi s, 2006) (see Figure 3-14).
The view that language is an innate ability uni que to humans also has its critics. For
i nstance, some researchers argue that certai n pri mates are able to l earn at least the basi cs of
language, an ability that calls i nto questi on the uni queness of the human linguistic capacity.
Others poi nt out that although humans may be geneti cal l y pri med to use language, its use still
requires significant soci al experi ence in order for it to be used effectively (MacWhi nney, 1991;
Savage-Rumbaugh et al., 1993; Gol dberg, 2004).
The I nteractiotlist Approaches. Nei ther the l earni ng theory nor the nativist perspective
fully explains language acqui si ti on. As a result, some theorists have turned to a theory that
combi nes both school s of thought. The interactionist perspective suggests that language de-
vel opment is produced through a combi nati on of genetically determi ned predi sposi ti ons and
envi ronmental ci rcumstances that help teach language.
The i nteracti oni st perspective accepts that innate factors shape the broad outlines of lan-
guage development. However, i nteracti oni sts also argue that the specific course of language
devel opment is determi ned by the language to whi ch chi l dren are exposed and the rei nforce-
ment they receive for using language in particular ways. Soci al factors are consi dered to be key
to development, si nce the moti vati on provided by one's membershi p in a soci ety and culture
and one's i nteracti ons with others leads to the use of language and the growth of language
skills (Di xon, 2004; Yang, 2006).
Just as there is support for some aspects of l earni ng theory and nativist posi ti ons, the inter-
acti oni st perspective has also received some support. We don't know, at the moment, whi ch of
these posi ti ons will ultimately provide the best explanation. More likely, different factors play
different roles at different ti mes during chi l dhood.
P
. J
infant-directed speech a type of speech directed
toward infants, characterized by short, simple
sentences
Speaking t o Children: The Language of Inf ant -Direct ed Speech
Say the following sentence aloud: Do you like the applesauce?
Now pretend that you are going to ask the same questi on of an infant, and speak it as you
woul d for a young child's ears.
Chances are several things happened when you translated the phrase for the infant. Fi rst of
all, the wording probabl y changed, and you may have said somethi ng like, "Does baby like the
appl esauce?" At the same time, the pitch of your voi ce probabl y rose, your general i ntonati on
most likely had a singsong quality, and you probabl y separated your words carefully.
I nfant-Directed speech. The shift in your language was due to your use of infant-directed
speech, a style of speech that characteri zes much of the verbal communi cati on directed to-
ward infants. Thi s type of speech pattern used to be called motherese, because it was assumed
that it applied onl y to mothers. However, that assumpti on was wrong, and the gender-neutral
term infant-directed speech is now used more frequently.
I nfant-di rected speech is characteri zed by short, simple sentences. Pi tch becomes higher,
the range of frequenci es increases, and i ntonati on is more varied. There is also repeti ti on of
words, and topics are restri cted to i tems that are assumed to be comprehensi bl e to infants,
such as concrete objects in the baby's envi ronment (Soderstrom, 2007; Matsuda, 2010).
Someti mes i nfant-di rected speech i ncl udes amusi ng sounds that are not even words,
i mi tati ng the prel i ngui sti c speech of i nfants. I n other cases, it has little formal structure,
but is si mi l ar to the ki nd of tel egraphi c speech that i nfants use as they develop their own
language skills.
I nfant-di rected speech changes as chi l dren become older. Around the end of the first
year, i nfant-di rected speech takes on more adultlike qualities. Sentences become longer
and more compl ex, al though individual words are still spoken slowly and deliberately. Pi tch
is also used to focus attenti on on parti cul arl y i mportant words (Soderstrom et al., 2008;
Ki tamura & Lam, 2009).
Cognitive Development in Infancy 16
I nfant-di rected speech plays an i mportant rol e i n i nfants' acqui si ti on of l anguage. As
di scussed next, i nfant-di rected speech occurs all over the worl d, though there are cul tural
vari ati ons. Newborns prefer such speech to regul ar l anguage, a fact that suggests that they
may be parti cul arl y recepti ve to it. Furthermore, some research suggests that babi es who are
exposed to a great deal of i nfant-di rected speech early i n life seem to begi n to use words and
exhi bi t other forms of l i ngui sti c competence earlier (Engl und & Behne, 2006; Soderstrom,
2007; Werker et al 2007).
Cultural Dimensions
Is Infant-Directed Speech Similar Across All Cultures?
Do mothers in the United States, Sweden, and Russia speak the
same way to their infants?
In some respects, they clearly do. Although the words themselves
differ across languages, the way the words are spoken to infants is
quite similar. According to a growing body of research, there are basic
similarities across cultures in the nature of infant-directed speech
(Rabain-Jamin & Sabeau-Jouannet, 1997; Werker et al., 2007; Fais
et al., 2010).
For example, 6 of the 10 most frequent major characteristics of
speech directed at infants used by native speakers of English and
Spanish are common to both languages: exaggerated intonation, high
pitch, lengthened vowels, repetition, lower volume, and heavy stress
on certain key words (such as emphasizing the word "ball" in the
sentence, "No, that's a ball") (Blount, 1982). Similarly, mothers in
the United States, Sweden, and Russia all exaggerate and elongate
the pronunciation of the three vowel sounds of "ee," "ah," and "oh"
when speaking to infants in similar ways, despite differences in the
languages in which the sounds are used (Kuhl et al., 1997).
Even deaf mothers use a form of infant-directed speech: When
communicating with their infants, deaf mothers use sign language at
a significantly slower tempo than when communicating with adults,
and they frequently repeat the signs (Swanson, Leonard, & Gandour,
1992; Masataka, 1996, 1998, 2000).

From an educator's perspective: What are some implica-

tions of differences in the ways adults speak to boys and
girls? How might such speech differences contribute to later
differences not only in speech, but also in attitudes?
What Can You Do to Promote Infants' Cognitive Development?
Becoming an Informed Consumer of Development
All parents want their children to reach their full cognitive potential,
but sometimes efforts to reach this goal take a bizarre path. For
instance, some parents spend hundreds of dollars enrolling in work-
shops with titles such as "How to Multiply Your Baby's Intelligence"
and buying books with titles such as How to Teach Your Baby to Read
(Doman & Doman, 2002).
Do such efforts ever succeed? Although some parents swear
they do, there is no scientific support for the effectiveness of such
programs. For example, despite the many cognitive skills of infants,
no infant can actually read. Furthermore, "multiplying" a baby's in-
telligence is impossible, and such organizations as the American
Academy of Pediatrics and the American Academy of Neurology have
denounced programs that claim to do so.
On the other hand, certain things can be done to promote cogni-
tive development in infants. The following suggestions, based upon
findings of developmental researchers, offer a starting point (Gopnik,
Meltzoff, & Kuhl, 2000; Cabrera, Shannon, & Tamis-LeMonda, 2007):
Provide infants the opportunity to explore the world. As Piaget suggests,
children learn by doing, and they need the opportunity to explore
and probe their environment.
Be responsive to infants on both a verbal and a nonverbal level. Try to
speak with babies, as opposed to at them. Ask questions, listen
to their responses, and provide further communication (Merlo,
Bowman, & Barnett, 2007).
Read to your infants. Although they may not understand the mean-
ing of your words, they will respond to your tone of voice and
the intimacy provided by the activity. Reading together also is as-
sociated with later literacy skills and begins to create a lifelong
reading habit. In fact, the American Academy of Pediatrics recom-
mends daily reading to children starting at the age of 6 months
(American Academy of Pediatrics, 1997; Holland, 2008; Robb,
Richert, & Wartella, 2009).
Keep in mind that you don't have to be with an infant 24 hours a day. Just
as infants need time to explore their world on their own, parents
and other caregivers need time off from child-care activities.
Don't push infants and don't expect too much too soon. Your goal should
not be to create a genius; it should be to provide a warm, nurturing
environment that will allow an infant to reach his or her potential.
156 The Preschool Years
In this chapter, we focus on the physical, cognitive, and social and personality growth that oc-
curs during the preschool years. We begin by considering the physical changes children undergo
during those years. We discuss weight and height, nutrition, and health and wellness. The brain
and its neural pathways change too, and we will touch on some intriguing findings relating to
gender differences in the way the brain functions. We also look at how both gross and fine mo-
tor skills change over the preschool years.
Intellectual development is the focus of the next section of the chapter. We examine the major
approaches to cognitive development, including Piaget's stage theory, information processing
approaches, and an emerging view of cognitive development that gives great weight to the influ-
ence of culture. We also consider the important advances in language development that occur
during the preschool years, and we discuss several factors that influence cognitive develop-
ment, including exposure to television and participation in child-care and preschool programs.
Finally, we look at social and personality development in these years, focusing first on how
children figure out who they are and develop a sense of racial and gender identity. We discuss
the nature of their friendships and the significance of the ways they play together. We next look
at parents, considering the different styles of parenting that are common today as well as their
implications for their children's future development and personalities. We conclude with a look
at the ways in which preschool-age children begin to develop a moral sense and learn how to
control aggression.
MODULE 4.1 Physical Development in the Preschool Years
>-[watch on mydevelopmentlab.com
\
To better understand the changes that the
preschool period brings-and to get a sense of
how parents and caregivers have to adjust to
those changes-log onto My Virtual Child through
MyDevelopmentLab.com.
Aaron
Lisa Turing is 3 years old and, her father jokes, probably holds the world record for land speed
achieved by a biped. He and Lisa's mother have been dazzled since Lisa's birth by her quick-
ness. She crawled early, and at great speed. When she decided to stand, she soon mastered that
skill and immediately moved on to walking. She walked at 10 months, walked quickly at about
11 months, and achieved a near-run by 1 year.
Now, at age 3, Lisa is a whirlwind, chasing Alley, thefamily dog, around the yard, tumbling
gleefully every once in a while, laughing when Alley licks her face, and popping up and starting
to run again. She follows the same pattern indoors, darting from room to room for the sheer
joy of movement, flopping onto armchairs and sofas, and moving kitchen chairs to climb onto
tables and countertops. If someone should ever forget to close the safety gate, Lisa would climb
the stairs before anyone could stop her.
Lisa's mother needs two hands to count how many times in the last three years she and her
husband have had to expand the definition of "child-proofing" to accommodate Lisa's rapidly
developing physical abilities. ^^ [Watch on mydevelopmentlab.com
In just three years, Lisa Turi ng has grown from a nearl y i mmobi l e newborn to a whi rl wi nd of
acti vi ty She moves with confi denceperhaps too much confi dence. She runs at breakneck
speed, chases her dog everywhere, fearlessly falls to the ground and rolls around, and then
jumps up and starts all over again. I ndoors she darts from room to room, pulls on handl es
and knobs, and cl i mbs chairs to reach tables and countertops. These advances in mobi l i ty are
challenging to her parents, who must rise to a whol e new level of vigilance to prevent i njuri es,
the greatest threat to preschool ers' physical well-being. (Thi nk what mi ght happen i f someone
left a rake or hoe i n the yard or i f any countertop corner were left unprotected.)
Parents and caregivers also must worry about colds and other illnesses, and, especially
in recent years, about maki ng sure their child gets enough of the ri ght ki nds of food to eat.
As they watch their child grow active, they must insist on quiet ti me and a bedti me that will
afford their child adequate sleep. I f this seems like a long list of worri es, remember that the list
of delights that the preschool years bri ng is far longer.
Physical Development in the Preschool Years | M{]{liJI| i] 157
The Growing Body
LOl What is the state of children's bodies and overall health during the preschool
years?
LEARNING OBJECTIVES
Duri ng the preschool years, chi l dren experi ence rapi d advances i n
thei r physi cal abi l i ti es that are nothi ng short of astoundi ng. J ust
how far they devel op is apparent when we l ook at the changes they
undergo i n thei r si ze, shape, and physi cal abi l i ti es.
By age 2, the average chi l d i n the Uni ted States wei ghs around
25 to 30 pounds and is cl ose to 36 i nches tall. By the ti me they are
6 years ol d, they wei gh about 46 pounds and stand 46 i nches tal l (see
Fi gure 4- 1).
These averages mask si gni fi cant i ndi vi dual di fferences. For
i nstance, 10 percent of 6-year-ol ds wei gh 55 pounds or more, and
10 percent wei gh 36 pounds or l ess. Furthermore, average di ffer-
ences between boys and gi rl s i ncrease duri ng the preschool years.
A l though at age 2 the di fferences are rel ati vel y smal l , duri ng the
preschool years boys start becomi ng tal l er and heavi er, on average,
than gi rl s.
Economi cs al so affects these averages. The better nutri ti on and
heal th care typi cal l y recei ved by chi l dren i n devel oped countri es
transl ates i nto di fferences i n growth. For i nstance, the average
Swedi sh 4-year-ol d is as tal l as the average 6-year-ol d i n Bangl adesh.
Even wi thi n the Uni ted States, chi l dren i n fami l i es wi th i ncomes be-
l ow the poverty l evel are mor e l i kel y to be short than chi l dren rai sed
i n mor e affl uent homes (Uni ted Nati ons, 1991; Leathers & Foster,
2004; Petrou & Kupek, 2010).
