LIFESPAN DEVELOPMENT
A Psychological Perspective Second Edition
By Martha Lally and Suzanne Valentine-French

1Lifespan Development: A Psychological Perspective
Second Edition
By Martha Lally and Suzanne Valentine-French (Published 2019)

This Open Education Resource (OER) textbook was funded by a grant from theCollege of Lake County Foundation and supported by the Business and Social
Sciences Division.
This textbook can be found at:
http://dept.clcillinois.edu/psy/LifespanDevelopment.pdf
Publication is under the following license:

Creative Commons Attribution-Noncommercial-Share Alike 3.0 unported license to view a copyof this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/ or send a letter to Creative
Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.

2

Table of Contents
Chapter 1: Introduction to Lifespan Development
Chapter 2: Heredity, Prenatal Development, and Birth
Chapter 3: Infancy and Toddlerhood
Chapter 4: Early Childhood
Chapter 5: Middle and Late Childhood
Chapter 6: Adolescence
Chapter 7: Emerging and Early Adulthood
Chapter 8: Middle Adulthood
Chapter 9: Late Adulthood
Chapter 10: Death and Dying

3

Table of Contents
Chapter 1: Introduction to Lifespan Development ....................................................................................... 9
Lifespan Perspective ............................................................................................................................. 10
Conceptions of Age ............................................................................................................................... 13
Periods of Development......................................................................................................................... 14
Issues in Lifespan Development ............................................................................................................. 16
Historical Theories on Development ....................................................................................................... 17
Contemporary Theories on Development ................................................................................................ 18
Descriptive Research ............................................................................................................................. 24
Correlational Research .......................................................................................................................... 26
Experimental Research .......................................................................................................................... 28
Research Involving Time-Spans ............................................................................................................. 29
Conducting Ethical Research .................................................................................................................. 32
References ............................................................................................................................................ 33

Chapter 2: Heredity, Prenatal Development, and Birth.............................................................................. 35
Heredity ............................................................................................................................................... 35
Genotypes and Phenotypes .................................................................................................................... 36
Genetic Disorders ................................................................................................................................. 37
Chromosomal Abnormalities .................................................................................................................. 39
Behavioral Genetics .............................................................................................................................. 41
Prenatal Development ........................................................................................................................... 43
The Germinal Period ............................................................................................................................. 43
The Embryonic Period ........................................................................................................................... 44
The Fetal Period.................................................................................................................................... 45
Prenatal Brain Development .................................................................................................................. 47
Teratogens ............................................................................................................................................ 47
Maternal Factors ................................................................................................................................... 53
Prenatal Assessment .............................................................................................................................. 57
Complications of Pregnancy .................................................................................................................. 59
Preparation for Childbirth ...................................................................................................................... 60
Stages of Birth for Vaginal Delivery ....................................................................................................... 61
Assessing the Neonate ........................................................................................................................... 63
Problems of the Newborn ...................................................................................................................... 63
Postpartum Maternal Concerns ............................................................................................................... 65
References ............................................................................................................................................ 65

Chapter 3: Infancy and Toddlerhood .......................................................................................................... 71
The Brain in the First Two Years ............................................................................................................ 72
Infant Sleep .......................................................................................................................................... 74
From Reflexes to Voluntary Movements ................................................................................................. 77
Motor Development .............................................................................................................................. 78
Sensory Capacities ................................................................................................................................ 79
Nutrition .............................................................................................................................................. 82
Global Considerations and Malnutrition .................................................................................................. 84
Piaget and the Sensorimotor Stage .......................................................................................................... 85
Language ............................................................................................................................................. 89
Components of Language ...................................................................................................................... 90
Language Developmental Progression .................................................................................................... 91
Theories of Language Development........................................................................................................ 934

Temperament ........................................................................................................................................ 97
Infant Emotions .................................................................................................................................... 99
Forming Attachments .......................................................................................................................... 101
Erikson: Trust vs. Mistrust ................................................................................................................... 102
Mary Ainsworth and the Strange Situation Technique ............................................................................ 102
Erikson: Autonomy vs. Shame and Doubt ............................................................................................. 106
Measuring Infant Development ............................................................................................................ 106
References .......................................................................................................................................... 106

Chapter 4: Early Childhood ....................................................................................................................... 115
Brain Maturation ................................................................................................................................. 116
Motor Skill Development..................................................................................................................... 117
Toilet Training .................................................................................................................................... 119
Sleep .................................................................................................................................................. 119
Sexual Development in Early Childhood ............................................................................................... 120
Nutritional Concerns ........................................................................................................................... 121
Piaget’s Preoperational Stage ............................................................................................................... 123
Vygotsky’s Sociocultural Theory of Cognitive Development .................................................................. 126
Information Processing ........................................................................................................................ 127
Attention ............................................................................................................................................ 127
Memory ............................................................................................................................................. 128
Neo-Piagetians .................................................................................................................................... 130
Children’s Understanding of the World ................................................................................................. 131
Language Development ....................................................................................................................... 133
Bilingualism ....................................................................................................................................... 134
Preschool ........................................................................................................................................... 135
Autism Spectrum Disorder ................................................................................................................... 136
Erikson: Initiative vs. Guilt .................................................................................................................. 139
Self-Concept and Self-Esteem .............................................................................................................. 139
Self-Control ........................................................................................................................................ 140
Gender ............................................................................................................................................... 140
Theories of Gender Development ......................................................................................................... 141
Transgender Children .......................................................................................................................... 142
Parenting Styles .................................................................................................................................. 143
Spanking ............................................................................................................................................ 145
Sibling Relationships ........................................................................................................................... 146
Play ................................................................................................................................................... 147
Children and the Media ....................................................................................................................... 149
Child Care .......................................................................................................................................... 150
Child Abuse........................................................................................................................................ 151
Adverse Childhood Experiences (ACEs) ............................................................................................... 152
References .......................................................................................................................................... 155

Chapter 5: Middle and Late Childhood .................................................................................................... 164
Physical Development ......................................................................................................................... 164
Sports ................................................................................................................................................ 165
Childhood Obesity .............................................................................................................................. 168
Concrete Operational Thought ............................................................................................................. 170
Information Processing ........................................................................................................................ 172
Language Development ....................................................................................................................... 174
Communication Disorders ................................................................................................................... 174

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Theories of Intelligence ....................................................................................................................... 175
Measuring Intelligence: Standardization and the Intelligence Quotient ...................................................... 179
Extremes of Intelligence: Intellectual Disability and Giftedness ............................................................... 181
Education ........................................................................................................................................... 183
Cultural Differences in the Classroom................................................................................................... 184
Children with Disabilities .................................................................................................................... 187
Children with Disabilities: Legislation .................................................................................................. 191
Erikson: Industry vs. Inferiority ............................................................................................................ 193
Self-Understanding ............................................................................................................................. 193
Kohlberg’s Stages of Moral Development ............................................................................................. 194
Friends and Peers ................................................................................................................................ 196
Bullying ............................................................................................................................................. 199
Family Life......................................................................................................................................... 200
References .......................................................................................................................................... 205

Chapter 6: Adolescence ............................................................................................................................ 215
Growth in Adolescence........................................................................................................................ 215
Sexual Development ........................................................................................................................... 216
Adolescent Brain ................................................................................................................................ 219
Adolescent Sleep ................................................................................................................................ 221
Adolescent Sexual Activity .................................................................................................................. 222
Eating Disorders ................................................................................................................................. 223
Piaget’s Formal Operational Stage ........................................................................................................ 225
Information Processing ........................................................................................................................ 227
Education ........................................................................................................................................... 228
School Based Preparatory Experiences ................................................................................................. 230
Teenagers and Working ....................................................................................................................... 230
Teenage Drivers .................................................................................................................................. 231
Self-concept and Self-esteem in Adolescence ........................................................................................ 233
Erikson: Identity vs. Role Confusion..................................................................................................... 233
Parents and Teens: Autonomy and Attachment ...................................................................................... 237
Peers .................................................................................................................................................. 238
Romantic Relationships ....................................................................................................................... 239
References .......................................................................................................................................... 240

Chapter 7: Emerging and Early Adulthood ............................................................................................... 246
Emerging Adulthood Defined .............................................................................................................. 246
Cultural Variations .............................................................................................................................. 248
When Does Adulthood Begin? ............................................................................................................. 249
Young Adults Living Arrangements ..................................................................................................... 250
The Physiological Peak........................................................................................................................ 251
Obesity .............................................................................................................................................. 252
A Healthy, But Risky Time .................................................................................................................. 254
Gender ............................................................................................................................................... 257
Sexuality ............................................................................................................................................ 258
Beyond Formal Operational Thought: Postformal Thought ..................................................................... 265
Education ........................................................................................................................................... 266
Career Development and Employment .................................................................................................. 268
Sexism ............................................................................................................................................... 270
Temperament and Personality in Adulthood .......................................................................................... 274
Attachment in Young Adulthood .......................................................................................................... 276

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Relationships with Parents and Siblings ................................................................................................ 279
Erikson: Intimacy vs. Isolation ............................................................................................................. 280
Factors influencing Attraction .............................................................................................................. 280
Friendships ......................................................................................................................................... 281
Love .................................................................................................................................................. 281
Adult Lifestyles .................................................................................................................................. 283
Intimate Partner Abuse ........................................................................................................................ 291
Parenthood ......................................................................................................................................... 293
References .......................................................................................................................................... 295

Chapter 8: Middle Adulthood ................................................................................................................... 307
Physical Changes ................................................................................................................................ 308
Sensory Changes ................................................................................................................................. 309
Health Concerns ................................................................................................................................. 311
Digestive Issues .................................................................................................................................. 319
Sleep .................................................................................................................................................. 319
Exercise, Nutrition, and Weight............................................................................................................ 321
Climacteric ......................................................................................................................................... 324
The Climacteric and Sexuality .............................................................................................................. 327
Brain Functioning ............................................................................................................................... 328
Crystalized versus Fluid Intelligence..................................................................................................... 329
Middle Adults Returning to Education .................................................................................................. 331
Gaining Expertise: The Novice and the Expert....................................................................................... 332
Work at Midlife .................................................................................................................................. 333
Leisure ............................................................................................................................................... 336
Midlife Crisis? .................................................................................................................................... 338
Stress ................................................................................................................................................. 339
Erikson: Generativity vs Stagnation ...................................................................................................... 344
Midlife Relationships .......................................................................................................................... 345
Middle Adult Lifestyles ....................................................................................................................... 348
Grandparents ...................................................................................................................................... 352
Friendships ......................................................................................................................................... 354
Women in Midlife ............................................................................................................................... 356
Religion and Spirituality ...................................................................................................................... 356
References .......................................................................................................................................... 358

Chapter 9: Late Adulthood ........................................................................................................................ 371
Late Adulthood in America .................................................................................................................. 371
The "Graying" of the World ................................................................................................................. 372
Life Expectancy vs Lifespan ................................................................................................................ 373
Gender Differences in Life Expectancy ................................................................................................. 375
Age Categories in Late Adulthood ........................................................................................................ 377
Theories of Aging ............................................................................................................................... 380
Physical Changes of Aging .................................................................................................................. 383
Sensory Changes in Late Adulthood ..................................................................................................... 385
Nutrition ............................................................................................................................................ 390
Chronic Conditions ............................................................................................................................. 390
Brain Functioning ............................................................................................................................... 394
Sleep .................................................................................................................................................. 396
Sexuality ............................................................................................................................................ 397
How Does Aging Affect Information Processing? .................................................................................. 399

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Memory ............................................................................................................................................. 399
Attention and Problem Solving............................................................................................................. 401
Intelligence and Wisdom ..................................................................................................................... 403
Neurocognitive Disorders .................................................................................................................... 404
Work, Retirement, and Leisure ............................................................................................................. 407
Ageism .............................................................................................................................................. 411
Living Arrangements ........................................................................................................................... 412
Erikson: Integrity vs. Despair ............................................................................................................... 414
Generativity in Late Adulthood ............................................................................................................ 414
Social Networks in Late Adulthood ...................................................................................................... 416
Late Adult Lifestyles ........................................................................................................................... 418
Gay and Lesbian Elders ....................................................................................................................... 421
Elder Abuse ........................................................................................................................................ 422
Substance Abuse and the Elderly .......................................................................................................... 423
Successful Aging ................................................................................................................................ 424
References .......................................................................................................................................... 425

Chapter 10: Death and Dying .................................................................................................................... 438
Death Defined..................................................................................................................................... 439
Most Common Causes of Death ........................................................................................................... 440
Suicide ............................................................................................................................................... 443
Fatal Drug Overdoses .......................................................................................................................... 446
Where do People Die? ......................................................................................................................... 447
Developmental Perceptions of Death and Death Anxiety ........................................................................ 448
Curative, Palliative, and Hospice Care .................................................................................................. 449
Family Caregivers ............................................................................................................................... 451
Advanced Directives ........................................................................................................................... 452
Cultural Differences in End-of-Life Decisions ....................................................................................... 452
Euthanasia .......................................................................................................................................... 454
Religious Practices after Death ............................................................................................................. 455
Green Burial ....................................................................................................................................... 456
Grief, Bereavement, and Mourning ....................................................................................................... 457
Models of Grief .................................................................................................................................. 458
Grief: Loss of Children and Parents ..................................................................................................... 460
Mourning ........................................................................................................................................... 462
References .......................................................................................................................................... 463

OER Attribution Information..................................................................................................................... 467

8

Chapter 1: Introduction to Lifespan Development
Developmental Psychology, also known as Human Development or Lifespan Development, isthe scientific study of ways in which people change, as well as stay the same, from conception todeath. You will no doubt discover in the course of studying that the field examines change acrossa broad range of topics. These include physical and other psychophysiological processes,
cognition, language, and psychosocial development, including the impact of family and peers.
Originally concerned with infants andFigure 1.1
children, the field has expanded to include
adolescence and more recently, aging and theentire life span. Previously, the message wasonce you are 25, your development isessentially completed. Our academic
knowledge of the lifespan has changed, andalthough there is still less research on
adulthood than on childhood, adulthood is
gaining increasing attention. This isparticularly true now that the large cohort
known as the “baby boomers” are beginningto enter late adulthood. The assumption thatearly childhood experiences dictate our futureis also being called into question. Rather, we
Sourcehave come to appreciate that growth andchange continues throughout life and experience continues to have an impact on who we are andhow we relate to others. We now recognize that adulthood is a dynamic period of life marked bycontinued cognitive, social, and psychological development.
You will also discover that developmental psychologists investigate key questions, such aswhether children are qualitatively different from adults or simply lack the experience that adults
draw upon. Other issues that they deal with is the question of whether development occurs
through the gradual accumulation of knowledge or through shifts from one stage of thinking toanother, or if children are born with innate knowledge or figure things out through experience,
and whether development is driven by the social context or something inside each child. From
the above explanation, you may be thinking already that developmental psychology is related toother applied fields. You are very right. The field informs several applied fields in psychology,
including, educational psychology, psychopathology, and forensic developmental psychology. It
also complements several other basic research fields in psychology including social psychology,
cognitive psychology, and comparative psychology. Lastly, it draws from the theories andresearch of several scientific fields including biology, sociology, health care, nutrition, andanthropology.

9

Learning Objectives: Lifespan Perspective••••

Explain the lifespan perspective and its assumptions about development.
Differentiate periods of human development.
Explain the issues underlying lifespan development
Identify the historical and contemporary theories impacting lifespan development

Lifespan Perspective
Paul Baltes identified several underlying principles of the lifespan perspective (Baltes, 1987;
Baltes, Lindenberger, & Staudinger, 2006).
Development is lifelong. Lifespan theorists believe that development is life-long, and change isapparent across the lifespan. No single age period is more crucial, characterizes, or dominates
human development. Consequently, the term lifespan development will be used throughout the
textbook.
Development is multidirectional. Humans change in many directions. We may show gains insome areas of development, while showing losses in other areas. Every change, whether it isfinishing high school, getting married, or becoming a parent, entails both growth and loss.
Development is multidimensional. We change across three general domains/dimensions;
physical, cognitive, and psychosocial. The physical domain includes changes in height andweight, sensory capabilities, the nervous system, as well as the propensity for disease and illness.
The cognitive domain encompasses the changes in intelligence, wisdom, perception, problemsolving, memory, and language. The psychosocial domain focuses on changes in emotion, selfperception and interpersonal relationships with families, peers, and friends. All three domains
influence each other. It is also important to note that a change in one domain may cascade andprompt changes in the other domains. For instance, an infant who has started to crawl or walk
will encounter more objects and people, thus fostering developmental change in the child’s
understanding of the physical and social world.
Development is multidisciplinary. As mentioned at the start of the chapter, humandevelopment is such a vast topic of study that it requires the theories, research methods, andknowledge base of many academic disciplines.
Development is characterized by plasticity. Plasticity is all about our ability to change andthat many of our characteristics are malleable. For instance, plasticity is illustrated in thebrain’s ability to learn from experience and how it can recover from injury.
Development is multicontextual. Development occurs in many contexts. Baltes (1987)
identified three specific contextual influences.

10•

Normative age-graded influences: An age-grade is a specific age group, such as
toddler, adolescent, or senior. Humans in a specific age-grade share particularexperiences and developmental changes.

•

Normative history-gradedinfluences: The time period inwhich you are born (see Table 1.1)
shapes your experiences. A cohort
is a group of people who are bornat roughly the same period in aparticular society. These people
travel through life often
experiencing similar circumstances.

•

Table 1.1 Which generation (cohort) are you?

Generation
Silent Generation
Baby Boomers
Generation X
Millennials
Generation Z

Born between …
1928 and 1945
1946 and 1964
1965 and 1980
1981-1996
1997-Present

SourceNon-normative life influences: Despite sharing an age and history with our peers,
each of us also has unique experiences that may shape our development. A child who
loses his/her parent at a young age has experienced a life event that is not typical of
the age group.

Another context that influences our lives is our social standing, socioeconomic status, or social
class. Socioeconomic status (SES) is a way to identify families and households based on theirshared levels of education, income, and occupation. While there is certainly individual variation,members of a social class tend to share similar lifestyles, patterns of consumption, parenting
styles, stressors, religious preferences, and other aspects of daily life. All of us born into a classsystem are socially located, and we may move up or down depending on a combination of bothsocially and individually created limits and opportunities.
Families with higher socioeconomic status usually are in occupations (e.g., attorneys, physicians,
executives) that not only pay better, but also grant them a certain degree of freedom and control
over their job. Having a sense of autonomy or control is a key factor in experiencing job
satisfaction, personal happiness, and ultimately health and well-being (Weitz, 2007). Thosefamilies with lower socioeconomic status are typically in occupations that are more routine, moreheavily supervised, and require less formal education. These occupations are also more subject
to job disruptions, including lay-offs and lower wages.
Poverty level is an income amount established by the federal government that is based on a setof income thresholds that vary by family size (United States Census Bureau, 2016). If a family’s
income is less than the government threshold, that family is considered in poverty. Those living
at or near poverty level may find it extremely difficult to sustain a household with this amount ofincome. Poverty is associated with poorer health and a lower life expectancy due to poorer diet,less healthcare, greater stress, working in more dangerous occupations, higher infant mortality
rates, poorer prenatal care, greater iron deficiencies, greater difficulty in school, and many otherproblems. Members of higher income status may fear losing that status, but the poor may havegreater concerns over losing housing.

11

Today we are more aware of thevariations in development and the impact Figure 1.2that culture and the environment have on
shaping our lives. Culture is the totalityof our shared language, knowledge,
material objects, and behavior. It
includes ideas about what is right andwrong, what to strive for, what to eat,
how to speak, what is valued, as well as
what kinds of emotions are called for incertain situations. Culture teaches us
how to live in a society and allows us toadvance because each new generation
can benefit from the solutions found andSourcepassed down from previous
Think of other ways culture may have affected yourgenerations. Culture is learned fromdevelopment. How might cultural differences influenceparents, schools, houses of worship,
interactions between teachers and students, nurses and patients,
media, friends and others throughout aor other relationships?
lifetime. The kinds of traditions andvalues that evolve in a particular culture serve to help members function and value their own
society. We tend to believe that our own culture’s practices and expectations are the rightones. This belief that our own culture is superior is called ethnocentrism and is a normal byproduct of growing up in a culture. It becomes a roadblock, however, when it inhibits
understanding of cultural practices from other societies. Cultural relativity is an appreciation
for cultural differences and the understanding that cultural practices are best understood fromthe standpoint of that particular culture.
Culture is an extremely important context for human development and understanding
development requires being able to identify which features of development are culturally
based. This understanding is somewhat new and still being explored. Much of whatdevelopmental theorists have described in the past has been culturally bound and difficult toapply to various cultural contexts. The reader should keep this in mind and realize that there is
still much that is unknown when comparing development across cultures.
Lifespan vs. Life expectancy: At this point you must be wondering what the difference between
lifespan and life expectancy is, according to developmentalists. Lifespan, or longevity, refers to
the length of time a species can exist under the most optimal conditions. For instance, the grey
wolf can live up to 20 years in captivity, the bald eagle up to 50 years, and the Galapagos tortoiseover 150 years (Smithsonian National Zoo, 2016). The longest recorded lifespan for a humanwas Jean Calment who died in 1994 at the age of 122 years, 5 months, and 14 days (Guinness
World Records, 2016). Life expectancy is the predicted number of years a person born in aparticular time period can reasonably expect to live (Vogt & Johnson, 2016).

12

Conceptions of Age
How old are you? Chances are you would answer that question based on the number of years
since your birth, or what is called your chronological age. Ever felt older than yourchronological age? Some days we might “feel” like we are older, especially if we are not feelingwell, are tired, or are stressed out. We might notice that a peer seems more emotionally maturethan we are, or that they are physically more capable. So years since birth is not the only way wecan conceptualize age.
Biological age: Another way developmental researchers can think about the concept of age is to
examine how quickly the body is aging, this is your biological age. Several factors determine therate at which our body ages. Our nutrition, level of physical activity, sleeping habits, smoking,alcohol consumption, how we mentally handle stress, and the genetic history of our ancestors, toname but a few.

Psychological age: Our psychologically
adaptive capacity compared to others of ourchronological age is our psychological age.
This includes our cognitive capacity alongwith our emotional beliefs about how old weare. An individual who has cognitive
impairments might be 20 years of age, yet
has the mental capacity of an 8-year-old. A
70- year-old might be travelling to new
countries, taking courses at college, or
starting a new business. Compared to othersof our age group, we may be more or lessadaptive and excited to meet new challenges.
Remember you are as young or old as you
feel.

Figure 1.3 You are as young as you feel!

SourceSocial age: Our social age is based on the social norms of our culture and the expectations ourculture has for people of our age group. Our culture often reminds us whether we are “on target”
or “off target” for reaching certain social milestones, such as completing our education, moving
away from home, having children, or retiring from work. However, there have been argumentsthat social age is becoming less relevant in the 21st century (Neugarten, 1979; 1996). If you lookaround at your fellow students in your courses at college you might notice more people who are
older than the more traditional aged college students, those 18 to 25. Similarly, the age at whichpeople are moving away from the home of their parents, starting their careers, getting married or
having children, or even whether they get married or have children at all, is changing.
Those who study lifespan development recognize that chronological age does not completely
capture a person’s age. Our age profile is much more complex than this. A person may bephysically more competent than others in their age group, while being psychologically immature.
So, how old are you?
13Periods of Development
Table 1.2 Age Periods of Development
Age Period

Description

Prenatal

Starts at conception, continues through implantation in the uterine
wall by the embryo, and ends at birth.

Infancy andToddlerhood

Starts at birth and continues to two years of age

Early Childhood

Starts at two years of age until six years of age

Middle and Late
Childhood

Starts at six years of age and continues until the onset of puberty

Adolescence

Starts at the onset of puberty until 18

Emerging
Adulthood

Starts at 18 until 25

Early Adulthood

Starts at 25 until 40-45

Middle Adulthood

Starts at 40-45 until 65

Late Adulthood

Starts at 65 onward

Table 1.2 reflects unique aspects of the various stages of childhood and adulthood that will be
explored in this book. So, while both an 8-month old and an 8-year-old are considered children,
they have very different motor abilities, social relationships, and cognitive skills. Theirnutritional needs are different and their primary psychological concerns are also distinctive. The
same is true of an 18-year-old and an 80-year-old, as both are considered adults.
Prenatal Development: Conception occurs and development begins. All of the major structuresof the body are forming, and the health of the mother is of primary concern. Understanding
nutrition, teratogens, or environmental factors that can lead to birth defects, and labor anddelivery are primary concerns.
Figure 1.4

Infancy and Toddlerhood: The first two years of life are ones ofdramatic growth and change. A newborn, with a keen sense ofhearing but very poor vision, is transformed into a walking, talking
toddler within a relatively short period of time. Caregivers are alsotransformed from someone who manages feeding and sleep
schedules to a constantly moving guide and safety inspector for amobile, energetic child.

SourceEarly Childhood: This period is also referred to as the preschool years and consists of the years
which follow toddlerhood and precede formal schooling. As a two to six-year-old, the child is
14

busy learning language, is gaining a sense of self and greater independence, and is beginning tolearn the workings of the physical world.
Middle and Late Childhood: The ages of six to the onset of puberty comprise middle and latechildhood, and much of what children experience at this age is connected to their involvement in
the early grades of school. Now the world becomes one of learning and testing new academic
skills and by assessing one’s abilities and accomplishments by making comparisons between self
and others.
Adolescence: Adolescence is a period of dramatic physical change marked by an overall growth
spurt and sexual maturation, known as puberty. It is also a time of cognitive change as theadolescent begins to think of new possibilities and to consider abstract concepts such as love,
fear, and freedom. Ironically, adolescents have a sense of invincibility that puts them at greaterrisk of dying from accidents or contracting sexually transmitted infections that can have lifelong
consequences.
Emerging Adulthood: The period of emerging adulthood is a transitional time between the endof adolescence and before individuals acquire all the benchmarks of adulthood. Continued
identity exploration and preparation for full independence from parents are demonstrated.
Although at one’s physiological peak, emerging adults are most at risk for involvement in violent
crimes and substance abuse.
Early Adulthood: The twenties and thirties are identified
as early adulthood. Intimate relationships, establishingfamilies, and work are primary concerns at this stage oflife.

Figure 1.5

Middle Adulthood: The forties through the mid-sixties isreferred to as middle adulthood. This is a period in which
aging becomes more noticeable and when many people
are at their peak of productivity in love and work.
Late Adulthood: Late adulthood is sometimes
subdivided into two categories: The young-old who arefrom 65-84 years and the oldest-old who are 85 years andolder. One of the primary differences between thesegroups is that the young-old are still relatively healthy,
productive, active, and the majority continue to live
independently. With both age groups the risks of diseases
such as, arteriosclerosis, cancer, and cerebral vasculardisease increases substantially.

15

SourceIssues in Lifespan Development
Nature and Nurture: Why are you the way you are? As you consider some of your features(height, weight, personality, being diabetic, etc.), ask yourself whether these features are a resultof heredity or environmental factors, or both. Chances are, you can see the ways in which bothheredity and environmental factors (such as lifestyle, diet, and so on) have contributed to thesefeatures. For decades, scholars have carried on the "nature/nurture" debate. For any particularfeature, those on the side of nature would argue that heredity plays the most important role inbringing about that feature. Those on the side of nurture would argue that one's environment ismost significant in shaping the way we are. This debate continues in all aspects of humandevelopment, and most scholars agree that there is a constant interplay between the two forces. It
is difficult to isolate the root of any single behavior as a result solely of nature or nurture.
Continuity versus
Discontinuity: Is humandevelopment best characterized
The tree represents continuous development, while the ladybug
represents discontinuous/stage development.
as a slow, gradual process, or isit best viewed as one of more
abrupt change? The answer tothat question often depends onwhich developmental theorist
you ask and what topic is being
studied. The theories of Freud,
Erikson, Piaget, and Kohlberg
are called stage theories. Stage
theories or discontinuous
development assume that
Sourcedevelopmental change often
occurs in distinct stages thatare qualitatively different from each other, and in a set, universal sequence. At each stage ofdevelopment, children and adults have different qualities and characteristics. Thus, stage
theorists assume development is more discontinuous. Others, such as the behaviorists,
Vygotsky, and information processing theorists, assume development is a more slow and gradualprocess known as continuous development. For instance, they would see the adult as notpossessing new skills, but more advanced skills that were already present in some form in thechild. Brain development and environmental experiences contribute to the acquisition of moredeveloped skills.
Figure 1.6

Active versus Passive: How much do you play a role in your own developmental path? Are youat the whim of your genetic inheritance or the environment that surrounds you? Some theorists
see humans as playing a much more active role in their own development. Piaget, for instancebelieved that children actively explore their world and construct new ways of thinking to explain
the things they experience. In contrast, many behaviorists view humans as being more passive inthe developmental process.

16

Stability versus Change: How similar are you to how you were as a child? Were you always as
out-going or reserved as you are now? Some theorists argue that the personality traits of adults
are rooted in the behavioral and emotional tendencies of the infant and young child. Others
disagree, and believe that these initial tendencies are modified by social and cultural forces overtime.

Historical Theories on Development
Preformationist View: Well into the 18th century, children
were merely thought of as little adults. Preformationism, or
the belief that a tiny, fully formed human is implanted in the
sperm or egg at conception and then grows in size until birth,
was the predominant early theory. Children were believed topossess all their sensory capabilities, emotions, and mental
aptitude at birth, and as they developed these abilities unfoldedon a predetermined schedule (Thomas, 1979). The environment
was thought to play no role in determining development.

Figure 1.7

John Locke (1632-1704): Locke, a British philosopher, refuted
the idea of innate knowledge and instead proposed that children
Source: A tiny person inside a sperm.
are largely shaped by their social environments, especially theireducation as adults teach them important knowledge. He
believed that through education a child learns socialization, or what is needed to be an
appropriate member of society. Locke advocated thinking of a child’s mind as a tabula rasa or
blank slate, and whatever comes into the child’s mind comes from the environment. Lockeemphasized that the environment is especially powerful in the child’s early life because heconsidered the mind the most pliable then. Locke indicated that the environment exerts its
effects through associations between thoughts and feelings, behavioral repetition, imitation, andrewards and punishments (Crain, 2005). Locke’s ideas laid the groundwork for the behavioral
perspective and subsequent learning theories of Pavlov, Skinner and Bandura.
Jean-Jacques Rousseau (1712-1778): Like Locke, Rousseau also believed that children were
not just little adults. However, he did not believe they were blank slates, but instead developed
according to a natural plan which unfolded in different stages (Crain, 2005). He did not believe
in teaching them the correct way to think, but believed children should be allowed to think bythemselves according to their own ways and an inner, biological timetable. This focus on
biological maturation resulted in Rousseau being considered the father of developmental
psychology. Followers of Rousseau’s developmental perspective include Gesell, Montessori,and Piaget.
Arnold Gesell (1880-1961): Gesell spent 50 years at the Yale Clinic of Child Development, andwith his colleagues he studied the neuromotor development of children. Gesell believed that thechild’s development was activated by genes and he called this process maturation (Crain, 2005).
Further, he believed that development unfolded in fixed sequences, and he opposed efforts toteach children ahead of schedule as he believed they will engage in behaviors when their nervous
systems had sufficiently matured.
17

Figure 1.8

Sigmund Freud from Wikimedia

Sigmund Freud (1856-1939): Freud was a very influential
figure in the area of development. Freud emphasized theimportance of early childhood experiences in shaping our
personality and behavior. In our natural state, we are biologicalbeings and are driven primarily by instincts. During childhood,
however, we begin to become social beings as we learn how tomanage our instincts and transform them into sociallyacceptable behaviors. His assumptions were that personality
formed during the first few years of life. The ways in which
parents or other caregivers interacted with children wereassumed to have a long-lasting impact on children’s emotional
states. His beliefs formed the psychodynamic perspective andhis theories of psychosexual development and psychopathology
dominated the field of psychiatry until the growth of
behaviorism in the 1950s.

However, Freud’s theory has been heavily criticized for several reasons. One is that it is very
difficult to test scientifically (Crews, 1998). Freud suggested that much of what determines ouractions were unknown to us, and as scientists we cannot measure these unconscious concepts. A
second criticism is that Freud’s case studies were not validated and cannot be used as evidence
for his theories. Many later theories, particularly behaviorism and humanism, came about aschallenges to Freud’s views.

Contemporary Theories on Development
Figure 1.9

Erikson (1902-1994) and Psychosocial Theory: Now, let's turn to aless controversial psychodynamic theorist, Erik Erikson. Erikson
presents eight developmental stages that encompass the entire
lifespan. For that reason, Erikson’s psychosocial theory forms thefoundation for much of our discussion of psychosocial development.

Erikson (1950) proposed a model of lifespan development thatprovides a useful guideline for thinking about the changes weexperience throughout life. Erikson broke with Freud’s emphasis on
sexuality as the cornerstone of social-emotional development andinstead suggested that social relationships fostered development.
Erikson proposed that each period of life has a unique challenge orcrisis that the person who reaches it must face, referred to as
psychosocial crises. According to Erikson, successful development
Erik Erikson
involves dealing with and resolving the goals and demands of each ofthese psychosocial crises in a positive way. These crises are usuallycalled stages, although that is not the term Erikson used. If a person does not resolve a stage
successfully, it may hinder their ability to deal with later stages. For example, the person who
does not develop a sense of trust (Erikson’s first stage) may find it challenging as an adult toform a positive intimate relationship (Erikson’s sixth stage). Or an individual who does notdevelop a clear sense of purpose and identity (Erikson’s fifth stage) may become self-absorbed
and stagnate rather than work toward the betterment of others (Erikson’s seventh stage).
18

However, most individuals are able to successfully complete the eight stages of his theory (SeeTable 1.3).
Table 1.3 Erikson’s Psychosocial Stages
Age range
Birth to 12 to
18 months

Psychosocial crisis
Trust versus Mistrust

Positive resolution of crisis
The child develops a feeling of trust in caregivers.

