Developmental Stages of

the Learner
Ellie Borre, Knia Frank, Erica Pueblos
Agenda:
● Introductions ● BREAK!
● Objectives ● Developmental Stages of Adulthood
● Key terms ○ Young Adulthood
● Developmental Characteristics ○ Middle-Aged Adulthood
● Developmental Stages of Childhood ○ Older Adulthood
○ Infancy ● Family Role in Patient Education
○ Early Childhood ● Evidence/Research
○ Middle & Late Childhood ● Summary
○ Adolescence
ELLIE BORRE, OTS
● Education: B.S. in Leisure Studies emphasis on Therapeutic Recreation from The University of Iowa

● Experience: 2 TR internships. 2 years as a Recreation Therapist at a residential treatment facility in Chicago,

OT volunteer hours at Niles school district, Athletico, Helping Hand school for children with Autism and IBJI.
● Likes: Sports, hiking, camping, snowboarding, STL Cardinals

and the Chicago Blackhawks

● Fun fact: I can unicycle
KNIA FRANK, OTS
● Education: B.A. in Broadcast Journalism with a minor in Nonprofits, Volunteerism, and Philanthropy

● Experience: 1 year Behavior Interventionist for SNN. OT volunteer for Atwater Park Center. Secretary for
Northeast Community Clinics Board of Directors. Substitute Teacher for Los Angeles Unified School District.

● Likes: Working out, experimenting with hair, people watching, singing

● Fun fact: Was featured on KTLA for a story on my hair

ERICA PUEBLOS, OTS
● Education: B.A. in Human Development from CSULB

● Experience: Downey Unified School District, Rancho Los Amigos Rehab, Special
Olympics World Games Los Angeles 2015, Special Olympics Southern California -
LA/SGV Regions,, High Hopes Head Injury Program, Special Olympics Coach

● Likes: Eating, working out, reading, going to the beach, Dodgers, Lakers, UCLA
football & baseball

● Fun fact: I was a teacher’s pet throughout elementary school

Learning Objectives:
1. Identify the physical, cognitive, and psychosocial characteristics of learners that
influence learning at various stages of growth and development
2. Recognize the role of health professionals in assessing stage-specific learner needs
according to maturational levels
3. Determine the role of the family in patient education
4. Discuss appropriate teaching strategies effective for learners at different
developmental stages
Key Terms
Pedagogy Personal fable
Object permanence Andragogy
Causality Dialectical thinking
Animistic thinking Ageism
Syllogistic reasoning Gerogogy
Conservation Crystallized intelligence
Imaginary audience Fluid intelligence
Sample question…
Knia’s undergraduate degree from USC was in Broadcast Journaling. She
enjoys experimenting with hairstyles, and was featured on KTLA for her
hair. Which of the following is something else that Knia enjoys?
a. Hiking
b. Eating
c. People watching
d. Going to the beach
Developmental Characteristics
● What influences a person’s ability ● Major factors associated with
& readiness to learn? learner readiness:
○ Growth and development interact ○ Physical
with experiential background ○ Cognitive
○ Physical & emotional health status ○ Psychosocial
○ Personal motivation
○ Environmental factors
Developmental Characteristics
3 Phases of Learning:
1. Dependence
2. Independence
3. Interdependence
Developmental Stages
of Childhood
Infancy and Toddlerhood
(first 12 months of life)

Pedagogy = the art and science of helping children to learn

Name: Oatea
Background: was forced to leave home after
9 months
Infancy and Toddlerhood
Growth and development is highly complex