Changes in Body Shape and St ruct ure
The bodi es of a 2- year - ol d and a 6- year - ol d var y not onl y i n
hei ght and wei ght, but al so i n shape. Dur i ng the pr eschool years,
boys and gi rl s become l ess r ound and mor e sl ender. Moreover,
thei r ar ms and l egs l engthen, and the si ze rel ati onshi p between
the head and the rest of the body becomes mor e adul tl i ke. I n fact,
by the ti me chi l dren reach age 6, thei r pr opor ti ons are si mi l ar to
those of adul ts.
Other physi cal changes occur i nternal l y. Muscl e si ze i ncreases,
and chi l dren grow stronger. Bones become sturdi er, and the sense
organs conti nue to devel op. For i nstance, the eustachian tube i n the
ear changes its ori entati on so radi cal l y that it may cause the earaches
that are so typi cal of the preschool years.
Nut rit ion: Eating the Right Foods
4
Age
] Boy's Weight | | Girl's Weight
50
40
30
20
10
0 -
1
Age
] Boy's Height Girl's Height
Because the rate of growth is sl ower than duri ng i nfancy, preschool ers
need l ess food, whi ch may cause parents to worry. However, chi l dren
tend to be adept at eati ng enough i f they are provi ded wi th nutri ti ous meal s. I n fact, anxi ousl y
encouragi ng chi l dren to eat mor e than they want may l ead to obesity, whi ch is defi ned as a
body wei ght mor e than 20 percent hi gher than the average wei ght for a person of a gi ven age
and hei ght. The preval ence of obesi ty among ol der preschool ers has i ncreased si gni fi cantl y
over the l ast 20 years.
The best strategy for parents is to make sure that they make a vari ety of l ow-fat,
hi gh-nutri ti on foods avai l abl e. Foods that have a rel ati vel y hi gh i ron content are parti cul arl y
i mportant: I ron-def i ci ency anemi a, whi ch causes constant fati gue, is one of the preval ent
FIGURE 4-1 Gaining Height and Weight
The preschool years are marked by steady increases in height and
weight. The figures show the median point for boys and girls at each
age, in which 50 percent of children in each category are above this
height or weight level and 50 percent are below.
Source: National Center for Health Statistics in collaboration with the National Center
for Chronic Disease Prevention and Health Promotion, 2000.
obesity body weight more than 20 percent higher
than the average weight for a person of a given age
and height
158 The Preschool Year s
Encouraging children to eat more than they seem to want
naturally may lead them to increase their food intake beyond
an appropriate level.
The danger of injuries during the preschool
years is in part a result of children's high lev-
els of physical activity. It is important to take
protective measures to reduce the hazards.
nutri ti onal probl ems i n devel oped countri es (Ranade, 1993; Brotanek
et al., 2007; Grant et al., 2007).
Wi thi n these bounds, chi l dren shoul d be given the opportuni ty
to devel op their own preferences. Exposi ng chi l dren to new foods by
encouragi ng them to take just one bite is a relatively l ow-stress way of
expandi ng children's diets (Shapi ro, 1997; Busi ck, 2008).
P j From a health care worker's perspective: How might
biology and environment combine to affect the physical
growth of a child adopted as an infant from a developing
country and reared in a more industrialized one?
Health and Illness
The average preschool er has 7 to 10 col ds and other mi nor respi ratory
i l l nesses i n each of the years from age 3 to 5. I n the Uni ted States, a runny
nose due to the common col d is the most frequentand happily, the least
severeki nd of heal th probl em duri ng the preschool years. I n fact, the
majori ty of chi l dren i n the Uni ted States are reasonabl y heal thy duri ng
this peri od (Kal b, 1997).
Al though the sni ffl es and coughs that are the symptoms of such i l l nesses are certai nl y
di stressi ng to chi l dren, the unpl easantness is usual l y not too severe and the i l l nesses usual l y
last onl y a few days.
The greatest ri sk that preschool ers face comes from nei ther illness nor nutri ti onal prob-
l ems but from acci dents: Before the age of 10, chi l dren are twice as likely to die from an i njury
as from an illness. I n fact, U.S. chi l dren have a one i n three chance every year of recei vi ng an
i njury that requi res medi cal attenti on (Nati onal Safety Counci l , 1989; Fi el d & Behrman, 2003;
Grani e, 2010).
The danger of i njuri es duri ng the preschool years is i n part a result of hi gh levels of physi -
cal activity. Combi ne the physi cal activity, curiosity, and l ack of judgment that characteri ze
this age group, and it is no wonder that preschool ers are acci dent-prone.
Furthermore, some chi l dren are more apt than others to take risks and consequentl y to
be i njured. Boys, who typically are more active than girls and tend to take more risks, have
a hi gher rate of i njuri es. Economi c factors also play a role. Chi l dren rai sed under condi ti ons
of poverty i n urban areas, whose i nner-ci ty nei ghborhoods may contai n more hazards than
more affluent areas, are two ti mes more likely to die of i njuri es than chi l dren l i vi ng i n af-
fl uence (Morrongi el l o & Hogg, 2004; Morrongi el l o et al., 2006; Morrongi el l o, Kl emenci c, &
Corbett, 2008).
Parents and caregi vers can take precauti ons to prevent i njuri es, starti ng by "chi l d-
proofi ng" homes and cl assrooms wi th el ectri cal outl et covers and chi l d l ocks on cabi nets. Car
seats and bi ke hel mets can hel p prevent i njuri es from acci dents. Parents and teachers also
need to be aware of the dangers from l ong-term hazards (Bul l & Durbi n, 2008; Morrongi el l o,
Corbett, & Bel l i ssi mo, 2008; Morrongi el l o et al , 2009).
For exampl e, l ead poi soni ng is a si gni fi cant danger for many chi l dren. Some 14 mi l l i on
chi l dren are at ri sk for lead poi soni ng due to exposure to lead, accordi ng to the Centers for
Di sease Control . Despi te stri ngent legal restri cti ons on the amount of l ead i n pai nt and gaso-
l i ne, lead is still found on pai nted walls and wi ndow framesparti cul arl y i n ol der homes
and i n gasol i ne, cerami cs, l ead-sol dered pipes, automobi l e and truck exhaust, and even dust
and water. The U.S. Department of Heal th and Human Servi ces has cal l ed l ead poi soni ng the
most severe heal th threat to chi l dren under age 6 (Duncan & Brooks-Gunn, 2000; Ri ppl e &
Zigler, 2003; Hubbs-Tai t et al , 2005).
Even ti ny amounts of l ead can permanentl y harm chi l dren. Exposure to l ead has been
l i nked to l ower i ntel l i gence, probl ems i n verbal and audi tory processi ng, and hyperacti v-
ity and distractibility. Hi gh l ead levels have also been l i nked to hi gher levels of anti soci al
behavi or, i ncl udi ng aggressi on and del i nquency i n school -age chi l dren. At yet hi gher levels of
exposure, l ead poi soni ng results i n illness and death (Ki nd, Di etri ch, & Bhattacharya, 2006;
Ni gg et al , 2008; Marcus, Ful ton, & Cl arke, 2010).
Physical Development in the Preschool Years | M{]{liJ I| i] 161
Motor Development
L03 How does motor development evolve In preschool children? J LEARNING OBJ ECTIVES
Anya sat in the sandbox at thepark, chatting with the other parents and playing with her two children,
5-year-old Nicholai and 13-month-old Smetna. While she chatted, she kept a close eye on Smetna, who
would still put sand in her mouth sometimes if she wasn't stopped. Today, however, Smetna seemed con-
tent to run the sand through her hands and try to put it into a bucket. Nicholai, meanwhile, was busy
with two other boys, rapidly filling and emptying the other sand buckets to build an elaborate sand city,
which they would then destroy with toy trucks.
When chi l dren of different ages gather at a playground, it's easy to see that preschool chi l dren
have come a long way in their motor development. Both their gross and fine motor skills have
become i ncreasi ngl y fi ne-tuned. Smetna, for example, is still masteri ng putting sand into a
bucket, while her older brother Ni chol ai uses that skill easily as part of his larger goal of build-
i ng a sand city.
Gross Motor Skills
By the ti me they are 3 years old, chi l dren have mastered a vari ety of skills: jumpi ng, hoppi ng
on one foot, skipping, and runni ng. By 4 and 5, their skills have become more refi ned as they
have gained i ncreasi ng control over their muscl es. For i nstance, at 4 they can throw a ball with
enough accuracy that a fri end can catch it, and by age 5 they can toss a ri ng and have it land
on a peg 5 feet away. Five-year-olds can learn to ride bikes, cl i mb ladders, and ski downhi l l
activities that all require consi derabl e coordi nati on (Cl ark & Humphrey, 1985). (Table 4-1
summari zes major gross motor skills that emerge duri ng the preschool years.)
These achi evements may be related to brai n devel opment and myel i nati on of neurons in
areas of the brai n related to bal ance and coordi nati on. Another likely reason is that chi l dren
spend a great deal of ti me practi ci ng these skills. Duri ng this peri od, the general level of activ-
ity is extraordi nari l y hi gh. I n fact, the activity level is hi gher at age 3 than at any other poi nt
in the entire life span (Eaton & Yu, 1989; Poest et al , 1990).
Girls and boys differ in certai n aspects of gross motor coordi nati on, in part because of
differences i n muscl e strength, whi ch is usually somewhat greater in boys than in girls. For
162 The Pr eschool Year s
TABLE 4 -1 MAJOR GROSS MOTOR SKILLS IN EARLY CHILDHOOD
3-Year-0lds
Cannot turn or stop suddenly or quickly
Jump a distance of 15 to 24 inches
Ascend a stairway unaided, alternating the feet
Can hop, using largely an irregular series
of jumps with some variations added
4-Year-0lds
Have more effective control of stopping, starting, and turning
Jump a distance of 24 to 33 inches
Descend a long stairway alternating the feet, if supported
Hop 4 to 6 steps on one foot
5-Year-0lds
Start, turn, and stop effectively in games
Can make a running jump of 28 to 36 inches
Descend a long stairway alternating the feet
Easily hop a distance of 16 feet
Source: From Corbin, A Textbook of Motor Development, le. Copyright 1973 The McGraw-Hill Companies. Reprinted with permission.
During the preschool years, children grow in
both fine and gross motor skills.
i nstance, boys can typi cal l y throw a bal l better and j ump hi gher, and a boy's overal l acti vi ty
l evel tends to be greater than a girl's (Eaton & Yu, 1989). On the other hand, gi rl s general l y
surpass boys i n tasks that i nvol ve l i mb coordi nati on. For i nstance, at age 5, gi rl s are better than
boys at j umpi ng jacks and bal anci ng on one foot (Cratty, 1979).
A nother aspect of muscul ar ski l l sone that parents often fi nd most probl emati ci s
bowel and bl adder control .
The Potty Quest ion: When-and How-Shoul d Children
Be Toilet Trained?
Few chi l d-care i ssues rai se so much concern among parents as toi l et trai ni ng. Current gui de-
l i nes of the A mer i can A cademy of Pedi atri cs suggest that there is no si ngl e ti me to begi n toi l et
trai ni ng and that trai ni ng shoul d begi n onl y when chi l dren are ready (A meri can A cademy of
Pedi atri cs, 2009; Lundbl ad, Hel l strom, & Berg, 2010).
When are chi l dren "ready"? The si gns of readi ness i ncl ude stayi ng dry at l east 2 hours at a
ti me duri ng the day or waki ng up dry after naps; regul ar and predi ctabl e bowel movements; an
i ndi cati on, through faci al expressi ons or words, that uri nati on or a bowel movement is about
to occur; the abi l i ty to fol l ow si mpl e di recti ons; the abi l i ty to get to the bathroom and undress
al one; di scomfort wi th soi l ed di apers; aski ng to use the toi l et or potty chai r; and the desi re to
wear underwear.
Furthermore, chi l dren must be ready not onl y physi cal l y, but emoti onal l y, and i f they show
strong si gns of resi stance to toi l et trai ni ng, toi l et trai ni ng shoul d be put off. Si mi l arl y, it may
be reasonabl e to del ay toi l et trai ni ng i f there is a maj or change i n the home envi ronment, such
as the bi rth of a new baby or a maj or i l l ness. A l though some chi l dren show si gns of readi ness
for toi l et trai ni ng between 18 and 24 months, some are not ready unti l 30 months or ol der
(A meri can A cademy of Pedi atri cs, 2003; Fri tz & Rockney, 2004; Connel l -Carri ck, 2006).
Parti al l y i n response to the A mer i can A cademy of Pedi atri cs gui del i nes, toi l et trai ni ng
has begun l ater over the l ast few decades. For exampl e, i n 1957, 92 percent of chi l dren were
toi l et trai ned by 18 months. I n 1999, onl y 25 percent were toi l et trai ned at that age, and just
60 percent of 36- month- ol ds were toi l et trai ned. Some 2 percent were still not toi l et trai ned
at the age of 4 (Goode, 1999).
Fine Motor Skills
At the same ti me, chi l dren are progressi ng i n thei r abi l i ty to use fi ne motor ski l l s, whi ch
i nvol ve mor e del i cate, smal l er body movements such as usi ng a fork and spoon, cutti ng wi th
sci ssors, tyi ng shoel aces, and pl ayi ng the pi ano.