18 months to
3 years

Autonomy versus
Shame/Doubt

The child learns what can and cannot b e controlled anddevelops a sense of free will.

3 to 6 years

Initiative versus Guilt

The child learns to become independent by exploring,manipulating, and taking action.

6 to 12 years

Industry versus Inferiority

12 to 18 years

Identity versus Role
Confusion

The child learns to do things well or correctly according tostandards set by others, particularly in school.
The adolescent develops a well-defined and positive sense of
self in relationship to others.

19 to 40 years

Intimacy versus Isolation

40 to 65 years

Generativity versus
Stagnation

65 to death

Ego Integrity versus
Despair

The person develops the ability to give and receive love and to
make long-term commitments.
The person develops an interest in guiding the developmentof the next generation, often by becoming a parent.
The person develops acceptance of how one has lived.

Erikson’s theory has been criticized for focusing so heavily on crises and assuming that thecompletion of one crisis is a prerequisite for the next crisis of development. His theory also
focused on the social expectations that are found in certain cultures, but not in all. For instance,
the idea that adolescence is a time of searching for identity might translate well in the middleclass culture of the United States, but not as well in cultures where the transition into adulthoodcoincides with puberty through rites of passage and where adult roles offer fewer choices.
Learning Theory: Also known as Behaviorism, is based on the premise that it is not possible toobjectively study the mind, and therefore psychologists should limit their attention to the study of
behavior itself. The most famous behaviorist was Burrhus Frederick (B. F.) Skinner (1904–
1990), who expanded the principles of behaviorism and also brought them to the attention of the
public at large. Skinner used the ideas of stimulus and response, along with the application of
rewards or reinforcements, to train pigeons and other animals. In addition, he used the generalprinciples of behaviorism to develop theories about how best to teach children and how to create
societies that were peaceful and productive (Skinner, 1957, 1968, 1972).
The behaviorists made substantial contributions to psychology by identifying the principles oflearning. Although the behaviorists were incorrect in their beliefs that it was not possible tomeasure thoughts and feelings, their ideas provided new insights that helped further our
understanding regarding the nature-nurture debate as well as the question of free will. The ideasof behaviorism are fundamental to psychology and have been developed to help us better
understand the role of prior experiences in a variety of areas of psychology.
19

Social Learning Theory, or learning by watching others, was developed by Albert Bandura(1977). His theory calls our attention to the ways in which many of our actions are not learned
through conditioning, as suggested by Skinner. Young children frequently learn behaviors
through imitation. Especially when children do not know what else to do, they learn by modelingor copying the behavior of others.
Bandura (1986) suggests that there is interplay between the environment and the individual. We
are not just the product of our surroundings, rather we influence our surroundings. There isinterplay between our personality and the way we interpret events and how they influence us.
This concept is called reciprocal determinism. An example of this might be the interplay
between parents and children. Parents not only influence their child's environment, perhaps
intentionally through the use of reinforcement, etc., but children influence parents aswell. Parents may respond differently with their first child than with their fourth. Perhaps they
try to be the perfect parents with their firstborn, but by the time their last child comes along they
have very different expectations, both of themselves and their child. Our environment creates us
and we create our environment.
Other social influences: TV or not TV? Bandura, Ross and Ross (1963)
began a series of studies to look at the impact of television on the behaviorof children. Bandura began by conducting an experiment in which heshowed children a film of a woman hitting an inflatable clown or “bobo”
doll. Then the children were allowed in the room, where they found the dolland during their play they began to hit it. The children also demonstrated
novel ways of being aggressive toward the doll that were not demonstrated
by those children who did not see the aggressive model. Bandura’s
research raised concerns about the impact of violence on young children.
Since then, considerable research has been conducted on the impact ofviolent media on children’s aggression including playing video games.

Figure 1.10
The Bobo Doll

SourceCognitive Theory: The cognitive theories focus on how our mental
processes or cognitions change over time. Three important theories are Jean Piaget’s, Lev
Vygotsky’s, and Information-processing.
Jean Piaget (1896-1980) was one of the most influential cognitive theorists in development. He
was inspired to explore children’s ability to think and reason by watching his own children’sdevelopment. He was one of the first to recognize and map out the ways in which children's
intelligence differs from that of adults (Piaget, 1929). He became interested in this area when he
was asked to test the IQ of children and began to notice that there was a pattern in their wrong
answers. He believed that children's intellectual skills change over time and that maturation,rather than training, brings about that change. Children of differing ages interpret the world
differently. Piaget theorized that children progressed through four stages of cognitive
development (see Table 1.4).

20

Table 1.4 Piaget’s Stages of Cognitive Development
Stage

Approximate
age range

Sensorimotor

Birth to about
2 years

Children experience the world through theirfundamental senses of seeing, hearing,
touching, and tasting.

Object permanence

Preoperational

2 to 7 years

Children acquire the ability to internally
represent the world through language andmental imagery. They also start to see theworld from other people’s perspectives.

Theory of mind;
rapid increase inlanguage ability

Concrete
operational

7 to 11 years

Children become able to think logically. They
can increasingly perform operations on objects
that are real.

Conservation

Formaloperational

11 years toadulthood

Adolescents can think systematically, canreason about abstract concepts, and canunderstand ethics and scientific reasoning.

Abstract logic

Characteristics

Stage attainments

Piaget has been criticized for overemphasizing the role that physical maturation plays incognitive development and in underestimating the role that culture and experience plays.
Looking across cultures reveals considerable variation in what children are able to do at various
ages. Research has shown considerable overlap among the four stages and that development ismore continuous.
Lev Vygotsky (1896-1934) was a Russian psychologist who wrote in the early 1900s, but whose
work was not discovered by researchers in the United States until the 1960s and became more
widely known in the 1980s (Crain, 2005). His sociocultural theory emphasizes the importanceof culture and interaction in the development of cognitive abilities. Vygotsky differed with
Piaget in that he believed that a person not only has a set of abilities, but also a set of potential
abilities that can be realized if given the proper guidance from others. Vygotsky developed
theories on teaching that have been adopted by educators today.
Information Processing is not the work of a single theorist, but based on the ideas and researchof several cognitive scientists studying how individuals perceive, analyze, manipulate, use, andremember information. This approach assumes that humans gradually improve in theirprocessing skills; that is, cognitive development is continuous rather than stage-like. The more
complex mental skills of adults are built from the primitive abilities of children. We are bornwith the ability to notice stimuli, store, and retrieve information. Brain maturation enables
advancements in our information processing system. At the same time, interactions with theenvironment also aid in our development of more effective strategies for processing information.
Urie Bronfenbrenner (1917-2005) developed the Ecological Systems Theory, which provides
a framework for understanding and studying the many influences on human development(Bronfenbrenner, 1979). Bronfenbrenner recognized that human interaction is influenced by21

larger social forces and that an understanding of these forces is essential for understanding an
individual. The individual is impacted by several systems including:o Microsystem includes the individual’s setting and those who have direct, significant
contact with the person, such as parents or siblings. The input of those is modified by the
cognitive and biological state of the individual as well. These influence the person’s
actions, which in turn influence systems operating on him or her.
o Mesosystem includes the larger organizational structures, such as school, the family, or
religion. These institutions impact the microsystems just described. The philosophy ofthe school system, daily routine, assessment methods, and other characteristics can affectthe child’s self-image, growth, sense of accomplishment, and schedule thereby impacting
the child, physically, cognitively, and emotionally.
o Exosystem includes the larger contexts of community. A community’s values, history,
and economy can impact the organizational structures it houses. Mesosystems bothinfluence and are influenced by the exosystem.
o Macrosystem includes the cultural elements, such as global economic conditions, war,technological trends, values, philosophies, and a society’s responses to the global
community.
o Chronosystem is the historical context in which these experiences occur. This relates tothe different generational time periods previously discussed, such as the baby boomers
and millennials.
In sum, a child’s experiences are shaped by larger forces, such as the family, schools, religion,
culture, and time period. Bronfenbrenner’s model helps us understand all of the different
environments that impact each one of us simultaneously. Despite its comprehensiveness,
Bronfenbrenner’s ecological system’s theory is not easy to use. Taking into consideration all thedifferent influences makes it difficult to research and determine the impact of all the different
variables (Dixon, 2003). Consequently, psychologists have not fully adopted this approach,although they recognize the importance of the ecology of the individual. Figure 1.11 is a modelof Bronfenbrenner’s Ecological Systems Theory.

22

Figure 1.11

Source23

Learning Objectives: Research Methods••••

Define the scientific method
Compare research methods noting the advantages and disadvantages of each.
Explain research involving time spans
Explain ways to conduct ethical research

An important part of learning any science, including psychology, is having a basic knowledge ofthe techniques used in gathering information. The hallmark of scientific investigation is that offollowing a set of procedures designed to keep questioning or skepticism alive while describing,
explaining, or testing any phenomenon. Science involves continuously renewing ourunderstanding of the subjects in question and an ongoing investigation of how and why eventsoccur. The scientific method is the set of assumptions, rules, and procedures scientists use to
conduct research.
A research design is the specific method a researcher uses to collect, analyze, and interpret
data. Psychologists use three major types of research designs in their research, and each provides
an essential avenue for scientific investigation. Descriptive research is research that describes
what is occurring at a particular point in time. Correlational research is research designed to
discover relationships among variables and to allow the prediction of future events from present
knowledge. Experimental research is research in which a researcher manipulates one or morevariables to see their effects. Each of the three research designs varies according to its strengths
and limitations.

Descriptive Research
Case Study: Sometimes the data in a descriptive research project are based on only a small setof individuals, often only one person or a single small group. These research designs are known
as case studies which are descriptive records of one or a small group of individuals’
experiences and behavior. Sometimes case studies involve ordinary individuals. Developmental
psychologist Jean Piaget observed his own children. More frequently, case studies are
conducted on individuals who have unusual or abnormal experiences. The assumption is that bycarefully studying these individuals, we can learn something about human nature. Case studies
have a distinct disadvantage in that, although it allows us to get an idea of what is currently
happening, it is usually limited to static pictures. Although descriptions of particularexperiences may be interesting, they are not always transferable to other individuals in similar
situations. They are also time consuming and expensive as many professionals are involved ingathering the information.
Observations: Another type of descriptive research is known as observation. When using
naturalistic observation, psychologists observe and record behavior that occurs in everyday
settings. For instance, a developmental psychologist might watch children on a playground and24describe what they say to each other. However, naturalistic observations do not allow the
researcher to have any control over the environment.
Laboratory observation, unlike the naturalistic observation, is conducted in a setting created by
the researcher. This permits the researcher to control more aspects of the situation. One example
of laboratory observation involves a systematic procedure known as the strange situation test,
which you will learn about in chapter three. Concerns regarding laboratory observations are thatthe participants are aware that they are being watched, and there is no guarantee that the behavior
demonstrated in the laboratory will generalize to the real world.
Survey: In other cases, the data fromdescriptive research projects come in theform of a survey, which is a measureadministered through either a verbal or
written questionnaire to get a picture of thebeliefs or behaviors of a sample of people ofinterest. The people chosen to participate in
the research, known as the sample, areselected to be representative of all the people
that the researcher wishes to know about
called the population. A representative
sample would include the same percentagesof males, females, age groups, ethnic groups,
and socio-economic groups as the larger
population.

Figure 1.12
How many surveys have you taken?

SourceSurveys gather information from many individuals in a short period of time, which is the greatest
benefit for surveys. Additionally, surveys are inexpensive to administer. However, surveys
typically yield surface information on a wide variety of factors but may not allow for in-depth
understanding of human behavior. Another problem is that respondents may lie because theywant to present themselves in the most favorable light, known as social desirability. They also
may be embarrassed to answer truthfully or are worried that their results will not be kept
confidential. Additionally, questions can be perceived differently than intended.
Interviews: Rather than surveying participants, they can be interviewed which means they are
directly questioned by a researcher. Interviewing participants on their behaviors or beliefs cansolve the problem of misinterpreting the questions posed on surveys. The examiner can explain
the questions and further probe responses for greater clarity and understanding. Although thiscan yield more accurate results, interviews take longer and are more expensive to administer thansurveys. Participants can also demonstrate social desirability, which will affect the accuracy of
the responses.
Psychophysiological Assessment: Researchers may also record psychophysiological data, suchas measures of heart rate, hormone levels, or brain activity to help explain development. These
measures may be recorded by themselves or in combination with behavioral data to better
understand the bidirectional relations between biology and behavior. Special equipment has beendeveloped to allow researchers to record the brain activity of very young and very small research
25subjects. One manner of understanding associations between brain development and behavioral
advances is through the recording of event-related potentials (ERPs). ERPs are recorded byfitting a research participant with a stretchy cap that contains many small sensors or electrodes.
These electrodes record tiny electrical currents on the scalp of the participant in response to thepresentation of stimuli, such as a picture or a sound.
Figure 1.13

Source

The use of ERPs has provided important insight as to how
infants and children understand the world around them.
Webb, Dawson, Bernier, and Panagiotides (2006) examined
face and object processing in children with autism spectrum
disorders, those with developmental delays, and those who
were typically developing. The children wore electrode caps
and had their brain activity recorded as they watched still
photographs of faces of their mother or of a stranger, andobjects, including those that were familiar or unfamiliar tothem. The researchers examined differences in face andobject processing by group by observing a component of thebrainwaves. Findings suggest that children with autism arein some way processing faces differently than typicallydeveloping children and those with more generaldevelopmental delays.

Secondary/Content Analysis involves analyzing information that has already been collected or
examining documents or media to uncover attitudes, practices or preferences. There are anumber of data sets available to those who wish to conduct this type of research. For example,
the U. S. Census Data is available and widely used to look at trends and changes taking place inthe United States. The researcher conducting secondary analysis does not have to recruit
subjects, but does need to know the quality of the information collected in the original study.

Correlational Research
In contrast to descriptive research, which is designed primarily to provide static pictures,
correlational research involves the measurement of two or more relevant variables and anassessment of the relationship between or among those variables. For instance, the variables ofheight and weight are systematically related (correlated) because taller people generally weighmore than shorter people.
The Pearson Correlation Coefficient, symbolized by the letter r, is the most common statisticalmeasure of the strength of linear relationships among variables. The value of the correlation
coefficient ranges from r= –1.00 to r = +1.00. The strength of the linear relationship is indexedby the distance of the correlation coefficient from zero (its absolute value). For instance, r = –.54
is a stronger relationship than r= .30, and r = .72 is a stronger relationship than r = –.57. The
direction of the linear relationship is indicated by the sign of the correlation coefficient. Positive
values of r (such as r = .54 or r = .67) indicate that the relationship is positive (i.e., the pattern ofthe dots on the scatter plot runs from the lower left to the upper right), whereas negative values
26

of r (such as r = –.30 or r = –.72) indicate negative relationships (i.e., the dots run from the upper
left to the lower right).
When the straight line indicates that
individuals who have high values for one
Figure 1.14
variable also tend to have high values forthe other variable, as in part (a), therelationship is said to be a positive
correlation. Examples of positive
correlations include those between
education and income, and between age
and mathematical abilities in children. In
each case people who score higher on oneof the variables also tend to score higher
on the other variable. Negative
correlations, in contrast, as shown inpart (b), occur when high values for one
variable tend to be associated with low
Some examples of relationships between two variables as shown inscatter plots. Source:
values for the other variable. Examplesof negative correlations include thosebetween the age of a child and the number of diapers the child uses, and between practice anderrors made on a learning task. In these cases, people who score higher on one of the variables
tend to score lower on the other variable.
An important limitation of correlational research designs is that they cannot be used to draw
conclusions about the causal relationships among the measured variables. Consider, for instance,a researcher who has hypothesized that viewing violent behavior will cause increased aggressive
play in children. He has collected, from a sample of fourth-grade children, a measure of how
much violent television each child views during the week, as well as a measure of how
aggressively each child plays. The researcher discovers a positive correlation between the two
measured variables. Although this positive correlation appears to support the hypothesis, itcannot be taken to indicate that viewing violent television causes aggressive behavior as there areother possible explanations. One alternative is that children who behaved aggressively at school
want to watch violent television shows. Still another possible explanation for the observed
correlation is that it has been produced by the presence of a third variable.
A third variable is a variable that is not partof the research hypothesis but produces theobserved correlation between them. In our
example a potential third variable is thediscipline style of the children’s parents.
Parents who use a harsh and punitive
discipline style may produce children whoboth like to watch violent television and who
behave aggressively in comparison tochildren whose parents use less harshdiscipline.

Figure 1.15

27

For this reason, we are left with the basic limitation of correlational research: Correlation does
not demonstrate causation! It is important that when you read about correlational research
projects, you keep in mind the possibility of third variables.
Strengths and limitations: Correlational research can be used when experimental research is
not possible because the variables cannot be manipulated or it would be unethical to use an
experiment. Correlational designs also have the advantage of allowing the researcher to study
behavior as it occurs in everyday life. We can also use correlational designs to make predictions.
For instance, we can predict from the scores on a battery of tests the success of job trainees
during a training session. However, we cannot use such correlational information to determine
whether one variable caused another variable. For that, researchers rely on an experiment.

Experimental Research
The goal of the experimental method is to provide more definitive conclusions about the causal
relationships among the variables in a research hypothesis than what is available fromcorrelational research. Experiments are designed to test hypotheses, or specific statements about
the relationship between variables. Experiments are conducted in a controlled setting in an effort
to explain how certain factors or events produce outcomes. A variable is anything that changes
in value. In the experimental research design, the variables of interest are called the independent
variable and the dependent variable. The independent variable in an experiment is the causing
variable that is created or manipulated by the experimenter. The dependent variable in anexperiment is a measured variable that is expected to be influenced by the experimental
manipulation.
A good experiment randomly assigns participants to at least two groups that are compared. The
experimental group receives the treatment under investigation, while the control group does notreceive the treatment the experimenter is studying as a comparison. For instance, to assess
whether violent TV affects aggressive behavior the experimental group might view a violent
television show, while the control group watches a non-violent show. Additionally, experimental
designs control for extraneous variables, or variables that are not part of the experiment that
could inadvertently affect either the experimental or control group, thus distorting the results.
Despite the advantage of determining causation, experiments do have limitations. One is thatthey are often conducted in laboratory situations rather than in the everyday lives of people.
Therefore, we do not know whether results that we find in a laboratory setting will necessarily
hold up in everyday life. Second, and more important, is that some of the most interesting andkey social variables cannot be experimentally manipulated because of ethical concerns. If wewant to study the influence of abuse on children’s development of depression, these relationships
must be assessed using correlational designs because it is simply not ethical to experimentallymanipulate these variables. Characteristics of descriptive, correlational, and experimental
research designs can be found in Table 1.5.

28

Table 1.5 Characteristics of the Three Research Designs
Research
DesignGoal

Descriptive

To create a snapshot of
the current state ofaffairs

Provides a relatively
complete picture of what is
occurring at a given time.
Allows the development ofquestions for further study.

Does not assess
relationships among
variables. May be unethicalif participants do not know
they are being observed.

Correlational

To assess therelationships between
and among two or
more variables

Allows testing of expected
relationships between andamong variables and themaking of predictions. Can
assess these relationships ineveryday life events.

Cannot be used to draw
inferences about thecausal relationships
between and among thevariables.

Experimental

To assess the causal
impact of one ormore experimental
manipulations on adependent variable

Allows drawing of
conclusions about thecausal relationships among
variables.

Cannot experimentallymanipulate many
important variables. May
be expensive and time
consuming.

Advantages

Disadvantages

Source: Stangor, C. (2011). Research methods for the behavioral sciences (4th ed.). Mountain View, CA: Cengage.

Research Involving Time-Spans
Cross-sectional research compares samples that
represent a cross-section of the population who varyin age. Participants might be asked to complete asurvey or take a test of some physical or cognitive
skill. The attitudes or skill levels based on age arecompared. In cross-sectional research, respondents
are measured only once, and consequently thismethod is not expensive or time consuming. In
addition, because participants are only tested at one
point in time, practice effects are not an issue as
children do not have the opportunity to become betterat the task over time. There is also no need to keep incontact with, or follow-up with, participants over time.

Figure 1.16 Cross-Sectional

SourceHowever, cross-sectional research does not allow the researcher to look at the impact of having
been born in a certain time-period, which is known as the cohort effect. For example, those born
during the depression have very different views about and experiences with the internet than29

those born in the last twenty years. Different attitudes about the Internet, for example, might not
be due to a person’s biological age as much as their life experiences as members of a cohort.
Longitudinal research involves studying a group of people who are the same age, andmeasuring them repeatedly over a period-of-time. This type of design allows researchers to study
individual differences in development. Longitudinal studies may be conducted over the shortterm, such as a span of months, or over much longer durations including years or decades. For
these reasons, longitudinal research designs are optimal for studying stability and change overtime.
Figure 1.17 Longitudinal Research

SourceProblems with longitudinal research include being very time consuming and expensive.
Researchers must maintain continued contact with participants over time, and these studies
necessitate that scientists have funding to conduct their work over extended durations. An
additional risk is attrition. Attrition occurs when participants fail to complete all portions of astudy. Participants may move, change their phone numbers, or simply become disinterested inparticipating over time. Researchers should account for the possibility of attrition by enrolling alarger sample into their study initially, as some participants will likely drop out over time. Even
with a large sample size, the experimenter never knows if there was something different about
the individuals who dropped out versus those that remained in the study.
The results from longitudinal studies may also be impacted by repeated assessments. Consider
how well you would do on a math test if you were given the exact same exam every day for aweek. Your performance would likely improve over time not necessarily because you developed
better math abilities, but because you were continuously practicing the same math problems.
This phenomenon is known as a practice effect. Practice effects occur when participants
become better at a task over time because they have done it again and again; not due to natural
psychological development.
Sequential research includes elements of both longitudinal and cross-sectional research
designs. Similar to longitudinal designs, sequential research features participants who arefollowed over time; similar to cross-sectional designs, sequential work includes participants ofdifferent ages. This research design is also distinct from those that have been discussed
previously in that individuals of different ages are enrolled into a study at various points in time30

to examine age-related changes, development within the same individuals as they age, andaccount for the possibility of cohort effects.

Figure 1.18 Sequential Research

SourceFor example, in a study with a sequential design, a researcher might enroll three separate groupsof children (Groups A, B, and C). Children in Group A would be enrolled when they are 2 years
old and would be tested again when they are 4 and 6 years old. This is similar in design to thelongitudinal study described previously. Children in Group B would also be enrolled when they
are 2 years old, but this would occur two years later when Group A is now 4 years old. Finally,children in Group C would be enrolled when they are 2 years old and Group A is now 6 andGroup B is now 4. At this time, the children would represent a cross-sectional design (2, 4, and6 years of age). Further, along the diagonal children of the same age can be compared todetermine if cohort effects are evident. Sequential designs are appealing because they allow
researchers to learn a lot about development in a relatively short amount of time.
Because they include elements of longitudinal and cross-sectional designs, sequential research
has many of the same strengths and limitations as these other approaches. For example,
sequential work may require less time and effort than longitudinal research, but more time andeffort than cross-sectional research. Although practice effects may be an issue if participants are
asked to complete the same tasks or assessments over time, attrition may be less problematicthan what is commonly experienced in longitudinal research since participants may not have toremain involved in the study for such a long period-of-time. Table 1.6 identifies advantages anddisadvantages for each of the described time span research design.

31

Table 1.6 Time Span Research Designs Advantages and Disadvantages

SourceConducting Ethical Research
One of the issues that all scientists must address concerns the ethics of their research. Research inpsychology may cause some stress, harm, or inconvenience for the people who participate in that
research. Psychologists may induce stress, anxiety, or negative moods in their participants,
expose them to weak electrical shocks, or convince them to behave in ways that violate theirmoral standards. Additionally, researchers may sometimes use animals, potentially harming
them in the process.
Decisions about whether research is ethical are made using established ethical codes developedby scientific organizations, such as the American Psychological Association, and federal
governments. In the United States, the Department of Health and Human Services provides theguidelines for ethical standards in research. The following are the American Psychological
Association code of ethics when using humans in research (APA, 2016).
•

No Harm: The most direct ethical concern of the scientist is to prevent harm to theresearch participants.

•

Informed Consent: Researchers must obtain informed consent, which explains as muchas possible about the true nature of the study, particularly everything that might be32

expected to influence willingness to participate. Participants can withdraw their consent
to participate at any point.
Infants and young children cannot verbally indicate their willingness to participate, muchless understand the balance of potential risks and benefits. As such, researchers areoftentimes required to obtain written informed consent from the parent or legal guardianof the child participant. Further, this adult is almost always present as the study isconducted. Children are not asked to indicate whether they would like to be involved in astudy until they are approximately seven years old. Because infants and young children
also cannot easily indicate if they would like to discontinue their participation in a study,
researchers must be sensitive to changes in the state of the participant, such asdetermining whether a child is too tired or upset to continue, as well as to what the parent
desires. In some cases, parents might want to discontinue their involvement in the
research. As in adult studies, researchers must always strive to protect the rights and wellbeing of the minor participants and their parents when conducting developmental
research.
•

Confidentiality: Researchers must also protect the privacy of the research participants’
responses by not using names or other information that could identify the participants.

•

Deception: Deception occurs whenever research participants are not completely andfully informed about the nature of the research project before participating in it.
Deception may occur when the researcher tells the participants that a study is about one
thing when in fact it is about something else, or when participants are not told about the
hypothesis.

•

Debriefing: At the end of a study debriefing, which is a procedure designed to fully
explain the purposes and procedures of the research and remove any harmful aftereffectsof participation, must occur.
References

American Psychological Association. (2016). Revision of ethical standards of 3.04 of the “Ethical Principles of Psychologists andCode of Conduct” (2002, as amended 2010). American Psychologist, 71, 900.
Baltes, P. B. (1987). Theoretical propositions of life span developmental psychology: On the dynamics between growth anddecline. Developmental Psychology, 23, 611-626.
Baltes, P. B., Lindenberger, U., & Staudinger, U. M. (2006). Life span theory in developmental psychology. In W. Damon, & R.
M. Lerner (Eds.), Handbook of child psychology, 6th edition (pp. 569-664). Hoboken, NJ: John Wiley & Sons.
Bandura, A. (1977). Social learning theory. New York: General Learning Press.
Bandura, A. (1986). Social foundations of thought and action: A social-cognitive theory. Upper Saddle River, NJ: Prentice Hall.
Bandura, A, Ross, D. &. Ross S. (1963). Imitation of film-mediated aggressive models. Journal of Abnormal and Social
Psychology, 66, 3-11.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard
University Press.

33

Crain, W. (2005). Theories of development concepts and applications (5th ed.). New Jersey: Pearson.
Crews, F. C. (1998). Unauthorized Freud: Doubters confront a legend. New York, NY: Viking Press.
Dixon, W. E. (2003). Twenty studies that revolutionized child psychology. Upper Saddle River, NJ: Prentice Hall.
Erikson, E. H. (1950). Childhood and society. New York: Norton.
Guinness World Records. (2016). Oldest person (ever). Retrieved fromhttp://www.guinnessworldrecords.com/search?term=oldest+person+%28ever%29
Neugarten, B. L. (1979). Policy for the 1980s: Age or need entitlement? In J. P. Hubbard (Ed.), Aging: Agenda for the eighties, anational journal issues book (pp. 48-52). Washington, DC: Government Research Corporation.
Neugarten, D. A. (Ed.) (1996). The meanings of age. Chicago, IL: The University of Chicago Press.
Piaget, J. (1929). The child's conception of the world. NY: Harcourt, Brace Jovanovich.
Smithsonian National Zoo. (2016). Retrieved from http://nationalzoo.si.edu/
Skinner, B. (1957). Verbal behavior. Acton, MA: Copley.
Skinner, B. (1968). The technology of teaching. New York, NY: Appleton-Century-Crofts.
Skinner, B. (1972). Beyond freedom and dignity. New York, NY: Vintage Books.
Thomas, R. M. (1979). Comparing theories of child development. Santa Barbara, CA: Wadsworth.
United States Census Bureau. (2016). Poverty. Retrieved from http://www.census.gov/topics/incomepoverty/poverty/about/glossary.html
Vogt, W.P., & Johnson, R.B. (2016). The SAGE dictionary of statistics and methodology. Los Angeles, CA: Sage
Webb, S. J., Dawson, G., Bernier, R., & Panagiotides, H. (2006). ERP evidence of atypical face processing in young children
with autism. Journal of Autism and Developmental Disorders, 36, 884-890. doi: 10.1007/s10803-006-0126-x
Weitz, R. (2007). The sociology of health, illness, and health care: A critical approach, (4th ed.). Belmont, CA: Thomson.

34

Chapter 2: Heredity, Prenatal Development, and Birth
In this chapter, we will begin by examining some of the ways in which heredity helps to shape
the way we are. We will look at what happens genetically during conception, and describe someknown genetic and chromosomal disorders. Next, we will consider what happens during
prenatal development, including the impact of teratogens. We will also discuss the impact thatboth the mother and father have on the developing fetus. Lastly, we will present the birth
process and some of the complications that can occur during delivery. Before going into these
topics, however, it is important to understand how genes and chromosomes affect development.

Learning Objectives: Heredity
•
•
•
•
•
•

Define genes
Distinguish between mitosis and meiosis, genotype and phenotype, homozygous
and heterozygous, and dominant and recessive
Describe some genetic disorders, due to a gene defect, and chromosomal disorders
Define polygenic and incomplete dominance
Describe the function of genetic counseling and why individuals may seek genetic
counselingDefine behavioral genetics, describe genotype-environment correlations andgenotype-environmental interactions, and define epigenetics

Heredity
As your recall from chapter one, nature refers to thecontribution of genetics to one’s development. The basic
building block of the nature perspective is the gene. Genes
are specific sequence of nucleotides and are recipes formaking proteins. Proteins are responsible for influencing thestructure and functions of cells. Genes are located on thechromosomes and there are an estimated 20,500 genes forhumans, according to the Human Genome Project (NIH,
2015). See Box 2.2 at the end of this section for more details
on the Human Genome Project.

Figure 2.1

SourceNormal human cells contain 46 chromosomes (or 23 pairs; one from each parent) in the nucleusof the cells. After conception, most cells of the body are created by a process called mitosis.
Mitosis is defined as the cell’s nucleus making an exact copy of all the chromosomes andsplitting into two new cells. However, the cells used in sexual reproduction, called the gametes(sperm or ova), are formed in a process called meiosis. In meiosis the gamete’s chromosomes
duplicate, and then divide twice resulting in four cells containing only half the genetic materialof the original gamete. Thus, each sperm and egg possesses only 23 chromosomes and combine
to produce the normal 46. See Figure 2.2 for details on both mitosis and meiosis. Given the35amount of genes present and the unpredictability of the meiosis process, the likelihood of having
offspring that are genetically identical (and not twins) is one in trillions (Gould & Keeton,
1997).
Of the 23 pairs of chromosomes
created at conception, 22 pairs are
similar in length. These are called
autosomes. The remaining pair, orsex chromosomes, may differ inlength. If a child receives the
combination of XY the child will be
genetically male. If the childreceives the combination XX thechild will be genetically female.

Figure 2.2 Mitosis vs. Meiosis

Genotypes and Phenotypes
The word genotype refers to thesum total of all the genes a person
inherits. The word phenotyperefers to the features that are
actually expressed. Look in the
mirror. What do you see, yourgenotype or your phenotype? What
determines whether or not genes are
expressed? Because genes are
inherited in pairs on thechromosomes, we may receive
either the same version of a gene from our mother and father, that is, be homozygous for thatcharacteristic the gene influences. If we receive a different version of the gene from each parent,
that is referred to as heterozygous. In the homozygous situation we will display thatcharacteristic. It is in the heterozygous condition that it becomes clear that not all genes are
created equal. Some genes are dominant, meaning they express themselves in the phenotype
even when paired with a different version of the gene, while their silent partner is calledrecessive. Recessive genes express themselves only when paired with a similar version gene.
Geneticists refer to different versions of a gene as alleles. Some dominant traits include having
facial dimples, curly hair, normal vision, and dark hair. Some recessive traits include red hair,
being nearsighted, and straight hair.
Most characteristics are not the result of a single gene; they are polygenic, meaning they are theresult of several genes. In addition, the dominant and recessive patterns described above areusually not that simple either. Sometimes the dominant gene does not completely suppress therecessive gene; this is called incomplete dominance. An example of this can be found in therecessive gene disorder sickle cell disease. The gene that produces healthy round-shaped red
blood cells is dominant. The recessive gene causes an abnormality in the shape of red blood
cells; they take on a sickle form, which can clog the veins and deprive vital organs of oxygen and36

increase the risk of stroke. To inherit the disorder a person must receive the recessive gene fromboth parents. Those who have inherited only one recessive-gene are called carriers and should
be unaffected by this recessive trait. Yet, carriers of sickle cell have some red blood cells thattake on the c-shaped sickle pattern. Under circumstances of oxygen deprivation, such as highaltitudes or physical exertion, carriers for the sickle cell gene may experience some of thesymptoms of sickle cell (Berk, 2004).
Box 2.1 Monozygotic and Dizygotic Twins
Many students are interested in twins. Monozygotic or identical twins occur when afertilized egg splits apart in the first two weeks of development. The result is thecreation of two separate, but genetically identical offspring. That is, they possess thesame genotype and often the same phenotype. About one-third of twins aremonozygotic twins. Sometimes, however, two eggs or ova are released and fertilized
by two separate sperm. The result is dizygotic or fraternal twins. These two
individuals share the same amount of genetic material as would any two children
from the same mother and father. In other words, they possess a different genotype
and phenotype. Older mothers are more likely to have dizygotic twins than areyounger mothers, and couples who use fertility drugs are also more likely to givebirth to dizygotic twins. Consequently, there has been an increase in the number offraternal twins recently (Bortolus et al., 1999).