Main focus of instruction for health maintenance is geared toward the

parents, who are considered the primary learners

Older toddler can be included in health care teaching and education process
Physical Development
● Exploration of self and environment
○ Sensorimotor period (Piaget) - coordination & integration of motor
activities with sensory perceptions
○ Object permanence = realizing that objects and events exist even
when they cannot be seen, heard, or touched
○ Encourage parents to create a safe environment for exploration
Cognitive Development
● Basic reasoning, understands object permanence, has beginnings of
memory, and develops an elementary concept of causality
○ Causality = the ability to grasp a cause-and-effect relationship between two
paired, successive events
○ Short attention spans & easily distracted
○ Language skills develop rapidly
○ Ask tons of questions!
○ Respond to simple, step-by-step commands & obey directives
Psychosocial Development
● Trust vs. Mistrust
○ Children develop sense of trust with
primary caretaker
● Autonomy vs. Shame & Doubt
○ Learn to balance feelings of love and hate
and learn to cooperate
● Routines give sense of security
 What do you think?
Two-year-old Oatea is seen playing with blocks alongside her older brother.. Oatea’s
mother tries to encourage her to interact with her brother so they can play together, but
Oatea seems uninterested. Based on her age, what type of play is Oatea participating in?
a. Cooperative Play
b. Solitary Play
c. Associative Play
d. Parallel Play
 Teaching Strategies
● Teach aspects of normal development, safety, health promotion, and
disease prevention
● Assess the parents’ and child’s anxiety levels
● Establish a relationship with child and parents
● Teach in familiar environment
Short-Term Learning
● Read simple stories with lots of pictures
● Use dolls or puppets to act out feelings and
behaviors
● Role-play to bring imagination to reality
● Give simple, concrete explanations with visual
and tactile experiences
● Brief teaching sessions
 Long-Term Learning
● Focus on rituals, imitation, and repetition of information
○ Words and actions to hold child’s attention
● Use reinforcement as an opportunity for children to achieve
permanence of learning
● Parents as role models → their values and beliefs serve to reinforce
healthy behaviors
 What do you think?
An OTR has the knowledge to direct parents to effectively manage their child’s
development and teach aspects of safety, health promotion, and disease prevention.
When a child is ill or injured, what is the first priority of an OT for teaching
interventions?
a. Assess the parents’ anxiety levels
b. Assess the child’s anxiety levels
c. Develop a rapport with the child
d. All of the above
 Early Childhood
(3-5 yo)

WHAT DOES LEARNING LOOK LIKE? - Oatea is now 4 years old.

- She enjoys playing Vet, since
● Interactions
thats moms job.
● Mimicking/Modeling - Oatea has developed
independence with dressing
and toileting
 Physical Development
● Fine and gross motor skills become refined
Cognitive Development
● Piaget: Preoperational stage
● Egocentric
● Precausal thinking allows young children to
understand that people can make things happen
● Animistic thinking—the tendency to endow
inanimate objects with life and consciousness
 Psychosocial Development
● Eriksons stage initiative versus guilt.
- Expanding imagination and
creativity
- Impulsive
- Curious about almost everything
- Interacting with playmates
- Role-playing
Barriers to learning
● Fear
● Impulsive
● Limited sense of time
● Lack of concrete understanding
 Teaching strategies
● Teach the parents
● Reassure the child
● Use friendly terminology
● Short and simple
 Short Term Learning
● Provide physical and visual stimuli
● Keep teaching sessions short - Give praise and approval
● Relate information - Give tangible rewards
● Encourage the child to choose
● Small group sessions
● Allow the child to manipulate
equipment
● Use storybooks
 Long Term Learning
● Enlist the help of parents
● Reinforce positive health behaviors
● Reinforce acquisition of specific skills
 What do you think?
3 ½ year old Oatea was brought into the ER by her mother with difficulty breathing. The doctor ordered the child
receive a chest x-ray to make sure there was nothing blocking her airway. The nurse came in to take the child to
the radiology. The child started screaming and would not let go of mom. What is the best way to tell the child
what is going on?
a. Tell the mother what the plan is and ask her to calm Oatea down
b. Reassure Oatea that she will be okay and that her mom will be waiting for her in the room when shes
done
c. Tell Oatea she’s going to get a giant picture taken to help her feel better, and when she gets back from the
picture her favorite juice will be waiting for her
d. Inform the mother of the procedure, and tell Oatea she will be right back
 Middle and Late Childhood
(6-11 yo)
What does learning look like?
● Minds are open
● Motivated to Learn
● Period of great change
- Oatea is now in elementary
school full day, which she loves
- Oatea comes home everyday
telling mom about what she
learned
- Oateas biggest concern is play
and learning
 Physical Development
- Motor abilities more coordinated
- Physical growth is highly variable
- Girls > Boys
 Cognitive Development
- Piaget concrete operations.
- Logical and rational thought processes
- Syllogistic reasoning—that is, they can consider two
premises and draw a logical conclusion from them
- Conservation, which is the ability to recognize that the properties
of an object stay the same even though its appearance and position may
change, are beginning to be mastered.
 What do you think?
Which of the following is a good example of syllogistic reasoning?
a. A lizard is a reptile, a crocodile is a reptile therefore they are both green
b. Water can be hot, water can be cold, so water changes
c. I swim in water, fish live in water, therefore fish swim
d. The sky is blue, the clouds are white so the clouds aren’t in the sky
Psychosocial Development