The ski l l s i nvol ved i n fi ne motor movements requi re practi ce. The emergence of fi ne
motor ski l l s shows cl ear devel opmental patterns. At age 3, chi l dren can draw a ci rcl e and
square wi th a crayon, and they can undo thei r cl othes when they go to the bathroom. They can
put a si mpl e ji gsaw puzzl e together, and they can fit bl ocks of di fferent shapes i nto matchi ng
hol es. However, they do not show much preci si on and pol i sh i n these tasks, often, for exampl e,
forci ng puzzl e pi eces i nto pl ace.
Physical Development in the Preschool Years | M{]{liJI| i] 22
By age 4, thei r fi ne motor skills are better. They can draw a person that l ooks like a person,
and they can fol d paper i nto tri angul ar designs. A nd by the ti me they are 5, they can hol d and
mani pul ate a thi n penci l properly.
Handedness. How do preschool ers deci de whi ch hand to hol d the penci l i n as they work on
thei r fi ne motor skills? For many, thei r choi ce was made soon after bi rth.
Begi nni ng i n earl y i nfancy, many chi l dren show signs of a preference for the use of one
hand over the otherthe devel opment of handedness. By 7 months, some i nfants seem to fa-
vor one hand by grabbi ng more wi th it (Saudi no & McManus, 1998; Segal owi tz &Rapi n, 2003;
Marschi k et al., 2008). Most chi l dren display a clear tendency by the end of the preschool
years. Some 90 percent are ri ght-handed and 10 percent are l eft-handed, and more boys than
girls are l eft-handed.
handedness the preference of using one hand
over another
Keeping Preschoolers Healthy
Becoming an Informed Consumer of Development
There is no way around it: Even the healthiest preschooler occasionally
gets sick. Social interaction with others ensures that illnesses will
be passed from one child to another. However, some diseases are
preventable, and others can be minimized if simple precautions are
taken:
Preschoolers should eat a well-balanced diet containing the
proper nutrients, particularly foods containing sufficient protein.
Keep offering healthy foods; even if children initially reject them,
they may grow to like them.
Encourage preschoolers to exercise.
Children should get as much sleep as they wish. Being fatigued
makes children more susceptible to illness.
Children should avoid contact with others who are ill. If they play
with kids who are sick, parents should make sure they wash their
hands thoroughly.
Be sure that children follow an appropriate schedule of immuniza-
tions.
Finally, if a child does get ill, remember this: Minor illnesses dur-
ing childhood sometimes provide immunity to more serious
nesses later on.
J
Cognitive Development in the Preschool Years 173
The Growth of Language and Learning
L08 How does language develop in the preschool years?
L09 What effects does television have on preschoolers?
L010 What kinds of preschool educational programs are available?
I
LEARNING OBJ ECTIVES
J
I tried it out and it was very great!
This is a picture of when I was running through the water with Mommy.
Where are you going when I go to the fireworks with Mommy and Daddy?
I didn't know creatures went on floats in pools.
We can always pretend we have another one.
And the teacher put it up on the counter so no one could reach it.
I really want to keep it while we're at the park.
You need to get your own ball if you want to play "hit the tree."
When I grow up and I'm a baseball player, I'll have my baseball hat, and I'll put it on, and I'll
play baseball. (Schatz, 1994, p. 179)
Listen to Ricky, at age 3. I n addition to recogni zi ng most letters of the alphabet, printing the
first letter of his name, and wri ti ng the word "HI ," he is capable of produci ng these compl ex
sentences.
Duri ng the preschool years, children's language skills reach new heights of sophi sti cati on.
They begi n the peri od with reasonabl e linguistic capabilities, but with significant gaps in both
comprehensi on and producti on. I n fact, no one woul d mi stake a 3-year-old's language for
an adult's. However, by the end of the preschool years, they can hol d their own with adults,
comprehendi ng and produci ng language with many of the qualities of adults' language. How
does this transformati on occur?
Language Development
Language bl ooms so rapidly between the late 2s and the mi d-3s that researchers have yet to
understand the exact pattern. What is clear is that sentence length i ncreases steadily, and the
number of ways chi l dren combi ne words and phrases to form sentencesknown as syntax
doubles each month. By the ti me a preschool er is 3, the vari ous combi nati ons reach i nto
the thousands (see Table 4-2 on page 174 for an example of one child's growth i n the use of
language; Wheel don, 1999, Pinker, 2005).
There are also enormous leaps in the number of words children use. By age 6, the aver-
age child has a vocabul ary of around 14,000 wordsacqui red at a rate of nearl y one new
word every 2 hours, 24 hours a day. They manage this feat through a process known as fast
mapping, in whi ch new words are associated with their meani ng after onl y a bri ef encounter
(Gershkoff-Stowe & Hahn, 2007; Krcmar, Grela, & Lin, 2007; Kan & Kohnert, 2009).
By the age of 3, preschool ers routi nel y use plurals and possessive forms of nouns (such
as "boys" and "boy's"), the past tense (adding "-ed" at the end of words), and articles ("the"
and "a"). They can ask, and answer, compl ex questions ("Where did you say my book i s?" and
"Those are trucks, aren't they?").
Preschool ers' skills extend to the appropriate formati on of words that they have never
before encountered. For example, in one classic experi ment (Berko, 1958), the experi menter
told the children that a figure was a "wug," and then showed them a card with two of the
cartoon figures. "Now there are two of them," the chi l dren were told, and they were then asked
to supply the mi ssi ng word in the sentence, "There are two " (the answer to
whi ch, of course, is "wugs"). (See Fi gure 4-6.)
Not onl y did chi l dren show that they knew rules about the plural forms of nouns, but they
understood possessive forms of nouns and the thi rd-person singular and past-tense forms of
verbsal l for words that they had never encountered, si nce they were nonsense words with
no real meani ng (O'Grady & Ai tchi son, 2005).
This is a wug.
Now there is another one.
There are two of them.
There are two .
FIGURE 4-6 Appropriate Formation of
Words
Even though no preschoolerlike the
rest of usis likely to have ever before
encountered a wug, they are able to
produce the appropriate word to fill in the
blank (which, for the record, is wugs).
Source: Reprinted by permission of Jean Berko Gleason.
syntax the way in which an individual combines
words and phrases to form sentences
fast mapping instances in which new words are
associated with their meaning after only a brief
encounter
V
174 The Pr eschool Year s
TABLE 4 -2 GROWING SPEECH CAPABILITIES
Over the course of just a
2 years, 3 months:
2 years, 4 months:
2 years, 5 months:
2 years, 6 months:
2 years, 7 months:
2 years, 8 months:
2 years, 9 months:
2 years, 10 months:
2 years, 11 months:
3 years, 0 months:
3 years, 1 month:
3 years, 2 months:
year, the sophistication of the language of a boy named Adam increases amazingly, as these speech samples show:
Play checkers. Big drum I got horn. A bunny-rabbit walk.
See marching bear go? Screw part machine. That busy bulldozer truck.
Now put boots on. Where wrench go? Mommy talking about lady. What that paper clip doing?
Write a piece of paper. What that egg doing? I lost a shoe. No, I don't want to sit seat.
Where piece a paper go? Ursula has a boot on. Going to see kitten. Put the cigarette down. Dropped a rubber band. Shadow has hat just
like that. Rintintin don't fly, Mommy.
Let me get down with the boots on. Don't be afraid a horses. How tiger be so healthy and fly like kite? Joshua throw like a penguin.
Where Mommy keep her pocket book? Show you something funny. J ust like turtle make mud pie.
Look at that train Ursula brought I simply don't want put in chair. You don't have paper. Do you want little bit, Cromer? I can't wear it
tomorrow.
That birdie hopping by Missouri in bag. Do want some pie on your face? Why you mixing baby chocolate? I finish drinking all up down my
throat. I said why not you coming in? Look at that piece of paper and tell it. Do you want me tie that round? We going turn light on so you
can't see.
I going come in fourteen minutes. I going wear that to wedding. I see what happens. I have to save them now. Those are not strong mens.
They are going sleep in wintertime. You dress me up like a baby elephant.
I like to play with something else. You know how to put it back together. I gon' make it like a rocket to blast off with. I put another one on
the floor. You went to Boston University? You want to give me some carrots and some beans? Press the button and catch it sir. I want some
other peanuts. Why you put the pacifier in his mouth? Doggies like to climb up.
So it can't be cleaned? I broke my racing car. Do you know the light wents off? What happened to the bridge? When it's got a flat tire it's
need a go to the station. I dream sometimes. I'm going to mail this so the letter can't come off. I want to have some espresso. The sun is
not too bright. Can I have some sugar? Can I put my head in the mailbox so the mailman can know where I are and put me in the mailbox?
Can I keep the screwdriver just like a carpenter keep the screwdriver?
Source: "Growing Speech Capabilities" from THE LANGUAGE INSTINCT by STEVEN PINKER. Copyright 1994 BY STEVEN PINKER. Reprinted with permission of HarperCollins
Publishers WILLIAM MORROW.
grammar the system of rules that determine how
our thoughts can be expressed
private speech speech by children that is spoken
I and directed to themselves
Preschool ers al so l earn what cannot be sai d as they acqui re the pri nci pl es of grammar.
Grammar is the system of rul es that determi ne how our thoughts can be expressed. For i nstance,
preschool ers come to l earn that "I am si tti ng" is correct, whi l e the si mi l arl y structured "I
am knowi ng [that]" is i ncorrect. A l though they still make frequent mi stakes of one sort or
another, 3-year-ol ds fol l ow the pri nci pl es of grammar most of the ti me. Some errors are very
noti ceabl esuch as the use of "mens" and "catched"but these errors are actual l y qui te rare. I n
fact, young preschool ers are correct i n thei r grammati cal constructi ons mor e than 90 percent of
the ti me (deVi l l i ers & deVi l l i ers, 1992; Guasti , 2002; A bbot-Smi th & Tomasel l o, 2010).
Private speech and Social speech. I n even a short vi si t to a preschool , you're l i kel y to
noti ce some chi l dren tal ki ng to themsel ves duri ng pl ay peri ods. A chi l d mi ght be remi ndi ng a
dol l about a tri p to the grocery store later, or, whi l e pl ayi ng wi th a toy raci ng car, mi ght speak
of an upcomi ng race. I n some cases, the tal k i s sustai ned, as when a chi l d, worki ng on a puzzl e,
says thi ngs l i ke, "Thi s pi ece goes her e. . . . Uh- oh, thi s one doesn't f i t . . . . Wher e can I put thi s
pi ece? . . . Thi s can't be ri ght."
Some devel opmental i sts suggest that private speech, speech by chi l dren that is spoken
and di rected to themsel ves, perf orms an i mportant functi on. For i nstance, Vygotsky suggested
that it is used as a gui de to behavi or and thought. By communi cati ng wi th themsel ves through
pri vate speech, chi l dren are abl e to try out i deas, acti ng as thei r own soundi ng boards. I n thi s
way, pri vate speech faci l i tates chi l dren's thi nki ng and hel ps them control thei r behavi or
much as you mi ght say "Take it easy" or "Cal m down" when tryi ng to control your anger over
some si tuati on. I n Vygotsky's vi ew, then, pri vate speech serves an i mportant soci al functi on
and is al so a forerunner to the i nternal di al ogues that we use when we reason wi th oursel ves
duri ng thi nki ng (Wi nsl er, De L eon, & Wal l ace, 2003; Wi nsl er et al , 2006).
Cognitive Development in the Preschool Years 175
I n addition, private speech may be a way for chi l dren to practi ce the practi cal skills
requi red in conversati on, known as pragmatics. Pragmatics is the aspect of language relating
to communi cati ng effectively and appropriately with others. The devel opment of pragmati c
abilities permi ts chi l dren to understand the basics of conversati onsturn-taki ng, sti cki ng to a
topic, and what shoul d and shoul d not be said, accordi ng to the conventi ons of society. When
chi l dren are taught that the appropriate response to receiving a gift is "thank you," or that they
shoul d use different language in various settings (on the playground versus in the cl assroom),
they are l earni ng the pragmati cs of language.
The preschool years also mark the growth of soci al speech. Social speech is speech
directed toward another person and meant to be understood by that person. Before age 3,
chi l dren seem to be speaki ng onl y for their own entertai nment, apparently uncari ng whether
anyone else can understand. However, during the preschool years, chi l dren begi n to direct
their speech to others, wanti ng others to listen and becomi ng frustrated when they cannot
make themselves understood. As a result, they begi n to adapt their speech to others through
pragmati cs, as discussed earlier.
pragmatics the aspect of language that relates to
communicating effectively and appropriately with
others
V
social speech speech directed toward another
person and meant to be understood by that person
202 Middle Chi l dhood
violin. We also discuss threats to their well-being, and consider the special needs that can
impinge on children's school lives.
Next we consider the growing intellectual and conceptual skills and the increasingly sophisti-
cated use of language that are hallmarks of this period. We visit the place where they spend
most of their time: school. We consider reading and the policy dispute over the best way to
teach it. We also address the surprisingly controversial topic of intelligence.