Source: Monozygotic Twins

Source Dizygotic Twins

Genetic Disorders
Most of the known genetic disorders are dominant gene-linked; however, the vast majority of
dominant gene linked disorders are not serious or debilitating. For example, the majority of thosewith Tourette's Syndrome suffer only minor tics from time to time and can easily control their
symptoms. Huntington's Disease is a dominant gene linked disorder that affects the nervous
system and is fatal, but does not appear until midlife. Recessive gene disorders, such as cystic
fibrosis and sickle-cell anemia, are less common, but may actually claim more lives because they
are less likely to be detected as people are unaware that they are carriers of the disease. Somegenetic disorders are sex-linked; the defective gene is found on the X-chromosome. Males have
only one X chromosome so are at greater risk for sex-linked disorders due to a recessive gene,37

such as hemophilia, color-blindness, and baldness. For females to be affected by the genetic
defects, they need to inherit the recessive gene on both X-chromosomes, but if the defective geneis dominant, females can be equally at risk. Table 2.1 lists several genetic disorders.
Table 2.1 Genetic Disorders
Recessive Disorders (Homozygous): The individual inherits a gene change from bothparents. If the gene is inherited from just one parent, the person is a carrier and does
not have the condition.
• Sickle Cell Disease (SCD) is a condition in which the red blood cells in the bodyare shaped like a sickle (like the letter C) and affect the ability of the blood totransport oxygen. Carriers may experience some effects, but do not have the fullcondition.
• Cystic Fibrosis (CF) is a condition that affects breathing and digestion due tothick mucus building up in the body, especially the lungs and digestive system. In
CF, the mucus is thicker than normal and sticky.
• Phenylketonuria (PKU) is a metabolic disorder in which the individual cannot
metabolize phenylalanine, an amino acid. Left untreated intellectual deficits
occur. PKU is easily detected and is treated with a special diet.
• Tay Sachs Disease is caused by enzyme deficiency resulting in the accumulationof lipids in the nerve cells of the brain. This accumulation results in progressive
damage to the cells and a decrease in cognitive and physical development. Deathtypically occurs by age five.
•

Albinism is when the individual lacks melanin and possesses little to no pigmentin the skin, hair, and eyes. Vision problems can also occur.

Cases per Birth

1 in 500 Black births
1 in 36,000 Hispanic
births1 in 3500

1 in 10,000

1 in 4000
1in 30 American
Jews is a carrier
1 in 20 French
Canadians is a carrier
Fewer than 20,000
US cases per year

Autosomal Dominant Disorders (Heterozygous): In order to have the disorder, theindividual only needs to inherit the gene change from one parent.
• Huntington’s Disease is a condition that affects the individual’s nervous system.
Nerve cells become damaged, causing various parts of the brain to deteriorate. The
disease affects movement, behavior and cognition. It is fatal, and occurs at
midlife.
• Tourette Syndrome is a tic disorder which results in uncontrollable motor andvocal tics as well as body jerking.
• Achondroplasia is the most common form of disproportionate short stature. The
individual has abnormal bone growth resulting in short stature, disproportionately
short arms and legs, short fingers, a large head, and specific facial features.

Cases per Birth

Sex-Linked Disorders: When the X chromosome carries the mutated gene, thedisorder is referred to as an X-linked disorder. Males are more affected than females
because they possess only one X chromosome without an additional X chromosome tocounter the harmful gene.
• Fragile X Syndrome occurs when the body cannot make enough of a protein it
needs for the brain to grow and problems with learning and behavior canoccur. Fragile X syndrome is caused from an abnormality in the X chromosome,which then breaks. If a female has fragile X, her second X chromosome usually ishealthy, but males with fragile X don’t have a second healthy X chromosome.
This is why symptoms of fragile X syndrome usually are more serious in males .
• Hemophilia occurs when there are problems in blood clotting causing bothinternal and external bleeding.
• Duchenne Muscular Dystrophy is a weakening of the muscles resulting in an
inability to move, wasting away, and possible death.

Cases per Birth38

1 in 10,000

1 in 250
1 in 15,000-40,000

1 in 4000 males
1 in 8000 females

1 in 10,000 males
1 in 3500 males

Chromosomal Abnormalities
A chromosomal abnormality occurs when a child inherits too many or two few
chromosomes. The most common cause of chromosomal abnormalities is the age of the mother.
As the mother ages, the ovum is more likely to suffer abnormalities due to longer term exposure
to environmental factors. Consequently, some gametes do not divide evenly when they are
forming. Therefore, some cells have more than 46 chromosomes. In fact, it is believed that close
to half of all zygotes have an odd number of chromosomes. Most of these zygotes fail to develop
and are spontaneously aborted by the mother’s body.
One of the most common chromosomal abnormalities is on pair 21. Trisomy 21 or Down
syndrome occurs when there are three rather than two 21st chromosomes. A person with Down
syndrome typically exhibits an intellectual disability and possesses certain physical features,such as short fingers and toes, folds of skin over the eyes, and a protruding tongue. There is as
much variation in people with Down syndrome as in most populations, and those differences
need to be recognized and appreciated. Refer to Table 2.2 on the prevalence of Down syndromein our home state of Illinois. Other less common chromosomal abnormalities of live-born infants
occur on chromosome 13 and chromosome 18.
Table 2.2: Illinois Prevalence Rates (2002-2014) for Down Syndrome (Trisomy 21) basedon Maternal Age

Source39

When the abnormality is on 23rd pair the result is a sex-linked chromosomal abnormality. A
person might have XXY, XYY, XXX, XO. Two of the more common sex-linked chromosomal
disorders are Turner syndrome and Klinefelter syndrome. Turner syndrome occurs when partor all of one of the X chromosomes is lost and the resulting zygote has an XO composition. Thisoccurs in 1 of every 2,500 live female births (Carroll, 2007) and affects the individual’s
cognitive functioning and sexual maturation. The external genitalia appear normal, but breasts
and ovaries do not develop fully and the woman does not menstruate. Turner syndrome also
results in short stature and other physical characteristics. Klinefelter syndrome (XXY) results
when an extra X chromosome is present in the cells of a male and occurs in 1 out of 650 live
male births. The Y chromosome stimulates the growth of male genitalia, but the additional X
chromosome inhibits this development. An individual with Klinefelter syndrome typically has
small testes, some breast development, infertility, and low levels of testosterone (National
Institutes of Health, 2019). See Table 2.3 for Chromosomal Disorders descriptions.
Table 2.3 Chromosomal Disorders
Autosomal Chromosome Disorders: The individual inherits too many or two few
chromosomes.
• Down Syndrome/Trisomy 21 is caused by an extra chromosome 21 andincludes a combination of birth defects. Affected individuals have some degreeof intellectual disability, characteristic facial features, often heart defects, andother health problems. The severity varies greatly among affected individuals.
• Trisomy 13 is caused by an extra chromosome 13. Affected individuals havemultiple birth defects and generally die in the first weeks or months of life.
• Trisomy 18 is caused by an extra chromosome 18 and the affected individualalso has multiple birth defects and early death.

Cases per Birth

Sex-Linked Chromosomal Disorders: The disorder occurs on chromosome pair
#23 or the sex chromosomes.
• Turner Syndrome is caused when all or part of one of the X chromosomes islost before or soon after conception due to a random event. The resulting zygote
has an XO composition. Turner Syndrome affects cognitive functioning andsexual maturation in girls. Infertility and a short stature may be noted.
• Klinefelter Syndrome is caused when an extra X chromosome is present in thecells of a male due to a random event. The Y chromosome stimulates the growthof male genitalia, but the additional X chromosome inhibits this development.
The male can have some breast development, infertility, and low levels of
testosterone.

Cases per Birth

1 in 691
1 in 300 births at
age 351 in 7,906
1 in 3,762

1 in 2500 females

1 in 650 males

Genetic Counseling: A service that assists individuals identify, test for, and explain potential
genetic conditions that could adversely affect themselves or their offspring is referred to as
genetic counseling (CDC, 2015b). The common reasons for genetic counseling include:•••

Family history of a genetic condition
Membership in a certain ethnic group with a higher risk of a genetic condition
Information regarding the results of genetic testing, including blood tests, amniocentesis,
or ultra sounds

40•

Learning about the chances of having a baby with a genetic condition if the parents areolder, have had several miscarriages, have offspring with birth defects, experience
infertility, or have a medical condition

Behavioral Genetics
Behavioral Genetics is the scientific study of the interplay between the genetic andenvironmental contributions to behavior. Often referred to as the nature/nurture debate, Gottlieb(1998, 2000, 2002) suggests an analytic framework for this debate that recognizes the interplay
between the environment, behavior, and genetic expression. This bidirectional interplay suggeststhat the environment can affect the expression of genes just as genetic predispositions can impact
a person’s potentials. Additionally, environmental circumstances can trigger symptoms of agenetic disorder. For example, a person who has sickle cell anemia, a recessive gene linked
disorder, can experience a sickle cell crisis under conditions of oxygen deprivation. Someone
predisposed genetically for type-two diabetes can trigger the disease through poor diet and little
exercise.
Research has shown how the environment and genotype interact in several ways. GenotypeEnvironment Correlations refer to the processes by which genetic factors contribute tovariations in the environment (Plomin, DeFries, Knopik, & Niederhiser, 2013). There are three
types of genotype-environment correlations:
Passive genotype-environment
Figure 2.3
correlation occurs when children
passively inherit the genes and theenvironments their family provides.
Certain behavioral characteristics,
such as being athletically inclined,
may run in families. The children
have inherited both the genes thatwould enable success at these
activities, and given theenvironmental encouragement toengage in these actions. Figure 2.3
highlights this correlation bydemonstrating how a family passes
on water skiing skills through both
genetics and environmental
opportunities.
Evocative genotype-environment correlation refers to how the social environment reacts toindividuals based on their inherited characteristics. For example, whether one has a more
outgoing or shy temperament will affect how he or she is treated by others.
Active genotype-environment correlation occurs when individuals seek out environments that
support their genetic tendencies. This is also referred to as niche picking. For example, children
who are musically inclined seek out music instruction and opportunities that facilitate theirnatural musical ability.
41

Conversely, Genotype-Environment Interactions involve genetic susceptibility to theenvironment. Adoption studies provide evidence for genotype-environment interactions. For
example, the Early Growth and Development Study (Leve, Neiderhiser, Scaramella, & Reiss,2010) followed 360 adopted children and their adopted and biological parents in a longitudinal
study. Results have shown that children whose biological parents exhibited psychopathology,
exhibited significantly fewer behavior problems when their adoptive parents used morestructured parenting than unstructured. Additionally, elevated psychopathology in adoptive
parents increased the risk for the children’s development of behavior problems, but only when
the biological parents’ psychopathology was high. Consequently, the results show how
environmental effects on behavior differ based on the genotype, especially stressfulenvironments on genetically at-risk children.
Lastly, Epigenetics studies modifications in DNA that affect gene expression and are passed onwhen the cells divide. Environmental factors, such as nutrition, stress, and teratogens are thought
to change gene expression by switching genes on and off. These gene changes can then be
inherited by daughter cells. This would explain why monozygotic or identical twins may
increasingly differ in gene expression with age. For example, Fraga et al. (2005) found thatwhen examining differences in DNA, a group of monozygotic twins were indistinguishable
during the early years. However, when the twins were older there were significant discrepancies
in their gene expression, most likely due to different experiences. These differences included
susceptibilities to disease and a range of personal characteristics.

Box 2.2 The Human Genome ProjectIn 1990 the Human Genome Project (HGP), an international scientific endeavor, began the taskof sequencing the 3 billion base pairs that make up the human genome. In April of 2003, morethan two years ahead of schedule, scientists gave us the genetic blueprint for building a human.
Since then, using the information from the HGP, researchers have discovered the genes
involved in over 1800 diseases. In 2005 the HGP amassed a large data base called HapMap
that catalogs the genetic variations in 11 global populations. Data on genetic variation can
improve our understanding of differential risk for disease and reactions to medical treatments,
such as drugs. Pharmacogenomic researchers have already developed tests to determine
whether a patient will respond favorably to certain drugs used in the treatment of breast cancer,lung cancer or HIV by using information from HapMap (NIH, 2015).
Future directions for the HGP include identifying the genetic markers for all 50 major forms ofcancer (The Cancer Genome Atlas), continued use of the HapMap for creating more effective
drugs for the treatment of disease, and examining the legal, social and ethical implications ofgenetic knowledge (NIH, 2015).
From the outset, the HGP made ethical issues one of their main concerns. Part of the HGP’s
budget supports research and holds workshops that address these concerns. Who owns thisinformation, and how the availability of genetic information may influence healthcare and its
impact on individuals, their families, and the greater community are just some of the manyquestions being addressed (NIH, 2015).

42

Learning Objectives: Prenatal Development
•
•
•
•
•
•
•

Describe the changes that occur in the three periods of prenatal development
Describe what occurs during prenatal brain development
Define teratogens and describe the factors that influence their effects
List and describe the effects of several common teratogens
Explain maternal and paternal factors that affect the developing fetus
Explain the types of prenatal assessment
Describe both the minor and major complications of pregnancy

Prenatal Development
Now we turn our attention to prenatal development which is divided into three periods: The
germinal period, the embryonic period, and the fetal period. The following is an overview ofsome of the changes that take place during each period.

The Germinal Period
The germinal period (about 14 days inlength) lasts from conception to implantationof the fertilized egg in the lining of theuterus (See Figure 2.5). At ejaculation
millions of sperm are released into thevagina, but only a few reach the egg andtypically only one fertilizes the egg. Once asingle sperm has entered the wall of the egg,
the wall becomes hard and prevents othersperm from entering. After the sperm hasentered the egg, the tail of the sperm breaks
off and the head of the sperm, containing thegenetic information from the father, unites
with the nucleus of the egg. It is typicallyfertilized in the top section of the fallopian
Sperm and Ovum at Conception
tube and continues its journey to the uterus.
As a result, a new cell is formed. This cell,
containing the combined genetic information from both parents, is referred to as a zygote.
Figure 2.4

During this time, the organism begins cell division through mitosis. After five days of mitosis
there are 100 cells, which is now called a blastocyst. The blastocyst consists of both an innerand outer group of cells. The inner group of cells, or embryonic disk will become the embryo,while the outer group of cells, or trophoblast, becomes the support system which nourishes thedeveloping organism. This stage ends when the blastocyst fully implants into the uterine wall
(U.S. National Library of Medicine, 2015a). Approximately 50-75% of blastocysts do not
implant in the uterine wall (Betts et al., 2019).
43

Mitosis is a fragile process and fewer than one half of all zygotes survive beyond the first two
weeks (Hall, 2004). Some of the reasons for this include the egg and sperm do not join properly,
thus their genetic material does not combine, there is too little or damaged genetic material, thezygote does not replicate, or the blastocyst does not implant into the uterine wall. The failure rate
is higher for in vitro conceptions. Figure 2.5 illustrates the journey of the ova from its release toits fertilization, cell duplication, and implantation into the uterine lining.

Figure 2.5 Germinal Period"Human Fertilization" by Ttrue12 Source

The Embryonic Period
Starting the third week the blastocyst has implanted in the uterine wall. Upon implantation thismulti-cellular organism is called an embryo. Now blood vessels grow forming the placenta.
The placenta is a structure connected to the uterus that provides nourishment and oxygen fromthe mother to the developing embryo via the umbilical cord. During this period, cells continue todifferentiate. Growth during prenatal development occurs in two major directions: from head to
tail called cephalocaudal development and from the midline outward referred to as
proximodistal development. This means that those structures nearest the head develop before
those nearest the feet and those structures nearest the torso develop before those away from the44

center of the body (such as hands andfingers). The head develops in the fourthweek and the precursor to the heart begins
to pulse. In the early stages of theembryonic period, gills and a tail areapparent. However, by the end of this stage
they disappear and the organism takes on amore human appearance. Some organisms
fail during the embryonic period, usually
due to gross chromosomal abnormalities. As
in the case of the germinal period, often themother does not yet know that she ispregnant. It is during this stage that the
major structures of the body are taking form
Photo by Lunar Caustic
making the embryonic period the time when
the organism is most vulnerable to the greatest amount of damage if exposed to harmful
substances. Potential mothers are not often aware of the risks they introduce to the developing
embryo during this time. The embryo is approximately 1 inch in length and weighs about 8
grams at the end of eight weeks (Betts et al., 2019). The embryo can move and respond to touchat this time.
Figure 2.6 The Embryo

The Fetal Period
From the ninth week until birth, the organism is referred to as a fetus. During this stage, themajor structures are continuing to develop. By the third month, the fetus has all its body parts
including external genitalia. In the following weeks, the fetus will develop hair, nails, teeth andthe excretory and digestive systems will continue to develop. The fetus is about 3 inches long
and weighs about 28 grams.
During the 4th - 6th months, the eyes become more sensitive to light and hearing develops. The
respiratory system continues to develop, and reflexes such as sucking, swallowing andhiccupping, develop during the 5th month. Cycles of sleep and wakefulness are present at thistime as well. The first chance of survival outside the womb, known as the age of viability isreached at about 24 weeks (Morgan, Goldenberg, & Schulkin, 2008). Many practitioners hesitate
to resuscitate before 24 weeks. The majority of the neurons in the brain have developed by 24
weeks, although they are still rudimentary, and the glial or nurse cells that support neurons
continue to grow. At 24 weeks the fetus can feel pain (Royal College of Obstetricians andGynecologists, 1997).

45

Figure 2.7 Fetus

Between the 7th - 9th months, the fetus is primarily
preparing for birth. It is exercising its muscles and its
lungs begin to expand and contract. The fetus gains
about 5 pounds and 7 inches during this last trimesterof pregnancy, and during the 8th month a layer of fat
develops under the skin. This layer of fat serves as
insulation and helps the baby regulate bodytemperature after birth.
At around 36 weeks the fetus is almost ready for birth.
It weighs about 6 pounds and is about 18.5 inches
long. By week 37 all of the fetus’s organ systems aredeveloped enough that it could survive outside themother’s uterus without many of the risks associatedwith premature birth. The fetus continues to gain
weight and grow in length until approximately 40
weeks. By then the fetus has very little room to movearound and birth becomes imminent. The progression
through the stages is shown in Figure 2.8.

SourceFigure 2.8 Prenatal Development Age Milestones

Source46

Prenatal Brain Development
Prenatal brain development begins in the third gestational week with the differentiation of stem
cells, which are capable of producing all the different cells that make up the brain (Stiles &Jernigan, 2010). The location of these stem cells in the embryo is referred to as the neuralplate. By the end of the third week, two ridges appear along the neural plate first forming theneural groove and then the neural tube. The open region in the center of the neural tube forms
the brain’s ventricles and spinal canal. By the end of the embryonic period, or week eight, theneural tube has further differentiated into the forebrain, midbrain, and hindbrain.
Brain development during the fetal period involves neuron production, migration, anddifferentiation. From the early fetal period until midgestation, most of the 85 billion neurons
have been generated and many have already migrated to their brain positions. Neurogenesis, orthe formation of neurons, is largely completed after five months of gestation. One exception isin the hippocampus, which continues to develop neurons throughout life. Neurons that form theneocortex, or the layer of cells that lie on the surface of the brain, migrate to their location in anorderly way. Neural migration is mostly completed in the cerebral cortex by 24 weeks (Poduri &Volpe, 2018). Once in position, neurons begin to produce dendrites and axons that begin to form
the neural networks responsible for information processing. Regions of the brain that containthe cell bodies are referred to as the gray matter because they look gray in appearance. The
axons that form the neural pathways make up the white matter because they are covered inmyelin, a fatty substance that is white in appearance. Myelin aids in both the insulation andefficiency of neural transmission. Although cell differentiation is complete at birth, the growthof dendrites, axons, and synapses continue for years.

Teratogens
Good prenatal care is essential. The developing child is most at risk for some of the severe
problems during the first three months of development. Unfortunately, this is a time at which
many mothers are unaware that they are pregnant. Today, we know many of the factors that canjeopardize the health of the developing child. The study of factors that contribute to birth defects
is called teratology. Teratogens are environmental factors that can contribute to birth defects,
and include some maternal diseases, pollutants, drugs and alcohol.
Factors influencing prenatal risks: There are several considerations in determining the typeand amount of damage that might result from exposure to a particular teratogen (Berger,
2005). These include:••

The timing of the exposure: Structures in the body are vulnerable to the most severe
damage when they are forming. If a substance is introduced during a particular structure's
critical period (time of development), the damage to that structure may be greater. For
example, the ears and arms reach their critical periods at about 6 weeks after conception.
If a mother exposes the embryo to certain substances during this period, the arms and ears
may be malformed.
The amount of exposure: Some substances are not harmful unless the amounts reach acertain level. The critical level depends in part on the size and metabolism of the mother.
47

•
•

•

The number of teratogens: Fetuses exposed to multiple teratogens typically have more
problems than those exposed to only one.
Genetics: Genetic make-up also plays a role on the impact a particular teratogen might
have on the child. This is suggested by fraternal twins exposed to the same prenatal
environment, but they do not experience the same teratogenic effects. The genetic makeup of the mother can also have an effect; some mothers may be more resistant toteratogenic effects than others.
Being male or female: Males are more likely to experience damage due to teratogens
than are females. It is believed that the Y chromosome, which contains fewer genes thanthe X, may have an impact.

Figure 2.9 illustrates the timing of teratogen exposure and the types of structural defects that canoccur during the prenatal period.

Figure 2.9 Critical Periods of Prenatal Development

SourceAlcohol: One of the most commonly used teratogens is alcohol, and because half of all
pregnancies in the United States are unplanned, it is recommended that women of child-bearing
age take great caution against drinking alcohol when not using birth control or when pregnant(CDC, 2005). Alcohol use during pregnancy is the leading preventable cause of intellectual
disabilities in children in the United States (Maier & West, 2001). Alcohol consumption,
particularly during the second month of prenatal development but at any point during pregnancy,
may lead to neurocognitive and behavioral difficulties that can last a lifetime.
48

In extreme cases, alcohol consumption during pregnancy can lead to fetal death, but also can
result in Fetal Alcohol Spectrum Disorders (FASD), which is an umbrella term for the rangeof effects that can occur due to alcohol consumption during pregnancy (March of Dimes, 2016a).
The most severe form of FASD is Fetal Alcohol Syndrome (FAS). Children with FAS sharecertain physical features such as flattened noses, small eye holes, and small heads (see Figure2.10). Cognitively, these children have poor judgment, poor impulse control, higher rates of
ADHD, learning issues, and lower IQ scores. These developmental problems and delays persist
into adulthood (Streissguth, Barr, Kogan, & Bookstein, 1996) and can include criminal behavior,
psychiatric problems, and unemployment (CDC, 2016a). Based on animal studies, it has been
hypothesized that a mother’s alcohol consumption during pregnancy may predispose her child to
like alcohol (Youngentob, Molina, Spear, & Youngentob, 2007). Binge drinking, or 4 or more
drinks in 2 to 3 hours, during pregnancy increases the chance of having a baby with FASD
(March of Dimes, 2016a).
Figure 2.10 Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorder Facial Features

Facial Feature

Potential Effect of Fetal Alcohol

Head size

Below-average head circumference

Eyes
skin

Smaller than average eye opening,Nosefolds nasal
at cornersof eyesLow
bridge,short nose

Midface

Smaller than average midface size

Lip and philtrum

Thin upper lip, indistinct philtrum

SourceTobacco: Another widely used teratogen is tobacco as more than 7% of pregnant womensmoked in 2016 (Someji & Beltrán-Sánchez, 2019). According to Tong et al. (2013) inconjunction with the Centers for Disease Control and Prevention, data from 27 sites in 2010
representing 52% of live births, showed that among women with recent live births:• About 23% reported smoking in the 3 months prior to pregnancy.
• Almost 11% reported smoking during pregnancy.
• More than half (54.3%) reported that they quit smoking by the last 3 months ofpregnancy.
• Almost 16% reported smoking after delivery.
When comparing the ages of women who smoked:• Women <20, 13.6% smoked during pregnancy• Women 20–24 ,17.6% smoked during pregnancy• Women 25–34 , 8.8% smoked during pregnancy• Women ≥35, 5.7% smoked during pregnancy
49

The findings among racial and ethnic groups indicated that smoking during pregnancy was
highest among American Indians/Alaska Natives (26.0%) and lowest among Asians/PacificIslanders (2.1%).
When a pregnant woman smokes the fetus is exposed to dangerous chemicals including nicotine,
carbon monoxide and tar, which lessen the amount of oxygen available to the fetus. Oxygen isimportant for overall growth and development. Tobacco use during pregnancy has been
associated with low birth weight, ecotopic pregnancy (fertilized egg implants itself outside of
the uterus), placenta previa (placenta lies low in the uterus and covers all or part of the cervix),
placenta abruption (placenta separates prematurely from the uterine wall), preterm delivery,
stillbirth, fetal growth restriction, sudden infant death syndrome (SIDS), birth defects, learning
disabilities, and early puberty in girls (Center for Disease Control, 2015d).
A woman being exposed to secondhand smoke during pregnancy has also been linked to lowbirth weight infants. In addition, exposure to thirdhand smoke, or toxins from tobacco smokethat linger on clothing, furniture, and in locations where smoking has occurred, results in anegative impact on infants’ lung development. Rehan, Sakurai, and Torday (2011) found thatprenatal exposure to thirdhand smoke played a greater role in altered lung functioning in children
than exposure postnatally.
Prescription/Over-the-counter Drugs: About 70% of pregnant women take at least one
prescription drug (March of Dimes, 2016e). A woman should not be taking any prescription drug
during pregnancy unless it was prescribed by a health care provider who knows she is pregnant.
Some prescription drugs can cause birth defects, problems in overall health, and development of
the fetus. Over-the-counter drugs are also a concern during the prenatal period because they may
cause certain health problems. For example, the pain reliever ibuprofen can cause serious bloodflow problems to the fetus during the last three months.

Illicit Drugs: Common illicit drugs include
cocaine, ecstasy and other club drugs,
heroin, marijuana, and prescription drugs
that are abused. It is difficult to completely
determine the effects of a particular illicit
drug on a developing child because mostmothers who use, use more than one
substance and have other unhealthy
behaviors. These include smoking, drinking
alcohol, not eating healthy meals, and being
more likely to get a sexually transmitted
disease. However, several problems seem
clear. The use of cocaine is connected withlow birth weight, stillbirths and spontaneous
Sourceabortion. Heavy marijuana use is associatedwith problems in brain development (Marchof Dimes, 2016c). If a baby’s mother used an addictive drug during pregnancy that baby can
Figure 2.11

50

get addicted to the drug before birth and go through drug withdrawal after birth, also known as
Neonatal abstinence syndrome (March of Dimes, 2015d). Other complications of illicit drug
use include premature birth, smaller than normal head size, birth defects, heart defects, andinfections. Additionally, babies born to mothers who use drugs may have problems later in life,
including learning and behavior difficulties, slower than normal growth, and die from sudden
infant death syndrome. Children of substance abusing parents are also considered at high risk fora range of biological, developmental, academic, and behavioral problems, including developing
substance abuse problems of their own (Conners, et al., 2003).
Box 2.3 Should Women Who Use Drugs During Pregnancy Be Arrested and Jailed?
Women who use drugs or alcohol during pregnancy can cause serious lifelong harmto their child. Some people have advocated mandatory screenings for women who
are pregnant and have a history of drug abuse, and if the women continue using, toarrest, prosecute, and incarcerate them (Figdor & Kaeser, 1998). This policy wastried in Charleston, South Carolina 20 years ago. The policy was called theInteragency Policy on Management of Substance Abuse During Pregnancy and had
disastrous results:
The Interagency Policy applied to patients attending the obstetrics clinic
at MUSC, which primarily serves patients who are indigent or on
Medicaid. It did not apply to private obstetrical patients. The policy
required patient education about the harmful effects of substance abuse
during pregnancy. A statement also warned patients that protection ofunborn and newborn children from the harms of illegal drug abuse could
involve the Charleston police, the Solicitor of the Ninth Judicial Court,
and the Protective Services Division of the Department of Social Services(DSS). (Jos, Marshall, & Perlmutter, 1995, pp. 120–121)
This policy seemed to deter women from seeking prenatal care, deterred themfrom seeking other social services, and was applied solely to low-income women,
resulting in lawsuits. The program was canceled after 5 years, during which 42
women were arrested. A federal agency later determined that the program involved
human experimentation without the approval and oversight of an institutional
review board (IRB).
In July 2014, Tennessee enacted a law that allows women who illegally use anarcotic drug while pregnant to be prosecuted for assault if her infant is harmed or
addicted to the drug (National Public Radio, 2015). According to the National
Public Radio report, a baby is born dependent on a drug every 30 minutes inTennessee, which is a rate three times higher than the national average. However,since the law took effect the number of babies born having drug withdrawal
symptoms has not diminished. Critics contend that the criminal justice systemshould not be involved in what is considered a healthcare problem. What do you
think? Is the issue of mothers using illicit drugs more of a legal or medical
concern?

51

Pollutants: There are more than 83,000 chemicals used in the United States with little
information on the effects of them during pregnancy (March of Dimes, 2016b).
• Lead: An environmental pollutant of significant concern is lead poisoning, which has
been linked to fertility problems, high blood pressure, low birth weight, prematurity,
miscarriage, and slowed neurological development. Grossman and Slutsky (2017) foundthat babies born in Flint Michigan, an area identified with high lead levels in the drinking
water, were premature, weighed less than average, and gained less weight than expected.
• Pesticides: The chemicals in certain pesticides are also potentially damaging and maylead to birth defects, learning problems, low birth weight, miscarriage, and prematurebirth (March of Dimes, 2014).
• Bisphenol A: Prenatal exposure to bisphenol A (BPA), a chemical commonly used inplastics and food and beverage containers, may disrupt the action of certain genes
contributing to certain birth defects (March of Dimes, 2016b).
• Radiation: If a mother is exposed to radiation, it can get into the bloodstream and passthrough the umbilical cord to the baby. Radiation can also build up in body areas close to
the uterus, such as the bladder. Exposure to radiation can slow the baby’s growth, cause
birth defects, affect brain development, cause cancer, and result in a miscarriage.
• Mercury: Mecury, a heavy metal, can cause brain damage and affect the baby’s hearing
and vision. This is why women are cautioned about the amount and type of fish they
consume during pregnancy.
Toxoplasmosis: The tiny parasite, toxoplasma gondii,
Figure 2.12
causes an infection called toxoplasmosis. According
to the March of Dimes (2012d), toxoplasma gondii
infects more than 60 million people in the UnitedStates. A healthy immune system can keep theparasite at bay producing no symptoms, so mostpeople do not know they are infected. As a routine
prenatal screening frequently does not test for thepresence of this parasite, pregnant women may want totalk to their health-care provider about being tested.
Toxoplasmosis can cause premature birth, stillbirth,and can result in birth defects to the eyes and brain.
SourceWhile most babies born with this infection show no
symptoms, ten percent may experience eye infections,enlarged liver and spleen, jaundice, and pneumonia. To avoid being infected, women should
avoid eating undercooked or raw meat and unwashed fruits and vegetables, touching cooking
utensils that touched raw meat or unwashed fruits and vegetables, and touching cat feces, soil orsand. If women think they may have been infected during pregnancy, they should have theirbaby tested.
Sexually Transmitted Diseases: Gonorrhea, syphilis, and chlamydia are sexually transmitted
infections that can be passed to the fetus by an infected mother. Mothers should be tested as earlyas possible to minimize the risk of spreading these infections to their unborn child. Additionally,
the earlier the treatment begins, the better the health outcomes for mother and baby (CDC,
2016d). Sexually transmitted diseases (STDs) can cause premature birth, premature rupture of52the amniotic sac, an ectopic pregnancy, birth defects, miscarriage, and still births (March ofDimes, 2013). Most babies become infected with STDS while passing through the birth canalduring delivery, but some STDs can cross the placenta and infect the developing fetus.
Human Immunodeficiency Virus (HIV): One of the most potentially devastating teratogens isHIV. HIV and Acquired Immune Deficiency Syndrome (AIDS) are leading causes of illness anddeath in the United States (Health Resources and Services Administration, 2015). One of themain ways children under age 13 become infected with HIV is via mother-to-child transmissionof the virus prenatally, during labor, or by breastfeeding (CDC, 2016c). There are somemeasures that can be taken to lower the chance the child will contract the disease. HIV positive
mothers who take antiviral medications during their pregnancy greatly reduce the chance of
passing the virus to the fetus. The risk of transmission is less than 2 percent; in contrast, it is 25
percent if the mother does not take antiretroviral drugs (CDC, 2016b). However, the long-termrisks of prenatal exposure to the medication are not known. It is recommended that women withHIV deliver the child by c-section, and that after birth they avoid breast feeding.
German measles (or rubella): Rubella, also called German measles, is an infection that causes
mild flu-like symptoms and a rash on the skin. However, only about half of children infectedhave these symptoms, while others have no symptoms (March of Dimes, 2012a). Rubella has
been associated with a number of birth defects. If the mother contracts the disease during the first
three months of pregnancy, damage can occur in the eyes, ears, heart or brain of the unborn
child. Deafness is almost certain if the mother has German measles before the 11th week ofprenatal development and can also cause brain damage. Women in the United States are muchless likely to be afflicted with rubella, because most women received childhood vaccinations that
protect her from the disease.