● Eriksons industry vs inferiority

● Gain awareness of uniqueness
● Develop self-concept
● Fear failure of being left out
 Barriers to Learning
● Children develop at different rates
● Frustration tolerance
● Limited understanding of consequence
 Teaching Strategies
● Include them in the entire process
● Keep terms simple and logical
● Observe the child’s reaction
● Parents should to taught to help foster independence
● Gear towards fostering normal development
 Short Term Learning
● Take responsibility - Individual/Group instruction
● Sessions can be longer - Provide time
● Use A/V - Prepare them in advance
● Clarify terminology
- Encourage participation
● Use analogies
- Provide nurture and support
● Show peers undergoing similar
situations
 Long Term Learning
● Help child acquire new skills
● Assist in teaching them to maintain own well-being
● Incorporate positive health actions into daily lives
 What do you think?
Oatea is 6 year-old girl. Her teachers report that she is displaying impulsive behaviors including
grabbing toys from peers, and incapable of sitting still for more than 10 minutes. The teacher is
looking to the mother for assistance with Oatea’s behavior since it is affecting her learning. What
might be good techniques to use with Oatea?
a. Provide Oatea with a star chart in which she can earn rewards for appropriate behavior
b. Use analogies to help Oatea understand why she needs to do things
c. Help teach Oatea how to maintain her own behaviors through deep breathing
d. Engage in role-playing activities to help her understand the teacher's point of view
 Adolescence
(12-19 yo)
What does learning look like? - Oatea is in high school just about to
● Period of transition get her driver's license.
- Oatea has a wonderful group of
● Many healthcare issues
friends she spends most of her time
● At risk population with
- Oatea biggest concern is fitting in, but
has recently been tempted by friends
to drink alcohol
 Physical Development
● Fine and gross motor skills fully developed
● Period of transitioning
● Preoccupation with appearance
● Sexual Urges
 Cognitive Development
● Piaget: Formal operations
● Higher-order level of reasoning, capable of abstract thought
● Imagery Audience: social thinking that has influence over behavior
● Personal fable: leads to adolescents to believe they are invulnerable
● 15 yo+ are not as susceptible to personal fable
 Psychosocial Development
● Eriksons identity vs role confusion
● Seeking independence and autonomy
● Conform to peers
● Need to develop coping skills
Barriers to Learning
● Rebellious
● Concern with fitting in
● 20% have serious health issues
● Imaginary audience
● Personal fable
 Teaching Strategies
● Develop trusting relationship
● Use peers going through similar experiences
● Use a variety of tools
 Short Term Learning
● Use one-to-one instruction
● Choose peer group discussion sessions
● Use face-to-face or computer group
discussion, role-playing, and gaming as
methods
● Employ adjunct instructional tools
● Clarify terminology and medical jargon
- Share decision making
- Include them
- Suggest options
- Give a rationale
- Approach them with respect
- Expect negative responses
- Avoid confrontation
 Long Term Learning
● Accept adolescents’ personal fable and imaginary audience as valid
● Acknowledge their feelings are real
● Allow them the opportunity to test their own convictions.
 What do you think?
Oatea is grounded for sneaking out to go out with friends. While she was out Oatea had
engaged in some recreational activities. When you try to talk to her about it Oatea runs
upstairs slamming her door, saying “you don’t understand anything.” How would you go
about teaching Oatea the harms of recreational activities?
a. Take her to an AA meeting so she can see the potential repercussions
b. Get literature about the risks of drugs and leave them under her door
c. Take time to sit with her and talk through her concerns before trying to teach
d. Storm upstairs after her yelling that you need to talk
BREAK TIME!
Developmental Stages
of Adulthood
Adulthood