Finally, we consider school-age children as members of society, including their membership in
school and family. We look at the ways school-age children understand themselves and develop
self-esteem. We consider how they relate to one another, including members of the opposite
sex. We then examine the many shapes and configurations that families take, finishing with a
further discussion of schooling.
MODULE 5.1 Physical Development in Middle Childhood
l b
It is a hot summer day in Atlanta. Adults move slowly through the humid air, but not 8-year-
old Suzanne McGuire. A look of triumph crosses her face as she rounds the corner from third
base to home plate.
Moments before, she was waiting for the pitcher to throw the ball. Her first two turns at
bat, Suzanne had struck out, leaving her unhappy and a bit humiliated.
On her third turn at bat, though, the pitch looked perfect. She swung at it with confidence
and high hope. When the bat connected with the ball, lobbing it well beyond the left fielder for
a home run, it created a moment she would never forget.
Suzanne McGui re has come a long way si nce the preschool years, when quick, coordi nated
runni ng and batting to the mark were not possible.
Such moments characteri ze mi ddl e chi l dhood, as children's physical, cognitive, and soci al
skills reach new heights. Begi nni ng at age 6 and conti nui ng to about age 12, this peri od is often
called the "school years." Physi cal growth is remarkabl e. Motor skills soar.
We begi n by exami ni ng physical and motor devel opment in mi ddl e chi l dhood. We discuss
how children's bodi es change, and the twin probl ems of mal nutri ti on and obesity. We exami ne
the devel opment of gross motor skillslike swi ngi ng a batand fine motor skillslike play-
i ng scales on a piano. We discuss the heal th of chi l dren during this peri od, i ncl udi ng their
psychol ogi cal health.
We finish the modul e by consi deri ng the sensory and l earni ng difficulties of chi l dren with
special needs. We also discuss a disorder that has grown in i mportance in recent decades,
attention deficit hyperactivity disorder.
LEARNING OBJ ECTIVES
T
The Growing Body
L01 In what ways do children grow during the school years, and what factors
influence their growth?
Cinderella, dressed in yella,
Went upstairs to kiss her fellah.
But she made a mistake and she kissed a snake.
How many doctors did it take?
One, two,...
While the other girls chanted this jump-rope rhyme, Kat proudly displayed her new ability to jump
backwards. In second grade, Kat was becoming quite good at jumping rope. In first grade, she simply
had not been able to master it. But over the summer, she had spent many hours practicing, and now that
practice was paying off.
Physical Development In Middle Childhood | M{]{l i J I * 2l 203
As Kat is gleefully experi enci ng, chi l dren make great physi cal stri des i n
mi ddl e chi l dhood, masteri ng many new skills. How does this progress oc-
cur? We'll first consi der typical physi cal growth duri ng this peri od, then
turn our attenti on to excepti onal chi l dren.
Sl ow but steady These words characteri ze the nature of growth
duri ng mi ddl e chi l dhood. I n contrast to the swi ft growth f rom bi rth
to age 5 and the remarkabl e growth spurt of adol escence, mi ddl e
chi l dhood is rel ati vel y tranqui l . The body has not shi fted i nto neutral ;
physi cal growth conti nues, but at a more statel y pace than i n the pre-
school years.
Height and Weight Changes
I n el ementary school , chi l dren i n the Uni ted States grow, on average, 2 to
3 i nches a year. By age 11, the average hei ght for girls is 4 feet, 10 i nches
whi l e boys average 4 feet, 9V2 i nches. Thi s is the onl y peri od i n life when
girls tend to be taller than boys. Thi s refl ects the slightly more rapi d
physi cal devel opment of girls, who start thei r adol escent growth spurt
around age 10.
Wei ght gai n i n mi ddl e chi l dhood follows a si mi l ar pattern; boys and girls both gai n
around 5 to 7 pounds a year. Wei ght is also redi stri buted. As "baby fat" di sappears, children's
bodi es become more muscul ar and thei r strength i ncreases.
These average hei ght and wei ght i ncreases disguise si gni fi cant i ndi vi dual di fferences.
Chi l dren of the same age can be 6 or 7 i nches apart i n hei ght.
Cult ural Patterns of Growth
Most chi l dren in North Ameri ca recei ve suffi ci ent nutri ents to grow to thei r full potenti al .
I n other parts of the worl d, however, i nadequate nutri ti on and di sease take thei r toll, produc-
i ng chi l dren who are shorter and wei gh less. The di screpanci es can be dramati c: Poor chi l dren
i n cities such as Cal cutta, Hong Kong, and Ri o de J anei ro are smal l er than affluent chi l dren
i n the same cities.
I n the Uni ted States, most vari ati ons i n hei ght and wei ght are the result of people's uni que
geneti c i nheri tance, i ncl udi ng geneti c factors rel ati ng to raci al and ethni c background. Asi an
and Oceani c Paci fi c chi l dren tend to be shorter than those of northern and central European
ancestry I n addi ti on, the rate of growth is general l y more rapi d for Bl ack chi l dren than for
Whi te (Deurenberg, Deurenberg-Yap, & Guri cci , 2002; Deurenberg et al., 2003).
Even wi thi n raci al and ethni c groups, i ndi vi dual s vary si gni fi cantl y We cannot attri bute
raci al and ethni c di fferences sol el y to geneti c factors because di etary customs as well as
vari ati ons i n levels of affl uence also may contri bute to di fferences. I n addi ti on, severe stress
brought on by factors such as parental confl i ct or al cohol i smcan affect the pi tui tary gl and,
thereby affecti ng growth (Koska et al , 2002).
Nut rit ion
There is a rel ati onshi p between size and nutri ti on. But size isn't the onl y area affected by diet.
For i nstance, nutri ti on is related to soci al and emoti onal functi oni ng at school age. Chi l dren
who recei ve more nutri ents are more i nvol ved wi th thei r peers, show more posi ti ve emoti on,
and have less anxi ety than chi l dren wi th less adequate nutri ti on. Nutri ti on is also l i nked to
cogni ti ve performance. For exampl e, i n one study, chi l dren i n Kenya who were well nouri shed
performed better on a test of verbal abilities and on other cogni ti ve measures than those who
had mi l d to moderate undernutri ti on. Mal nutri ti on may i nfl uence cogni ti ve devel opment by
dampeni ng children's curiosity, responsi veness, and moti vati on to l earn (Gri gorenko, 2003;
Ordovas, 2010).
Al though undernutri ti on and mal nutri ti on cl earl y lead to physical, soci al , and cogni ti ve
di ffi cul ti es, i n some cases overnutritionthe i ntake of too many cal ori esl eads to probl ems
of its own, i n parti cul ar chi l dhood obesi ty
Variations of 6 inches in height between children of the same
age are not unusual and well within normal ranges.
204 Mi ddl e Chi l dhood
Inadequate nutrition and disease affect growth significantly. Children in poorer areas of cities
such as Calcutta, Hong Kong, and Rio de Janeiro are smaller than their counterparts
in affluent areas of the same cities.
Age: 2 to 5 6 to 11 12 to 19
FIGURE 5-1 Fat of the Land
The percent of children and adolescents who are overweight has increased
dramatically in the last 4 decades.
Source: CDC, 2009.
Childhood Obesity
When her mother asks i f she woul d like bread wi th her meal , Ruthel l en repl i es she better
notshe thi nks she may be getti ng fat. Ruthel l en, who is of nor mal wei ght and hei ght, is
6 years ol d.
A l though hei ght can be of concern to both chi l dren and parents, wei ght is an even
greater worry for some. Wei ght concerns can border on obsessi on, parti cul arl y i n gi rl s.
Many 6-year-ol d gi rl s worry about becomi ng "fat," and some
40 percent of gi rl s ages 9 to 10 are tryi ng to l ose wei ght. Thei r
concern wi th wei ght often refl ects the U.S. preoccupati on wi th
sl i mness, whi ch permeates the enti re soci ety (Schrei ber et al.,
1996; Greenwood & Pi etromonaco, 2004; Li echty, 2010).
Despi te the preval ent vi ew that thi nness is a vi rtue, chi l d-
hood obesi ty is ri si ng. Obesity is defi ned as body wei ght that
is mor e than 20 percent above the average for a gi ven age and
hei ght. Fi fteen percent of U.S. chi l dren are obesea fi gure
that has tri pl ed si nce the 1960s (Brownl ee, 2002; Di etz, 2004;
Mann, 2005) (see Fi gure 5-1).
The costs of chi l dhood obesi ty l ast a l i feti me. Obese
chi l dren are mor e l i kel y to be overwei ght as adul ts, and have
a greater ri sk of heart di sease, di abetes, and other di seases.
Some sci enti sts bel i eve an epi demi c of obesi ty may be l eadi ng
to a decl i ne i n life span i n the Uni ted States (Kri shnamoorthy,
Hart, & J el al i an, 2006; Park, 2008; Keel et al , 2010).
Geneti c and soci al characteri sti cs as wel l as di et i nfl uence
obesi ty. Parti cul ar i nheri ted genes predi spose certai n chi l dren
to be overwei ght. For exampl e, adopted chi l dren's wei ghts tend
to refl ect those of thei r bi rth parents rather than thei r adopti ve
parents (Whi taker et al , 1997; Bray, 2008).
Physical Development in Middle Childhood I
From Research to Practice
Do Media Images Affect Preadolescent Children's Body Image?
Dissatisfaction with body image is on the rise. In one study of children
ages 8-10, more than half of the girls and more than a third of the
boys were already dissatisfied with their size, even at their young
age. What's worse is that body image dissatisfaction is related to un-
healthy behaviors such as eating disorders, smoking, depression, and
low self-esteem (Wood, Becker, & Thompson, 1996; Jung & Peterson,
2007).
Why are children acquiring dissatisfaction with their bodies?
One answer relates to the media. Television, magazines, and other
media present models of idealized beauty and fitness as if they are
the norm in the real world. Not only are certain body types overrep-
resented, but people with such idealized body types are portrayed
as admirable because of their looks. Children compare themselves
to these idealized same-sex media images and often conclude that
they just don't measure up (Fouts & Burggraf, 1999; Hargreaves &
Tiggemann, 2003).
In reality, no one can measure up to some kinds of body rep-
resentations. For example, the body dimensions of male action
figures marketed to young boys are so exaggerated that they are
actually physically unattainable in real life. Furthermore, male
characters in video games that are popular with young boys are
also exceedingly big and muscular (Pope, Olivardia, Gruber, &
Borowiecki, 1999; Scharrer, 2004; Harrison & Bond, 2007;
Downs & Smith, 2010).
Research also shows that boys and girls view media differently
and reach different conclusions about their own body image as a
result. One study of children aged 8-11 showed that boys' ideal body
image is to be bigger and more muscular than they actually are, while
girls' ideal image is to be considerably thinner. Interestingly, when
girls' and boys' perceptions of their actual body image are assessed,
girls see themselves more accurately as being heavier than their ideal.
In contrast, boys have a distorted self-perception: they see them-
selves as bigger and more muscular than they actually are (Jung &
Peterson, 2007).
Not only are children exposed to unrealistic body image portrayals
in the media, but also they are apt to admire these characters and try
to be like them. One suggestion for how parents and teachers can try to
inoculate children against these influences is to teach them that media
representations are often exaggerated and unattainable. Furthermore,
children should be exposed to a healthier, broader range of body
typesones with which they can identify (Jung & Peterson, 2007).
Do you think it is significant that big and strong male media
characters are also often portrayed as being dominant and
successful, or that slender and beautiful female media char-
acters are also often portrayed as being popular with boys?
What can parents and teachers do to reduce the influence of
media images on children's body image?
Soci al factors also affect children's wei ght probl ems. Chi l dren need to control thei r own
eating. Parents who are control l i ng and directive about thei r children's eati ng may produce
chi l dren who l ack i nternal control s to regulate their own food i ntake (J ohnson & Bi rch, 1994;
Fai th, J ohnson, & Al l i son, 1997; Wardl e, Guthri e, & Sanderson, 2001).
Poor di ets al so contri bute to obesi ty. Despi te thei r knowl edge that certai n foods are
necessary for a bal anced, nutri ti ous di et, many parents provi de thei r chi l dren wi th too
few frui ts and vegetabl es and more fats and sweets than recommended. School l unch pro-
grams have someti mes contri buted to the probl em by fai l i ng to provi de
nutri ti ous opti ons (J ohnston, Del va, & O'Mal l ey, 2007; Story, Nanney, &
Schwartz, 2009).
Gi ven how energeti c chi l dren thi s age can be, it is surpri si ng that a
major factor i n chi l dhood obesi ty is a l ack of exerci se. School -age chi l -
dren tend to engage i n rel ati vel y little exerci se and are not parti cul arl y fit.
A round 40 percent of boys aged 6 to 12 are unabl e to do more than one
pul l -up, and a quarter can't do any. Furthermore, chi l dren have shown little
or no i mprovement i n the amount of exerci se they get, despi te nati onal ef-
forts to i ncrease the fi tness of school -age chi l dren, i n part because many
school s have reduced the ti me available for recess and gym cl asses. From
ages 6 to 18, boys decrease thei r physi cal acti vi ty by 24 percent and girls
by 36 percent (Moore, Gao, & Bradl ee, 2003; Sallis & Gl anz, 2006; Wei ss &
Raz, 2006).