Maternal Factors
Mothers over 35: Most women over 35 who become pregnant are in good health and have
healthy pregnancies. However, according to the March of Dimes (2016d), women over age 35
are more likely to have an increased risk of:
•
•
•
•
•
•
•
•
•

Fertility problems
High blood pressure
Diabetes
Miscarriages
Placenta Previa
Cesarean section
Premature birth
Stillbirth
A baby with a genetic disorder or other birth defects

Because a woman is born with all her eggs, environmental teratogens can affect the quality of theeggs as women get older. Also, a woman’s reproductive system ages which can adversely affectthe pregnancy. Some women over 35 choose special prenatal screening tests, such as a maternal
blood screening, to determine if there are any health risks for the baby.
53

Although there are medical concerns associatedwith having a child later in life, there are also
many positive consequences to being a moremature parent. Older parents are more confident,
less stressed, and typically married providing
family stability. Their children perform better onmath and reading tests, and they are less prone to
injuries or emotional troubles (Albert, 2013).
Women who choose to wait are often welleducated and lead healthy lives. According toGregory (2007), older women are more stable,
demonstrate a stronger family focus, possess
Sourcegreater self-confidence, and have more money.
Having a child later in one’s career equals overall higher wages. In fact, for every year a woman
delays motherhood, she makes 9% more in lifetime earnings. Lastly, women who delay having
children actually live longer. Sun et al. (2015) found that women who had their last child after
the age of 33 doubled their chances of living to age 95 or older than women who had their lastchild before their 30th birthday. A woman’s natural ability to have a child at a later age indicatesthat her reproductive system is aging slowly, and consequently so is the rest of her body.
Figure 2.13

Teenage Pregnancy: A teenage mother is at a greater risk for having pregnancy complications
including anemia, and high blood pressure. These risks are even greater for those under age 15.
Infants born to teenage mothers have a higher risk for being premature and having low
birthweight or other serious health problems. Premature and low birthweight babies may haveorgans that are not fully developed which can result in breathing problems, bleeding in the brain,vision loss, and serious intestinal problems. Very low birthweight babies (less than 3 1/3
pounds) are more than 100 times as likely to die, and moderately low birthweight babies(between 3 1/3 and 5 ½ pounds) are more than 5 times as likely to die in their first year, thannormal weight babies (March of Dimes, 2012c). Again, the risk is highest for babies of mothers
under age 15. Reasons for these health issues include that teenagers are the least likely of all age
groups to get early and regular prenatal care. Additionally, they may engage in negative
behaviors including eating unhealthy food, smoking, drinking alcohol, and taking drugs.
Additional concerns for teenagers are repeat births. About 25% of teen mothers under age 18
have a second baby within 2 years after the first baby’s birth.
Gestational Diabetes: Seven percent of pregnant women develop gestational diabetes (Marchof Dimes, 2015b). Diabetes is a condition where the body has too much glucose in the
bloodstream. Most pregnant women have their glucose level tested at 24 to 28 weeks ofpregnancy. Gestational diabetes usually goes away after the mother gives birth, but it might
indicate a risk for developing diabetes later in life. If untreated, gestational diabetes can causepremature birth, stillbirth, the baby having breathing problems at birth, jaundice, or low blood
sugar. Babies born to mothers with gestational diabetes can also be considerably heavier (morethan 9 pounds) making the labor and birth process more difficult. For expectant mothers,
untreated gestational diabetes can cause preeclampsia (high blood pressure and signs that theliver and kidneys may not be working properly) discussed later in the chapter. Risk factors forgestational diabetes include age (being over age 25), being overweight or gaining too much54

weight during pregnancy, family history of diabetes, having had gestational diabetes with a priorpregnancy, and race and ethnicity (African-American, Native American, Hispanic, Asian, orPacific Islander have a higher risk). Eating healthy and maintaining a healthy weight during
pregnancy can reduce the chance of gestational diabetes. Women who already have diabetes andbecome pregnant need to attend all their prenatal care visits, and follow the same advice as thosefor women with gestational diabetes as the risk of preeclampsia, premature birth, birth defects,
and stillbirth are the same.
High Blood Pressure (Hypertension): Hypertension is a condition in which the pressure
against the wall of the arteries becomes too high. There are two types of high blood pressureduring pregnancy, gestational and chronic. Gestational hypertension only occurs during
pregnancy and goes away after birth. Chronic high blood pressure refers to women who alreadyhad hypertension before the pregnancy or to those who developed it during pregnancy and it
continued after birth. According to the March of Dimes (2015c) about 8 in every 100 pregnant
women have high blood pressure. High blood pressure during pregnancy can cause prematurebirth and low birth weight (under five and a half pounds), placental abruption, and mothers candevelop preeclampsia.
Rh Disease: Rh is a protein found in the blood. Most people are Rh positive, meaning they havethis protein. Some people are Rh negative, meaning this protein is absent. Mothers who are Rh
negative are at risk of having a baby with a form of anemia called Rh disease (March of Dimes,2009). A father who is Rh-positive and mother who is Rh-negative can conceive a baby who is
Rh-positive. Some of the fetus’s blood cells may get into the mother’s bloodstream and her
immune system is unable to recognize the Rh factor. The immune system starts to produce
antibodies to fight off what it thinks is a foreign invader. Once her body produces immunity, theantibodies can cross the placenta and start to destroy the red blood cells of the developing fetus.
As this process takes time, often the first Rh positive baby is not harmed, but as the mother’sbody will continue to produce antibodies to the Rh factor across her lifetime, subsequentpregnancies can pose greater risk for an Rh positive baby. In the newborn, Rh disease can leadto jaundice, anemia, heart failure, brain damage and death.
Weight Gain during Pregnancy: According to March of Dimes (2016f) during pregnancy most
women need only an additional 300 calories per day to aid in the growth of the fetus. Gaining
too little or too much weight during pregnancy can be harmful. Women who gain too little may
Table 2.4 Weight Gain during Pregnancy
If you were a healthy
weight before pregnancy

If you were
underweight before
pregnancy• gain 25-35lbs• gain 28-40lbs• 1-4½lbs in the first• 1-4½lbs in the firsttrimester and 1lb pertrimester and a
week in the second
little more than 1lb
and third trimesters
per week
thereafter
Mothers of twins need to gain more in each category.

If you were overweight
before pregnancy

If you were obese before
pregnancy

•
•

•
•

Source55

gain 12-25 lbs
1-4½lbs in the firsttrimester and a little
more than ½lb per
week in the second
and third trimesters

11-20lbs
1-4½lbs in the firsttrimester and lessthan ½lb per week inthe second and third
trimesters

have a baby who is low-birth weight, while those who gain too much are likely to have apremature or large baby. There is also a greater risk for the mother developing preeclampsia anddiabetes, which can cause further problems during the pregnancy. Table 2.4 shows the healthy
weight gain during pregnancy. Putting on the weight slowly is best. Mothers who are concerned
about their weight gain should talk to their health care provider.
Stress: Feeling stressed is common during pregnancy, but high levels of stress can cause
complications including having a premature baby or a low-birthweight baby. Babies born earlyor too small are at an increased risk for health problems. Stress-related hormones may cause
these complications by affecting a woman’s immune systems resulting in an infection andpremature birth. Additionally, some women deal with stress by smoking, drinking alcohol, or
taking drugs, which can lead to problems in the pregnancy. High levels of stress in pregnancy
have also been correlated with problems in the baby’s brain development and immune system
functioning, as well as childhood problems such as trouble paying attention and being afraid(March of Dimes, 2012b).
Depression: Depression is a significant medical condition in which feelings of sadness,
worthlessness, guilt, and fatigue interfere with one’s daily functioning. Depression can occur
before, during, or after pregnancy, and 1 in 7 women is treated for depression sometime between
the year before pregnancy and year after pregnancy (March of Dimes, 2015a). Women who
have experienced depression previously are more likely to have depression during pregnancy.
Consequences of depression include the baby being born premature, having a low birthweight,
being more irritable, less active, less attentive, and having fewer facial expressions. About 13%
of pregnant women take an antidepressant during pregnancy. It is important that women taking
antidepressants during pregnancy discuss the medication with a health care provider as somemedications can cause harm to the developing organism. In fact, birth defects happen about 2 to
3 times more often in women who are prescribed certain Selective Serotonin Reuptake Inhibitors(SSRIs) for their depression.
Paternal Impact: The age of fathers at the time ofconception is also an important factor in health risks
for children. According to Nippoldt (2015) offspringof men over 40 face an increased risk of miscarriages,
autism, birth defects, achondroplasia (bone growth
disorder) and schizophrenia. These increased healthrisks are thought to be due to accumulated
chromosomal aberrations and mutations during thematuration of sperm cells in older men (Bray,
Gunnell, & Smith, 2006). However, like older women,
the overall risks are small.

Figure 2.14 Hazardous Occupations

SourceIn addition, men are more likely than women to workin occupations where hazardous chemicals, many of which have teratogenic effects or may cause
genetic mutations, are used (Cordier, 2008). These may include petrochemicals, lead, andpesticides that can cause abnormal sperm and lead to miscarriages or diseases. Men are also
more likely to be a source of secondhand smoke for their developing offspring. As noted earlier,smoking by either the mother or around the mother can hinder prenatal development.
56

Prenatal Assessment
A number of assessments are suggested to women as part of their routine prenatal care to findconditions that may increase the risk of complications for the mother and fetus (Eisenberg,
Murkoff, & Hathaway, 1996). These can include blood and urine analyses and screening anddiagnostic tests for birth defects.
Ultrasound is one of the main screening tests
Figure 2.15 Preparing for an Ultrasounddone in combination with blood tests. The
ultrasound is a test in which sound waves areused to examine the fetus. There are two general
types. Transvaginal ultrasounds are used inearly pregnancy, while transabdominal
ultrasounds are more common and used after 10
weeks of pregnancy (typically, 16 to 20 weeks).
Ultrasounds are used to check the fetus fordefects or problems. It can also find out the ageof the fetus, location of the placenta, fetal
position, movement, breathing and heart rate,
amount of amniotic fluid, and number of fetuses.
Most women have at least one ultra soundduring pregnancy, but if problems are noted,
Sourceadditional ultrasounds may be recommended.
When diagnosis of a birth defectis necessary, ultrasounds help
guide the more invasive
diagnostic tests of amniocentesis
and chorionic villus sampling.
Amniocentesis is a procedure inwhich a needle is used towithdraw a small amount ofamniotic fluid and cells from thesac surrounding the fetus andlater tested (see Figure 2.16).

Figure 2.16 Amniocentesis

Chorionic Villus Sampling is aprocedure in which a small
sample of cells is taken from theplacenta and tested. Bothamniocentesis and chorionicvillus sampling have a risk of
miscarriage, and consequently
they are not done routinely.
Source57

Box 2.4 Infertility and Reproductive Technology
Infertility: Infertility affects about 10 to 15 percent of couples in the United States (Mayo
Clinic, 2015). For men, the most common cause is a lack of, or low sperm production, and for
women, it is the failure to ovulate. Another common cause for women is pelvic inflammatory
disease (PID), which is an infection of a woman’s reproductive organs (Carroll, 2007). It is
often a complication caused by and STD, such as chlamydia and gonorrhea, although otherinfections that are not sexually transmitted can also cause PID.
Fertility treatment: The majority of infertility cases are treated using fertility drugs toincrease ovulation, or with surgical procedures to repair the reproductive organs or remove
scar tissue from the reproductive tract. In in vitro fertilization (IVF) eggs are removed fromthe female and are fertilized outside the woman’s body. The fertilized egg is then reinserted in
the woman’s uterus. The success rate varies depending on the type of egg implanted, such aswhether the egg was recently removed from the woman, used after being frozen, or donatedfrom another woman. Success is also highly dependent on the age of the mother (See Figure2.17).
Figure 2.17 Percentage of Pregnancies, Live Births, and Single-Infant Live Births
from IVF from Fresh Non-Donor Eggs

SourceHigher success rates, but less common procedures include gamete intra-fallopian tube
transfer (GIFT) which involves implanting both sperm and ova into the fallopian tube andfertilization is allowed to occur naturally (Carroll, 2007). Zygote intra-fallopian tube
transfer (ZIFT) is another procedure in which sperm and ova are fertilized outside of thewoman’s body and the fertilized egg is then implanted in the fallopian tube. This allows thezygote to travel down the fallopian tube and embed in the lining of the uterus naturally. This
procedure also has a higher success rate than IVF.
58

Complications of Pregnancy
Minor complications: There are a number of common side effects of pregnancy. Not everyone
experiences all of these, nor to the same degree. And although they are considered "minor" this is
not to say that these problems are not potentially very uncomfortable. These side effects include
nausea (particularly during the first 3-4 months of pregnancy as a result of higher levels of
estrogen in the system), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia,
constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on theabdomen).
Major Complications: The following are some serious complications of pregnancy which canpose health risks to mother and child and that often require hospitalization.
Ectopic Pregnancy occurs when the zygote becomes attached to the fallopian tube before
reaching the uterus. About 1 in 50 pregnancies in the United States are tubal pregnancies andthis number has been increasing because of the higher rates of pelvic inflammatory disease andChlamydia (Carroll, 2007). Abdominal pain, vaginal bleeding, nausea and fainting are symptoms
of ectopic pregnancy.
Preeclampsia, also known as Toxemia, is characterized by a sharp rise in blood pressure, aleakage of protein into the urine as a result of kidney problems, and swelling of the hands, feet,and face during the third trimester of pregnancy. Preeclampsia is the most common complicationof pregnancy. It is estimated to affect 5% to 10% of all pregnancies globally and accounts for
40% to 60% of maternal deaths in developing countries (National Institute of Child Health andHuman Development, 2013). Rates are lower in the United States and preeclampsia affects
about 3% to 5% of pregnant women.
Preeclampsia occurs most frequently in first pregnancies, and it is more common in women who
are obese, have diabetes, or are carrying twins. When preeclampsia causes seizures, thecondition is known as eclampsia, which is the second leading cause of maternal death in the
United States. Preeclampsia is also a leading cause of fetal complications, which include lowbirth weight, premature birth, and stillbirth. Treatment is typically bed rest and sometimes
medication. If this treatment is ineffective, labor may be induced.
Maternal Mortality: Acording to the CDC (2019), about 700 American women die fromcomplications related to pregnancy each year, and this number is rising. Further, 60% of thosedeaths could have been prevented. Bleeding, infections, and heart-related problems are the maincauses. Possible contributing factors include the high caesarean section rate and obesity.
Compared to other developed nations, this number is considered high. Approximately 1000
women die in childbirth around the world each day (World Health Organization, 2010). Rates
are highest in Subsaharan Africa and South Asia, although there has been a substantial decreasein these rates. The campaign to make childbirth safe for everyone has led to the development ofclinics accessible to those living in more isolated areas and training more midwives to assist inchildbirth.

59

Spontaneous abortion is experienced in an estimated 20-40 percent of undiagnosed pregnancies
and in another 10 percent of diagnosed pregnancies. Usually the body aborts due tochromosomal abnormalities, and this typically happens before the 12th week ofpregnancy. Cramping and bleeding result and normal periods return after several months. Some
women are more likely to have repeated miscarriages due to chromosomal, amniotic, or
hormonal problems, but miscarriage can also be a result of defective sperm (Carrell et. al.,2003).

Learning Objectives: Birth
•
•
•
•
•

Describe how expectant parents prepare for childbirth
Describe the stages of vaginal delivery
Explain why a caesarean or induced birth is necessary
Describe the two common procedures to assess the condition of the newborn
Describe problems newborns experience before, during, and after birth

Preparation for Childbirth
Prepared childbirth refers to being not only in good physical condition to help provide a healthy
environment for the baby to develop, but also helping individuals to prepare to accept their newroles as parents. Additionally, parents can receive information and training that will assist themfor delivery and life with the baby. The more future parents can learn about childbirth and thenewborn, the better prepared they will be for the adjustment they must make to a new life.
One of the most common methods for preparing for childbirth is The Lamaze Method. Thismethod originated in Russia and was brought to the United States in the 1950s by Fernand
Lamaze. The emphasis of this method is on teaching the woman to be in control in the process ofdelivery. It includes learning muscle relaxation, breathing though contractions, having a focal
point (usually a picture to look at) during contractions and having a support person who goes
through the training process with the mother and serves as a coach during delivery (Eisenberg,
Murkoff, & Hathaway, 1996).
Choosing Where to Have the Baby and Who Will Deliver: The vast majority of births occur
in a hospital setting. However, one percent of women choose to deliver at home (Martin,
Hamilton, Osterman, Curtin, & Mathews, 2015). Women who are at low risk for birthcomplications can successfully deliver at home. More than half (67%) of home deliveries are bycertified nurse midwifes. Midwives are trained and licensed to assist in delivery and are far lessexpensive than the cost of a hospital delivery. However, because of the potential for acomplication during the birth process, most medical professionals recommend that delivery takeplace in a hospital. Despite the concerns, in the United States women who have had previous
children, who are over 25, and who are white are more likely to have out-of-hospital births(MacDorman, Menacker, & Declercq, 2010). In addition to home births, one-third of out-of-

60hospital births occur in freestanding clinics, birthing centers, in physician’s offices, or otherlocations.

Stages of Birth for Vaginal Delivery
Figure 2.17 Stages of Birth for a Vaginal Delivery

SourceThe First Stage of labor begins withuterine contractions that may initiallylast about 30 seconds and be spaced
15 to 20 minutes apart. These increasein duration and frequency to more thana minute in length and about 3 to 4
minutes apart. Typically, doctors
advise that they be called whencontractions are coming about every 5
minutes. Some women experience
false labor or Braxton-Hicks
contractions, especially with the firstchild. These may come and go. They
tend to diminish when the motherbegins walking around. Real labor
pains tend to increase withwalking. Labor may also be signaled
by a bloody discharge being expelledfrom the cervix. In one out of 8
pregnancies, the amniotic sac or waterin which the fetus is suspended may
break before labor begins. In suchcases, the physician may induce laborwith the use of medication if it does
not begin on its own in order to reduce
the risk of infection. Normally thissac does not rupture until the laterstages of labor.

The first stage of labor is typically the longest. During this stage the cervix or opening to theuterus dilates to 10 centimeters or just under 4 inches (See Figure 2.17). This may take around12-16 hours for first children or about 6-9 hours for women who have previously given birth.
Labor may also begin with a discharge of blood or amniotic fluid.
The Second Stage involves the passage of the baby through the birth canal. This stage takes
about 10-40 minutes. Contractions usually come about every 2-3 minutes. The mother pushes
and relaxes as directed by the medical staff. Normally the head is delivered first. The baby isthen rotated so that one shoulder can come through and then the other shoulder. The rest of thebaby quickly passes through. At this stage, an episiotomy or incision made in the tissue
between the vaginal opening and anus, may be performed to avoid tearing the tissue of the back61

of the vaginal opening (Mayo Clinic, 2016). The baby's mouth and nose are suctioned out. The
umbilical cord is clamped and cut.
The Third Stage is relatively painless. During this stage, the placenta or afterbirth is delivered.
This is typically within 20 minutes after delivery. If an episiotomy was performed it is stitched
up during this stage.
More than 50% of women giving birth at hospitals use an epidural anesthesia during
delivery (American Pregnancy Association, 2015). An epidural block is a regional
analgesic that can be used during labor and alleviates most pain in the lower body withoutslowing labor. The epidural block can be used throughout labor and has little to no effect on thebaby. Medication is injected into a small space outside the spinal cord in the lower back. It takes
10 to 20 minutes for the medication to take effect. An epidural block with stronger medications,such as anesthetics, can be used shortly before a C-section or if a vaginal birth requires the use offorceps or vacuum extraction.
A Cesarean section (C-section) is surgery to deliver the baby by being removed through themother's abdomen. In the United States, about one in three women have their babies delivered
this way (Martin et al., 2015). Most C-sections are done when problems occur during delivery
unexpectedly. These can include:• Health problems in the mother• Signs of distress in the baby
• Not enough room for the baby to go through the vagina• The position of the baby, such as a breech presentation where the head is not in the
downward position
C-sections are also more common among women carrying more than one baby. Although thesurgery is relatively safe for mother and baby, it is considered major surgery and carries healthrisks. Additionally, it also takes longer to recover from a C-section than from vaginal birth. After
healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems
with an attempted vaginal birth later. However, more than half of women who have a C-section
can have a vaginal birth later.
Induced birth: Sometimes a baby’s arrival may need to be induced or delivered before labor
begins. Inducing labor may be recommended for a variety of reasons when there is concern forthe health of the mother or baby. For example:• The mother is approaching two weeks beyond her due date and labor has not started
naturally• The mother’s water has broken, but contractions have not begun• There is an infection in the mother’s uterus• The baby has stopped growing at the expected pace
• There is not enough amniotic fluid surrounding the baby
• The placenta peels away, either partially or completely, from the inner wall of the uterus
before delivery• The mother has a medical condition that might put her or her baby at risk, such as highblood pressure or diabetes (Mayo Clinic, 2014)62

Assessing the Neonate
The Apgar assessment is conducted one
minute and five minutes after birth.
This is a very quick way to assess the
newborn's overall condition. Fivemeasures are assessed: Heart rate,
respiration, muscle tone (assessed bytouching the baby's palm), reflex
response (the Babinski reflex is tested),and color. A score of 0 to 2 is given oneach feature examined. An Apgar of 5or less is cause for concern. The second
Apgar should indicate improvementwith a higher score (see Figure 2.18).
Another way to assess the condition of
the newborn is the Neonatal Behavioral
Assessment Scale (NBAS). The baby's
motor development, muscle tone, andstress response are assessed. This tool
has been used around the world tofurther assess the newborn, especiallythose with low Apgar scores, and to
make comparisons of infants indifferent cultures (Brazelton & Nugent,1995).

Figure 2.18 APGAR Scores

Source:Problems of the Newborn
Anoxia: Anoxia is a temporary lack ofoxygen to the brain. Difficulty during delivery
may lead to anoxia which can result in brain
damage or in severe cases, death. Babies who
suffer both low birth weight and anoxia are
more likely to suffer learning disabilities laterin life as well.

Figure 2.19 Newborn in Neonatal Unit

Low Birth weight: We have been discussing
a number of teratogens associated with low
birth weight such as alcohol, tobacco, etc. A
child is considered low birth weight if he or
she weighs less than 5 pounds 8 ounces (2500
grams). About 8.2 percent of babies born in
Sourcethe United States are of low birth weight(Center for Disease Control, 2015a). A low birth weight baby has difficulty maintaining
63

adequate body temperature because it lacks the fat that would otherwise provide insulation. Sucha baby is also at more risk for infection, and 67 percent of these babies are also preterm which
can make them more at risk for respiratory infection. Very low birth weight babies (2 pounds orless) have an increased risk of developing cerebral palsy.
Additionally, Pettersson, Larsson, D’Onofrio, Almqvist, and Lichtenstein (2019) analyzed fetal
growth and found that reduced birth weight was correlated with a small, but significant increase
in several psychiatric disorders in adulthood. These included: attention-deficit/hyperactivity
disorder, autism, depression, and obsessive-compulsive disorder. Pettersson et al. theorized that
“reduced fetal growth compromises brain development during a critical period, which in turnslightly increases the risk not only for neurodevelopmental disorders but also for virtually all
mental health conditions” (p. 540). An insufficient supply of oxygen and nutrients for thedeveloping fetus are proposed as factors that increased the risk for neurodevelopmental
disorders.
Preterm: A newborn might also have a low birth weight if it is born at less than 37 weeks
gestation, which qualifies it as a preterm baby (CDC, 2015c). Early birth can be triggered byanything that disrupts the mother's system. For instance, vaginal infections can lead to prematurebirth because such infection causes the mother to release anti-inflammatory chemicals which, inturn, can trigger contractions. Smoking and the use of other teratogens can lead to preterm
birth. The earlier a woman quits smoking, the lower the chance that the baby will be born
preterm (Someji & Beltrán-Sánchez, 2019). A significant consequence of preterm birth includes
respiratory distress syndrome, which is characterized by weak and irregular breathing (UnitedStates National Library of Medicine, 2015b).
Figure 2.20 Saybie

Saybie (name given to her by the hospital), a baby
girl born in San Diego, California is now considered
the world’s smallest baby ever to survive (Chiu,
2019). She was born in December 2018 at 23 weeks
and 3 days weighing only 8.6 ounces (same size as
an apple). After five months in the hospital, Saybie
went home in May 2019 weighing 5 pounds.

Small-for-Date Infants: Infants that have birthweights that are below expectation based on their
Sourcegestational age are referred to as small-for-date.
These infants may be full term or preterm, but stillweigh less than 90 % of all babies of the same gestational age. This is a very serious situation
for newborns as their growth was adversely affected. Regev et al. (2003) found that small-fordate infants died at rates more than four times higher than other infants. Remember that manycauses of low birth weight and preterm births are preventable with proper prenatal care.

64

Postpartum Maternal Concerns
After pregnancy many women experience emotional changes. The “baby blues” are often
mentioned as a common occurrence in new mothers. The baby blues are feelings of sadness
that occur 3 to 5 days after having a baby, and typically disappear usually within 10 days of thebirth. New mothers may have trouble sleeping, be moody, and feel let-down from the birthing
experience. However, postpartum depression is not the same as the baby blues. According to the
Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5), (American
Psychiatric Association, 2013), peripartum onset of depression, also known as postpartum
depression, is a type of depression that occurs during pregnancy or in the 4 weeks following
pregnancy. Approximately 1 out of 8 women experience postpartum depression and symptoms
can include feelings of sadness, sleeplessness, and difficulty bonding with the newborn.
Changing hormone levels are thought to be a factor in the occurrence of peripartum depression,
however, risk factors include having depression previously, a family history of depression, being
younger than 20, experiencing stress, and substance use. Peripartum-onset mood disorders, bothdepression and mania, can present with or without psychotic features. Hallucinations anddelusions are associated with postpartum psychotic episodes and have included commandhallucinations to kill the infant or delusions that the infant is possessed. Psychotic features occur
in approximately 1 in 500 to 1 in 1,000 deliveries, and the risk is higher for women with priorpostpartum mood episodes (American Psychiatric Association, 2013).
Postpartum anxiety is also a concern for many new mothers. According to Bregel (2017) because
oxytocin, a bonding hormone, rises during preganancy, brain areas related to empathy andanxiety are heightened. Consequently, the new mother is “hard-wired” to respond to and fend
for her baby, which can lead to toxic levels of stress and anxiety. These can manifest as
heightened alertness, intrusive and horrifying thoughts of something terrible happening to theinfant, and physiological arousal. Just as for peripartum depression and postpartum psychosis, a
new mother experiencing postpartum anxiety should seek assistance from a health care provider.

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United States National Library of Medicine. (2014). In vitro fertilization. Retrieved fromhttps://medlineplus.gov/ency/article/007279.htm
United States National Library of Medicine. (2015a). Fetal development. Retrieved fromhttps://www.nlm.nih.gov/medlineplus/ency/article/002398.htm
United States National Library of Medicine. (2015b). Neonatal respiratory distress syndrome. Retrieved fromhttps://medlineplus.gov/ency/article/001563.htm

69World Health Organization. (2010, September 15). Maternal deaths worldwide drop by a third, WHO. Retrieved fromhttp://www.who.int/mediacentre/news/releases/ 2010/maternal_mortality_20100915/en/index.html

Youngentob, S. L., Molina, J. C., Spear, N. E., & Youngentob, L. M. (2007). The effect of gestational ethanol exposure on
voluntary ethanol intake in early postnatal and adult rats. Behavioral Neuroscience, 121(6), 1306-1315.
doi.org/10.1037/0735-7044.121.6.1306

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Chapter 3: Infancy and Toddlerhood
We will now turn our attention to the physical, cognitive, and socioemotional development
during the first two years. Researchers have given this part of the lifespan more attention thanany other period, perhaps because changes during this time are so dramatic and so noticeable.
We have also assumed that what happens during these years provides a foundation for one’s life
to come. However, it has been argued that the significance of development during these years
has been overstated (Bruer, 1999).

Learning Objectives: Physical Development in Infancy and Toddlerhood
•
•
•
•
•
•
•
•
•

Summarize overall physical growth during infancy
Describe the growth of the brain during infancy
Explain infant sleep
Identify newborn reflexes
Compare gross and fine motor skills
Contrast development of the senses in newborns
Describe the habituation procedure
Explain the merits of breastfeeding and when to introduce more solid foods
Discuss the nutritional concerns of marasmus and kwashiorkor

Overall Physical Growth: The average newborn in the United States weighs about 7.5 pounds(between 5 and 10 pounds) and is about 20 inches in length. For the first few days of life, infants
typically lose about 5 percent of their body weight as they eliminate waste and get used tofeeding. This often goes unnoticed by most parents but can be cause for concern for those whohave a smaller infant. This weight loss is temporary, however, and is followed by a rapid periodof growth. By the time an infant is 4 months old, it usually doubles in weight and by one year has
tripled the birth weight. By age 2, the weight has quadrupled, so we can expect that a 2-year-old
should weigh between 20 and 40 pounds. The average length at one year is about 29.5 inches andat two years it is around 34.4 inches (Bloem, 2007).
Body Proportions: Another dramatic physical changethat takes place in the first several years of life is thechange in body proportions. The head initially makes
up about 50 percent of our entire length when we aredeveloping in the womb. At birth, the head makes up
about 25 percent of our length, and by age 25 itcomprises about 20 percent our length.

Figure 3.1 Changes in Proportions

Source71

The Brain in the First Two Years
Some of the most dramatic physical change that occurs during this period is in the brain. We areborn with most of the brain cells that we will ever have; that is, about 85 billion neurons
whose function is to store and transmit information (Huttenlocher & Dabholkar, 1997). Whilemost of the brain’s neurons are present at birth, they are not fully mature. During the next
several years dendrites, or branching extensions that collect information from other neurons,
will undergo a period of exuberance. Because of this proliferation of dendrites, by age two asingle neuron might have thousands of dendrites. Synaptogenesis, or the formation ofconnections between neurons, continues from the prenatal period forming thousands of newconnections during infancy and toddlerhood. This period of rapid neural growth is referred toas synaptic blooming.
Figure 3.2 Components of the Neuron

SourceThe blooming period of neural growth is then followed by a period of synaptic pruning, where
neural connections are reduced thereby making those that are used much stronger. It isthought that pruning causes the brain to function more efficiently, allowing for mastery of
more complex skills (Kolb & Whishaw, 2011). Experience will shape which of theseconnections are maintained and which of these are lost. Ultimately, about 40 percent of theseconnections will be lost (Webb, Monk, and Nelson, 2001). Blooming occurs during the first few
years of life, and pruning continues through childhood and into adolescence in various areas of
the brain.

72

Another major change occurring in the central nervous system is the development of myelin, acoating of fatty tissues around the axon of the neuron (Carlson, 2014). Myelin helps insulate thenerve cell and speed the rate of transmission of impulses from one cell to another. This enhances
the building of neural pathways and improves coordination and control of movement and thoughtprocesses. The development of myelin continues into adolescence but is most dramatic during
the first several years of life.
The infant brain grows very fast. At birth the brain is about 250 grams (half a pound) and by one
year it is already 750 grams (Eliot, 1999). Comparing to adult size, the newborn brain isapproximately 33% of adult size at birth, and in just 90 days, it is already at 55% of adult size
(Holland et al., 2014). Most of the neural activity is occurring in the cortex or the thin outer
covering of the brain involved in voluntary activity and thinking. The cortex is divided into twohemispheres, and each hemisphere is divided into four lobes, each separated by folds known asfissures. If we look at the cortex starting at the front of the brain and moving over the top (seeFigure 3.3), we see first the frontal lobe (behind the forehead), which is responsible primarily
for thinking, planning, memory, and judgment. Following the frontal lobe is the parietal lobe,
which extends from the middle to the back of the skull and which is responsible primarily forprocessing information about touch. Next is the occipital lobe, at the very back of the skull,
which processes visual information. Finally, in front of the occipital lobe, between the ears, is the
temporal lobe, which is responsible for hearing and language (Jarrett, 2015).
Figure 3.3 The Two Hemispheres

The brain is divided into two hemispheres (left and right), each of which has four lobes (temporal, frontal,
occipital, and parietal). Furthermore, there are specific cortical areas that control different processes.
SourceAlthough the brain grows rapidly during infancy, specific brain regions do not mature at thesame rate. Primary motor areas develop earlier than primary sensory areas, and the prefrontal
cortex, that is located behind the forehead, is the least developed (Giedd, 2015). As the prefrontal
73

cortex matures, the child is increasingly able to regulate or control emotions, to plan activities,
strategize, and have better judgment. This is not fully accomplished in infancy and toddlerhood,
but continues throughout childhood, adolescence and into adulthood.
Lateralization is the process in which different functions become localized primarily on one sideof the brain. For example, in most adults the left hemisphere is more active than the right during
language production, while the reverse pattern is observed during tasks involving visuospatial
abilities (Springer & Deutsch, 1993). This process develops over time, however, structural
asymmetries between the hemispheres have been reported even in fetuses (Chi, Dooling, &Gilles, 1997; Kasprian et al., 2011) and infants (Dubois et al., 2009).
Lastly, neuroplasticity refers to the brain’s ability to change, both physically and chemically, toenhance its adaptability to environmental change and compensate for injury. The control ofsome specific bodily functions, such as movement, vision, and hearing, is performed in specified
areas of the cortex, and if these areas are damaged, the individual will likely lose the ability toperform the corresponding function. The brain’s neurons have a remarkable capacity toreorganize and extend themselves to carry out these particular functions in response to the needsof the organism, and to repair any damage. As a result, the brain constantly creates new neuralcommunication routes and rewires existing ones. Both environmental experiences, such as
stimulation and events within a person’s body, such as hormones and genes, affect the brain’s
plasticity. So too does age. Adult brains demonstrate neuroplasticity, but they are influenced
less extensively than those of infants (Kolb & Fantie, 1989; Kolb & Whishaw, 2011).

