Readiness for school (kindergarten) requires emotionalmaturity, peer group and individual social skills, cognitive abilities, and fine and gross motor skills (Table 7-1). Other issuesinclude chronologic age and gender. Children tend to do betterin kindergarten if their fifth birthday is at least 4 to 6 monthsbefore the beginning of school. Girls usually are ready earlierthan boys. If the child is in less than the average developmentalrange, he or she should not be forced into early kindergarten.Holding a child back for reasons of developmental delay, inthe false hope that the child will catch up, can also lead to difficulties. The child should enroll on schedule, and educational planning should be initiated to address any deficiencies.
Physicians should be able to identify children at risk for school difficulties, such as those who have developmental delays or physical disabilities. These children may require specialized school services.
Some define adolescence as 10 to 25 years of age but adolescenceis perhaps better characterized by the developmental stages(early, middle, and late adolescence) that all teens must negotiate to develop into healthy, functional adults. Different behavioral and developmental issues characterize each stage. The ageat which each issue manifests and the importance of these issuesvary widely among individuals, as do the rates of cognitive, psychosexual, psychosocial, and physical development.
During early adolescence, attention is focused on the present and on the peer group. Concerns are primarily related
Ease of separation of the child from the parent Speech development and articulation Understanding of and ability to follow complex directions Specific pre-academic skills
Knowledge of colors Counts to 10 Knows age, first and last names, address, and phone number Ability to copy shapes
Motor skills Stand on one foot, skip, and catch a bounced ball Dresses and undresses without assistance
Does the child play well with other children?
Does the child separate well, such as a child playing in the backyard alone with occasional monitoring by the parent? Does the child show interest in books, letters, and numbers? Can the child sustain attention to quiet activities? How frequent are toilet-training accidents?
to the body’s physical changes and normality. Strivings for independence are ambivalent. These young adolescents are difficult to interview because they often respond with short, clipped conversation and may have little insight. They are just becoming accustomed to abstract thinking.
Middle adolescence can be a difficult time for adolescents and the adults who have contact with them. Cognitive processes are more sophisticated. Through abstract thinking, middle adolescents can experiment with ideas, consider things as they might be, develop insight, and reflect on their own feelings and the feelings of others. As they mature, these adolescents focus on issues of identity not limited solely to the physical aspects of their body. They explore their parents’ and culture’s values, sometimes by expressing the contrary side of the dominant value. Many middle adolescents explore these values in their minds only; others do so by challenging their parents’ authority. Many engage in high-risk behaviors, including unprotected sexual intercourse, substance abuse, or dangerous driving. The strivings of middle adolescents for independence, limit testing, and need for autonomy often distress their families, teachers, or other authority figures. These adolescents are at higher risk for morbidity and mortality from accidents, homicide, or suicide.
Late adolescence usually is marked by formal operational thinking, including thoughts about the future (e.g., educational, vocational, and sexual). Late adolescents are usually more committed to their sexual partners than are middle adolescents. Unresolved separation anxiety from previous developmental stages may emerge, at this time, as the young person begins to move physically away from the family of origin to college or vocational school, a job, or military service.
Child behavior is determined by heredity and by the environment. Behavioral theory postulates that behavior is primarily a product of external environmental determinants and that manipulation of the environmental antecedents and consequences of behavior can be used to modify maladaptive behavior and to increase desirable behavior (operant conditioning). The four major methods of operant conditioning are positive reinforcement, negative reinforcement, extinction, and punishment. Many common behavioral problems of children can be ameliorated by these methods.