Why is the level of exercise relatively low? One answer is that many kids
are watching television and playing computer or video games. Such sedentary
activities not onl y prevent exercise, but children often snack while viewing TV
or surfing the Web (Anderson & Butcher, 2006; Pardee et al., 2007; Landhui s
et al , 2008).
"Remember when we used to have tofatten thekids upfirst f"
206 Mi ddl e Chi l dhood
REVIEW, CHECK, AND APPLY
1
REVIEW
L01 In what ways do children grow during the school
years, and what factors influence their growth?
In middle childhood, height and weight
increase gradually.
Differences in height and weight are
influenced by both genetic and social factors.
Adequate nutrition promotes physical,
social, and cognitive development, while
overnutrition and a sedentary lifestyle may
lead to obesity.
CHECK YOURSELF
1. Due to the sudden changes taking place during
this stage, it is not uncommon in middle school to
see children of the same age who are 6 to
7 inches apart in height.
True
False
2. Which of the following is NOT a long-term out-
come associated with childhood obesity?
a. cognitive deficits
b. being overweight as adults
c. greater risk of heart disease
d. higher prevalence of diabetes
APPLYING LIFESPAN DEVELOPMENT
What are some aspects of U.S. culture that may
contribute to obesity among school-age children?
V*
-
[study and Review on
MyDevelopmentLab.com
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Motor Development and Safety
LEARNING OBJECTIVES I
L 0 2
In what ways do motor skills develop over middle childhood?
L03 What are the main health concerns at this age?
The fact that the fi tness level of school -age chi l dren is not as hi gh as we woul d desi re does
not mean that such chi l dren are physi cal l y i ncapabl e. I n fact, even wi thout regul ar exerci se,
chi l dren's gross and fi ne motor skills devel op substanti al l y over the course of the school
years.
Gross Motor Skills
During middle childhood, children master many types of skills that
earlier they could not perform well, such as riding a bike, ice skat-
ing, swimming, and skipping rope. Is this the same for children of
other cultures?
One i mportant i mprovement i n gross motor skills is i n muscl e coordi nati on. Watchi ng a
softbal l player pi tch a bal l past a batter to her catcher, or Kat, the jump-roper descri bed earlier
i n the modul e, we are struck by the many skills chi l dren have mastered
si nce thei r awkward preschool days. Most can readi l y l earn to ride a bi ke,
ice skate, swi m, and skip rope (Cratty, 1986) (see Fi gure 5-2).
Years ago devel opmental i sts concl uded that gender di fferences i n
gross motor skills became i ncreasi ngl y pronounced duri ng these years,
wi th boys outperformi ng girls (Espenschade, 1960). However, when
compari ng boys and girls who regul arl y take part i n si mi l ar acti vi ti es
such as softbal l gender vari ati ons are mi ni mal (Hal l & Lee, 1984;
J uri mae & Saar, 2003).
Why the change? Expectati ons probabl y played a role. Soci ety did not
expect girls to be hi ghl y active and told girls they woul d do worse than
boys i n sports. The girls' performance refl ected that message.
Today, society's message has changed, at least officially. For i n-
stance, the A meri can Academy of Pedi atri cs suggests that boys and girls
shoul d engage i n the same sports and games, and that they can do so i n
mi xed-gender groups. There is no reason to separate the sexes i n physi -
cal exerci se and sports unti l puberty, when the smal l er size of femal es
makes them more suscepti bl e to i njury i n contact sports (Raudsepp &
Li bl i k, 2002; Vi l hjal msson & Kri stjansdotti r, 2003; A meri can Academy
of Pedi atri cs, 1999, 2004).
Physical Development in Middle Childhood 207
6 Years
Girls superior in
accuracy of
movement; boys
superior in more
forceful, less
complex acts.
Can throw with
the proper weight
shift and step.
Acquire the ability
to skip.
7 Years
Can balance on
one foot with eyes
closed.
Can walk on a 2-
inch-wide balance
beam without
falling off.
Can hop and jump
accurately into
small squares
(hopscotch).
Can correctly
execute a jumping-
jack exercise.
8 Years
Can judge and
intercept directions
of small balls
thrown from a
distance.
Both girls and boys
can run 17 feet per
second.
Boys can achieve
standing broad
jump of 5 feet;
girls can achieve
standing broad
jump of 4.5 feet.
Can grip objects
with 12 pounds of
pressure.
Can engage in
alternate rhyth-
mical hopping in a
2-2, 2-3, or 3-3
pattern.
Girls can throw a
small ball 33 feet;
boys can throw a
small ball 59 feet.
The number of
games partici-
pated in by both
sexes is the great-
est at this age.
FIGURE 5-2 Gross Motor Skills Developed From 6 and 12 Years
Source: Adapted from Cratty, B. J., PERCEPTUAL AND MOTOR DEVELOPMENT IN INFANTS AND CHILDREN, 3rd ed. Copyright Pearson Education, Inc.
Reprinted with permission from Pearson Education, Inc.
9 Years
Girls can jump
vertically 8.5
inches over their
standing height
plus reach; boys
can jump vertically
10 inches.
Boys can run 16.6
feet per second;
girls can run 16
feet per second.
11 Years 12 Years
Can achieve high
jump of 3 feet.
Fine Motor Skills
Typi ng at a computer keyboard. Wri ti ng i n cursi ve wi th pen and penci l . Drawi ng detai l ed
pi ctures. These are some of the accompl i shments that depend on the i mproved fi ne motor
coordi nati on of earl y and mi ddl e chi l dhood. Si x- and 7-year-ol ds are abl e to tie thei r shoes
and fasten buttons; by age 8, they can use each hand i ndependentl y; and by 11 and 12, they can
mani pul ate objects wi th al most as much capabi l i ty as they wi l l show i n adul thood.
One reason fi ne motor ski l l s i mprove i s that the amount of myel i n i n the brai n i ncreases
si gni fi cantl y between the ages of 6 and 8 (Lecours, 1982), rai si ng the speed at whi ch el ectri cal
i mpul ses travel between neurons. Messages reach muscl es more rapi dl y and control them bet-
ter. Myel i n al so provi des protecti ve i nsul ati on that surrounds parts of nerve cel l s.
Health During Middle Childhood
Imani was miserable. Her nose was running, her Hps were chapped, and her throat was sore. Although she
had stayed home from school and watched old reruns on TV, she still felt that she was suffering mightily.
Despi te her mi sery, I mani s si tuati on i s not so bad. She'l l get over the col d i n a few days and
be none the worse for it. I n fact, she may be a l i ttl e better off, for she is now i mmune to the
speci fi c col d germs that made her ill.
I mani 's col d may end up bei ng the most seri ous i l l ness she gets duri ng mi ddl e chi l dhood.
Thi s is general l y a peri od of robust heal th, and most ai l ments chi l dren do contract tend to be
mi l d and bri ef. Routi ne i mmuni zati ons have produced a consi derabl y l ower i nci dence of the
l i fe-threateni ng i l l nesses that 50 years ago cl ai med a si gni fi cant number of chi l dren.
However, i l l ness is not uncommon. More than 90 percent of chi l dren are l i kel y to have
at l east one seri ous medi cal condi ti on over the 6-year peri od of mi ddl e chi l dhood, accordi ng
to one l arge survey. A nd though most chi l dren have short-term i l l nesses, about one i n ni ne
208 Middle Chi l dhood
has a chroni c, persistent condi ti on, such as repeated mi grai ne headaches
(Dey & Bl oom, 2005; Si ni atchki n et al., 2010).
Accidents. The i ncreasi ng i ndependence of school -age chi l dren leads
to new safety issues. Between the ages of 5 and 14, the rate of i njury for
children increases. Boys are more apt to be i njured than girls, probabl y
because their overall level of physical activity is greater. Some ethni c and
racial groups are at greater risk than others: I njury death rates are hi ghest
for Ameri can I ndi an and Alaska Natives, and lowest for Asi an and Paci fi c
I slanders. Whi tes and Afri can-Ameri cans have approximately the same
death rates from i njuri es (Noonan, 2003; Borse et al., 2008).
The i ncreased mobi l i ty of this age is a source of several kinds of ac-
cidents. Chi l dren who regularly walk to school , many traveling such a
distance alone for the first time, face bei ng hit by cars and trucks. Due
to l ack of experi ence, they may mi sjudge how far they are from an on-
comi ng vehicle. Bi cycl e acci dents pose an i ncreasi ng risk, parti cul arl y as
children venture out onto busier roads (Schnitzer, 2006).
The most frequent i njury to chi l dren is automobi l e accidents. Auto
crashes annually kill five out of every 100,000 chi l dren between the ages
of 5 and 9. Fi res and burns, drowning, and gun-rel ated deaths follow in frequency (Field &
Behrman, 2002; Schiller & Bernadel , 2004).
Two ways to reduce auto and bi cycl e i njuri es are to use seat belts consi stentl y and to
wear appropri ate protecti ve cycl i ng gear. Bi cycl e hel mets have si gni fi cantl y reduced head
i njuri es, and i n many l ocal i ti es thei r use is mandatory. Knee and el bow pads have proven
to reduce i njuri es for rol l er-bl adi ng and skateboardi ng (Ameri can Academy of Pedi atri cs
Commi ttee on Acci dent and Poi son Preventi on, 1990; Lee, Schofer, & Koppel man, 2005;
Bl ake et al., 2008).
Safety on the Web. The newest threat to children's safety comes from a source that was
unheard of a generati on ago: the I nternet. Al though claims that cyberspace is overrun with
pornography and child mol esters are exaggerated, it is true that the Web makes available mate-
rial many parents fi nd objecti onabl e. Furthermore, soci al -networki ng sites such as Facebook
and video sites allow chi l dren to virtually i nteract with others about whom parents have little
or no knowledge. Fi nal l yas we'll consider later i n the chapter when we discuss bul l yi ngthe
I nternet provides a place where chi l dren can be bullied (Brant, 2003; OSTWG, 2010).
Computer software developers have devised programs that will bl ock parti cul ar com-
puter sites, but most experts feel the most reliable safeguard is parental supervi si on. Parents
shoul d warn their chi l dren never to provide personal i nformati on, such as home addresses or
telephone numbers, in chat rooms or on soci al -network sites such as Facebook. I n addition,
chi l dren shoul d not hol d face-to-face meeti ngs with people they meet via computer, at least
not without a parent present (Nati onal Center for Mi ssi ng and Expl oi ted Chi l dren, 2002;
OSTWG, 2010).
From an educator's perspective: Do you think using blocking software or
computer chips to screen offensive Internet content is a practical idea? Are such
controls the best way to keep children safe in cyberspace?
Psychological Disorders
Tyler Whitley, 7, is 4 feet 4 inches and weighs 74 pounds. He has blond hair, blue eyes, a generous
spiritand bipolar disorder, a serious mental illness. Highly irritable and angry one minute, he'll be
laughing hysterically the next. Grand illusions kick in: he can leap to the ground from the top of a tall
tree or jump from a grocery cart and fly. And then there are the heart-wrenching bouts of depression
when Tyler tells his parents, "I should never have been born. I need to go to heaven so people can be
happy' (Kalb, 2003, p. 68)
Bi pol ar disorder such as Tyler's is di agnosed when a person cycles back and forth between
two extreme emoti onal states: unrealistically high spirits and energy, and depression. For
Physical Development In Middle Childhood
years most peopl e negl ected the symptoms of such psychol ogi cal di sorders i n chi l dren, and
even today they may be overl ooked. Yet it is a common probl em: One i n five chi l dren and
adol escents has a psychol ogi cal di sorder that produces at least some i mpai rment. For exampl e,
about 5 percent of preteens suffer from chi l dhood depressi on, and 13 percent of chi l dren
between ages 9 and 17 experi ence an anxi ety di sorder (Kal b, 2003; Beardsl ee & Gol dman,
2003; Tol an & Dodge, 2005; Ci cchetti & Cohen, 2006; Hi rshfel d-Becker et al 2010).
Psychol ogi cal di sorders may be negl ected because chi l dren and adults express symptoms
differently. Even when such di sorders are di agnosed accurately, the correct treatment may be
elusive. For exampl e, i n 2002 more than 10 mi l l i on prescri pti ons for anti depressant drugs were
wri tten for chi l dren under 18 even though such drugs have never been approved for children's
use. But because the drugs have been approved for adults, physi ci ans who prescri be them for
chi l dren are acti ng legally (Goode, 2004).
Advocates for the use of anti depressants such as Prozac, Zol oft, Paxi l , and Wel l butri n for
chi l dren suggest that drug therapi es can successful l y treat thei r depressi on and other psycho-
l ogi cal di sorders. Drugs may provi de the onl y rel i ef i n cases where tradi ti onal therapi es that
use verbal methods are i neffecti ve. At least one cl i ni cal test shows that the drugs are effective
wi th chi l dren (Ebmei er, Donaghey, & Steele, 2006; Barton, 2007; Lovri n, 2009).
Cri ti cs, however, questi on the l ong-term effecti veness of anti depressants for chi l dren.