Infant Sleep
Figure 3.4
A newborn typically sleeps approximately 16.5
hours per 24-hour period. This is usually polyphasic
sleep in that the infant is accumulating the 16.5
hours over several sleep periods throughout the day(Salkind, 2005). The infant is averaging 15 hours
per 24-hour period by one month, and 14 hours by 6months. By the time children turn two, they are
averaging closer to 10 hours per 24 hours.
Additionally, the average newborn will spend close
to 50% of the sleep time in the Rapid Eye Movement (REM) phase, which decreases to 25% to
30% in childhood.
Sudden Unexpected Infant Deaths (SUID): Each year in the United States, there are about
3,500 Sudden Unexpected Infant Deaths (SUID). These deaths occur among infants less than
one-year-old and have no immediately obvious cause (CDC, 2019). The three commonly
reported types of SUID are:•Sudden Infant Death Syndrome (SIDS): SIDS is identified when the death of ahealthy infant occurs suddenly and unexpectedly, and medical and forensic investigation
findings (including an autopsy) are inconclusive. SIDS is the leading cause of death in
74

•

•

infants 1 to 12 months old, and approximately 1,400 infants died of SIDS in 2017 (CDC,2019). Because SIDS is diagnosed when no other cause of death can be determined,
possible causes of SIDS are regularly researched. One leading hypothesis suggests that
infants who die from SIDS have abnormalities in the area of the brainstem responsible forregulating breathing (Weekes-Shackelford & Shackelford, 2005).
Unknown Cause: The sudden death of an infant less than one year of age that cannot be
explained because a thorough investigation was not conducted, and cause of death could
not be determined. In 2017, 1300 infants died from unknown causes (CDC, 2019).
Accidental Suffocation and Strangulation in Bed: Reasons for accidental suffocation
include: Suffocation by soft bedding, another person rolling on top of or against the
infant while sleeping, an infant being wedged between two objects such as a mattress andwall, and strangulation such as when an infant’s head and neck become caught between
crib railings. In 2017, 900 infants died from accidental suffocation and strangulation.
The 2017 percentages of infants who died based on each of the three types are listed in
Figure 3.5.

Figure 3.5

As can be seen in the next graph (Figure 3.6), the combined SUID death rate declined
considerably following the release of the American Academy of Pediatrics safe sleep
recommendations in 1992, which advocated that infants be placed for sleep on their backs(nonprone position). These recommendations were followed by a major Back to Sleep
Campaign in 1994. However, accidental suffocation and strangulation in bed mortality rates
remained unchanged until the late 1990s. In 1998 death rates from accidental suffocation andstrangulation in bed actually started to increase, and they reached the highest rate at 24.6 deaths
per 100,000 live births in 2017 (CDC, 2019).
75

Figure 3.6

Should infants be sharing the bed with parents?
Colvin, Collie-Akers, Schunn and Moon (2014) analyzed
a total of 8207 deaths from 24 states during 2004–2012
that were contained in the National Center for the Review
and Prevention of Child Deaths Case Reporting System, adatabase of death reports from state child death review
teams. The results indicated that younger victims (0-3months) were more likely to die by bed-sharing andsleeping in an adult bed/on a person. A higher percentageof older victims (4 months to 364 days) rolled into objects
Sourcein the sleep environment and changed position fromside/back to prone. Carpenter et al. (2013) compared infants who died of SIDS with a matched
control and found that infants younger than three months old who slept in bed with a parent
were five times more likely to die of SIDS compared to babies who slept separately from theparents but were still in the same room. They concluded that bed sharing, even when the parents
do not smoke or take alcohol or drugs, increases the risk of SIDS. However, when combinedwith parental smoking and maternal alcohol consumption and/or drug use, risks associated with
bed sharing greatly increased.
Figure 3.7

The two studies discussed above were based on American statistics. What about the rest of theworld? Co-sleeping occurs in many cultures, primarily because of a more collectivist
perspective that encourages a close parent-child bond and interdependent relationship (Morelli,
Rogoff, Oppenheim, & Goldsmith, 1992). In countries where co-sleeping is common, however,76parents and infants typically sleep on floor mats and other hard surfaces which minimize thesuffocation that can occur with bedding (Nelson, Schiefenhoevel, & Haimerl, 2000).

From Reflexes to Voluntary Movements
Table 3.1 Some Common Infant Reflexes
Reflex
Sucking

Description
Suck on anything that touches thelips

Rooting

Turning the head when the cheekis touched

Grasp

Fingers automatically grip
anything that touches the palm of
the handBabinski

The toes will fan out and curlwhen the sole of the foot isstroked from heel to toe

Image

SourceSourceSourceSourceMoro

A sudden noise or loss of support
to the head and neck will cause
infants to spread out their arms
and legs then quickly contract thelimbs inward

Tonic Neck

When lying on the back with thehead to one side infants will
extend the arm and leg on thatside while flexing the limbs on
the opposite side (looks like afencer pose).
Legs move in stepping likemotion when feet touch a smoothsurface

SourceStepping

SourceSource77

Newborns are equipped with a number of reflexes (see Table 3.1) which are involuntary
movements in response to stimulation. Some of the more common reflexes, such as the sucking
reflex and rooting reflex, are important to feeding. The grasping and stepping reflexes are
eventually replaced by more voluntary behaviors. Within the first few months of life thesereflexes disappear, while other reflexes, such as the eye-blink, swallowing, sneezing, gagging,
and withdrawal reflex stay with us as they continue to serve important functions. Reflexes offer
pediatricians insight into the maturation and health of the nervous system. Reflexes that persist
longer than they should can impede normal development (Berne, 2006). In preterm infants andthose with neurological impairments, some of these reflexes may be absent at birth. Once
present, they may persist longer than in a neurologically healthy infant (El-Dib, Massaro, Glass& Aly, 2012).

Motor Development
Motor development occurs in an orderly sequence as infants move from reflexive reactions(e.g., sucking and rooting) to more advanced motor functioning. As mentioned during theprenatal section, development occurs according to the Cephalocaudal (from head to tail) andProximodistal (from the midline outward) principles. For instance, babies first learn to holdtheir heads up, then to sit with assistance, then to sit unassisted, followed later by crawling,pulling up, cruising or walking while holding on to something, and then unassisted walking(Eisenberg, Murkoff, & Hathaway, 1989). As motor skills develop, there are certain
developmental milestones that young children should achieve. For each milestone there is anaverage age, as well as a range of ages in which the milestone should be reached. An example ofa developmental milestone is a baby holding up its head. Babies on average are able to hold up
their head at 6 weeks old, and 90% of babies achieve this between 3 weeks and 4 months old.
On average, most babies sit alone at 7 months old. Sitting involves both coordination andmuscle strength, and 90% of babies achieve this milestone between 5 and 9 months old. If thechild is displaying delays on several milestones, that is reason for concern, and the parent or
caregiver should discuss this with the child’s pediatrician. Developmental delays can be
identified and addressed through early intervention.
Figure 3.8

SourceMotor Skills refer to our ability to move our bodies and manipulate
objects. Fine motor skills focus on the muscles in our fingers, toes,and eyes, and enable coordination of small actions (e.g., grasping a
toy, writing with a pencil, and using a spoon). Newborns cannot
grasp objects voluntarily but do wave their arms toward objects ofinterest. At about 4 months of age, the infant is able to reach for an
object, first with both arms and within a few weeks, with only one
arm. At this age grasping an object involves the use of the fingers andpalm, but no thumbs. This is known as the Palmer Grasp. The useof the thumb comes at about 9 months of age when the infant is able
to grasp an object using the forefinger and thumb. Now the infant
uses a Pincer Grasp, and this ability greatly enhances the ability tocontrol and manipulate an object and infants take great delight in this
newfound ability. They may spend hours picking up small objects

78

from the floor and placing them in containers. By 9 months, an infant can also watch a moving
object, reach for it as it approaches, and grab it.
Gross motor skills focus on large muscle groups that control our head, torso, arms and legs
and involve larger movements (e.g., balancing, running, and jumping). These skills begin todevelop first. Examples include moving to bring the chin up when lying on the stomach, moving
the chest up, and rocking back and forth on hands and knees. But it also includes exploring an
object with one’s feet as many babies do as early as 8 weeks of age if seated in a carrier or otherdevice that frees the hips. This may be easier than reaching for an object with the hands, which
requires much more practice (Berk, 2007). Sometimes an infant will try to move toward an
object while crawling and surprisingly move backward because of the greater amount of strength
in the arms than in the legs.

Sensory Capacities
Throughout much of history, the newborn was considered a passive, disorganized being who
possessed minimal abilities. William James, an early psychologist, had described the newborn’sworld as “a blooming, buzzing confusion,” (Shaffer, 1985). However, current researchtechniques have demonstrated just how developed the newborn is with especially organizedsensory and perceptual abilities.
Vision: The womb is a dark environment void of visual stimulation. Consequently, vision is oneof the most poorly developed senses at birth, and time is needed to build those neural pathways
between the eyes and the brain (American Optometric Association [AOA], 2019). Newborns
typically cannot see further than 8 to 10 inches away from their faces (AOA, 2019). An 8-week
old’s vision is 20/300. This means an object 20 feet away from an infant has the same clarity as
an object 300 feet away from an adult with normal vision. By 3-months visual acuity has
sharpened to 20/200, which would allow them the see the letter E at the top of a standard eye
chart (Hamer, 2016). As a result, the world looks blurry to young infants (Johnson & deHaan,
2015).
Why is visual acuity so poor in the infant? The fovea, which is the central field of vision in theretina and allows us to see sharp detail, is not fully developed at birth, and does not start toreach adult levels of development until 15 months (Li & Ding, 2017). Even by 45 months someof the sensory neurons (cones) of the fovea are still not fully grown. Can babies see color?
Young infants can perceive color, but the colors need to be very pure forms of basic colors, suchas vivid red or green rather than weaker pastel shades. Most studies report that babies can see thefull spectrum of colors by five months of age (AOA, 2019).
Newborn infants prefer and orient to face-like stimuli more than they do other patterned stimuli(Farroni et al., 2005). They also prefer images of faces that are upright and not scrambled (Chien,2011). Infants also quickly learn to distinguish the face of their mother from faces of other
women (Bartrip, Morton, & De Schonen, 2001). When viewing a person’s face, one-month olds
fixate on the outer edges of the face rather than the eyes, nose, or mouth, and two-month olds
gaze more at the inner features, especially the eyes (Hainline, 1978).

79

Researchers have examined the development of attention and tracking in the visual system andhave found the following for young infants:• One-month-olds have difficulty disengaging their attention and can spend several minutes
fixedly gazing at a stimulus (Johnson & deHaan, 2015).
• Aslin (1981) found that when tracking an object visually, the eye movements ofnewborns and one-month olds are not smooth but saccadic, that is step-like jerky
movements. Aslin also found their eye movements lag behind the object’s motion. Thismeans young infants do not anticipate the trajectory of the object. By two months of age,
their eye movements are becoming smoother, but they still lag behind the motion of theobject and will not achieve this until about three to four months of age (Johnson &deHaan, 2015).
• Newborns also orient more to the visual field toward the side of the head, than to thevisual field on either side of the nose (Lewis, Maurer, & Milewski, 1979). By two to
three months, stimuli in both fields are now equally attended to (Johnson & deHaan,
2015).
Binocular vision, which requires input from both eyes, is evident around the third month andcontinues to develop during the first six months (Atkinson & Braddick, 2003). By six months
infants can perceive depth perception in pictures as well (Sen, Yonas, & Knill, 2001). Infants
who have experience crawling and exploring will pay greater attention to visual cues of depth
and modify their actions accordingly (Berk, 2007).
Hearing: The infant’s sense of hearing is very keen at
Figure 3.9
birth, and the ability to hear is evidenced as soon as
the seventh month of prenatal development. Newborns
prefer their mother’s voices over another female when
speaking the same material (DeCasper & Fifer, 1980).
Additionally, they will register in utero specificinformation heard from their mother’s voice.
DeCasper and Spence (1986) tested 16 infants(average age of 55.8 hours) whose mothers had
previously read to them prenatally. The mothers read
Sourceseveral passages to their fetuses, including the first 28
paragraphs of the Cat in the Hat, beginning when they
were 7 months pregnant. The fetuses had been exposed to the stories an average of 67 times or
3.5 hours. When the experimental infants were tested, the target stories (previously heard) weremore reinforcing than the novel story as measured by their rate of sucking. However, for control
infants, the target stories were not more reinforcing than the novel story indicating that theexperimental infants had heard them before.
An infant can distinguish between very similar sounds as early as one month after birth and candistinguish between a familiar and non-familiar voice even earlier. Infants are especiallysensitive to the frequencies of sounds in human speech and prefer the exaggeration of infantdirected speech, which will be discussed later. Additionally, infants are innately ready to respondto the sounds of any language, but between six and nine months they show preference forlistening to their native language (Jusczyk, Cutler, & Redanz, 1993). Their ability to distinguish80the sounds that are not in the language around them diminishes rapidly (Cheour-Luhtanen, et al.,1995).
Touch and Pain: Immediately after birth, a newborn is sensitive to touch and temperature, andis also highly sensitive to pain, responding with crying and cardiovascular responses (Balaban &Reisenauer, 2013). Newborns who are circumcised, which is the surgical removal of theforeskin of the penis, without anesthesia experience pain as demonstrated by increased bloodpressure, increased heart rate, decreased oxygen in the blood, and a surge of stress hormones(United States National Library of Medicine, 2016). Research has demonstrated that infants who
were circumcised without anesthesia experienced more pain and fear during routine childhood
vaccines. Fortunately, today many local pain killers are currently used during circumcision.
Figure 3.10

SourceTaste and Smell: Studies of taste and smell
demonstrate that babies respond with different
facial expressions, suggesting that certain
preferences are innate. Newborns can distinguishbetween sour, bitter, sweet, and salty flavors andshow a preference for sweet flavors. Newborns
also prefer the smell of their mothers. An infant
only 6 days old is significantly more likely toturn toward its own mother’s breast pad than tothe breast pad of another baby’s mother (Porter,
Makin, Davis, & Christensen, 1992), and within
hours of birth an infant also shows a preference
for the face of its own mother (Bushnell, 2001;
Bushnell, Sai, & Mullin, 1989).

Intermodality: Infants seem to be born with the ability to perceive the world in an intermodal
way; that is, through stimulation from more than one sensory modality. For example, infants who
sucked on a pacifier with either a smooth or textured surface preferred to look at a corresponding(smooth or textured) visual model of the pacifier. By 4 months, infants can match lip movementswith speech sounds and can match other audiovisual events. Sensory processes are certainly
affected by the infant's developing motor abilities (Hyvärinen, Walthes, Jacob, Nottingham
Chapin, & Leonhardt, 2014). Reaching, crawling, and other actions allow the infant to see,touch, and organize his or her experiences in new ways.
How are Infants Tested: Habituation procedures, that is measuring decreased
responsiveness to a stimulus after repeated presentations, have increasingly been used toevaluate infants to study the development of perceptual and memory skills. Phelps (2005)
describes a habituation procedure used when measuring the rate of the sucking reflex.
Researchers first measure the initial baseline rate of sucking to a pacifier equipped withtransducers that measure muscle contractions. Next, an auditory stimulus is presented, such as ahuman voice uttering a speech sound such as “da.” The rate of sucking will typically increase
with the new sound, but then decrease to baseline levels as “da” is repeatedly presented, showing
habituation. If the sound “ma” was then presented, the rate of sucking would again increase,demonstrating that the infant can discriminate between these two stimuli.
81

Additionally, the speed or efficiency with which infants show habituation has been shown topredict outcomes in behaviors, such as language acquisition and verbal and nonverbal
intelligence. Infants who show difficulty during habituation, or habituate at slower than normal
rates, have been found to be at an increased risk for significant developmental delays. Infants
with Down syndrome, teratogen-exposed infants, malnourished infants, and premature infants
have all been studied. Researchers have found that at the age of 16 months, high-risk infants
show rates of habituation comparable to newborn infants (Phelps, 2005).

Nutrition
Figure 3.11
Breast milk is considered the ideal diet for newborns.
Colostrum, the first breast milk produced during pregnancy
and just after birth has been described as “liquid gold” (UnitedStates Department of Health and Human Services (USDHHS),
2011). It is very rich in nutrients and antibodies. Breast milkchanges by the third to fifth day after birth, becoming muchthinner, but containing just the right amount of fat, sugar,
water, and proteins to support overall physical andneurological development. For most babies, breast milk is alsoeasier to digest than formula. Formula fed infants experience
more diarrhea and upset stomachs. The absence of antibodies
Sourcein formula often results in a higher rate of ear infections andrespiratory infections. Children who are breastfed have lower
rates of childhood leukemia, asthma, obesity, type 1 and 2 diabetes, and a lower risk of SIDS.
The USDHHS recommends that mothers breast feed their infants until at least 6 months of age,and that breast milk be used in the diet throughout the first year or two.
Several recent studies have reported that it is not just babies that benefit from breastfeeding.
Breastfeeding stimulates contractions in the uterus to help it regain its normal size, and women
who breastfeed are more likely to space their pregnancies further apart. Mothers who breastfeed
are at lower risk of developing breast cancer (Islami et al., 2015), especially among higher risk
racial and ethnic groups (Islami et al., 2015; Redondo et al., 2012). Women who breastfeed havelower rates of ovarian cancer (Titus-Ernstoff, Rees, Terry, & Cramer, 2010), reduced risk fordeveloping Type 2 diabetes (Schwarz et al., 2010; Gunderson, et al., 2015), and rheumatoid
arthritis (Karlson, Mandl, Hankinson, & Grodstein, 2004). In most studies these benefits havebeen seen in women who breastfeed longer than 6 months.
Current rates of breastfeeding indicate that 83.2% of mothers have breastfed their infants at somepoint (CDC, 2018). However, most mothers who breastfeed in the United States stopbreastfeeding exclusively at about 6-8 weeks, often in order to return to work outside the home
(USDHHS, 2011). Mothers can certainly continue to provide breast milk to their babies byexpressing and freezing the milk to be bottle fed at a later time or by being available to theirinfants at feeding time. However, some mothers find that after the initial encouragement theyreceive in the hospital to breastfeed, the outside world is less supportive of such efforts. Someworkplaces support breastfeeding mothers by providing flexible schedules and welcoming
infants, but many do not. In addition, not all women may be able to breastfeed. Women with82

HIV are routinely discouraged from breastfeeding as the infection may pass to the infant.
Similarly, women who are taking certain medications or undergoing radiation treatment may be
told not to breastfeed (USDHHS, 2011).
Besides the nutritional benefits of breastfeeding, breast
milk is free. Anyone who has priced formula recently
can appreciate this added incentive tobreastfeeding. Prices for a year’s worth of formula andfeeding supplies can cost between $1,500 and $3000 per
year (Los Angles County Department of Public Health,2019). In addition to the formula, costs include bottles,
nipples, sterilizers, and other supplies.
One early argument given to promote the practice ofbreastfeeding was that it promoted bonding and healthyemotional development for infants. However, this does
not seem to be the case. Breastfed and bottle-fed infants
adjust equally well emotionally (Ferguson &Woodward, 1999). This is good news for mothers who
may be unable to breastfeed for a variety of reasons andfor fathers who might feel left out.

Figure 3.12

SourceWhen to Introduce More Solid Foods: Solid foods should not be introduced until the infant isready. According to The Clemson University Cooperative Extension (2014), some things to lookfor include that the infant:
•
•
•
•
•
•

can sit up without needing support
can hold its head up without wobblingshows interest in foods others are eating
is still hungry after being breastfed or formula fed
is able to move foods from the front to the back of the mouth
is able to turn away when they have had enough

For many infants who are 4 to 6 months of age, breast milk or formula can be supplemented withmore solid foods. The first semi-solid foods that are introduced are iron-fortified infant cereals
mixed with breast milk or formula. Typically rice, oatmeal, and barley cereals are offered as anumber of infants are sensitive to more wheat-based cereals. Finger foods such as toast squares,
cooked vegetable strips, or peeled soft fruit can be introduced by 10-12 months. New foods
should be introduced one at a time, and the new food should be fed for a few days in a row toallow the baby time to adjust to the new food. This also allows parents time to assess if the childhas a food allergy. Foods that have multiple ingredients should be avoided until parents haveassessed how the child responds to each ingredient separately. Foods that are sticky (such as
peanut butter or taffy), cut into large chunks (such as cheese and harder meats), and firm andround (such as hard candies, grapes, or cherry tomatoes) should be avoided as they are a choking
hazard. Honey and corn syrup should be avoided as these often contain botulism spores. In

83children under 12 months, this can lead to death (Clemson University Cooperative Extension,2014).

Global Considerations and Malnutrition
Children in developing countries and countries experiencing the harsh conditions of war are at
risk for two major types of malnutrition, also referred to as wasting. Infantile marasmus refers
to starvation due to a lack of calories and protein. Children who do not receive adequate
nutrition lose fat and muscle until their bodies can no longer function. Babies who are breastfed
are much less at risk of malnutrition than those who are bottle-fed.
After weaning, children who have diets
deficient in protein may experiencekwashiorkor known as the “disease of thedisplaced child” often occurring after anotherchild has been born and taken overbreastfeeding. This results in a loss of appetiteand swelling of the abdomen as the body
begins to break down the vital organs as asource of protein.

Figure 3.13 Kwashiorkor

Around the world the rates of wasting havebeen dropping. However, according to theWorld Health Organization and UNICEF, in2014 there were 50 million children under theage of five that experienced these forms of(Photo Courtesy Centers for Disease Control and Prevention)
wasting, and 16 million were severely wasted(UNICEF, 2015). This works out to 1 childin every 13 children in the world suffers from some form of wasting, and the majority of thesechildren live in Asia (34.3 million) and Africa (13.9 million). Wasting can occur as a result of
severe food shortages, regional diets that lack certain proteins and vitamins, or infectious
diseases that inhibit appetite (Latham, 1997).
The consequences of wasting depend on how late in the progression of the disease parents andguardians seek medical treatment for their children. Unfortunately, in some cultures families do
not seek treatment early, and as a result by the time a child is hospitalized the child often dies
within the first three days after admission (Latham, 1997). Several studies have reported longterm cognitive effects of early malnutrition (Galler & Ramsey, 1989; Galler, Ramsey, Salt &Archer, 1987; Richardson, 1980), even when home environments were controlled (Galler,
Ramsey, Morley, Archer & Salt, 1990). Lower IQ scores (Galler et al., 1987), poor attention(Galler & Ramsey, 1989), and behavioral issues in the classroom (Galler et al., 1990) have beenreported in children with a history of serious malnutrition in the first few years of life.

84

Learning Objectives: Cognitive Development in Infancy and Toddlerhood
•
•
•
•
•

Compare the Piagetian concepts of schema, assimilation, and accommodation
List and describe the six substages of sensorimotor intelligence
Describe the characteristics of infant memory
Describe components and developmental progression of language
Identify and compare the theories of language

Piaget and the Sensorimotor Stage
Schema, Assimilation and Accommodation: Piaget believed that we are continuously trying tomaintain cognitive equilibrium, or a balance, in what we see and what we know (Piaget, 1954).
Children have much more of a challenge in maintaining this balance because they are constantly
being confronted with new situations, new words, new objects, etc. All this new informationneeds to be organized, and a framework for organizing information is referred to as a schema.
Children develop schemata through the processes of assimilation and accommodation.

When faced withsomething new, a child
may demonstrateassimilation, which is
fitting the new
information into an
existing schema, such as
calling all animals withfour legs "doggies"
because he or she knows
the word doggie. Insteadof assimilating theinformation, the child
may demonstrateaccommodation, which is
expanding the frameworkof knowledge toaccommodate the newsituation and thus
learning a new word to
more accurately name theSourceanimal. For example,
recognizing that a horse isdifferent than a zebra means the child has accommodated, and now the child has both a zebra
schema and a horse schema. Even as adults we continue to try and "make sense" of new
Figure 3.14 Assimilation and Accommodation85

situations by determining whether they fit into our old way of thinking (assimilation) or whether
we need to modify our thoughts (accommodation).
According to the Piagetian perspective, infants learn about the world primarily through theirsenses and motor abilities (Harris, 2005). These basic motor and sensory abilities provide thefoundation for the cognitive skills that will emerge during the subsequent stages of cognitive
development. The first stage of cognitive development is referred to as the sensorimotor stage
and it occurs through six substages. Table 3.2 identifies the ages typically associated with each
substage.
Table 3.2 Infant Ages for the Six Substages of the Sensorimotor Stage
Substage 1
Substage 2
Substage 3
Substage 4
Substage 5
Substage 6

Reflexes (0–1 month)
Primary Circular Reactions (1–4 months)
Secondary Circular Reactions (4–8 months)
Coordination of Secondary Circular Reactions (8–12 months)
Tertiary Circular Reactions (12–18 months)
Beginning of Representational Thought (18–24 months)

Source:Substage 1: Reflexes. Newborns learn about their world through the use of their reflexes, suchas when sucking, reaching, and grasping. Eventually the use of these reflexes becomes moredeliberate and purposeful.
Substage 2: Primary Circular Reactions. During these next 3 months, the infant begins toactively involve his or her own body in some form of repeated activity. An infant may
accidentally engage in a behavior and find it interesting such as making a vocalization. This
interest motivates trying to do it again and helps the infant learn a new behavior that originallyoccurred by chance. The behavior is identified as circular because of the repetition, and as
primary because it centers on the infant's own body.
Substage 3: Secondary Circular Reactions. The infant
begins to interact with objects in the environment. At
first the infant interacts with objects (e.g., a crib mobile)
accidentally, but then these contacts with the objects aredeliberate and become a repeated activity. The infant
becomes more and more actively engaged in the outside
world and takes delight in being able to make things
happen. Repeated motion brings particular interest as, forexample, the infant is able to bang two lids together fromthe cupboard when seated on the kitchen floor.
Substage 4: Coordination of Secondary Circular
Reactions. The infant combines these basic reflexes andsimple behaviors and uses planning and coordination toachieve a specific goal. Now the infant can engage in86

Figure 3.15

Sourcebehaviors that others perform and anticipate upcoming events. Perhaps because of continued
maturation of the prefrontal cortex, the infant become capable of having a thought and carryingout a planned, goal-directed activity. For example, an infant sees a toy car under the kitchen
table and then crawls, reaches, and grabs the toy. The infant is coordinating both internal andexternal activities to achieve a planned goal.
Substage 5: Tertiary Circular Reactions. The toddler is considered a “little scientist” andbegins exploring the world in a trial-and-error manner, using both motor skills and planningabilities. For example, the child might throw her ball down the stairs to see what happens. The
toddler’s active engagement in experimentation helps them learn about their world.

Figure 3.16

Substage 6: Beginning of Representational
Thought. The sensorimotor period ends with theappearance of symbolic or representational
thought. The toddler now has a basic
understanding that objects can be used as
symbols. Additionally, the child is able to solve
problems using mental strategies, to remember
something heard days before and repeat it, and toengage in pretend play. This initial movementfrom a “hands-on” approach to knowing about
the world to the more mental world of substage
six marks the transition to preoperational thought.

SourceDevelopment of Object Permanence: A critical milestone during the sensorimotor period isthe development of object permanence. Object permanence is the understanding that even if
something is out of sight, it still exists (Bogartz, Shinskey, & Schilling, 2000). According to
Piaget, young infants do not remember an object after it has been removed from sight. Piaget
studied infants’ reactions when a toy was first shown to them and then hidden under a blanket.
Infants who had already developed object permanence would reach for the hidden toy,
indicating that they knew it still existed, whereas infants who had not developed object
permanence would appear confused. Piaget emphasizes this construct because it was an
objective way for children to demonstrate that they can mentally represent their world.
Children have typically acquired this milestone by 8 months. Once toddlers have masteredSourcepermanence, they enjoy games like hide and seek, and they realize that when someone
objectleaves the room they will come back. Toddlers also point to pictures in books and look in
appropriate places when you ask them to find objects.
In Piaget’s view, around the same time children develop object permanence, they also begin
to exhibit stranger anxiety, which is a fear of unfamiliar people (Crain, 2005). Babies may
demonstrate this by crying and turning away from a stranger, by clinging to a caregiver, or byattempting to reach their arms toward familiar faces, such as parents. Stranger anxiety results
when a child is unable to assimilate the stranger into an existing schema; therefore, she cannot
predict what her experience with that stranger will be like, which results in a fear response.
87

Critique of Piaget: Piaget thought that children’s ability to understand objects, such aslearning that a rattle makes a noise when shaken, was a cognitive skill that develops slowly
as a child matures and interacts with the environment. Today, developmental psychologists
think Piaget was incorrect. Researchers have found that even very young children understandobjects and how they work long before they have experience with those objects (Baillargeon,
1987; Baillargeon, Li, Gertner, & Wu, 2011). For example, Piaget believed that infants did not
fully master object permanence until substage 5 of the sensorimotor period (Thomas, 1979).
However, infants seem to be able to recognize that objects have permanence at much younger
ages. Diamond (1985) found that infants show earlier knowledge if the waiting period is shorter.
At age 6 months, they retrieved the hidden object if their wait for retrieving the object is nolonger than 2 seconds, and at 7 months if the wait is no longer than 4 seconds.
Others have found that children as young as 3 months old have demonstrated knowledge ofthe properties of objects that they had only viewed and did not have prior experience with. In
one study, 3-month-old infants were shown a truck rolling down a track and behind a screen.
The box, which appeared solid but was actually hollow, was placed next to the track. The
truck rolled past the box as would be expected. Then the box was placed on the track to block
the path of the truck. When the truck was rolled down the track this time, it continued
unimpeded. The infants spent significantly more time looking at this impossible event (Figure3.17). Baillargeon (1987) concluded that they knew solid objects cannot pass through each other.
Baillargeon’s findings suggest that very young children have an understanding of objects andhow they work, which Piaget (1954) would have said is beyond their cognitive abilities dueto their limited experiences in the world.

Figure 3.17

In Baillargeon’s (1987) study, infants observed a truck (a) roll down an unobstructed track, (b) roll down anunobstructed track with an obstruction (box) beside it, and (c) roll down and pass through what appeared to be
an obstruction.

Infant Memory
Memory requires a certain degree of brain maturation, so it should not be surprising that infant
memory is rather fleeting and fragile. As a result, older children and adults experience infantileamnesia, the inability to recall memories from the first few years of life. Several hypotheses havebeen proposed for this amnesia. From the biological perspective, it has been suggested that
infantile amnesia is due to the immaturity of the infant brain, especially those areas that are88crucial to the formation of autobiographical memory, such as the hippocampus. From thecognitive perspective, it has been suggested that the lack of linguistic skills of babies andtoddlers limit their ability to mentally represent events; thereby, reducing their ability to encode
memory. Moreover, even if infants do form such early memories, older children and adults may
not be able to access them because they may be employing very different, more linguistically
based, retrieval cues than infants used when forming the memory. Finally, social theorists argue
that episodic memories of personal experiences may hinge on an understanding of “self”,
something that is clearly lacking in infants and young toddlers.
However, in a series of clever studies Carolyn Rovee-Collier and her colleagues havedemonstrated that infants can remember events from their life, even if these memories are shortlived. Three-month-old infants were taught that they could make a mobile hung over their crib
shake by kicking their legs. The infants were placed in their crib, on their backs. A ribbon wastied to one foot and the other end to a mobile. At first infants made random movements, but thencame to realize that by kicking they could make the mobile shake. After two 9-minute sessions
with the mobile, the mobile was removed. One week later the mobile was reintroduced to one
group of infants and most of the babies immediately started kicking their legs, indicating thatthey remembered their prior experience with the mobile. A second group of infants was shown
the mobile two weeks later, and the babies made only random movements. The memory had
faded (Rovee-Collier, 1987; Giles & Rovee-Collier, 2011). Rovee-Collier and Hayne (1987)
found that 3-month-olds could remember the mobile after two weeks if they were shown themobile and watched it move, even though they were not tied to it. This reminder helped mostinfants to remember the connection between their kicking and the movement of the mobile. Like
many researchers of infant memory, Rovee-Collier (1990) found infant memory to be very
context dependent. In other words, the sessions with the mobile and the later retrieval sessions
had to be conducted under very similar circumstances or else the babies would not remember
their prior experiences with the mobile. For instance, if the first mobile had had yellow blocks
with blue letters, but at the later retrieval session the blocks were blue with yellow letters, thebabies would not kick.
Infants older than 6 months of age can retain information for longer periods of time; they alsoneed less reminding to retrieve information in memory. Studies of deferred imitation, that is,
the imitation of actions after a time delay, can occur as early as six-months of age (Campanella& Rovee-Collier, 2005), but only if infants are allowed to practice the behavior they were shown.
By 12 months of age, infants no longer need to practice the behavior in order to retain thememory for four weeks (Klein & Meltzoff, 1999).

Language
Our vast intelligence also allows us to have language, a system of communication that uses
symbols in a regular way to create meaning. Language gives us the ability to communicate ourintelligence to others by talking, reading, and writing. Although other species have at least someability to communicate, none of them have language. There are many components of languagethat will now be reviewed.

89

Components of Language
Phoneme: A phoneme is the smallest unit of sound that makes ameaningful difference in a language. The word “bit” has threephonemes. In spoken languages, phonemes are produced by the
positions and movements of the vocal tract, including our lips,
teeth, tongue, vocal cords, and throat, whereas in sign languages
phonemes are defined by the shapes and movement of the hands.