Andragogy = the art and science of teaching

adults-Theory by Knowles Retrieved from shutterstock

More learner centered and less teacher centered

Assumptions of Knowles’s framework
1. His or her self-concept moves from being a dependent personality to
an independent, self-directed human being
2. He or she accumulates a growing bank of previous experience that
serves as a rich resource for learning
3. Readiness to learn becomes depends on tasks of social roles
4. Learning is problem centered as opposed to subject centered
 Paradoxical Learners
Adults are said to be autonomous, self-directed and independent

BUT

Learners want and often need structure, clear concise specifics, and
guidance
 12 Learning Principles
1. Related to immediate problem or
deficit
2. Voluntary or self-initiated
3. Person & problem centered
4. Self- controlled & self-directed
5. Teacher is facilitator
6. Information and assignments are
pertinent
7. New material draws on past experiences
8. Threat to self is reduced to minimum
9. Learners is an active participant
10. Able to learn in a group
11. Nature of learning and activity changes
frequently
12. Reinforced by application and prompt
feedback
Why Adults Learn
1. Goal oriented

Retrieved from firstshowing.net

Why Adults Learn
2. Activity Oriented

Retrieved from iransafebox.net

Why Adults Learn
3. Learning Oriented

Retrieved from justjaredjr.com

 Young Adulthood (20-24 yr olds)
-Oatea just celebrated her 23rd
-Establish long term relationships
birthday
-Deciding on an occupation
-She’s been applying to grad
-Can be stressful
schools and is anxious about
getting in
-Long term bf wants to propose
but she wants to finish school first
Development
Physical: Physical abilities are at their peak and body at its optimal
functioning capacity
Cognitive: Capacity fully developed, but with maturity
can accumulate new knowledge
Piaget: formal operations
Psychosocial: Erikson’s intimacy vs. isolation
Retrieved from pinterest.com
Teaching Strategies
-Health professional educators give this period the least amount of
attention
- Find a way to reach out and communicate about health promotion and
disease prevention measures.
-Know the individual’s lifestyle in order to help figure out what to focus
education measures on
-Allow for mutual collaboration and make it convenient
 What Would You Do?
Oatea came in for her physical for grad school. You notice her blood pressure is abnormally
high. She revealed to you that she is in a rush to get to brunch at her favorite soul food
spot. How would you proceed?

A. Quickly tell her that her brunching habits are unhealthy.

B. Ask her to come in again before brunch next week to discuss concerns
C. Ask about what she orders for brunch and possibly offer healthier alternatives
D. Wait until she comes in again to bring up concern because she’s currently in a rush
 Middle Adulthood (41-64)
-Transition between young adult
and older adulthood (⅕
population)
-Starting later and lasting longer
-Highly accomplished in careers,
sense of who they are, grown
children
-Oatea is the mother of 2 children
over the age of 25
- She just had her 3rd article
published in AJOT on her new
intervention for dementia
-She is preparing for her home for
her mother’s arrival
 Development
Physical: Skin and muscle tone decreases, metabolism slows, body weight tends to
increase, energy levels lessen & hormonal changes bring about variety of symptoms. Visual
and hearing acuity start to diminish
Cognitive: Piaget: formal operations. Cognitive development stops here (abstract thinking)
Critics believe in postformal operations known as
Dialectical thinking- ability to search for complex and changing understandings to find a
variety of solutions to any given situation or problem (see the bigger picture)
Psychosocial: Erickson’s generativity vs. self-absorption and stagnation
 Teaching Strategies
-Stress may interfere with motivation for learning
- Many want and need information related to chronic illnesses that can
arise at this phase of life
-Reinforcement for learning is internalized
-Instructional methods and tools similar for young adults
But content coincides with concerns and problems specific to this group
 What Would You Do?
Oatea is taking medication for her high blood pressure, but when she came in for her
annual physical she tells you she is stressed about work and caring for her mother. You
have 15 minutes to spend with her.
A. Let her vent about her stressors to you as actively listen
B. Inform her that her high levels of stress and high blood pressure can lead to a stroke
C. Teach her some stress reduction techniques
D. Offer her caregiving strategies to implement with her mother
Older Adulthood (65 years -)
The young old (65-74)
The old-old (75-84)
Oldest old (85 and older)
85 and older make up the fastest growing segment today
In 2006, 40% of the federal budget allocated for Medicare, Medicaid, Social
Security
16% have a college degree at the bachelor’s level or higher
 Older Adulthood
Gerogogy- the teaching of older persons. Accommodates normal cognitive,
psychosocial, and physical changes at this phase of development