No one knows the consequences of their use on the devel opi ng brai n, nor the overall l ong-
term effects. Little is known about the correct dosage for age or size, and some observers
suggest that children's versi ons of the drugs, i n orange- or mi nt-fl avored syrups, mi ght l ead to
overdoses or eventual l y encourage the use of illegal drugs (Andersen & Navalta, 2004; Couzi n,
2004; Cheung, Emsl i e, & Mayes, 2006).
Finally, some evi dence l i nks anti depressants wi th an i ncreased ri sk of sui ci de. The pos-
sible l i nk prompted the U.S. Federal Drug Admi ni strati on to issue a warni ng about a class of
anti depressants known as SSRI s i n 2004. Some experts have urged thei r use wi th chi l dren and
adol escents be banned compl etel y (Bostwi ck, 2006; Goren, 2008; Sammons, 2009).
Al though the use of anti depressants to treat chi l dren is controversi al , it is clear that chi l d-
hood depressi on and other psychol ogi cal di sorders remai n a si gni fi cant probl em. These di sor-
ders must not be i gnored. Not onl y are they disruptive duri ng chi l dhood, but they put chi l dren
at ri sk for future di sorders (Vedantam, 2004; Bostwi ck, 2006; Goren, 2008; Frani c et al., 2010).
As we'll see next, adults also need to pay attenti on to other speci al needs that affect many
school -age chi l dren.
218 Middle Chi l dhood
Language Development: What Words Mean
I f you listen to school -age children, their speech sounds similar to that of adults. However, the
apparent similarity is deceiving. The linguistic sophi sti cati on of chi l drenparti cul arl y early
in the school -age peri odsti l l needs refi ni ng to reach adult levels.
Mastering the Mechanics of Language. Vocabul ary conti nues to i ncrease rapidly dur-
i ng the school years. The average 6-year-ol d has a vocabul ary of from 8,000 to 14,000 words,
whereas another 5,000 words appear from ages 9 to 11.
Children's mastery of grammar also i mproves. For i nstance, the passive voi ce is sel dom
used duri ng the early school -age years (as in "The dog was walked by J on," compared with
the acti ve-voi ce "J on walked the dog"). Six- and 7-year-ol ds rarely use condi ti onal sentences,
such as "I f Sarah will set the table, I will wash the dishes." Duri ng mi ddl e chi l dhood, however,
the use of passive voi ce and condi ti onal sentences i ncreases. I n addition, children's under-
standi ng of syntax, the rules governi ng how words and phrases can be combi ned to form
sentences, grows.
By first grade, most children pronounce words quite accurately. However, certai n pho-
nemes, units of sound, remai n troubl esome. For i nstance, the ability to pronounce j, v, th, and
zh sounds develops later.
School -age children also may have difficulty decodi ng sentences when the meani ng de-
pends on intonation, or tone of voice. For example, consider the sentence, "George gave a book
to Davi d and he gave one to Bill." I f the word "he" is emphasized, the meani ng is "George gave
a book to Davi d and Davi d gave a different book to Bill." But i f the i ntonati on emphasizes
the word "and," then the meani ng changes to "George gave a book to David and George also
gave a book to Bill." School -age chi l dren cannot easily sort out subtleties such as these (Wells,
Peppe, & Goul andri s, 2004; Thornton, 2010).
Conversati onal skills also develop as children become more competent in using pragmat-
ics, the rules governing the use of language to communi cate in soci al settings.
For example, although children in early chi l dhood are aware of the rules of conversational
turn-taki ng, their use is someti mes primitive. Consi der the following conversati on between
6-year-ol ds Yonni e and Max:
Yonnie: My dad drives a FedEx truck
Max: My sister's name is Molly.
Cognitive Development in Middle Childhood l i WHi J Wj j 219
Yonnie: He gets up really early in the morni ng.
Max: She wet her bed last night.
Later, however, conversations show more gi ve-and-take, with chi l dren respondi ng to each
others comments. For i nstance, this conversati on between 11-year-ol ds Mi a and J osh reflects
a greater mastery of pragmati cs:
Mia: I don't know what to get Claire for her birthday.
Josh: I 'm getting her earrings.
Mia: She already has a lot of jewelry.
Josh: I don't thi nk she has that much.
Metalinguistic Awareness. A significant devel opment in middle chi l dhood is children's
i ncreasi ng understandi ng of their own use of language, or metalinguistic awareness. By age
5 or 6, they understand that a set of rules governs language. I n the early years they learn and
comprehend these rules implicitly, but duri ng middle chi l dhood they understand them more
explicitly (Benel l i et al , 2006; Sai egh-Haddad, 2007).
Metal i ngui sti c awareness helps children's comprehensi on when i nformati on is fuzzy or
i ncompl ete. For i nstance, when preschool ers receive ambi guous or unclear i nformati on, such
as di recti ons for a compl i cated game, they rarely ask for clarification, and tend to bl ame them-
selves for any confusi on. By the age of 7 or 8, chi l dren realize that mi scommuni cati on may be
due to the person communi cati ng with them as well. Consequently, school -age chi l dren are
more likely to ask for clarifications (Apperly & Robi nson, 2002).
How Language Promotes Self-Control. Thei r growing sophi sti cati on with language helps
chi l dren control and regulate their behavior. I n one experi ment, chi l dren were told they could
have one marshmal l ow treat i f they chose to eat it immediately, but two treats i f they waited.
Most of the children, who ranged in age from 4 to 8, chose to wait, but the strategies they used
differed significantly.
The 4-year-ol ds often chose to l ook at the marshmal l ows whi l e waiting, a strategy that
was not terri bl y effective. I n contrast, 6- and 8-year-ol ds used language to help overcome
temptati on, al though i n different ways. The 6-year-ol ds spoke and sang to themsel ves, re-
mi ndi ng themsel ves they woul d get more treats i f they waited. The 8-year-ol ds focused on as-
pects of the marshmal l ows unrel ated to taste, such as appearance, whi ch hel ped them to wait.
I n short, chi l dren used "self-talk" to regulate their behavior. Thei r sel f-control grew as
their linguistic capabilities i ncreased.
Biiingualism: Speaking in Many Tongues
For picture day at New York's P.S. 217, a neighborhood elementary school in Brooklyn, the notice to
parents was translated into five languages. That was a nice gesture, but insufficient: More than 40 per-
cent of the children are immigrants whose families speak any one of twenty-six languages, ranging from
Armenian to Urdu. (Leslie, 1991, p. 56)
Across Ameri ca, the voices with whi ch chi l dren speak are changi ng. Nearly one in five people
in the Uni ted States speaks a language other than Engl i sh at home, a percentage that is grow-
ing. Biiingualismthe use of more than one l anguagei s i ncreasi ngl y common (Shi n &
Bruno, 2003; Graddol , 2004) (see Fi gure 5-5).
Chi l dren with little or no Engl i sh profi ci ency must l earn both the standard school cur-
ri cul um and the language i n whi ch it is taught. One approach to achi evi ng this is bilingual
education, i n whi ch chi l dren are initially taught i n their native language, whi l e they l earn
Engl i sh. Thi s enabl es students to develop a strong foundati on in basi c subject areas usi ng
their native language. The goal of most bi l i ngual programs is to gradually shift i nstructi on
i nto Engl i sh.
An alternative approach is to i mmerse students in Engl i sh, teachi ng solely in that lan-
guage. To proponents of this approach, initially teachi ng students in another language hi nders
their efforts to learn English and slows their i ntegrati on i nto society.
metalinguistic awareness an understanding of
one's own use of language
biiingualism the use of more than one language
220 Mi ddl e Chi l dhood
Alaska
33S Miles
Number of Speakers
(by county)
0
l -99
100 - 499
500 - 999
1,000 - 4,999
5,000 - 19,999
20,000 - 49,999
H 50,000 99,999
100,000 * 499,999
500,000 - 999,999
1,000,000 - 3,500,000
0 736 Miles 0 Mile?
UF The Top 10 Languages Other Than English Spoken in the United States
These figures show the number of U.S. residents over the age of 5 who speak a language other than English at home. With increases
in the number and variety of languages spoken in the United States, what types of approaches might an educator use to meet the needs
of bilingual students?
Source: Modern Language Association, www.mla.org/census_map,2005. Based on data from U.S. Census Bureau, 2000.
These two qui te di fferent, hi ghl y pol i ti ci zed approaches have some pol i ti ci ans argui ng for
"Engl i sh-onl y" l aws, whi l e others urge school s to respect the chal l enges nonnati ve speakers
face by offeri ng some i nstructi on i n thei r nati ve l anguage. Sti l l , the psychol ogi cal research is
cl ear: Bei ng bi l i ngual offers cogni ti ve advantages. Wi th a wi der range of l i ngui sti c possi bi l i -
ti es to choose f rom i n assessi ng a si tuati on, speakers of two l anguages show greater cogni ti ve
fl exi bi l i ty. They sol ve probl ems wi th greater creati vi ty and versati l i ty. L earni ng i n ones nati ve
tongue is al so associ ated wi th hi gher sel f-esteem i n mi nori ty students (Lesaux & Si egel , 2003;
Chen & Bond, 2007; Bi al ystok & Vi swanathan, 2009).
Bi l i ngual students often have greater metal i ngui sti c awareness, understand the rul es
of l anguage mor e expl i ci tl y, and show great cogni ti ve sophi sti cati on. They may even score
hi gher on tests of i ntel l i gence, accordi ng to some research. Furthermore, brai n scans compar-
i ng bi l i ngual i ndi vi dual s wi th those who speak onl y one l anguage fi nd di fferences suggesti ng
di fferent types of brai n acti vati on (Swanson, Saez, & Gerber, 2004; Carl son & Mel tzoff, 2008;
Kovel man, Baker, & Peti tto, 2008; Pi l l er, 2010).
Fi nal l y, because many l i ngui sts contend that uni versal processes underl i e l anguage acqui -
si ti on, as we noted i n Chapter 3, i nstructi on i n a nati ve l anguage may enhance i nstructi on i n
a second l anguage. I n fact, as we di scuss next, many educators bel i eve that second-l anguage
l earni ng shoul d be a regul ar part of el ementary school i ng for all chi l dren (Kecskes & Papp,
2000; McCardl e & Hoff, 2006).
258 Adol escence
including those relating to obesity and nutrition, harmful substances, and sexually transmitted
infections.
Beyond the physical aspects of development, adolescents grow cognitively as well. The most
notable change we will di scuss is adolescents' growing awareness of their own thought pro-
cesses. We also consider how adolescents deal with the institution that occupies a great deal
of their waking ti meschool and di scuss the growing impact of the Internet on adolescents'
lives, learning, and relationships.
Finally, we turn to the changes that adolescents undergo in their relationships with others.
We begin with a consideration of the ways in which they create their concepts of themselves
and how they form and protect their self-esteem and identity. We di scuss their relationships
with parents as adolescents redefine their place within the family. Finally, we di scuss dating
and sex, which achieve central importance during this period and which encompass i ssues of
intimacy.
MODULE 6.1 Physical Development in Adolescence
The Middle School Marathon
Like most children, Luke Voss would sometimes complain about all the
work he had to do. But it wasn't until he reached middle school that his
mother, Gisela, realized he actually had something to complain about.
"He was at school from 8 to 3, and with soccer practice he wouldn't
be done until 5," Gisela explained. "If we all ate dinner togetherand
it's important to me that we dohe wouldn't even start cracking the
books until 7. He missed out on sleep, and his anxiety stressed every-
body else out. We'd rush through the meal knowing that he had hours
of work ahead of him, and he'd start begging for help even before he left
the table."
Luke eventually grew more accustomed to the rigors of middle school.
But this did not change thefundamentals of the situation, for Luke or for
his mother: too much work, too many family and extracurricular respon-
sibilites, and only so many hours in the day. "This is an insane way for
families to live," Gisela admitted. (Mohler, 2009)
Like Luke, many adol escents struggle to meet soci ety'sand their owndemands as they
traverse the challenges of the teenage years. These challenges extend far beyond managi ng
an overstuffed schedule. Wi th bodi es that are conspi cuousl y changi ng; temptati ons of sex,
al cohol , and other drugs; cognitive advances that make the worl d seem i ncreasi ngl y com-
plex; soci al networks that are in constant flux; and careeni ng emoti ons, adol escents fi nd
themsel ves i n a peri od of life that evokes exci tement, anxiety, glee, and despair, someti mes
in equal measure.
Adolescence is the devel opmental stage between chi l dhood and adul thood. I t is generally
said to start just before the teenage years, and end just after them. Consi dered nei ther chi l dren
nor adults, adolescents are i n a transi ti onal stage marked by consi derabl e growth.
Thi s modul e focuses on physical growth during adol escence. We first consi der the ex-
traordi nary physical maturati on that occurs duri ng adol escence, triggered by the onset of
puberty. We then discuss the consequences of early and late maturati on and how they differ
for mal es and females. We also consi der nutri ti on. After exami ni ng the causesand conse-
quencesof obesity, we discuss eating disorders, whi ch are surprisingly common at this stage.