Figure 3.18

There are hundreds of unique phonemes that can be made byhuman speakers, but most languages only use a small subset ofthe possibilities. English contains about 45 phonemes, whereas
other languages have as few as 15 and others more than 60. The
Hawaiian language contains less phonemes as it includes only 5
vowels (a, e, i, o, and u) and 7 consonants (h, k, l, m, n, p, and w).
Infants are born able to detect all phonemes, but they lose theirability to do so as they get older; by 10 months of age a child’s ability to recognize phonemes
becomes very similar to that of the adult speakers of the native language. Phonemes that were
initially differentiated come to be treated as equivalent (Werker & Tees, 2002).
Morpheme: Whereas phonemes are the smallest units of sound in language, a morpheme is astring of one or more phonemes that makes up the smallest units of meaning in a language.
Some morphemes are prefixes and suffixes used to modify other words. For example, the syllable“re-” as in “rewrite” or “repay” means “to do again,” and the suffix “-est” as in “happiest” or“coolest” means “to the maximum.”
Semantics: Semantics refers to the set of rules we use to obtain meaning from morphemes. For
example, adding “ed” to the end of a verb makes it past tense.
Syntax: Syntax is the set of rules of a language by which we construct sentences. Each language
has a different syntax. The syntax of the English language requires that each sentence have anoun and a verb, each of which may be modified by adjectives and adverbs. Some syntaxes
make use of the order in which words appear. For example, in English the meaning of thesentence “The man bites the dog” is different from “The dog bites the man.”
Pragmatics: The social side of language is expressed through pragmatics, or how wecommunicate effectively and appropriately with others. Examples of pragmatics include turntaking, staying on topic, volume and tone of voice, and appropriate eye contact.
Lastly, words do not possess fixed meanings, but change their interpretation as a function of thecontext in which they are spoken. We use contextual information, the information surrounding
language, to help us interpret it. Examples of contextual information include our knowledge andnonverbal expressions, such as facial expressions, postures, and gestures. Misunderstandings caneasily arise if people are not attentive to contextual information or if some of it is missing, suchas it may be in newspaper headlines or in text messages.
90Language Developmental Progression
An important aspect of cognitive development is language acquisition. The order in whichchildren learn language structures is consistent across children and cultures (Hatch, 1983).
Starting before birth, babies begin to develop language and communication skills. At birth,babies recognize their mother’s voice and can discriminate between the language(s) spoken by
their mothers and foreign languages, and they show preferences for faces that are moving in
synchrony with audible language (Blossom & Morgan, 2006; Pickens et al., 1994; Spelke &Cortelyou, 1981).
Do newborns communicate? Of course, they do. They do not,however, communicate with the use of oral language. Instead, they
communicate their thoughts and needs with body posture (being
relaxed or still), gestures, cries, and facial expressions. A person
who spends adequate time with an infant can learn which cries
indicate pain and which ones indicate hunger, discomfort, or
frustration.

Figure 3.19

SourceIntentional Vocalizations: In terms of producing spoken
language, babies begin to coo almost immediately. Cooing is a one-syllable combination of aconsonant and a vowel sound (e.g., coo or ba). Interestingly, babies replicate sounds from theirown languages. A baby whose parents speak French will coo in a different tone than a baby
whose parents speak Spanish or Urdu. These gurgling, musical vocalizations can serve as asource of entertainment to an infant who has been laid down for a nap or seated in a carrier on a
car ride. Cooing serves as practice for vocalization, as well as the infant hears the sound of hisor her own voice and tries to repeat sounds that are entertaining. Infants also begin to learn thepace and pause of conversation as they alternate their vocalization with that of someone else
and then take their turn again when the other person’s vocalization has stopped.
At about four to six months of age, infants begin making even more elaborate vocalizations that
include the sounds required for any language. Guttural sounds, clicks, consonants, and vowel
sounds stand ready to equip the child with the ability to repeat whatever sounds arecharacteristic of the language heard. Eventually, these sounds will no longer be used as theinfant grows more accustomed to a particular language.
At about 7 months, infants begin babbling, engaging in intentional vocalizations that lackspecific meaning and comprise a consonant-vowel repeated sequence, such as ma-ma-ma, da-dada. Children babble as practice in creating specific sounds, and by the time they are a 1 year old,the babbling uses primarily the sounds of the language that they are learning (de BoyssonBardies, Sagart, & Durand, 1984). These vocalizations have a conversational tone that sounds
meaningful even though it is not. Babbling also helps children understand the social,communicative function of language. Children who are exposed to sign language babble in sign
by making hand movements that represent real language (Petitto & Marentette, 1991).
Gesturing: Children communicate information through gesturing long before they speak, andthere is some evidence that gesture usage predicts subsequent language development
91(Iverson & Goldin-Meadow, 2005). Deaf babies also use gestures to communicate wants,
reactions, and feelings. Because gesturing seems to be easier than vocalization for some
toddlers, sign language is sometimes taught to enhance one’s ability to communicate by making
use of the ease of gesturing. The rhythm and pattern of language is used when deaf babies sign,
just as it is when hearing babies babble.
Understanding: At around ten months of age, the infant can understand more than he or she
can say, which is referred to as receptive language. You may have experienced thisphenomenon as well if you have ever tried to learn a second language. You may have been able
to follow a conversation more easily than contribute to it. One of the first words that children
understand is their own name, usually by about 6 months, followed by commonly used words
like “bottle,” “mama,” and “doggie” by 10 to 12 months (Mandel, Jusczyk, & Pisoni, 1995).
Infants shake their head “no” around 6–9 months, and they respond to verbal requests to do
things like “wave bye-bye” or “blow a kiss” around 9–12 months. Children also use
contextual information, particularly the cues that parents provide, to help them learn language.
Children learn that people are usually referring to things that they are looking at when they are
speaking (Baldwin, 1993), and that that the speaker’s emotional expressions are related to thecontent of their speech.
Holophrasic Speech: Children begin using their first words at about 12 or 13 months of age
and may use partial words to convey thoughts at even younger ages. These one-word
expressions are referred to as holophrasic speech. For example, the child may say “ju” for theword “juice” and use this sound when referring to a bottle. The listener must interpret themeaning of the holophrase, and when this is someone who has spent time with the child,interpretation is not too difficult. But, someone who has not been around the child will havetrouble knowing what is meant. Imagine the parent who to a friend exclaims, “Ezra’s talking all
the time now!” The friend hears only “ju da ga” to which the parent explains means, “I wantsome milk when I go with Daddy.”
Language Errors: The early utterances of children contain many errors, for instance, confusing/b/ and /d/, or /c/ and /z/. The words children create are often simplified, in part because they are
not yet able to make the more complex sounds of the real language (Dobrich & Scarborough,1992). Children may say “keekee” for kitty, “nana” for banana, and “vesketti” for spaghetti
because it is easier. Often these early words are accompanied by gestures that may also be easierto produce than the words themselves. Children’s pronunciations become increasingly accurate
between 1 and 3 years, but some problems may persist until school age.
A child who learns that a word stands for an object may initially think that the word can be used
for only that particular object, which is referred to as underextension. Only the family’s Irish
Setter is a “doggie”, for example. More often, however, a child may think that a label applies toall objects that are similar to the original object, which is called overextension. For example,
all animals become “doggies”. The first error is often the result of children learning the meaningof a word in a specific context, while the second language error is a function of the child’s
smaller vocabulary.
First words and cultural influences: If the child is using English, first words tend to be
nouns. The child labels objects such as cup, ball, or other items that they regularly interact
92

with. In a verb-friendly language such as Chinese, however, children may learn more verbs. This
may also be due to the different emphasis given to objects based on culture. Chinese children
may be taught to notice action and relationships between objects, while children from the UnitedStates may be taught to name an object and its qualities (color, texture, size, etc.). These
differences can be seen when comparing interpretations of art by older students from China andthe United States (Imai et al., 2008).
Two-word sentences and telegraphic (text message) speech: By the time they become
toddlers, children have a vocabulary of about 50-200 words and begin putting those words
together in telegraphic speech, such as “baby bye-bye” or “doggie pretty”. Words needed toconvey messages are used, but the articles and other parts of speech necessary for grammaticalcorrectness are not yet used. These expressions sound like a telegraph, or perhaps a better
analogy today would be that they read like a text message. Telegraphic speech/text message
speech occurs when unnecessary words are not used. “Give baby ball” is used rather than “Givethe baby the ball.”Infant-directed Speech: Why is a horse a “horsie”? Have you ever wondered why adults tend
to use “baby talk” or that sing-song type of intonation and exaggeration used when talking tochildren? This represents a universal tendency and is known as infant-directed speech. It
involves exaggerating the vowel and consonant sounds, using a high-pitched voice, anddelivering the phrase with great facial expression (Clark, 2009). Why is this done? Infants are
frequently more attuned to the tone of voice of the person speaking than to the content of thewords themselves and are aware of the target of speech. Werker, Pegg, and McLeod (1994) foundthat infants listened longer to a woman who was speaking to a baby than to a woman who was
speaking to another adult. Adults may use this form of speech in order to clearly articulate thesounds of a word so that the child can hear the sounds involved. It may also be because when thistype of speech is used, the infant pays more attention to the speaker and this sets up a pattern ofinteraction in which the speaker and listener are in tune with one another.

Theories of Language Development
Psychological theories of language learning differ in terms of the importance they place onnature and nurture. Remember that we are a product of both nature and nurture. Researchers
now believe that language acquisition is partially inborn and partially learned through ourinteractions with our linguistic environment (Gleitman & Newport, 1995; Stork & Widdowson,1974). First to be discussed are the biological theories, including nativist, brain areas and critical
periods. Next, learning theory and social pragmatics will be presented.
Nativism: The linguist Noam Chomsky is a believer in the nature approach to language, arguingthat human brains contain a language acquisition device (LAD) that includes a universal
grammar that underlies all human language (Chomsky, 1965, 1972). According to this approach,each of the many languages spoken around the world (there are between 6,000 and 8,000) is anindividual example of the same underlying set of procedures that are hardwired into humanbrains. Chomsky’s account proposes that children are born with a knowledge of general rules ofsyntax that determine how sentences are constructed. Language develops as long as the infant is93

exposed to it. No teaching, training, or reinforcement is required for language to develop as
proposed by Skinner.
Chomsky differentiates between the deep structure of an idea; that is, how the idea isrepresented in the fundamental universal grammar that is common to all languages, and thesurface structure of the idea or how it is expressed in any one language. Once we hear or
express a thought in surface structure, we generally forget exactly how it happened. At the end of
a lecture, you will remember a lot of the deep structure (i.e., the ideas expressed by the
instructor), but you cannot reproduce the surface structure (the exact words that the instructorused to communicate the ideas).
Although there is general agreement among psychologists that babies are geneticallyprogrammed to learn language, there is still debate about Chomsky’s idea that there is a universal
grammar that can account for all language learning. Evans and Levinson (2009) surveyed theworld’s languages and found that none of the presumed underlying features of the language
acquisition device were entirely universal. In their search they found languages that did not havenoun or verb phrases, that did not have tenses (e.g., past, present, future), and even some that did
not have nouns or verbs at all, even though a basic assumption of a universal grammar is that all
languages should share these features.
Brain Areas for Language: For the
Figure 3.20 Drawing of Brain Showing Broca’s and
90% of people who are right-handed,
Wernicke’s Areas
language is stored and controlled by
the left cerebral cortex, although forsome left-handers this pattern isreversed. These differences can easily
be seen in the results of neuroimaging
studies that show that listening to andproducing language creates greater
activity in the left hemisphere than in
the right. Broca’s area, an area infront of the left hemisphere near the
motor cortex, is responsible for
language production (Figure 3.20).
This area was first localized in the1860s by the French physician PaulFor most people the left hemisphere is specialized for language.
Broca, who studied patients with
Broca’s area, near the motor cortex, is involved in language
lesions to various parts of the brain.
production, whereas Wernicke’s area, near the auditory cortex, is
specialized for language comprehension.
Wernicke’s area, an area of the brain
next to the auditory cortex, is
Sourceresponsible for language comprehension.
Is there a critical period for learning language? Psychologists believe there is a critical
period, a time in which learning can easily occur, for language. This critical period appears tobe between infancy and puberty (Lenneberg, 1967; Penfield & Roberts, 1959), but isolating theexact timeline has been elusive. Children who are not exposed to language early in their lives
94Figure 3.21 Victor of Aveyon

will likely never grasp the grammatical and communication
nuances of language. Case studies, including Victor the“Wild Child,” who was abandoned as a baby in 18th century
France and not discovered until he was 12, and Genie, achild whose parents kept her locked away from 18 months
until 13 years of age, are two examples of children who
were deprived of language. Both children made some
progress in socialization after they were rescued, but neitherof them ever developed a working understanding of
language (Rymer, 1993). Yet, such case studies are fraught
with many confounds. How much did the years of social
isolation and malnutrition contribute to their problems inlanguage development?

A better test for the notion of critical periods for language isfound in studies of children with hearing loss. Several
studies show that the earlier children are diagnosed withhearing impairment and receive treatment, the better the child’s long-term language
development. For instance, Stika et al. (2015) reported that when children’s hearing loss was
identified during newborn screening, and subsequently addressed, the majority showed normal
language development when later tested at 12-18 months. Fitzpatrick, Crawford, Ni, andDurieux-Smith (2011) reported that early language intervention in children who weremoderately to severely hard of hearing, demonstrated normal outcomes in language proficiency
by 4 to 5 years of age. Tomblin et al. (2015) reported that children who were fit with hearing
aids by 6 months of age showed good levels of language development by age 2. Those whose
hearing was not corrected until after 18 months showed lower language performance, even in
the early preschool years. However, this study did reveal that those whose hearing wascorrected by toddlerhood had greatly improved language skills by age 6. The research withhearing impaired children reveals that this critical period for language development is not
exclusive to infancy, and that the brain is still receptive to language development in earlychildhood. Fortunately, it is has become routine to screen hearing in newborns, because when
hearing loss is not treated early, it can delay spoken language, literacy, and impact children’ssocial skills (Moeller & Tomblin, 2015).
SourceLearning Theory: Perhaps the most straightforward explanation of language development isthat it occurs through the principles of learning, including association and reinforcement(Skinner, 1953). Additionally, Bandura (1977) described the importance of observation andimitation of others in learning language. There must be at least some truth to the idea that
language is learned through environmental interactions or nurture. Children learn the languagethat they hear spoken around them rather than some other language. Also supporting this idea isthe gradual improvement of language skills with time. It seems that children modify theirlanguage through imitation and reinforcement, such as parental praise and being understood. For
example, when a two-year-old child asks for juice, he might say, “me juice,” to which hismother might respond by giving him a cup of apple juice.

95

Figure 3.22 Three theorists who provide explanations for language development

B. F. Skinner Source

Albert Bandura Source

Noam Chomsky Source

However, language cannot be entirely learned. For one, children learn words too fast for them tobe learned through reinforcement. Between the ages of 18 months and 5 years, children learn up
to 10 new words every day (Anglin, 1993). More importantly, language is more generative than
it is imitative. Language is not a predefined set of ideas and sentences that we choose when weneed them, but rather a system of rules and procedures that allows us to create an infinite numberof statements, thoughts, and ideas, including those that have never previously occurred. When achild says that she “swimmed” in the pool, for instance, she is showing generativity. No adultspeaker of English would ever say “swimmed,” yet it is easily generated from the normal systemof producing language.
Other evidence that refutes the idea that all language is learned through experience comes fromthe observation that children may learn languages better than they ever hear them. Deaf children
whose parents do not communicate using ASL very well nevertheless are able to learn it perfectlyon their own and may even make up their own language if they need to (Goldin-Meadow &Mylander, 1998). A group of deaf children in a school in Nicaragua, whose teachers could notsign, invented a way to communicate through made-up signs (Senghas, Senghas, & Pyers, 2005).
The development of this new Nicaraguan Sign Language has continued and changed as new
generations of students have come to the school and started using the language. Although theoriginal system was not a real language, it is becoming closer and closer every year, showing thedevelopment of a new language in modern times.
Social pragmatics: Another view emphasizes the very social nature of human language.
Language from this view is not only a cognitive skill, but also a social one. Language is a tool
humans use to communicate, connect to, influence, and inform others. Most of all, language
comes out of a need to cooperate. The social nature of language has been demonstrated by anumber of studies that have shown that children use several pre-linguistic skills (such as pointing
and other gestures) to communicate not only their own needs, but what others may need. So, a
child watching her mother search for an object may point to the object to help her mother find it.
Eighteen-month to 30-month-olds have been shown to make linguistic repairs when it is clear96

that another person does not understand them (Grosse, Behne, Carpenter & Tomasello, 2010).
Grosse et al. (2010) found that even when the child was given the desired object, if there had
been any misunderstanding along the way (such as a delay in being handed the object, or theexperimenter calling the object by the wrong name), children would make linguistic repairs.
This would suggest that children are using language not only as a means of achieving somematerial goal, but to make themselves understood in the mind of another person.

Learning Objectives: Psychosocial Development in Infancy and Toddlerhood
•
•
•
•
•
•

Identify styles of temperament and explore goodness-of-fit
Describe infant emotions, self-awareness, stranger wariness, and separation anxiety
Describe the early theories of attachment
Contrast styles of attachment according to the Strange Situation Technique
Explain the factors that influence attachment
Use Erikson’s theory to characterize psychosocial development during infancy

Temperament
Perhaps you have spent time with a number of infants. How were they alike? How did theydiffer? How do you compare with your siblings or other children you have known well? You
may have noticed that some seemed to be in a better mood than others and that some were moresensitive to noise or more easily distracted than others. These differences may be attributed totemperament. Temperament is the innate characteristics of the infant, including mood, activity
level, and emotional reactivity, noticeable soon after birth.
In a 1956 landmark study, Chess and Thomas (1996) evaluated 141 children’s temperament
based on parental interviews. Referred to as the New York Longitudinal Study, infants wereassessed on 9 dimensions of temperament including: Activity level, rhythmicity (regularity of
biological functions), approach/withdrawal (how children deal with new things), adaptability tosituations, intensity of reactions, threshold of responsiveness (how intense a stimulus has to be
for the child to react), quality of mood, distractibility, attention span, and persistence. Based on
the infants’ behavioral profiles, they were categorized into three general types of temperament:•••

Easy Child (40%) who is able to quickly adapt to routine and new situations, remains
calm, is easy to soothe, and usually is in a positive mood.
Difficult Child (10%) who reacts negatively to new situations, has trouble adapting toroutine, is usually negative in mood, and cries frequently.
Slow-to-Warm-Up Child (15%) has a low activity level, adjusts slowly to newsituations and is often negative in mood.

As can be seen the percentages do not equal 100% as some children were not able to be placed
neatly into one of the categories. Think about how you might approach each type of child inorder to improve your interactions with them. An easy child will not need much extra attention,
while a slow to warm up child may need to be given advance warning if new people or situations
are going to be introduced. A difficult child may need to be given extra time to burn off their97

energy. A caregiver's ability to work well and accurately read the child will enjoy a goodnessof-fit, meaning their styles match and communication and interaction can flow. Parents who
recognize each child’s temperament and accept it, will nurture more effective interactions withthe child and encourage more adaptive functioning. For example, an adventurous child whoseparents regularly take her outside on hikes would provide a good “fit” to her temperament.
Parenting is bidirectional: Not only do parents
Figure 3.23
affect their children, children influence theirparents. Child characteristics, such astemperament, affect parenting behaviors androles. For example, an infant with an easytemperament may enable parents to feel more
effective, as they are easily able to soothe thechild and elicit smiling and cooing. On the other
hand, a cranky or fussy infant elicits fewer
positive reactions from his or her parents and may
result in parents feeling less effective in theparenting role (Eisenberg et al., 2008). Over
Sourcetime, parents of more difficult children may
become more punitive and less patient with theirchildren (Clark, Kochanska, & Ready, 2000; Eisenberg et al., 1999; Kiff, Lengua, & Zalewski,2011). Parents who have a fussy, difficult child are less satisfied with their marriages and havegreater challenges in balancing work and family roles (Hyde, Else-Quest, & Goldsmith, 2004).
Thus, child temperament is one of the child characteristics that influences how parents behavewith their children.
Temperament does not change dramatically as we grow up, but we may learn how to workaround and manage our temperamental qualities. Temperament may be one of the things about
us that stays the same throughout development. In contrast, personality, defined as anindividual’s consistent pattern of feeling, thinking, and behaving, is the result of the continuousinterplay between biological disposition and experience.
Personality also develops from temperament in other ways (Thompson, Winer, & Goodvin,2010). As children mature biologically, temperamental characteristics emerge and change overtime. A newborn is not capable of much self-control, but as brain-based capacities for selfcontrol advance, temperamental changes in self-regulation become more apparent. For example,
a newborn who cries frequently does not necessarily have a grumpy personality; over time, with
sufficient parental support and increased sense of security, the child might be less likely to cry.
In addition, personality is made up of many other features besides temperament. Children’sdeveloping self-concept, their motivations to achieve or to socialize, their values and goals, theircoping styles, their sense of responsibility and conscientiousness, and many other qualities areencompassed into personality. These qualities are influenced by biological dispositions, but evenmore by the child’s experiences with others, particularly in close relationships, that guide thegrowth of individual characteristics. Indeed, personality development begins with the biologicalfoundations of temperament but becomes increasingly elaborated, extended, and refined over98

time. The newborn that parents gazed upon becomes an adult with a personality of depth andnuance.

Infant Emotions
At birth, infants exhibit two emotional responses: Attraction and withdrawal. They show
attraction to pleasant situations that bring comfort, stimulation, and pleasure, and they withdraw
from unpleasant stimulation such as bitter flavors or physical discomfort. At around two months,
infants exhibit social engagement in the form of social smiling as they respond with smiles tothose who engage their positive attention (Lavelli & Fogel, 2005).
Figure 3.24

SourceSocial smiling becomes more stable and organized as infants learn
to use their smiles to engage their parents in interactions. Pleasure isexpressed as laughter at 3 to 5 months of age, and displeasure
becomes more specific as fear, sadness, or anger between ages 6 and8 months. Anger is often the reaction to being prevented fromobtaining a goal, such as a toy being removed (Braungart-Rieker,
Hill-Soderlund, & Karrass, 2010). In contrast, sadness is typicallythe response when infants are deprived of a caregiver (Papousek,
2007). Fear is often associated with the presence of a stranger,
known as stranger wariness, or the departure of significant others
known as separation anxiety. Both appear sometime between 6
and 15 months after object permanence has been acquired. Further,
there is some indication that infants may experience jealousy as
young as 6 months of age (Hart & Carrington, 2002).

Emotions are often divided into two general categories: Basic emotions, such as interest,
happiness, anger, fear, surprise, sadness and disgust, which appear first, and self-conscious
emotions, such as envy, pride, shame, guilt, doubt, and embarrassment. Unlike primaryemotions, secondary emotions appear as children start to develop a self-concept and requiresocial instruction on when to feel such emotions. The situations in which children learn selfconscious emotions varies from culture to culture. Individualistic cultures teach us to feel pridein personal accomplishments, while in more collective cultures children are taught to not callattention to themselves, unless you wish to feel embarrassed for doing so (Akimoto &Sanbinmatsu, 1999).
Facial expressions of emotion are important regulators of social interaction. In the developmental
literature, this has been investigated under the concept of social referencing; that is, the process
whereby infants seek out information from others to clarify a situation and then use that
information to act (Klinnert, Campos, & Sorce, 1983). To date, the strongest demonstration ofsocial referencing comes from work on the visual cliff. In the first study to investigate thisconcept, Sorce, Emde, Campos, and Klinnert (1985) placed mothers on the far end of the “cliff”
from the infant. Mothers first smiled to the infants and placed a toy on top of the safety glass to
attract them; infants invariably began crawling to their mothers. When the infants were in thecenter of the table, however, the mother then posed an expression of fear, sadness, anger,interest, or joy. The results were clearly different for the different faces; no infant crossed the99table when the mother showed fear; only 6% did when the mother posed anger, 33% crossed
when the mother posed sadness, and approximately 75% of the infants crossed when the motherposed joy or interest.
Other studies provide similar support for facial expressions as regulators of social interaction.
Experimenters posed facial expressions of neutral, anger, or disgust toward babies as they moved
toward an object and measured the amount of inhibition the babies showed in touching the object(Bradshaw, 1986). The results for 10- and 15-month olds were the same: Anger produced thegreatest inhibition, followed by disgust, with neutral the least. This study was later replicatedusing joy and disgust expressions, altering the method so that the infants were not allowed totouch the toy (compared with a distractor object) until one hour after exposure to the expression(Hertenstein & Campos, 2004). At 14 months of age, significantly more infants touched the toy
when they saw joyful expressions, but fewer touched the toy when the infants saw disgust.
A final emotional change is in self-regulation. Emotional self-regulation refers to strategies we
use to control our emotional states so that we can attain goals (Thompson & Goodvin, 2007).
This requires effortful control of emotions and initially requires assistance from caregivers(Rothbart, Posner, & Kieras, 2006). Young infants have very limited capacity to adjust theiremotional states and depend on their caregivers to help soothe themselves. Caregivers can offer
distractions to redirect the infant’s attention and comfort to reduce the emotional distress. As
areas of the infant’s prefrontal cortex continue to develop, infants can tolerate more stimulation.
By 4 to 6 months, babies can begin to shift their attention away from upsetting stimuli (Rothbart
et al, 2006). Older infants and toddlers can more effectively communicate their need for help
and can crawl or walk toward or away from various situations (Cole, Armstrong, & Pemberton,
2010). This aids in their ability to self-regulate. Temperament also plays a role in children’sability to control their emotional states, and individual differences have been noted in theemotional self-regulation of infants and toddlers (Rothbart & Bates, 2006).
Development of sense of self: During the second year of life,
children begin to recognize themselves as they gain a sense of
self as object. In a classic experiment by Lewis and Brooks(1978) children 9 to 24 months of age were placed in front of amirror after a spot of rouge was placed on their nose as theirmothers pretended to wipe something off the child’s face. If
the child reacted by touching his or her own nose rather that of
the “baby” in the mirror, it was taken to suggest that the childrecognized the reflection as him- or herself. Lewis and Brooks
found that somewhere between 15 and 24 months most infants
developed a sense of self-awareness. Self-awareness is therealization that you are separate from others (Kopp, 2011).
Once a child has achieved self-awareness, the child is moving
toward understanding social emotions such as guilt, shame orembarrassment, as well as, sympathy or empathy.

100

Figure 3.25

SourceForming Attachments
Figure: 3.26 Mutually enjoyableinteractions promote infant bonding

Attachment is the close bond with a caregiverfrom which the infant derives a sense of
security. The formation of attachments in infancy
has been the subject of considerable research asattachments have been viewed as foundations for
future relationships. Additionally, attachments
form the basis for confidence and curiosity as
toddlers, and as important influences on selfconcept.

Freud’s Psychoanalytic Theory: According to
Freud (1938) infants are oral creatures who obtain(credit: Peter Shanks)
pleasure from sucking and mouthing objects.
Freud believed the infant will become attached toa person or object that provides this pleasure. Consequently, infants were believed to become
attached to their mother because she was the one who satisfied their oral needs and provided
pleasure. Freud further believed that the infants will become attached to their mothers “if themother is relaxed and generous in her feeding practices, thereby allowing the child a lot of oral
pleasure,” (Shaffer, 1985, p. 435). Was Freud correct in his explanation for why infants became
attached?
Harlow’s Research: In one classic study showing if nursing was the most important factor to
attachment, Wisconsin University psychologists Harry and Margaret Harlow investigated the
responses of young monkeys. The infants were separated from their biological mothers, and twosurrogate mothers were introduced to their cages. One, the wire mother, consisted of a roundwooden head, a mesh of cold metal wires, and a bottle of milk from which the baby monkey
could drink. The second mother was a foam-rubber form wrapped in a heated terry-cloth blanket.
The infant monkeys went to the wire mother for food, but they overwhelmingly preferred andspent significantly more time with the warm terry-cloth mother. The warm terry-cloth motherprovided no food but did provide comfort (Harlow, 1958). The infant's need for physicalcloseness and touching is referred to as contact comfort. Contact comfort is believed to be thefoundation for attachment. The Harlows’ studies confirmed that babies have social as well as
physical needs. Both monkeys and human babies need a secure base that allows them to feel safe.
From this base, they can gain the confidence they need to venture out and explore their worlds.
Bowlby’s Theory: Building on the work of Harlow and others, John Bowlby developed theconcept of attachment theory. He defined attachment as the affectional bond or tie that an
infant forms with the mother (Bowlby, 1969). An infant must form this bond with a primary
caregiver in order to have normal social and emotional development. In addition, Bowlby
proposed that this attachment bond is very powerful and continues throughout life. He usedthe concept of secure base to define a healthy attachment between parent and child (Bowlby,
1982). A secure base is a parental presence that gives the child a sense of safety as the child
explores the surroundings.

101

Figure 3.27 John Bowlby

SourceBowlby said that two things are needed for a healthy
attachment: The caregiver must be responsive to the child’s
physical, social, and emotional needs; and the caregiver andchild must engage in mutually enjoyable interactions(Bowlby, 1969). Additionally, Bowlby observed that infants
would go to extraordinary lengths to prevent separationfrom their parents, such as crying, refusing to be comforted,
and waiting for the caregiver to return. He observed thatthese same expressions were common to many othermammals, and consequently argued that these negative
responses to separation serve an evolutionary function.
Because mammalian infants cannot feed or protect
themselves, they are dependent upon the care and protectionof adults for survival. Thus, those infants who were able tomaintain proximity to an attachment figure were more likely
to survive and reproduce.

Erikson: Trust vs. Mistrust
As previously discussed in chapter 1, Erikson formulated an eight stage theory of psychosocial
development. Erikson was in agreement on the importance of a secure base, arguing that themost important goal of infancy was the development of a basic sense of trust in one’s caregivers.
Consequently, the first stage, trust vs. mistrust, highlights the importance of attachment. Erikson
maintained that the first year to year and a half of life involves the establishment of a sense oftrust (Erikson, 1982). Infants are dependent and must rely on others to meet their basic physicalneeds as well as their needs for stimulation and comfort. A caregiver who consistently meetsthese needs instills a sense of trust or the belief that the world is a trustworthy place. The
caregiver should not worry about overly indulging a child’s need for comfort, contact or
stimulation.
Problems establishing trust: Erikson (1982) believed that mistrust could contaminate all
aspects of one’s life and deprive the individual of love and fellowship with others. Consider the
implications for establishing trust if a caregiver is unavailable or is upset and ill-prepared to care
for a child. Or if a child is born prematurely, is unwanted, or has physical problems that makehim or her less desirable to a parent. Under these circumstances, we cannot assume that theparent is going to provide the child with a feeling of trust.

Mary Ainsworth and the Strange Situation Technique
Developmental psychologist Mary Ainsworth, a student of John Bowlby, continued studying thedevelopment of attachment in infants. Ainsworth and her colleagues created a laboratory test thatmeasured an infant’s attachment to his or her parent. The test is called The Strange Situation
Technique because it is conducted in a context that is unfamiliar to the child and therefore likely
to heighten the child’s need for his or her parent (Ainsworth, 1979).

102During the procedure, that lasts about 20 minutes, the parent and the infant are first left alone,while the infant explores the room full of toys. Then a strange adult enters the room and talks fora minute to the parent, after which the parent leaves the room. The stranger stays with the infant
for a few minutes, and then the parent again enters, and the stranger leaves the room. During theentire session, a video camera records the child’s behaviors, which are later coded by trainedcoders. The investigators were especially interested in how the child responded to the caregiver
leaving and returning to the room, referred to as the “reunion.” On the basis of their behaviors,
the children are categorized into one of four groups where each group reflects a different kind of
attachment relationship with the caregiver. One style is secure and the other three styles arereferred to as insecure.
•

A child with a secure attachment style usually explores freely while the caregiver ispresent and may engage with the stranger. The child will typically play with the toys andbring one to the caregiver to show and describe from time to time. The child may be upset
when the caregiver departs but is also happy to see the caregiver return.

•

A child with an ambivalent (sometimes called resistant) attachment style is wary about
the situation in general, particularly the stranger, and stays close or even clings to the
caregiver rather than exploring the toys. When the caregiver leaves, the child is extremely
distressed and is ambivalent when the caregiver returns. The child may rush to the
caregiver, but then fails to be comforted when picked up. The child may still be angryand even resist attempts to be soothed.

•

A child with an avoidant attachment style will avoid or ignore the mother, showing
little emotion when the mother departs or returns. The child may run away from themother when she approaches. The child will not explore very much, regardless of who isthere, and the stranger will not be treated much differently from the mother.

•

A child with a disorganized/disoriented attachment style seems to have an inconsistent
way of coping with the stress of the strange situation. The child may cry during theseparation, but avoid the mother when she returns, or the child may approach the motherbut then freeze or fall to the floor.

How common are the attachment styles among children in the United States? It is estimated thatabout 65 percent of children in the United States are securely attached. Twenty percent exhibit
avoidant styles and 10 to 15 percent are ambivalent. Another 5 to 10 percent may becharacterized as disorganized (Ainsworth, Blehar, Waters, & Wall, 1978).