Ageism- prejudice against older adult perpetuates negative stereotype of

aging as period of decline
● https://www.youtube.com/watch?v=J6zenOjPC1A
 Development
Physical: Sensory declines (mainly visual & auditory)
Organ functioning, decreased cardiac output, lung capacity, metabolic rate
 Development
Cognitive: Actual loss of neurons with no regenerative powers
Crystallized intelligence- absorbed over a lifetime
Fluid intelligence- capacity to perceive relationships to reason and to
perform abstract thinking ( 5 negative effects)
 Development
Psychosocial; Erikson’s ego integrity vs. despair
Most common psychosocial tasks:
-Retirement
-Illness or death of a spouse, relative or friend
- Moving away from loved ones
-Relocation to and unfamiliar environment (extended care, senior living)
 Development
Traits regarding goals and values that impact motivation and learning
1. Independence
-Oatea lost her mother and
2. Social acceptability husband this year
3. Adequacy of personal -Her children and grandchildren
resources moved out of state
-She retired and now enjoys
1. Coping Mechanisms
cooking
2. Meaning of Life
 Teaching Strategies
-Understand older person’s developmental tasks
-Older person’s may delay medical attention
-Reminiscing is a beneficial approach to use to establish a therapeutic
relationship
-Talking about patient’s life can speak to their abilities and concerns
 Helpful Tips
Physical Needs:
-Teach in brightly lit room (no glare), large print, well spaced letters
-Eliminate extraneous noise, don’t cover mouth when speaking, Speak
slowly
-Keep sessions short, frequent breaks, comfortable seating
-Don’t confuse loss of energy for lack of motivation
 Helpful Tips
Cognitive Needs:
1. Allow time for processing and reacting
2. Be aware of effects of medications
3. Be certain ask of prior knowledge on a topic to avoid patronizing
4. Any information that upsets established habits are hard to teach
5. Brief sessions that are relevant and focused on here and now
6. Have a summary with time for Q&A at the end
 Helpful Tips
Psychosocial Needs:
1. Assess family relationships
2. Determine availability of resources
3. Encourage active involvement
4. Identify coping mechanisms
 Senior Myths
Seniors are not senile just because they are old
There are many seniors who are not cranky
Rather than being lonely, older adults report their satisfaction with life
continues at a steady level throughout the period of adulthood
Contact with significant others remains constant over time
 What Would You Do?
Oatea came to your office with her great nephew and expressed interest in coming to your
cooking group. The group is held on Tuesday evenings across town. Oatea has poor vision
and doesn’t like to drive on the freeway. What do you do?
A. Offer a different topic group that meets earlier on her side of town
B. Offer to livestream the class for Oatea
C. Help Oatea figure out the bus route to get to the group on Tuesdays
D. Ask the great nephew to accompany Oatea to the cooking class
 The Role of Family in
Patient Education
● Provide emotional, physical, and social support
● Determine who will be primary caregiver
● Explore caregiver learning style preferences, cognitive abilities, fears
and concerns, and current knowledge
● Family is single most significant determinant of success or failure of
the education plan
 State of the Evidence
● Need more research on how teaching and learning are affected by
situational variables, by personality traits, by temperament responses,
and by sociocultural influences
● Importance of support systems on the success of educated people of
all ages to maintain and improve health status
 Summary
● Understand specific and varied tasks associated with each
developmental stage to individualize the education approach
● Readiness to learn in children is subject centered
● Motivation to learn in adults is problem centered and more oriented to
psychosocial tasks
● OTR must facilitate the teaching-learning process along with the client
 What do you think?
As an OT, you have the potential to work with clients of all ages and abilities. What
are the three major stage-range factors associated with learner readiness that
must be taken into account at each development period throughout the life cycle?
a. Physical, sensorimotor, and cognitive
b. Physical, cognitive, and psychosocial
c. Cognitive, psychosocial, moral development
d. Cognitive, sensorimotor, moral development
Reference
Bastable, B. & Dart, M. A. (2011). Developmental Stages of the Learner. In Health Professional
as educator: principles of teaching and learning. (pp. 151-197). Jones & Bartlett Learning.