The modul e concl udes with a discussion of several major threats to adolescents' well-
bei ngdrugs, alcohol, tobacco, and sexually transmi tted i nfecti ons.
Physical Maturation
LOI What physical changes do adolescents experience?
L02 What are the consequences of early and late maturation?
L03 What are the nutritional needs and concerns of adolescents?
For young males oftheAwa tribe, adolescence begins with an elaborate andto Western eyesgrue-
some ceremony to mark thepassage from childhood to adulthood. The boys are whipped for 2 or 3 days
with sticks and prickly branches. Through the whipping, the boys atone for their previous infractions and
honor tribesmen who were killed in warfare.
We are no doubt grateful we were spared such physical trials when we entered adol escence.
But members of Western cultures have their own rites of passage, admittedly less fearsome,
such as bar mi tzvahs and bat mitzvahs at age 13 for J ewish boys and girls, and confi rmati on
ceremoni es in many Chri sti an denomi nati ons (Herdt, 1998; Eccl es, Templ eton, & Barber,
2003; Hoffman, 2003).
I^N From an educator's perspective: Why do you think many cultures regard
^ the passage to adolescence as a significant transition that calls for unique
ceremonies?
Physical Development in Adolescence IrtBlHiJWjJ 259
LEARNING OBJECTIVES
J
J
Regardless of their nature, the underlying purpose of these ceremoni es tends to be the
same across cultures: symbol i cal l y celebrating the physical changes that transform a child's
body i nto an adult body capable of reproducti on.
Growth During Adolescence: The Rapid Pace of Physical
and Sexual Mat urat ion
I n onl y a few months, adol escents can grow several i nches as they are transformed, at least
physically, from chi l dren to young adults. Duri ng such a growth spurta peri od of very
rapid growth in hei ght and wei ghtboys, on average, grow 4.1 i nches a year and girls
3.5 i nches. Some adol escents grow as much as 5 i nches i n a single year (Tanner, 1972; Cai no
et al 2004).
Boys' and girls' growth spurts begi n at different ages. As you can see in Fi gure 6-1, girls'
spurts begi n around age 10, while boys start around age 12. Duri ng the 2-year peri od from
age 11, girls tend to be taller than boys. But by 13, boys, on average, are taller than gi rl sa
state that persists for the remai nder of the life span.
Puberty: The St art of Sexual Mat urat ion
Puberty, the peri od when the sexual organs mature, begi ns when the pituitary gland in the
brai n signals other glands to begi n produci ng the sex hormones, androgens (mal e hormones)
or estrogens (female hormones), at adult levels. (Mal es and females produce both types of sex
hormones, but mal es have hi gher levels of androgens and females, of estrogens.) The pituitary
gland also signals the body to produce more growth hormones. These i nteract with the sex
hormones to cause the growth spurt and puberty. The hormone leptin also appears to play a
role in the onset of puberty.
Like the growth spurt, puberty begi ns earlier for girls, starting at around age 11 or 12,
whereas boys begi n at about age 13 or 14. However, this varies widely. Some girls begi n pu-
berty as early as 7 or 8 or as late as age 16.
Puberty in Girls. Al though it is not clear why puberty begi ns when it does, envi ronmental
and cultural factors play a role. For example menarche, the onset of menstruati on and prob-
ably the most obvious sign of puberty in girls, varies greatly around the world. I n poorer,
developing countri es, menstruati on begi ns later than in more economi cal l y advantaged
adolescence the developmental stage that lies
between childhood and adulthood
puberty the period during which the sexual
organs mature
menarche the onset of menstruation
260 Adol escence
ni
'5
E
re
13
DI
'5
X
24
23 _
22 _
21 _
20 _
19 _
18 _
17 _
16 _
15 _
14 _
13 _
12 _
11 _
10 _
9 _
8 _
7 _
6 _
5 _
4 _
3 _
2 _
1 _
0 _
9 11 13 15 17 19 11 13 15 17 19
Age Age
Boy Girl
FIGURE 6-1 Growth Patterns
Patterns of growth are depicted in two ways. The first figure shows height at a given age, while the second shows the height increase that
occurs from birth through the end of adolescence. Notice that girls begin their growth spurt around age 10, while boys begin their growth spurt
at about age 12. However, by the age of 13, boys tend to be taller than girls. What are the social consequences of being taller or shorter than
average for boys and girls?
Source: Adapted from Cratty, 1986.
countri es. Even wi thi n weal thi er countri es, more affl uent gi rl s begi n to menstruate earl i er
than l ess affl uent gi rl s.
I t appears that gi rl s who are better nouri shed and heal thi er tend to start menstruati on
earl i er than those sufferi ng f rom mal nutri ti on or chroni c di sease. Some studi es have suggested
that wei ght or the proporti on of fat to muscl e i n the body pl ay a key rol e i n the onset of men-
arche. For exampl e, i n the Uni ted States, athl etes wi th a l ow percentage of body fat may start
menstruati ng l ater than l ess acti ve gi rl s. Conversel y, obesi tywhi ch i ncreases the secreti on
of l epti n, a hor mone rel ated to the onset of menstruati onl eads to earl i er puberty (Ri chards,
1996; Vi zmanos & Marti -Henneberg, 2000; Woel fl e, Harz, & Roth, 2007; Oswal & Yeo, 2010).
Other factors can affect the ti mi ng of menarche. For exampl e, envi ronmental stress
f rom parental di vorce or i ntense fami l y confl i ct can effect an earl y onset (Kal ti al a-Hei no,
K osunen, & Ri mpel a, 2003; El l i s, 2004; Bel sky et al 2007).
Over the past century or so, gi rl s i n the Uni ted States and other cul tures have been enter-
i ng puberty at earl i er ages. I n the late ni neteenth century, menstruati on began, on average,
around age 14 or 15, compared wi th todays 11 or 12. The average age for other i ndi cators of
puberty, such as the attai ni ng of adul t hei ght and sexual maturi ty, has al so dropped, probabl y
due to reduced di sease and i mproved nutri ti on (Hughes, 2007; McDowel l , Brody, & Hughes,
2007; Harri s, Pri or, & K oehoorn, 2008).
The earl i er start of puberty is an exampl e of a si gni fi cant secular trend. Secul ar trends
occur when a physi cal characteri sti c changes over the course of several generati ons, such
as earl i er onset of menstruati on or i ncreased hei ght resul ti ng f rom better nutri ti on over the
centuri es.
Menstruati on is one of several changes i n puberty rel ated to the devel opment of pri mary
and secondary sex characteri sti cs. Primary sex characteristics are associ ated wi th the devel -
opment of the organs and body structures rel ated di rectl y to reproducti on. Secondary sex
characteristics are the vi si bl e si gns of sexual maturi ty that do not i nvol ve the sex organs
di rectl y.
secondary sex characteristics the visible signs
of sexual maturity that do not directly involve the
sex organs
J
secular trend a pattern of change occurring over
several generations
primary sex characteristics characteristics
associated with the development of the organs
and structures of the body that directly relate to
reproduction
Note the changes that have occurred in just a few years in these pre- and post-puberty
photos of the same boy.
I n girls, developing pri mary sex characteri sti cs involves changes in the vagina and uterus.
Secondary sex characteri sti cs include the devel opment of breasts and pubic hair. Breasts begin
to grow around age 10, and pubi c hair appears at about age 11. Underarm hair appears about
2 years later.
For some girls, signs of puberty start unusual l y early. One out of seven Caucasi an girls
develops breasts or pubi c hair by age 8. For Afri can Ameri can girls, the figure is one out of
two. The reasons for this earlier onset are unclear, and what defines normal and abnormal
onset is a controversy among specialists (Lemoni ck, 2000; The Endocri ne Society, 2001;
Ri tzen, 2003).
Puberty in Boys. Boys' sexual maturati on follows a somewhat different course. Growth
of the peni s and scrotum accel erates around age 12, reachi ng adult size about 3 or 4 years
later. As boys' peni ses enlarge, other pri mary sex characteri sti cs develop. The prostate gl and
and semi nal vesicles, whi ch produce semen (the fluid that carri es sperm), enlarge. A boy's
first ejacul ati on, known as spermarche, usually occurs around age 13, more than a year
after the body begi ns produci ng sperm. At first, the semen contai ns relatively few sperm,
but the sperm count i ncreases si gni fi cantl y with age. Secondary sex characteri sti cs are also
developing. Pubi c hair begi ns to grow around age 12, followed by the growth of underarm
and facial hair. Finally, boys' voi ces deepen as the vocal cords become l onger and the l arynx
larger. (Fi gure 6-2 summari zes the changes that occur in sexual maturati on duri ng early
adol escence.)
The surge in hormones that triggers puberty also may lead to rapid mood swings. Boys
may have feelings of anger and annoyance associated with hi gher hormone levels. I n girls,
hi gher levels of hormones are associated with depression as well as anger (Buchanan, Eccl es, &
Becker, 1992).
Body I mage: Reactions to Physical Changes in Adolescence. Unlike infants, who also
undergo rapid growth, adolescents are aware of what is happeni ng to their bodi es, and they
may react with horror or joy. Few, though, are neutral about the changes they are witnessing.
Some of the changes of adol escence carry psychological weight. I n the past, girls tended
to view menarche with anxi ety because Western soci ety emphasi zed the negative aspects of
menstruati on, its cramps and messi ness. Today, however, soci ety views menstruati on more
positively, in part because more open discussion has demystified it; for example, television
commerci al s for tampons are commonpl ace. As a result, menarche now typically increases
262 Adol escence
Average Male Average Female
10 11 12 13 14 15 16 17 18
Age in Years
l l Height spurt I I Penis growth
I I First ejaculation I I Pubic hair
FIGURE 6-2 Sexual Maturation
The changes in sexual maturation that occur
adolescence.
Source: Adapted from Tanner, 1978.
10 11 12 13 14 15 16 17 18
Age in Years
I I Height spurt I I Pubic hair
I I Breast development
I I Onset of menstruation
males and females during early
<; Hwat ch on mydevel o pment l ab. co m
Log onto MyDevelopmentLab.com to watch
12-year-old Kianna, her mother, and her best
friend talk about how important body image is in
adolescence.
/
sel f-esteem, enhances status, and provi des greater sel f-awareness, as gi rl s see themsel ves as
young adul ts (J ohnson, Roberts, & Worel l , 1999; Matl i n, 2003).
A boys fi rst ejacul ati on is roughl y equi val ent to menarche. However, whi l e gi rl s general l y
tell thei r mothers about the onset of menstruati on, boys rarel y menti on thei r fi rst ejacul ati on
to thei r parents or even thei r fri ends (Stei n & Rei ser, 1994). Why? One reason i s that moth-
ers provi de the tampons or sani tary napki ns gi rl s need. For boys, the fi rst ejacul ati on may be
seen as a si gn of thei r buddi ng sexual i ty, an area they feel both uncertai n about and rel uctant
to di scuss wi th others.
Menstruati on and ejacul ati ons occur pri vatel y, but changes i n body shape and si ze are
qui te publ i c. Teenagers frequentl y are embarrassed by these changes. Gi rl s, i n parti cul ar, are
often unhappy wi th thei r new bodi es. Western i deal s of beauty cal l for an extreme thi nness at
odds wi th the actual shape of most women. Puberty consi derabl y i ncreases the amount of fatty
ti ssue, and enl arges the hi ps and buttocksa far cry f rom the penci l -thi n body soci ety seems
to demand (Unger & Crawford, 2004; McCabe & Ri cci ardel l i , 2006; Cotruf o et al., 2007).
H ow chi l dren react to the onset of puberty depends i n part on when it happens. Gi rl s and
boys who mature ei ther much earl i er or l ater than most of thei r peers are especi al l y affected.
The Timing of Puberty: The Consequences of Early and Late Maturation. There
are soci al consequences for earl y or late maturati on. A nd these soci al consequences are very
i mportant to adol escents.
Earl y Maturati on. For boys, earl y maturati on is l argel y a pl us. Earl y-maturi ng boys tend to
be mor e successful athl etes, presumabl y because of thei r l arger si ze. They al so tend to be mor e
popul ar and to have a more posi ti ve sel f-concept.
Earl y maturati on i n boys, though, does have a downsi de. Boys who mature earl y are more
apt to have di ffi cul ti es i n school , and to become i nvol ved i n del i nquency and substance abuse.
Bei ng l arger i n si ze, they are mor e l i kel y to seek the company of ol der boys and become i n-
vol ved i n age-i nappropri ate acti vi ti es. Earl y-maturers are al so mor e conf ormi ng and l acki ng
i n humor al though they are more responsi bl e and cooperati ve i n adul thood. Overal l , though,
earl y maturati on is posi ti ve for boys (Taga, Markey, & Fri edman, 2006; Costel l o et al., 2007;
Lynne et al , 2007).