103

Some cultural differences in attachment
styles have been found (Rothbaum, Weisz,
Pott, Miyake, & Morelli, 2010). For
example, German parents value
independence and Japanese mothers are
typically by their children’s sides. As aresult, the rate of insecure-avoidant
attachments is higher in Germany andinsecure-resistant attachments are higher inJapan. These differences reflect culturalvariation rather than true insecurity,
however (van Ijzendoorn and Sagi,
1999). Overall, secure attachment is themost common type of attachment seen in

Figure 3.28

Sourceevery culture studied thus far (Thompson, 2006).
Caregiver Interactions and the Formation of Attachment: Most developmental psychologists
argue that a child becomes securely attached when there is consistent contact from one or morecaregivers who meet the physical and emotional needs of the child in a responsive andappropriate manner. However, even in cultures where mothers do not talk, cuddle, and play with
their infants, secure attachments can develop (LeVine et. al., 1994).
The insecure ambivalent style occurs when the parent is insensitive and responds inconsistently
to the child’s needs. Consequently, the infant is never sure that the world is a trustworthy placeor that he or she can rely on others without some anxiety. A caregiver who is unavailable,
perhaps because of marital tension, substance abuse, or preoccupation with work, may send amessage to the infant he or she cannot rely on having needs met. An infant who receives only
sporadic attention when experiencing discomfort may not learn how to calm down. The child
may cry if separated from the caregiver and also cry upon their return. They seek constantreassurance that never seems to satisfy their doubt. Keep in mind that clingy behavior can also
just be part of a child’s natural disposition or temperament and does not necessarily reflect somekind of parental neglect. Additionally, a caregiver that attends to a child’s frustration can help
teach them to be calm and to relax.
The insecure avoidant style is marked by insecurity, but this style is also characterized by atendency to avoid contact with the caregiver and with others. This child may have learned thatneeds typically go unmet and learns that the caregiver does not provide care and cannot be relied
upon for comfort, even sporadically. An insecure avoidant child learns to be more independentand disengaged.
The insecure disorganized/disoriented style represents the most insecure style of attachment
and occurs when the child is given mixed, confused, and inappropriate responses from the
caregiver. For example, a mother who suffers from schizophrenia may laugh when a child ishurting or cry when a child exhibits joy. The child does not learn how to interpret emotions or toconnect with the unpredictable caregiver. This type of attachment is also often seen in children

104who have been abused. Research has shown that abuse disrupts a child’s ability to regulate theiremotions (Main & Solomon, 1990).
Caregiver Consistency: Having a consistentcaregiver may be jeopardized if the infant iscared for in a day care setting with a highturn-over of staff or if institutionalized andgiven little more than basic physicalcare. Infants who, perhaps because of being
in orphanages with inadequate care, have not
had the opportunity to attach in infancy may
still form initial secure attachments several
years later. However, they may have more
emotional problems of depression, anger, or
be overly friendly as they interact with others(O’Connor et. al., 2003).

Figure 3.29

SourceSocial Deprivation: Severe deprivation of parental attachment can lead to serious problems.
According to studies of children who have not been given warm, nurturing care, they may show
developmental delays, failure to thrive, and attachment disorders (Bowlby, 1982). Non-organic
failure to thrive is the diagnosis for an infant who does not grow, develop, or gain weight onschedule and there is no known medical explanation for this failure. Poverty, neglect,
inconsistent parenting, and severe family dysfunction are correlated with non-organic failure to
thrive. In addition, postpartum depression can cause even a well-intentioned mother to neglect
her infant.
Reactive Attachment Disorder: Children who experience social neglect or deprivation,
repeatedly change primary caregivers that limit opportunities to form stable attachments or are
reared in unusual settings (such as institutions) that limit opportunities to form stable attachments
can certainly have difficulty forming attachments. According to the Diagnostic and Statistical
Manual of Mental Disorders, 5th edition (American Psychiatric Association, 2013), thosechildren experiencing neglectful situations and also displaying markedly disturbed anddevelopmentally inappropriate attachment behavior, such as being inhibited and withdrawn,minimal social and emotional responsiveness to others, and limited positive affect, may bediagnosed with reactive attachment disorder. This disorder often occurs with developmental
delays, especially in cognitive and language areas. Fortunately, the majority of severely
neglected children do not develop reactive attachment disorder, which occurs in less than 10% ofsuch children. The quality of the caregiving environment after serious neglect affects thedevelopment of this disorder.
Resiliency: Being able to overcome challenges and successfully adapt is resiliency. Even young
children can exhibit strong resiliency to harsh circumstances. Resiliency can be attributed tocertain personality factors, such as an easy-going temperament. Some children are warm,
friendly, and responsive, whereas others tend to be more irritable, less manageable, and difficult
to console, and these differences play a role in attachment (Gillath, Shaver, Baek, & Chun, 2008;
Seifer, Schiller, Sameroff, Resnick, & Riordan, 1996). It seems safe to say that attachment, like105

most other developmental processes, is affected by an interplay of genetic and socializationinfluences.
Receiving support from others also leads to resiliency. A positive and strong support group canhelp a parent and child build a strong foundation by offering assistance and positive attitudes
toward the newborn and parent. In a direct test of this idea, Dutch researcher van den Boom
(1994) randomly assigned some babies’ mothers to a training session in which they learned tobetter respond to their children’s needs. The research found that these mothers’ babies weremore likely to show a secure attachment style in comparison to the mothers in a control groupthat did not receive training.

Erikson: Autonomy vs. Shame and Doubt
As the child begins to walk and talk, an interest in independence or autonomy replaces a concern
for trust. The toddler tests the limits of what can be touched, said, and explored. Erikson (1982)
believed that toddlers should be allowed to explore their environment as freely as safety allows
and in so doing will develop a sense of independence that will later grow to self-esteem,
initiative, and overall confidence. If a caregiver is overly anxious about the toddler’s actions forfear that the child will get hurt or violate other’s expectation, the caregiver can give the child themessage that he or she should be ashamed of their behavior and instill a sense of doubt in theirown abilities. Parenting advice based on these ideas would be to keep toddlers safe but let themlearn by doing.

Measuring Infant Development
The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III)
comprehensively assess children within the age range of 1 to 42 months (Pearson Education,2016). Children are evaluated in five key developmental domains, including cognition,
language, social-emotional, motor, and adaptive behavior. By identifying developmental delaysin the very young, the Bayley Scales can highlight which early intervention techniques might bemost beneficial. Detailed information is even able to be obtained from non-verbal children.
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Chapter 4: Early Childhood
Our discussion will now focus on the physical, cognitive and socioemotional development
during the ages from two to six, referred to as early childhood. Early childhood represents a time
period of continued rapid growth, especially in the areas of language and cognitive development.
Those in early childhood have more control over their emotions and begin to pursue a variety ofactivities that reflect their personal interests. Parents continue to be very important in the child’sdevelopment, but now teachers and peers exert an influence not seen with infants and toddlers.

Learning Objectives: Physical Development in Early Childhood
•
•
•
•
•
•
•

Summarize the overall physical growth
Describe the changes in brain maturation
Describe the changes in sleep
Summarize the changes in gross and motor skills
Describe when a child is ready for toilet training
Describe sexual development
Identify nutritional concerns

Overall Physical Growth: Children between the agesof two and six years tend to grow about 3 inches inheight and gain about 4 to 5 pounds in weight eachyear. Just as in infancy, growth occurs in spurts rather
than continually. According to the Centers for Disease
Control and Prevention (2000) the average 2-year-old
weighs between 23 and 28 pounds and stands between
33 and 35 inches tall. The average 6-year-old weighs
between 40 and 50 pounds and is about 44 to 47 inches
in height. The 3-year-old is still very similar to a
toddler with a large head, large stomach, short arms andlegs. By the time the child reaches age 6, however, thetorso has lengthened, and body proportions havebecome more like those of adults.

Figure 4.1

This growth rate is slower than that of infancy and isaccompanied by a reduced appetite between the ages of
2 and 6. This change can sometimes be surprising toparents and lead to the development of poor eating
Sourcehabits. However, children between the ages of 2 and 3
need 1,000 to 1,400 calories, while children between
the ages of 4 and 8 need 1,200 to 2,000 calories (Mayo Clinic, 2016a).

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Brain Maturation
Brain weight: The brain is about 75 percent its adult weight by three years of age. By age 6, it is
at 95 percent its adult weight (Lenroot & Giedd, 2006). Myelination and the development ofdendrites continue to occur in the cortex and as it does, we see a corresponding change in what
the child is capable of doing. Greater development in the prefrontal cortex, the area of the brain
behind the forehead that helps us to think, strategize, and control attention and emotion, makes it
increasingly possible to inhibit emotional outbursts and understand how to play games.
Understanding the game, thinking ahead, and coordinating movement improve with practice andmyelination.
Growth in the Hemispheres andCorpus Callosum: Between ages
3 and 6, the left hemisphere of thebrain grows dramatically. Thisside of the brain or hemisphere istypically involved in language
skills. The right hemisphere
continues to grow throughout
early childhood and is involved intasks that require spatial skills,
such as recognizing shapes andpatterns. The corpus callosum, adense band of fibers that connects
the two hemispheres of the brain,
contains approximately 200
million nerve fibers that connect
the hemispheres (Kolb &Whishaw, 2011). The corpus
callosum is illustrated in Figure
4.2.

Figure 4.2 Corpus Callosum

Source

The corpus callosum is located a couple of inches below the longitudinal fissure, which runs thelength of the brain and separates the two cerebral hemispheres (Garrett, 2015). Because the twohemispheres carry out different functions, they communicate with each other and integrate theiractivities through the corpus callosum. Additionally, because incoming information is directed
toward one hemisphere, such as visual information from the left eye being directed to the righthemisphere, the corpus callosum shares this information with the other hemisphere.
The corpus callosum undergoes a growth spurt between ages 3 and 6, and this results inimproved coordination between right and left hemisphere tasks. For example, in comparison toother individuals, children younger than 6 demonstrate difficulty coordinating an Etch A Sketch
toy because their corpus callosum is not developed enough to integrate the movements of both
hands (Kalat, 2016).

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Motor Skill Development
Early childhood is the time period when most children acquire the
Figure 4.3
basic skills for locomotion, such as running, jumping, andskipping, and object control skills, such as throwing, catching, andkicking (Clark, 1994). Children continue to improve their grossmotor skills as they run and jump. Fine motor skills are also beingrefined in activities, such as pouring water into a container,
drawing, coloring, and buttoning coats and using scissors. Table
4.1 highlights some of the changes in motor skills during earlychildhood between 2 and 5 years of age. The development ofgreater coordination of muscles groups and finer precision can beseen during this time period. Thus, average 2-year-olds may beable to run with slightly better coordination than they managed asa toddler, yet they would have difficulty peddling a tricycle,
something the typical 3-year-old can do. We see similar changes infine motor skills with 4-year-olds who no longer struggle to put on
Sourcetheir clothes, something they may have had problems with twoyears earlier. Motor skills continue to develop into middle
childhood, but for those in early childhood, play that deliberately involves these skills isemphasized.
Children’s Art: Children’s art highlights many developmental changes. Kellogg (1969) notedthat children’s drawings underwent several transformations. Starting with about 20 different
types of scribbles at age 2, children move on to experimenting with the placement of scribbles on
the page. By age 3 they are using the basic structure of scribbles to create shapes and are
beginning to combine these shapes to create more complex images. By 4 or 5 children are
creating images that are more recognizable representations of the world. These changes are afunction of improvement in motor skills, perceptual development, and cognitive understandingof the world (Cote & Golbeck, 2007).
The drawing of tadpoles (see Figure: 4.4) is a pervasive
Figure 4.4
feature of young children’s drawings of self and others.
Tadpoles emerge in children’s drawing at about the ageof 3 and have been observed in the drawings of young
children around the world (Gernhardt, Rubeling & Keller,2015), but there are cultural variations in the size, numberof facial features, and emotional expressions displayed.
Gernhardt et al. found that children from Westerncontexts (i.e., urban areas of Germany and Sweden) andurban educated non-Western contexts (i.e., urban areas ofSourceTurkey, Costa Rica and Estonia) drew larger images,
with more facial detail and more positive emotional
expressions, while those from non-Western rural contexts (i.e., rural areas of Cameroon andIndia) depicted themselves as smaller, with less facial details and a more neutral emotional
expression. The authors suggest that cultural norms of non-Western traditionally rural cultures,117

which emphasize the social group rather than the individual, may be one of the factors for thesmaller size of the figures compared to the larger figures from children in the Western cultures
which emphasize the individual.
Table 4.1 Changes in Gross and Fine Motor Skills in Early Childhood

Age 2

Age 3

Age 4

Age 5

Gross Motor Skills

Fine Motor Skills•

Can kick a ball without losingbalance•

Able to turn a door knob••

Can pick up objects while standing,
without losing balance (This often
occurs by 15 months. It is a cause forconcern if not seen by 2 years).

Can look through a book turning one page ata time•Can build a tower of 6 to 7 cubes•

Able to put on simple clothes without help
(The child is often better at removing clothes
than putting them on).

•Can run with better coordination.
(May still have a wide stance).

•

Can briefly balance and hop on one
foot•

Can build a block tower of more than nine
cubes

•

May walk up stairs with alternating
feet (without holding the rail)•

Can easily place small objects in a small
opening•

Can pedal a tricycle•

Can copy a circle•

Can draw a person with 3 parts•

Can feed self easily•Shows improved balance•

Can cut out a picture using scissors•

Hops on one foot without losingbalance•

Can draw a square••

Throws a ball overhand withcoordination

Manages a spoon and fork neatly whileeating•Puts on clothes properly•

Shows more skill with simple tools andwriting utensils•

Can copy a triangle•

Can use a knife to spread soft foods•Has better coordination (getting thearms, legs, and body to work
together)•

Skips, jumps, and hops with goodbalance•

Stays balanced while standing on one
foot with eyes closed

Source: NIH: US National Library of Medicine

118

Toilet Training
Figure: 4.5

SourceToilet training typically occurs during the first two years of earlychildhood (24-36 months). Some children show interest by age 2,
but others may not be ready until months later. The average age forgirls to be toilet trained is 29 months and for boys it is 31 months,
and 98% of children are trained by 36 months (Boyse & Fitzgerald,2010). The child’s age is not as important as his/her physical andemotional readiness. If started too early, it might take longer to train
a child. If a child resists being trained, or it is not successful after a
few weeks, it is best to take a break and try again later. Most
children master daytime bladder control first, typically within two to
three months of consistent toilet training. However, nap andnighttime training might take months or even years.

According to the Mayo Clinic (2016b) the following questions can help parents determine if achild is ready for toilet training:• Does your child seem interested in the potty chair or toilet, or in wearing underwear?
• Can your child understand and follow basic directions?
• Does your child complain about wet or dirty diapers?
• Does your child tell you through words, facial expressions or posture when he or sheneeds to go?
• Does your child stay dry for periods of two hours or longer during the day?
• Can your child pull down his or her pants and pull them up again?
• Can your child sit on and rise from a potty chair? (p. 1)
Some children experience elimination disorders that may require intervention by the child’s
pediatrician or a trained mental health practitioner. Elimination disorders include: enuresis, or
the repeated voiding of urine into bed or clothes (involuntary or intentional) and encopresis, therepeated passage of feces into inappropriate places (involuntary or intentional) (American
Psychiatric Association, 2013). The prevalence of enuresis is 5%-10% for 5-year-olds, 3%-5%
for 10-year-olds and approximately 1% for those 15 years of age or older. Around 1% of 5-yearolds have encopresis, and it is more common in males than females.

Sleep
During early childhood, there is wide variation in the number of hours of sleep recommended perday. For example, two-year-olds may still need 15-16 hours per day, while a six-year-old may
only need 7-8 hours. The National Sleep Foundation’s 2015 recommendations based on age arelisted in Figure 4.6.

119

Figure 4.6

Sexual Development in Early Childhood
Historically, children have been thought of as innocent or incapable of sexual arousal (Aries,
1962). Yet, the physical dimension of sexual arousal is present from birth. However, to associate
the elements of seduction, power, love, or lust that is part of the adult meanings of sexuality
would be inappropriate. Sexuality begins in childhood as a response to physical states andsensation and cannot be interpreted as similar to that of adults in any way (Carroll, 2007).
Infancy: Boys and girls are capable of erections and vaginal lubrication even before birth(Martinson, 1981). Arousal can signal overall physical contentment and stimulation that
accompanies feeding or warmth. Infants begin to explore their bodies and touch their genitals assoon as they have the sufficient motor skills. This stimulation is for comfort or to relieve tension
rather than to reach orgasm (Carroll, 2007).
Early Childhood: Self-stimulation is common in early childhood for both boys andgirls. Curiosity about the body and about others’ bodies is a natural part of early childhood aswell. As children grow, they are more likely to show their genitals to siblings or peers, and to
take off their clothes and touch each other (Okami, Olmstead, & Abramson, 1997). Masturbationis common for both boys and girls. Boys are often shown by other boys how to masturbate, but
girls tend to find out accidentally. Additionally, boys masturbate more often and touchthemselves more openly than do girls (Schwartz, 1999).
120

Hopefully, parents respond to this without undue alarm and without making the child feel guilty
about their bodies. Instead, messages about what is going on and the appropriate time and place
for such activities help the child learn what is appropriate.

Nutritional Concerns
In addition to those in early childhood having a smaller appetite, their parents may notice a
general reticence to try new foods, or a preference for certain foods, often served or eaten in aparticular way. Some of these changes can be traced back to the “just right” (or just-so)
phenomenon that is common in early childhood. Many young children desire consistency andmay be upset if there are even slight changes to their daily routines. They may like to line up
their toys or other objects or place them in symmetric patterns. They may arrange the objects
until they feel “just right”. Many young children have a set bedtime ritual and a strong
preference for certain clothes, toys or games. All these tendencies tend to wane as children
approach middle childhood, and the familiarity of such ritualistic behaviors seem to bring a senseof security and general reduction in childhood fears and anxiety (Evans, Gray, & Leckman,
1999; Evans & Leckman, 2015).
Malnutrition due to insufficient food is notcommon in developed nations, like theUnited States, yet many children lack abalanced diet. Added sugars and solid fats
contribute to 40% of daily calories forchildren and teens in the US. Approximately
half of these empty calories come from six
sources: soda, fruit drinks, dairy desserts,
grain desserts, pizza, and whole milk (CDC,2015). Caregivers need to keep in mind thatthey are setting up taste preferences at thisage. Young children who grow accustomed
to high fat, very sweet and salty flavors may
have trouble eating foods that have subtler
Sourceflavors, such as fruits andvegetables. Consider the following advice(See Box 4.1) about establishing eating patterns for years to come (Rice, 1997). Notice thatkeeping mealtime pleasant, providing sound nutrition and not engaging in power struggles overfood are the main goals:
Figure 4.7 Nutritious Lunch

121

Box 4.1

Tips for Establishing Healthy Eating Patterns
2. Recognize that appetite varies. Children may eat well at one meal and have no appetite atanother. Rather than seeing this as a problem, it may help to realize that appetites dovary. Continue to provide good nutrition, but do not worry excessively if the child does not
eat at a particular meal.
3. Keep it pleasant. This tip is designed to help caregivers create a positive atmosphere during
mealtime. Mealtimes should not be the time for arguments or expressing tensions. You do notwant the child to have painful memories of mealtimes together or have nervous stomachs andproblems eating and digesting food due to stress.
4. No short order chefs. While it is fine to prepare foods that children enjoy, preparing a
different meal for each child or family member sets up an unrealistic expectation fromothers. Children probably do best when they are hungry, and a meal is ready. Limiting snacks
rather than allowing children to “graze” can help create an appetite for what is being served.
5. Limit choices. If you give your young child choices, make sure that you give them one or
two specific choices rather than asking “What would you like for lunch?” If given an open
choice, children may change their minds or ask for something that is not available orappropriate.
6. Serve balanced meals. This tip encourages caregivers to serve balanced meals. A box ofmacaroni and cheese is not a balanced meal. Meals prepared at home tend to have better
nutritional value than fast food or frozen dinners. Prepared foods tend to be higher in fat andsugar content, as these ingredients enhance taste and profit margin because fresh food is often
costlier and less profitable. However, preparing fresh food at home is not costly. It does,
however, require more activity. Preparing meals and including the children in kitchen chores
can provide a fun and memorable experience.
Do not bribe. Bribing a child to eat vegetables by promising desert is not a good idea. The
child will likely find a way to get the desert without eating the vegetables (by whining or
fidgeting, perhaps, until the caregiver gives in). In addition, bribery teaches the child thatsome foods are better than others. Children tend to naturally enjoy a variety of foods until
they are taught that some are considered less desirable than others. Most important is not toforce your child to eat or fight over eating food.

122

Learning Objectives: Cognitive Development in Early Childhood
•
•
•
•
•
•
•
•
•

Describe Piaget’s preoperational stage and the characteristics of preoperational
thought
Summarize the challenges to Piaget’s theory
Describe Vygotsky’s theory of cognitive development
Describe Information processing research on attention and memory
Describe the views of the neo-Piagetians
Describe theory-theory and the development of theory of mind
Describe the developmental changes in language
Describe the various types of early childhood education
Describe the characteristics of autism

Early childhood is a time of pretending, blending fact and fiction, and learning to think of theworld using language. As young children move away from needing to touch, feel, and hear about
the world, they begin learning basic principles about how the world works. Concepts such as
tomorrow, time, size, distance and fact vs. fiction are not easy to grasp at this age, but these tasks
are all part of cognitive development during early childhood.

Piaget’s Preoperational Stage
Piaget’s stage that coincides with early childhood is the preoperational stage. According to
Piaget, this stage occurs from the age of 2 to 7 years. In the preoperational stage, children use
symbols to represent words, images, and ideas, which is why children in this stage engage inpretend play. A child’s arms might become airplane wings as she zooms around the room, or achild with a stick might become a brave knight with a sword. Children also begin to use
language in the preoperational stage, but they cannot understand adult logic or mentallymanipulate information. The term operational refers to logical manipulation of information, so
children at this stage are considered pre-operational. Children’s logic is based on their own
personal knowledge of the world so far, rather than on conventional knowledge.
The preoperational period is divided into two stages: The symbolic function substage occurs
between 2 and 4 years of age and is characterized by the child being able to mentally represent an
object that is not present and a dependence on perception in problem solving. The intuitive
thought substage, lasting from 4 to 7 years, is marked by greater dependence on intuitive thinking
rather than just perception (Thomas, 1979). This implies that children think automaticallywithout using evidence. At this stage, children ask many questions as they attempt to understandthe world around them using immature reasoning. Let us examine some of Piaget’s assertions
about children’s cognitive abilities at this age.

123Pretend Play: Pretending is a favorite activity
at this time. A toy has qualities beyond theway it was designed to function and can now
be used to stand for a character or object
unlike anything originally intended. A teddy
bear, for example, can be a baby or the queen
of a faraway land. Piaget believed thatchildren’s pretend play helped children
solidify new schemata they were developing
cognitively. This play, then, reflected changes
in their conceptions or thoughts. However,children also learn as they pretend andexperiment. Their play does not simply
represent what they have learned (Berk,
2007).

Figure 4. 8

SourceEgocentrism: Egocentrism in early childhood refers to the tendency of young children not to beable to take the perspective of others, and instead the child thinks that everyone sees, thinks, andfeels just as they do. Egocentric children are not able to infer the perspective of other people andinstead attribute their own perspective to situations. For example, ten-year-old Keiko’s birthday
is coming up, so her mom takes 3-year-old Kenny to the toy store to choose a present for his
sister. He selects an Iron Man action figure for her, thinking that if he likes the toy, his sister will
too.
Piaget’s classic experiment on egocentrism involved showing
children a three-dimensional model of a mountain and asking
them to describe what a doll that is looking at the mountainfrom a different angle might see (see Figure 4.9). Children
tend to choose a picture that represents their own, rather thanthe doll’s view. By age 7 children are less self-centered.
However, even younger children when speaking to others tend
to use different sentence structures and vocabulary whenaddressing a younger child or an older adult. This indicatessome awareness of the views of others.

Figure 4.9 “What does
Dolly see?”

Conservation Errors: Conservation refers to the ability to
Sourcerecognize that moving or rearranging matter does not change
the quantity. Using Kenny and Keiko again, dad gave a slice of pizza to 10-year-old Keiko andanother slice to 3-year-old Kenny. Kenny’s pizza slice was cut into five pieces, so Kenny told his
sister that he got more pizza than she did. Kenny did not understand that cutting the pizza into smaller
pieces did not increase the overall amount. This was because Kenny exhibited centration or focused on
only one characteristic of an object to the exclusion of others. Kenny focused on the five pieces of pizza to
his sister’s one piece even though the total amount was the same. Keiko was able to consider several
characteristics of an object than just one. Because children have not developed this understanding ofconservation, they cannot perform mental operations.

124

The classic Piagetian experiment
Figure 4.10 Conservation of Liquid. Does
associated with conservation involves
pouring liquid in a tall, narrow container make itliquid (Crain, 2005). As seen in Figure
have more?
4.10, the child is shown two glasses(as shown in a) which are filled to thesame level and asked if they have thesame amount. Usually the childagrees they have the same amount.
The experimenter then pours the liquid
in one glass to a taller and thinner
glass (as shown in b). The child isagain asked if the two glasses have thesame amount of liquid. The
preoperational child will typically say
the taller glass now has more liquid because it is taller (as shown in c). The child has centrated
on the height of the glass and fails to conserve.
Classification Errors: Preoperational children have difficulty understanding that an object can
be classified in more than one way. For example, if shown three white buttons and four black
buttons and asked whether there are more black buttons or buttons, the child is likely to respondthat there are more black buttons. They do not consider the general class of buttons. Because
young children lack these general classes, their reasoning is typically transductive, that is,making faulty inferences from one specific example to another. For example, Piaget’s daughter
Lucienne stated she had not had her nap, therefore it was not afternoon. She did not understandthat afternoons are a time period and her nap was just one of many events that occurred in theafternoon (Crain, 2005). As the child’s vocabulary improves and more schemata are developed,
the ability to classify objects improves.
Animism: Animism refers to attributing life-like qualities to objects. The cup is alive, the chairthat falls down and hits the child’s ankle is mean, and the toys need to stay home because they
are tired. Cartoons frequently show objects that appear alive and take on lifelike qualities.
Young children do seem to think that objects that move may be alive, but after age three, they
seldom refer to objects as being alive (Berk, 2007).
Critique of Piaget: Similar to the critique of the sensorimotor period, several psychologists
have attempted to show that Piaget also underestimated the intellectual capabilities of thepreoperational child. For example, children’s specific experiences can influence when they areable to conserve. Children of pottery makers in Mexican villages know that reshaping clay does
not change the amount of clay at much younger ages than children who do not have similar
experiences (Price-Williams, Gordon, & Ramirez, 1969). Crain (2005) indicated thatpreoperational children can think rationally on mathematical and scientific tasks, and they are notas egocentric as Piaget implied. Research on Theory of Mind (discussed later in the chapter) has
demonstrated that children overcome egocentrism by 4 or 5 years of age, which is sooner than
Piaget indicated.

125

Vygotsky’s Sociocultural Theory of Cognitive Development
Figure 4.11 Lev Vygotsky

Lev Vygotsky (1896-1934) was a Russian psychologist who
argued that culture has a major impact on a child’s cognitive
development. Piaget and Gesell believed development
stemmed directly from the child, and although Vygotsky
acknowledged intrinsic development, he argued that it is thelanguage, writings, and concepts arising from the culture thatelicit the highest level of cognitive thinking (Crain, 2005). He
believed that the social interactions with adults and morelearned peers can facilitate a child’s potential for learning.
Without this interpersonal instruction, he believed children’s
minds would not advance very far as their knowledge would
be based only on their own discoveries. Some of Vygotsky’s
key concepts are described below.

Zone of Proximal Development and Scaffolding:
Vygotsky’s best-known concept is the zone of proximal
development (ZPD). Vygotsky stated that children should be taught in the ZPD, which occurs
when they can almost perform a task, but not quite on their own without assistance. With theright kind of teaching, however, they can accomplish it successfully. A good teacher identifies achild’s ZPD and helps the child stretch beyond it. Then the adult (teacher) gradually withdraws
support until the child can then perform the task unaided. Researchers have applied the metaphorof scaffolds (the temporary platforms on which construction workers stand) to this way ofteaching. Scaffolding is the temporary support that parents or teachers give a child to do a task.
SourcePrivate Speech: Do you ever talk to yourself? Why? Chances are, this occurs when you are
struggling with a problem, trying to remember something, or feel very emotional about asituation. Children talk to themselves too. Piaget interpreted this as egocentric speech or speechthat is focused on the child and does not include another’s point of view.
Vygotsky, however, believed that children talk tothemselves in order to solve problems or clarify
thoughts. As children learn to think in words, they doso aloud before eventually closing their lips andengaging in private speech or inner speech.
Thinking out loud eventually becomes thought
accompanied by internal speech and talking to oneself
becomes a practice only engaged in when we aretrying to learn something or remember
something. This inner speech is not as elaborate as
the speech we use when communicating with others(Vygotsky, 1962).

126

Figure 4.12 Children talk tothemselves to better problem solve

SourceContrast with Piaget: Piaget was highly critical of teacher-directed instruction believing thatteachers who take control of the child’s learning place the child into a passive role (Crain, 2005).
Further, teachers may present abstract ideas without the child’s true understanding, and instead
they just repeat back what they heard. Piaget believed children must be given opportunities todiscover concepts on their own. As previously stated, Vygotsky did not believe children could
reach a higher cognitive level without instruction from more learned individuals. Who iscorrect? Both theories certainly contribute to our understanding of how children learn.

Information Processing
Information processing researchers have focused on several issues in cognitive development forthis age group, including improvements in attention skills, changes in the capacity and theemergence of executive functions in working memory. Additionally, in early childhood memory
strategies, memory accuracy, and autobiographical memory emerge. Early childhood is seen by
many researchers as a crucial time period in memory development (Posner & Rothbart, 2007).

Attention
Changes in attention have been described by many as the key to changes in human memory(Nelson & Fivush, 2004; Posner & Rothbart, 2007). However, attention is not a unified
function; it is comprised of sub-processes. The ability to switch our focus between tasks or
external stimuli is called divided attention or multitasking. This is separate from our ability tofocus on a single task or stimulus, while ignoring distracting information, called selective
attention. Different from these is sustained attention, or the ability to stay on task for long
periods of time. Moreover, we also have attention processes that influence our behavior andenable us to inhibit a habitual or dominant response, and others that enable us to distractourselves when upset or frustrated.

Figure 4.13 These children
will experience difficulty
focusing on anything except
playing

SourceDivided Attention: Young children (age 3-4) haveconsiderable difficulties in dividing their attention
between two tasks, and often perform at levels equivalent
to our closest relative, the chimpanzee, but by age five
they have surpassed the chimp (Hermann, Misch,
Hernandez-Lloreda & Tomasello, 2015; Hermann &Tomasello, 2015). Despite these improvements, 5-yearolds continue to perform below the level of school-age
children, adolescents, and adults.
Selective Attention: Children’s ability with selective
attention tasks improve as they age. However, this ability
is also greatly influenced by the child’s temperament(Rothbart & Rueda, 2005), the complexity of the stimulus
or task (Porporino, Shore, Iarocci & Burack, 2004), andalong with whether the stimuli are visual or auditory(Guy, Rogers & Cornish, 2013). Guy et al. found thatchildren’s ability to selectively attend to visual127information outpaced that of auditory stimuli. This may explain why young children are not able
to hear the voice of the teacher over the cacophony of sounds in the typical preschool classroom(Jones, Moore & Amitay, 2015). Jones and his colleagues found that 4 to 7-year-olds could notfilter out background noise, especially when its frequencies were close in sound to the target
sound. In comparison, 8 to 11-year-old older children often performed similar to adults.
Sustained Attention: Most measures of sustained attention typically ask children to spend
several minutes focusing on one task, while waiting for an infrequent event, while there are
multiple distractors for several minutes. Berwid, Curko-Kera, Marks and Halperin (2005) asked
children between the ages of 3 and 7 to push a button whenever a “target” image was displayed,
but they had to refrain from pushing the button when a non-target image was shown. The
younger the child, the more difficulty he or she had maintaining their attention.

MemoryBased on studies of adults, people with amnesia, and neurological research on memory,
researchers have proposed several “types” of memory (see Figure 4.14). Sensory memory (alsocalled the sensory register) is the first stage of the memory system, and it stores sensory input in
its raw form for a very brief duration; essentially long enough for the brain to register and start
processing the information. Studies of auditory sensory memory have found that the sensory
memory trace for the characteristics of a tone last about one second in 2-year-olds, two seconds
in 3-year-olds, more than two seconds in 4-year-olds and three to five seconds in 6-year-olds(Glass, Sachse, & vob Suchodoletz, 2008). Other researchers have found that young children
hold sounds for a shorter duration than do older children and adults, and that this deficit is notdue to attentional differences between these age groups but reflect differences in the performanceof the sensory memory system (Gomes et al., 1999).