The story is a bi t di fferent for earl y-maturi ng girls. For them, the obvi ous changes i n thei r
bodi essuch as the devel opment of breastsmay l ead them to feel uncomfortabl e and di fferent
from thei r peers. Moreover, because girls, i n general , mature earl i er than boys, earl y maturati on
tends to come at a very young age i n the gi rl s life. Earl y-maturi ng girls may have to endure
ri di cul e from thei r less mature cl assmates (Franko & Stri egel -Moore, 2002; Ol i vardi a & Pope,
2002; Mendl e, Turkhei mer, & Emery, 2007). ^^-[Watch on mydevel opmentl ab.com
Earl y maturati on, though, i s not a compl etel y negati ve experi ence for gi rl s. Those who
mature earl i er are mor e often sought as dates, and thei r popul ari ty may enhance thei r
Physical Development in Adolescence IrtBlHiJWjJ 42
sel f-concept. Thi s can be psychologically challenging, however. Earl y-maturers may not be
socially ready for the ki nd of one-on-one dating situations that most girls deal with at a later
age. Moreover, their obvious deviance from their l ater-maturi ng peers may produce anxiety,
unhappi ness, and depression (Kal ti al a-Hei no et al , 2003).
Consequentl y, unl ess a young girl who has devel oped secondary sex characteri sti cs early
can handl e the di sapproval she may encounter when she conspi cuousl y displays her growi ng
sexuality, the outcome of early maturati on may be negative. I n countri es i n whi ch attitudes
about sexual i ty are more l i beral , the results of earl y maturati on may be more positive. For
exampl e, in Germany, whi ch has a more open vi ew of sex, earl y-maturi ng girls have hi gher
sel f-esteem than such girls in the Uni ted States. Furthermore, the consequences of early
maturati on vary even wi thi n the Uni ted States, dependi ng on the views of girls' peer groups
and on prevai l i ng communi ty standards regardi ng sex (Petersen, 2000; Giire,U<;anok, &
Sayil, 2006).
Late Maturation. As with early-maturers, the situation for l ate-maturers is mi xed, although
here boys fare worse than girls. Boys who are smaller and lighter tend to be consi dered less
attractive. Bei ng small, they are at a disadvantage in sports activities. They may also suffer
socially as boys are expected to be taller than their dates. I f these difficulties di mi ni sh a boy's
sel f-concept, the disadvantages of late maturati on could extend well into adul thood. Copi ng
with the challenges of late maturati on may actually help mal es, however. Late-maturi ng boys
grow up to be assertive and insightful, and are more creatively playful than early maturers
(Livson & Peski n, 1980; Kal ti al a-Hei no et al , 2003).
The picture for l ate-maturi ng girls is quite positive even though they may be overl ooked
in dating and other mi xed-sex activities duri ng juni or high and middle school , and may have
relatively low soci al status (Apter et al , 1981; Cl arke-Stewart & Fri edman, 1987). I n fact, late-
maturi ng girls may suffer fewer emoti onal probl ems. Before they reach 10th grade and have
begun to mature visibly, they are more apt to fit the slender, "l eggy" body type soci ety ideal-
izes than their earl y-maturi ng peers, who tend to l ook heavier in compari son (Petersen, 1988;
Kami naga, 2007; Leen-Fel dner, Reardon, & Hayward, 2008).
The reacti ons to early and late maturati on paint a compl ex picture. As we have seen, an
individual's devel opment is affected by a constel l ati on of factors. Some developmentalists
suggest that changes in peer groups, family dynami cs, and parti cul arl y school s and other
soci etal i nsti tuti ons may determi ne an adolescent's behavi or more than age of maturati on,
and the effects of puberty in general (Dorn, Susman, & Poni raki s, 2003; Stice, 2003; Mendl e,
Turkhei mer, & Emery, 2007; Spear, 2010).
Nut rit ion, Food, and Eating Disorders:
Fueling the Growth of Adolescence
A rice cake in the afternoon, an apple for dinner. That was Heather Rhodes's typical diet her
freshman year at St. Joseph's College in Rensselaer, Indiana, when she began to nurture a fear
(exacerbated, she says, by the sudden death of a friend) that she was gaining weight. But when
Heather, now 20, returned home to Joliet, Illinois, for summer vacation a year and a half ago,
her family thought she was melting away.... Her 5'7" frame held a mere 85 poundsdown
22 pounds from her senior year in high school "[But] when I looked in the mirror," she says,
"I thought my stomach was still huge and my face was fat." (Sandler, 1994, p. 56)
Heather's probl em: a severe eating disorder, anorexi a nervosa. As we have seen, the cultural
ideal of slim and fit favors late-developing girls. But when devel opment does occur, how do
girls, and increasingly, boys, cope with an i mage in the mi rror that deviates from the popular
medi a ideal?
The rapid physical growth of adol escence is fueled by an i ncrease in food consumpti on.
Particularly during the growth spurt, adolescents eat substantial quantities of food, i ncreas-
ing their intake of calories rather dramatically. Duri ng the teenage years, the average girl
requires some 2,200 calories a day, and the average boy requires 2,800. Of course, not just any
calories nouri sh this growth. Several nutri ents are essential, particularly cal ci um and iron.
Mi l k and certai n vegetables provide cal ci um for bone growth, and cal ci um may prevent the
264 Adol escence
Obesity has become the most common nutritional concern during
adolescence. In addition to issues of health, what are some psy-
chological concerns about obesity in adolescence?
Obesity. The most common nutri ti onal concern i n adol escence is obe-
sity. One i n 5 adol escents is overwei ght, and 1 i n 20 can be cl assi fi ed as
obese (more than 20 percent above average body wei ght). The proporti on
of femal es who are cl assi fi ed as obese i ncreases over the course of adol es-
cence (Br ook & Tepper, 1997; Cri tser, 2003; K i mm et al 2003).
A dol escents are obese for the same reasons as younger chi l dren, but
speci al concerns wi th body i mage may have severe psychol ogi cal conse-
quences at thi s age. The potenti al heal th consequences of obesi ty duri ng
adol escence are al so probl emati c. Obesi ty taxes the ci rcul atory system,
i ncreasi ng the ri sk of hi gh bl ood pressure and di abetes. Obese adol es-
cents al so have an 80 percent chance of becomi ng obese adul ts (Bl ai ne,
Rodman, & Newman, 2007; Gobl e, 2008; Wang et al 2008).
L ack of exerci se i s a maj or cul pri t. One survey f ound that by the end
of the teenage years, few femal es get much exerci se outsi de of school
physi cal educati on cl asses. I n fact, the ol der they get, the l ess they exerci se. Thi s is espe-
ci al l y true for ol der Bl ack femal e adol escents, more than hal f of whom report no physi cal
exerci se outsi de of school , compared wi th about a thi rd of Whi te adol escents (Deforche, De
Bourdeaudhui j, & Tanghe, 2006; Del va, O'Mal l ey, & J ohnston, 2006; Rei chert et al., 2009; Li ou,
Li ou, & Chang, 2010).
Addi ti onal reasons for the hi gh rate of obesi ty duri ng adol escence i ncl ude the easy avai l -
abi l i ty of fast foods, whi ch del i ver l arge porti ons of hi gh-cal ori e, hi gh-fat cui si ne at pri ces
adol escents can afford. Furthermore, many adol escents spend a si gni fi cant proporti on of
thei r l ei sure ti me i nsi de thei r homes watchi ng tel evi si on, pl ayi ng vi deo games, and surfi ng the
Web. Such sedentary acti vi ti es not onl y keep adol escents f rom exerci si ng, but they often are
accompani ed by snacks of j unk foods (Ri deout, Vandewater, & Wartel l a, 2003; Del mas et al.,
2007; Krebs et al., 2007; Bray, 2008).
osteoporosi sthe thi nni ng of bonesthat affects 25 percent of women
i n l ater life. I ron is al so necessary, as i ron-defi ci ency anemi a is not un-
common among teenagers.
For most adol escents, the maj or i ssue is eati ng a suffi ci ent bal ance of
nutri ti ous foods. Two extremes of nutri ti on concern a substanti al mi nor-
i ty and can create real threats to heal th: obesi ty and eati ng di sorders l i ke
the one affl i cti ng Heather Rhodes.
anor exi a nervosa a severe eating disorder in
which individuals refuse to eat, while denying that
their behavior and appearance, which may become
skeletal, are out of the ordinary
bul i mi a an eating disorder characterized by binges
on large quantities of food, followed by purges of
the food through vomiting or the use of laxatives
Anorexia Nervosa and Bulimia. Fear of fat and of growi ng obese can create i ts own
pr obl emsf or exampl e, Heather Rhodes suffered f rom anorexia nervosa, a severe eati ng
di sorder i n whi ch i ndi vi dual s refuse to eat. A troubl ed body i mage l eads some adol escents
to deny that thei r behavi or and appearance, whi ch may become skel etal , are out of the
ordi nary.
A norexi a is a dangerous psychol ogi cal di sorder; some 15 to 20 percent of its vi cti ms starve
themsel ves to death. I t pri mari l y affl i cts women between the ages of 12 and 40; i ntel l i gent,
successful , and attracti ve Whi te adol escent gi rl s f rom affl uent homes are the most suscep-
ti bl e. A norexi a is al so becomi ng a probl em for boys; about 10 percent of vi cti ms are mal e.
Thi s percentage i s ri si ng and is often associ ated wi th the use of steroi ds (J acobi et al., 2004;
Ri cci ardel l i & McCabe, 2004; Cri sp et al., 2006).
Though they eat little, anorexi cs tend to focus on food. They may shop often, col l ect cook-
books, tal k about food, or cook huge meal s for others. They may be i ncredi bl y thi n but thei r
body i mages are so di storted that they see themsel ves as di sgusti ngl y fat and try to l ose more
wei ght. Even when they grow skel etal , they cannot see what they have become.
Bulimia, another eati ng di sorder, is characteri zed by binge eating, consumi ng l arge
amounts of food, fol l owed by purging through vomi ti ng or the use of l axati ves. Bul i mi cs may
eat an enti re gal l on of i ce cream or a whol e package of torti l l a chi ps, but then feel such power-
ful gui l t and depressi on that they i ntenti onal l y ri d themsel ves of the food. The di sorder poses
real ri sks. Though a bul i mi a sufferers wei ght remai ns fai rl y normal , the constant vomi ti ng
and di arrhea of the bi nge-and-purge cycl es may produce a chemi cal i mbal ance that tri ggers
heart fai l ure.
Physical Development in Adolescence I r t Bl Hi J Wj J 265
Why eati ng di sorders occur is not clear, but several factors may be at work. Di eti ng often
precedes the onset of eati ng di sorders, as soci ety exhorts even normal -wei ght i ndi vi dual s to
be ever thi nner. Losi ng wei ght may lead to feel i ngs of control and success that encourage more
di eti ng. Gi rl s who mature early and have a hi gher level of body fat are more suscepti bl e to
eati ng di sorders i n later adol escence as they try to tri m thei r mature bodi es to fit the cul tural
ideal of a thi n, boyi sh physi que. Cl i ni cal l y depressed adol escents are also prone to devel op eat-
i ng di sorders later (Gi ordana, 2005; Santos, Ri chards, & Bl eckl ey, 2007; Courtney, Gamboz, &
J ohnson, 2008; Rodgers, Paxton, & Chabrol , 2010).
Some experts suggest that a bi ol ogi cal cause may underl i e both anorexi a nervosa and
bul i mi a. Twi n studi es suggest geneti c components are involved. I n addi ti on, hormonal i mbal -
ances someti mes occur i n sufferers (Kump et al., 2007; Kaye, 2008; Wade et al., 2008; Baker
et al , 2009).
Other attempts to expl ai n the eati ng di sorders emphasi ze psychol ogi cal and soci al fac-
tors. For i nstance, some experts suggest that the di sorders are a resul t of perfecti oni sti c,
overdemandi ng parents or by-products of other fami l y di ffi cul ti es. Cul ture also plays a rol e.
A norexi a nervosa, for i nstance, is found pri mari l y i n cul tures that i deal i ze sl ender femal e
bodi es. Because i n most pl aces such a standard does not hol d, anorexi a is not preval ent
outsi de the Uni ted States (Hai nes & Neumark-Sztai ner, 2006; Harri son & Hefner, 2006;
Bennett, 2008).
For exampl e, anorexi a is relatively rare i n Asi a, wi th the excepti ons of areas i n whi ch
Western i nfl uence is greatest. Furthermore, anorexi a nervosa is a fairly recent disorder. I t was
not seen i n the seventeenth and ei ghteenth centuri es, when the ideal of the femal e body was
a pl ump corpul ence. The i ncreasi ng number of boys wi th anorexi a i n the Uni ted States may
be rel ated to a growi ng emphasi s on a muscul ar mal e physi que that features little body fat
(Mangweth, Hausmann, & Wal ch, 2004; Maki no et al., 2006; Greenberg, Cwi kel , & Mi rsky,
2007; Pearson, Combs, & Smi th, 2010).
Because anorexi a nervosa and bul i mi a have both bi ol ogi cal and envi ronmental causes,
treatment typi cal l y requi res a mi x of approaches (e.g., both psychol ogi cal therapy and di etary
modi fi cati ons). I n more extreme cases, hospi tal i zati on may be necessary (Wi l son, Gri l o, &
Vi tousek, 2007; Keel & Haedt, 2008; Stei n, Latzer, & Meri ck, 2009).
This young woman suffers from anorexia
nervosa, a severe eating disorder in which
people refuse to eat, while denying that their
behavior and appearance are out of the
ordinary.