Figure 4.14

128

The second stage of the memory system is called short-term or working memory. Working
memory is the component of memory in which current conscious mental activity occurs.
Working memory often requires conscious effort and adequate use of attention to function
effectively. As you read earlier, children in this age group struggle with many aspects ofattention, and this greatly diminishes their ability to consciously juggle several pieces of
information in memory. The capacity of working memory, that is the amount of information
someone can hold in consciousness, is smaller in young children than in older children and adults(Galotti, 2018). The typical adult and teenager can hold a 7-digit number active in their shortterm memory. The typical 5-year-old can hold only a 4-digit number active. This means that themore complex a mental task is, the less efficient a younger child will be in paying attention to,and actively processing, information in order to complete the task.
Changes in attention and the working memory system also involve changes in executivefunction. Executive function (EF) refers to self-regulatory processes, such as the ability toinhibit a behavior or cognitive flexibility, that enable adaptive responses to new situations or toreach a specific goal. Executive function skills gradually emerge during early childhood andcontinue to develop throughout childhood and adolescence. Like many cognitive changes, brain
maturation, especially the prefrontal cortex, along with experience influence the development ofexecutive function skills. Children show higher executive function skills when parents are warm
and responsive, use scaffolding when the child is trying to solve a problem, and provide
cognitively stimulating environments (Fay-Stammbach, Hawes & Meredith, 2014). For
instance, scaffolding was positively correlated with greater cognitive flexibility at age two andinhibitory control at age four (Bibok, Carpendale & Müller, 2009).
Older children and adults use mental strategies to aid their memory performance. For instance,
simple rote rehearsal may be used to commit information to memory. Young children often do
not rehearse unless reminded to do so, and when they do rehearse, they often fail to use
clustering rehearsal. In clustering rehearsal, the person rehearses previous material while
adding in additional information. If a list of words is read out loud to you, you are likely torehearse each word as you hear it along with any previous words you were given. Youngchildren will repeat each word they hear, but often fail to repeat the prior words in the list. In
Schneider, Kron-Sperl and Hunnerkopf’s (2009) longitudinal study of 102 kindergarten children,the majority of children used no strategy to remember information, a finding that was consistent
with previous research. As a result, their memory performance was poor when compared to theirabilities as they aged and started to use more effective memory strategies.
The third component in memory is long-term memory, which is also known as permanent
memory. A basic division of long-term memory is between declarative and non-declarative
memory. Declarative memories, sometimes referred to as explicit memories, are memories forfacts or events that we can consciously recollect. Non-declarative memories, sometimes
referred to as implicit memories, are typically automated skills that do not require conscious
recollection. Remembering that you have an exam next week would be an example of adeclarative memory. In contrast, knowing how to walk so you can get to the classroom or how
to hold a pencil to write would be examples of non-declarative memories. Declarative memory
is further divided into semantic and episodic memory. Semantic memories are memories forfacts and knowledge that are not tied to a timeline, while episodic memories are tied to specific
events in time.
129

Figure 4.15 How long willthese children remember
their trip to Disneyland?

SourceA component of episodic memory is autobiographicalmemory, or our personal narrative. As you may recall in
Chapter 3, the concept of infantile amnesia was introduced.
Adults rarely remember events from the first few years oflife. In other words, we lack autobiographical memories
from our experiences as an infant, toddler and very youngpreschooler. Several factors contribute to the emergence ofautobiographical memory, including brain maturation,
improvements in language, opportunities to talk about
experiences with parents and others, the development oftheory of mind, and a representation of “self” (Nelson &Fivush, 2004). Two-year-olds do remember fragments ofpersonal experiences, but these are rarely coherent accountsof past events (Nelson & Ross, 1980). Between 2 and 2 ½
years of age children can provide more information aboutpast experiences. However, these recollections requireconsiderable prodding by adults (Nelson & Fivush, 2004).
Over the next few years, children will form more detailed
autobiographical memories and engage in more reflection of
the past.

Neo-Piagetians
As previously discussed, Piaget’s theory has been criticized on many fronts, and updates toreflect more current research have been provided by the Neo-Piagetians, or those theorists who
provide “new” interpretations of Piaget’s theory. Morra, Gobbo, Marini and Sheese (2008)
reviewed Neo-Piagetian theories, which were first presented in the 1970s, and identified how
these “new” theories combined Piagetian concepts with those found in Information Processing.
Similar to Piaget’s theory, Neo-Piagetian theories believe in constructivism, assume cognitive
development can be separated into different stages with qualitatively different characteristics,
and advocate that children’s thinking becomes more complex in advanced stages. Unlike Piaget,
Neo-Piagetians believe that aspects of information processing change the complexity of eachstage, not logic as determined by Piaget.
Neo-Piagetians propose that working memory capacity is affected by biological maturation, andtherefore restricts young children’s ability to acquire complex thinking and reasoning skills.
Increases in working memory performance and cognitive skills development coincide with thetiming of several neurodevelopmental processes. These include myelination, axonal andsynaptic pruning, changes in cerebral metabolism, and changes in brain activity (Morra et al.,2008). Myelination especially occurs in waves between birth and adolescence, and the degree of
myelination in particular areas explains the increasing efficiency of certain skills. Therefore,
brain maturation, which occurs in spurts, affects how and when cognitive skills develop.
Additionally, all Neo-Piagetian theories support that experience and learning interact withbiological maturation in shaping cognitive development.

130Children’s Understanding of the World
Both Piaget and Vygotsky believed that children actively try to understand the world aroundthem, referred to as constructivism. However, Piaget is identified as a cognitive
constructivitst, which focuses on independent learning, while Vygotsky is a social constrctivist
relying on social interactions for learning. More recently developmentalists have added to thisunderstanding by examining how children organize information and develop their own theories
about the world.
Theory-Theory is the tendency ofchildren to generate theories to
Figure 4.16
explain everything they encounter.
This concept implies that humans
are naturally inclined to findreasons and generate explanations
for why things occur. Children
frequently ask question about what
they see or hear around them.
When the answers provided do notsatisfy their curiosity or are toocomplicated for them to understand,they generate their own theories. In
much the same way that scientists
construct and revise their theories,
Sourcechildren do the same with theirintuitions about the world as theyencounter new experiences (Gopnik & Wellman, 2012). One of the theories they start to generatein early childhood centers on the mental states; both their own and those of others.
Theory of mind refers to the ability to think about other people’s thoughts. This mental mind
reading helps humans to understand and predict the reactions of others, thus playing a crucialrole in social development. One common method for determining if a child has reached thismental milestone is the false belief task. The research began with a clever experiment by
Wimmer and Perner (1983), who tested whether children can pass a false-belief test (see Figure4.17). The child is shown a picture story of Sally, who puts her ball in a basket and leaves theroom. While Sally is out of the room, Anne comes along and takes the ball from the basket andputs it inside a box. The child is then asked where Sally thinks the ball is located when she
comes back to the room. Is she going to look first in the box or in the basket? The right answer isthat she will look in the basket, because that is where she put it and thinks it is; but we have toinfer this false belief against our own better knowledge that the ball is in the box. This is very
difficult for children before the age of four because of the cognitive effort it takes. Three-yearolds have difficulty distinguishing between what they once thought was true and what they now
know to be true. They feel confident that what they know now is what they have always known(Birch & Bloom, 2003). Even adults need to think through this task (Epley, Morewedge, &Keysar, 2004). To be successful at solving this type of task the child must separate what he or
she “knows” to be true from what someone else might “think” is true.
131

In Piagetian terms, children must give up atendency toward egocentrism. The child mustalso understand that what guides people’s
actions and responses are what they believe
rather than what is reality. In other words,
people can mistakenly believe things that are
false and will act based on this false knowledge.
Consequently, prior to age four children are
rarely successful at solving such a task
(Wellman, Cross & Watson, 2001).

Figure 4. 17

Researchers examining the development oftheory of mind have been concerned by theoveremphasis on the mastery of false belief as
the primary measure of whether a child has
attained theory of mind. Two-year-olds
understand the diversity of desires, yet as noted
earlier it is not until age four or five thatchildren grasp false belief, and often not until
middle childhood do they understand thatpeople may hide how they really feel. In part,
because children in early childhood havedifficulty hiding how they really feel. Wellman
and his colleagues (Wellman, Fang, Liu, Zhu &Liu, 2006) suggest that theory of mind iscomprised of a number of components, eachwith its own developmental timeline (see Table
4.2).
Those in early childhood in the US, Australia,
and Germany develop theory of mind in the
Sourcesequence outlined in Table 4.2. Yet, Chineseand Iranian preschoolers acquire knowledge access before diverse beliefs (Shahaeian, Peterson,
Slaughter & Wellman, 2011). Shahaeian and colleagues suggested that cultural differences inchild-rearing may account for this reversal. Parents in collectivistic cultures, such as China andIran, emphasize conformity to the family and cultural values, greater respect for elders, and theacquisition of knowledge and academic skills more than they do autonomy and social skills(Frank, Plunkett & Otten, 2010). This could reduce the degree of familial conflict of opinions
expressed in the family. In contrast, individualistic cultures encourage children to think forthemselves and assert their own opinion, and this could increase the risk of conflict in beliefs
being expressed by family members. As a result, children in individualistic cultures would
acquire insight into the question of diversity of belief earlier, while children in collectivistic
cultures would acquire knowledge access earlier in the sequence. The role of conflict in aiding
the development of theory of mind may account for the earlier age of onset of an understandingof false belief in children with siblings, especially older siblings (McAlister & Petersen, 2007;
Perner, Ruffman & Leekman, 1994).
132

Table 4.2 Components of Theory of Mind
Component

Description

Diverse-desires

Understanding that two people may have different desires
regarding the same object.
Understanding that two people may hold different beliefs
about an object.
Understanding that people may or may not have access to
information.
Understanding that someone might hold a belief based on
false information.
Understanding that people may not always express theirtrue emotions.

Diverse-beliefs
Knowledge access(knowledge/ignorance)
False belief
Hidden emotion

This awareness of the existence of theory of mind is part of social intelligence, such asrecognizing that others can think differently about situations. It helps us to be self-conscious oraware that others can think of us in different ways and it helps us to be able to be understanding
or be empathic toward others. Moreover, this mind reading ability helps us to anticipate andpredict people’s actions. The awareness of the mental states of others is important forcommunication and social skills.

Language Development
Vocabulary growth: A child’s vocabulary expands between the ages of two to six from about
200 words to over 10,000 words. This “vocabulary spurt” typically involves 10-20 new words
per week and is accomplished through a process called fast-mapping. Words are easily learned
by making connections between new words and concepts already known. The parts of speech thatare learned depend on the language and what is emphasized. Children speaking verb-friendly
languages, such as Chinese and Japanese, learn verbs more readily, while those speaking English
tend to learn nouns more readily. However, those learning less verb-friendly languages, such as
English, seem to need assistance in grammar to master the use of verbs (Imai et al., 2008).
Literal meanings: Children can repeat words and phrases after having heard them only once or
twice, but they do not always understand the meaning of the words or phrases. This is especiallytrue of expressions or figures of speech which are taken literally. For example, a classroom fullof preschoolers hears the teacher say, “Wow! That was a piece of cake!” The children beganasking “Cake? Where is my cake? I want cake!”
Overregularization: Children learn rules of grammar as they learn language but may apply
these rules inappropriately at first. For instance, a child learns to add “ed” to the end of a word toindicate past tense. Then form a sentence such as “I goed there. I doed that.” This is typical atages two and three. They will soon learn new words such as “went” and “did” to be used inthose situations.
The impact of training: Remember Vygotsky and the Zone of Proximal Development?
Children can be assisted in learning language by others who listen attentively, model moreaccurate pronunciations and encourage elaboration. The child exclaims, “I’m goed there!” and133the adult responds, “You went there? Say, ‘I went there.’ Where did you go?” Children may beripe for language as Chomsky suggests, but active participation in helping them learn isimportant for language development as well. The process of scaffolding is one in which theguide provides needed assistance to the child as a new skill is learned.

Bilingualism
Although monolingual speakers often do not realize it, the majority of children around the world
are Bilingual, meaning that they understand and use two languages (Meyers-Sutton, 2005).
Even in the United States, which is a relatively monolingual society, more than 60 million people(21%) speak a language other than English at home (Camarota & Zeigler, 2014; Ryan, 2013).
Children who are dual language learners are one of the fastest growing populations in the UnitedStates (Hammer et al., 2014). They make up nearly 30% of children enrolled in early childhood
programs, like Head Start. By the time they enter school, they are very heterogeneous in theirlanguage and literacy skills, with some children showing delays in being proficient in either one
or both languages (Hammer et al., 2014). Hoff (2018) reports language competency isdependent on the quantity, quality, and opportunity to use a language. Dual language learners
may hear the same number of words and phrases (quantity) overall, as do monolingual children,
but it is split between two languages (Hoff, 2018). Thus, in any single language they may be
exposed to fewer words. They will show higher expressive and receptive skills in the language
they come to hear the most.
In addition, the quality of the languages spoken to the child may differ in bilingual versus
monolingual families. Place and Hoff (2016) found that for many immigrant children in the
United States, most of the English heard was spoken by a non-native speaker of the language.
Finally, many children in bilingual households will sometimes avoid using the family’s heritage
language in favor of the majority language (DeHouwer, 2007, Hoff, 2018). A common pattern in
Spanish-English homes, is for the parents to speak to the child in Spanish, but for the child torespond in English. As a result, children may show little difference in the receptive skills
between English and Spanish, but better expressive skills in English (Hoff, 2018).
There are several studies that have documented the advantages of learning more than one
language in childhood for cognitive executive function skills. Bilingual children consistently
outperform monolinguals on measures of inhibitory control, such as ignoring irrelevant
information (Bialystok, Martin & Viswanathan, 2005). Studies also reveal an advantage forbilingual children on measures of verbal working memory (Kaushanskaya, Gross, & Buac, 2014;
Yoo & Kaushanskaya, 2012) and non-verbal working memory (Bialystok, 2011). However, it
has been reported that among lower SES populations the working memory advantage is notalways found (Bonifacci, Giombini, Beloocchi, & Conteno, 2011).
There is also considerable research to show that being bilingual, either as a child or an adult,
leads to greater efficiency in the word learning process. Monolingual children are strongly
influenced by the mutual-exclusivity bias, the assumption that an object has only a single name
(Kaushanskaya, Gross, & Buac, 2014). For example, a child who has previously learned theword car, may be confused when this object is referred to as an automobile or sedan. Researchshows that monolingual children find it easier to learn the name of a new object, than acquiring a134new name for a previously labelled object. In contrast, bilingual children and adults show little
difficulty with either task (Kaushanskaya & Marian, 2009). This finding may be explained by theexperience bilinguals have in translating between languages when referring to familiar objects.

Preschool
Providing universal preschool has become an important lobbying point for federal, state, andlocal leaders throughout our country. In his 2013 State of the Union address, President Obamacalled upon congress to provide high quality preschool for all children. He continued to support
universal preschool in his legislative agenda, and in December 2014 the President convened
state and local policymakers for the White House Summit on Early Education (White House
Press Secretary, 2014). However, universal preschool covering all four-year olds in the
country would require significant funding. Further, how effective preschools are in preparing
children for elementary school, and what constitutes high quality preschool have been debated.
To set criteria for designation as a high-quality preschool, the National Association for the
Education of Young Children (NAEYC) identifies 10 standards (NAEYC, 2016). These
include:
•
•
•
•
•
•
•
•
•
•

Positive relationships among all children and adults are promoted.
A curriculum that supports learning and development in social, emotional, physical,
language, and cognitive areas.
Teaching approaches that are developmentally, culturally and linguistically appropriate.
Assessment of children’s progress to provide information on learning and development.
The health and nutrition of children are promoted, while they are protected from illness
and injury.
Teachers possess the educational qualifications, knowledge, and commitment to promotechildren’s learning.
Collaborative relationships with families are established and maintained.
Relationships with agencies and institutions in the children’s communities are establishedto support the program’s goals.
The indoor and outdoor physical environments are safe and well-maintained.
Leadership and management personnel are well qualified, effective, and maintainlicensure status with the applicable state agency.

Parents should review preschool programs using the NAEYC criteria as a guide and template forasking questions that will assist them in choosing the best program for their child. Selecting theright preschool is also difficult because there are so many types of preschools available. Zachry(2013) identified Montessori, Waldorf, Reggio Emilia, High Scope, Parent Co-Ops and Bank
Street as types of preschool programs that focus on children learning through discovery.
Teachers act as guides and create activities based on the child’s developmental level.

135

Head Start: For children who live in
Figure 4.18 Four Year Old Head Start Students
poverty, Head Start has been
providing preschool education since
1965 when it was begun by President
Lyndon Johnson as part of his war on
poverty. It currently serves nearly
one million children and annually
costs approximately 7.5 billion
dollars (United States Department of
Health and Human Services, 2015).
However, concerns about theeffectiveness of Head Start have beenongoing since the program began.
Armor (2015) reviewed existing
research on Head Start and foundSourcethere were no lasting gains, and theaverage child in Head Start had notlearned more than children who did not receive preschool education.
A 2015 report evaluating the effectiveness of Head Start comes from the What Works
Clearinghouse. The What Works Clearinghouse identifies research that provides reliable
evidence of the effectiveness of programs and practices in education and is managed by theInstitute of Education Services for the United States Department of Education. After reviewing
90 studies on the effectiveness of Head Start, only one study was deemed scientifically
acceptable and this study showed disappointing results (Barshay, 2015). This study showed that
3-and 4-year-old children in Head Start received “potentially positive effects” on general reading
achievement, but no noticeable effects on math achievement and social-emotional development.
Nonexperimental designs are a significant problem in determining the effectiveness of Head
Start programs because a control group is needed to show group differences that would
demonstrate educational benefits. Because of ethical reasons, low income children are usuallyprovided with some type of pre-school programming in an alternative setting. Additionally, head
Start programs are different depending on the location, and these differences include the lengthof the day or qualification of the teachers. Lastly, testing young children is difficult and strongly
dependent on their language skills and comfort level with an evaluator (Barshay, 2015).

Autism Spectrum Disorder
A greater discussion on disorders affecting children and special educational services to assist
them will occur in Chapter 5. However, because characteristics of Autism Spectrum Disordermust be present in the early developmental period, as established by the Diagnostic andStatistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association (APA),
2013), this disorder will be presented here. So, what exactly is an Autism Spectrum Disorder?
Autism spectrum disorder is probably the most misunderstood and puzzling of theneurodevelopmental disorders. Children with this disorder show signs of significant
disturbances in three main areas: (a) deficits in social interaction, (b) deficits in136

communication, and (c) repetitive patterns of behavior or interests. These disturbances
appear early in life and cause serious impairments in functioning (APA, 2013). The childwith autism spectrum disorder might exhibit deficits in social interaction by not initiating
conversations with other children or turning their head away when spoken to. These children do
not make eye contact with others and seem to prefer playing alone rather than with others. In acertain sense, it is almost as though these individuals live in a personal and isolated socialworld which others are simply not privy to or able to penetrate. Communication deficits canrange from a complete lack of speech, to one-word responses (e.g., saying “Yes” or “No”
when replying to questions or statements that require additional elaboration), to echoedspeech (e.g., parroting what another person says, either immediately or several hours or evendays later), and to difficulty maintaining a conversation because of an inability toreciprocate others’ comments. These deficits can also include problems in using andunderstanding nonverbal cues (e.g., facial expressions, gestures, and postures) that facilitate
normal communication.
Repetitive patterns of behavior or interests can be exhibited a number of ways. The childmight engage in stereotyped, repetitive movements (rocking, head-banging, or repeatedly
dropping an object and then picking it up), or she might show great distress at smallchanges in routine or the environment. For example, the child might throw a temper tantrum
if an object is not in its proper place or if a regularly-scheduled activity is rescheduled. In
some cases, the person with autism spectrum disorder might show highly restricted andfixated interests that appear to be abnormal in their intensity. For instance, the child mightlearn and memorize every detail about something even though doing so serves no apparent
purpose. Importantly, autism spectrum disorder is not the same thing as intellectual disability,
although these two conditions can occur together. The DSM-5 specifies that the symptoms ofautism spectrum disorder are not caused or explained by intellectual disability.
The qualifier “spectrum” in autism spectrum disorderis used to indicate that individuals with the disordercan show a range, or spectrum, of symptoms thatvary in their magnitude and severity: Some severe,others less severe. The previous edition of the DSM
included a diagnosis of Asperger’s disorder, generally
recognized as a less severe form of autistim spectrum
disorder. Individuals diagnosed with Asperger’s
disorder were described as having average or highintelligence and a strong vocabulary, but exhibiting
impairments in social interaction and social
communication, such as talking only about their special
interests (Wing, Gould, & Gillberg, 2011). However,
because research has failed to demonstrate that
SourceAsperger’s disorder differs from autism spectrum
disorder, the DSM-5 does not include it. Some
individuals with autism spectrum disorder, particularly those with better language andintellectual skills, can live and work independently as adults. However, most do not because
the symptoms cause serious impairment in many aspects of life (APA, 2013).
Figure 4.19 Dr. Temple
Grandin, an advocate forindividuals with autism137

To determine current prevalence rates, the Autism and Developmental Disabilities Monitoring(ADDM) Network provides estimates of the prevalence of autism spectrum disorders among 8year-old children who reside within 11 ADM sites in the United States, including Arizona,
Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina,
Tennessee, and Wisconsin (Baio et al., 2018). For 2014 (most recent data), estimates indicatedthat nearly 1 in 59 children in the United States has autism spectrum disorder, and the disorder is
4 times more common in boys (1 out of 38) than girls (1 out of 152).
Rates of autistim spectrum disorder have increased dramatically since the 1980s. For example,
California saw an increase of 273% in reported cases from 1987 through 1998 (Byrd, 2002).
Between 2000 and 2008, the rate of autism diagnoses in the United States increased 78% (CDC,2012) and between 2000 and 2014 the rate increased 150% (Baio et al., 2018). Although it isdifficult to interpret this increase, it is possible that the rise in prevalence is the result of thebroadening of the diagnosis, increased efforts to identify cases in the community, and greaterawareness and acceptance of the diagnosis. In addition, mental health professionals are now
more knowledgeable about autism spectrum disorder and are better equipped to make thediagnosis, even in subtle cases (Novella, 2008).
The exact causes of autism spectrum disorder remain unknown despite massive research
efforts over the last two decades (Meek, Lemery-Chalfant, Jahromi, & Valiente, 2013). Autism
appears to be strongly influenced by genetics, as identical twins show concordance rates of 60%–
90%, whereas concordance rates for fraternal twins and siblings are 5%–10% (Autism Genome
Project Consortium, 2007). Many different genes and gene mutations have been implicated in
autism (Meek et al., 2013). Among the genes involved are those important in the formation ofsynaptic circuits that facilitate communication between different areas of the brain (Gauthieret al., 2011). A number of environmental factors are also thought to be associated withincreased risk for autism spectrum disorder, at least in part, because they contribute to new
mutations. These factors include exposure to pollutants, such as plant emissions and mercury,urban versus rural residence, and vitamin D deficiency (Kinney, Barch, Chayka, Napoleon, &Munir, 2009).
A recent Swedish study looking at the records of over one million children born between 1973
and 2014 found that exposure to prenatal infections increased the risk for autism spectrum
disorders (al-Haddad et al., 2019). Children born to mothers with an infection during pregnancy
has a 79% increased risk of autism. Infections included: sepsis, flu, pneumonia, meningitis,
encephalitis, an infection of the placental tissues or kidneys, or a urinary tract infection. One
possible reason for the autism diagnosis is that the fetal brain is extremely vulnerable to damage
from infections and inflammation. These results highlighted the importance of pregnant
women receiving a flu vaccination and avoiding any infections during pregnancy.
There is no scientific evidence that a link exists between autism and vaccinations (Hughes,
2007). Indeed, a recent study compared the vaccination histories of 256 children with autism
spectrum disorder with that of 752 control children across three time periods during their firsttwo years of life (birth to 3 months, birth to 7 months, and birth to 2 years) (DeStefano, Price, &Weintraub, 2013). At the time of the study, the children were between 6 and 13 years old, andtheir prior vaccination records were obtained. Because vaccines contain immunogens
138

(substances that fight infections), the investigators examined medical records to see how many
immunogens children received to determine if those children who received more immunogens
were at greater risk for developing autism spectrum disorder. The results of this study clearly
demonstrated that the quantity of immunogens from vaccines received during the first two
years of life were not at all related to the development of autism spectrum disorder.

Learning Objectives: Psychosocial Development in Early Childhood
•
•
•
•
•
•
•
•
•
•
•

Describe Erikson’s third stage of initiative vs. guilt
Describe the changes in self-concept and self-esteem
Describe children’s understanding of others
Describe emotional regulation and delayed gratification
Describe young children’s understanding of morality
Summarize the main theories of gender development
Explain the terms transgender, gender dysphoria, and intersex
Describe the major parenting styles and their consequences for children
Describe the role of siblings in children’s development
Summarize the types of play in which children engage
Describe the influence of the media on young children’s social development

Erikson: Initiative vs. Guilt
The trust and autonomy of previous stages develop into a desire to take initiative or to think ofideas and initiative action (Erikson, 1982). Children may want to build a fort with the cushions
from the living room couch or open a lemonade stand in the driveway or make a zoo with theirstuffed animals and issue tickets to those who want to come. Or they may just want to getthemselves ready for bed without any assistance. To reinforce taking initiative, caregivers should
offer praise for the child’s efforts and avoid being critical of messes or mistakes. Placing
pictures of drawings on the refrigerator, purchasing mud pies for dinner, and admiring towers oflegos will facilitate the child’s sense of initiative.

Self-Concept and Self-Esteem
Early childhood is a time of forming an initial sense of self. Self-concept is our self-description
according to various categories, such as our external and internal qualities. In contrast, selfesteem is an evaluative judgment about who we are. The emergence of cognitive skills in thisage group results in improved perceptions of the self. If asked to describe yourself to others you
would likely provide some physical descriptors, group affiliation, personality traits, behavioral
quirks, values, and beliefs. When researchers ask young children the same open-ended question,
the children provide physical descriptors, preferred activities, and favorite possessions. Thus, athree-year-old might describe herself as a three years-old girl with red hair, who likes to playwith legos. This focus on external qualities is referred to as the categorical self.
139

However, even children as young as three know there is more to themselves than these external
characteristics. Harter and Pike (1984) challenged the method of measuring personality with an
open-ended question as they felt that language limitations were hindering the ability of young
children to express their self-knowledge. They suggested a change to the method of measuring
self-concept in young children, whereby researchers provide statements that ask whether
something is true of the child (e.g., “I like to boss people around”, “I am grumpy most of thetime”). Consistent with Harter and Pike’s suspicions, those in early childhood answer thesestatements in an internally consistent manner, especially after the age of four (Goodvin, Meyer,
Thompson & Hayes, 2008) and often give similar responses to what others (parents and teachers)
say about the child (Brown, Mangelsdorf, Agathen, & Ho, 2008; Colwell & Lindsey, 2003).
Young children tend to have a generally positive selfimage. This optimism is often the result of a lack ofsocial comparison when making self-evaluations(Ruble, Boggiano, Feldman, & Loeble, 1980), andwith comparison between what the child once could
do to what they can do now (Kemple, 1995).
However, this does not mean that preschool children
are exempt from negative self-evaluations. Preschool
children with insecure attachments to their caregivers
tend to have lower self-esteem at age four (Goodvin
et al., 2008). Maternal negative affect was also foundby Goodwin and her colleagues to produce morenegative self-evaluations in preschool children.

Figure 4.20

SourceSelf-Control
Self-control is not a single phenomenon but is multi-facetted. It includes response initiation,
the ability to not initiate a behavior before you have evaluated all the information, response
inhibition, the ability to stop a behavior that has already begun, and delayed gratification, theability to hold out for a larger reward by forgoing a smaller immediate reward (Dougherty,
Marsh, Mathias, & Swann, 2005). It is in early childhood that we see the start of self-control, aprocess that takes many years to fully develop. In the now classic “Marshmallow Test” (Mischel,Ebbesen, & Zeiss, 1972) children are confronted with the choice of a small immediate reward (amarshmallow) and a larger delayed reward (more marshmallows). Walter Mischel and hiscolleagues over the years have found that the ability to delay gratification at the age of four
predicted better academic performance and health later in life (Mischel, et al., 2011). Selfcontrol is related to executive function, discussed earlier in the chapter. As executive function
improves, children become less impulsive (Traverso, Viterbori, & Usai, 2015).

GenderAnother important dimension of the self is the sense of self as male or female. Preschool aged
children become increasingly interested in finding out the differences between boys and girls,
both physically and in terms of what activities are acceptable for each. While two-year-olds can140

identify some differences and learn whether they are boys or girls, preschoolers become moreinterested in what it means to be male or female. Gender is the cultural, social andpsychological meanings associated with masculinity and feminity (Spears Brown & Jewell,
2018). A person’s sense of self as a member of a particular gender is known as gender identity.
The development of gender identity appears to be due to an interaction among biological, socialand representational influences (Ruble, Martin, & Berenbaum, 2006). Gender roles, or the
expectations associated with being male or female, are learned in one’s culture throughout
childhood and into adulthood.
Gender socialization focuses on what young children
learn about gender from society, including parents, peers,
media, religious institutions, schools, and public policies.
Children learn about what is acceptable for females andmales early, and in fact, this socialization may even begin
the moment a parent learns that a child is on theway. Knowing the sex of the child can conjure up imagesof the child’s behavior, appearance, and potential on thepart of a parent, and this stereotyping continues to guide
perception through life. Consider parents of newborns,
shown a 7-pound, 20-inch baby, wrapped in blue (a color
designating males) describe the child as tough, strong, andangry when crying. Shown the same infant in pink (acolor used in the United States for baby girls), theseparents are likely to describe the baby as pretty, delicate,and frustrated when crying (Maccoby & Jacklin,
1987). Female infants are held more, talked to more
frequently and given direct eye contact, while male infantinteractions are often mediated through a toy or activity.

Figure 4.21 Gender Roles

SourceAs they age, sons are given tasks that take them outside the house and that have to be performed
only on occasion, while girls are more likely to be given chores inside the home, such as
cleaning or cooking that are performed daily. Sons are encouraged to think for themselves when
they encounter problems and daughters are more likely to be given assistance, even when they
are working on an answer. Parents also talk to their children differently according to theirgender. For example, parents talk to sons more in detail about science, and they discuss numbers
and counting twice as often than with daughters (Chang, Sandhofer, & Brown, 2011). How arethese beliefs about behaviors and expectations based on gender transmitted to children?

Theories of Gender Development
One theory of gender development in children is social learning theory, which argues thatbehavior is learned through observation, modeling, reinforcement, and punishment (Bandura,
1997). Children are rewarded and reinforced for behaving in concordance with gender roles thathave been presented to them since birth and punished for breaking gender roles. In addition,social learning theory states that children learn many of their gender roles by modeling the
behavior of adults and older children and, in doing so, develop ideas about what behaviors are141

appropriate for each gender. Cognitive social learning theory also emphasizes reinforcement,
punishment, and imitation, but adds cognitive processes. These processes include attention, selfregulation, and self-efficacy. Once children learn the significance of gender, they regulate theirown behavior based on internalized gender norms (Bussey & Bandura, 1999).
Another theory is that children develop their own conceptions of the attributes associated withmaleness or femaleness, which is referred to as gender schema theory (Bem, 1981). Oncechildren have identified with a particular gender, they seek out information about gender traits,
behaviors, and roles. This theory is more constructivist as children are actively acquiring theirgender. For example, friends discuss what is acceptable for boys and girls, and popularity may
be based on what is considered ideal behavior for their gender.
Developmental intergroup theory states that many of our gender stereotypes are so strong
because we emphasize gender so much in culture (Bigler & Liben, 2007). Developmental
intergroup theory postulates that adults’ heavy focus on gender leads children to pay attention togender as a key source of information about themselves and others, to seek out any possible
gender differences, and to form rigid stereotypes based on gender that are subsequently difficult
to change.

Transgender Children
Many young children do not conform to the gender roles modeled by the culture and even pushback against assigned roles. However, a small percentage of children actively reject the toys,
clothing, and anatomy of their assigned sex and state they prefer the toys, clothing and anatomyof the opposite sex. Approximately 0.3 percent of the United States population identify astransgender or identifying with the gender opposite their natal sex (Olson & Gülgöz, 2018).
Transgender adults have stated that they identified with the opposite gender as soon as they
began talking (Russo, 2016). Some of these children may experience gender dysphoria, or
distress accompanying a mismatch between one’s gender identity and biological sex (APA,
2013), while other children do not experience discomfort regarding their gender identity.
Current research is now looking at those young children who identify as transgender and havesocially transitioned. In 2013, a longitudinal study following 300 socially transitioned
transgender children between the ages of 3 and 12 began (Olson & Gülgöz, 2018). Sociallytransitioned transgender children identify with the gender opposite than the one assigned at birth,and they change their appearance and pronouns to reflect their gender identity. Findings fromthe study indicated that the gender development of these socially transitioned children looked
similar to the gender development of cisgender children, or those whose gender and sex
assignment at birth matched. These socially transitioned transgender children exhibited similar
gender preferences and gender identities as their gender matched peers. Further, these children
who were living everyday according to their gender identity and were supported by theirfamilies, exhibited positive mental health.
Some individuals who identify as transgender are intersex; that is born with either an absence orsome combination of male and female reproductive organs, sex hormones, or sex chromosomes(Jarne & Auld, 2006). In humans, intersex individuals make up more than 150 million people, or142about two percent of the world’s population (Blackless et al., 2000). There are dozens of intersex
conditions, and intersex individuals demonstrate the diverse variations of biological sex. Some
examples of intersex conditions include:•••

Turner syndrome or the absence of, or an imperfect, second X chromosome
Congenital adrenal hyperplasia or a genetic disorder caused by an increased
production of androgens
Androgen insensitivity syndrome or when a person has one X and one Y chromosome,but is resistant to the male hormones or androgens

Greater attention to the rights of children born intersex is occurring in the medical field, andintersex children and their parents should work closely with specialists to ensure these children
develop positive gender identities.
How much does gender matter for children: Starting at birth, children learn the social
meanings of gender from adults and their culture. Gender roles and expectations are especiallyportrayed in children’s toys, books, commercials, video games, movies, television shows andmusic (Khorr, 2017). Therefore, when children make choices regarding their gender
identification, expression, and behavior that may be contrary to gender stereotypes, it isimportant that they feel supported by the caring adults in their lives. This support allows children
to feel valued, resilient, and develop a secure sense of self (American Academy of Pediatricians,2015).

Parenting Styles
Relationships between parents and children continue to play a significant role in children’sdevelopment during early childhood. As children mature, parent-child relationships naturally
change. Preschool and grade-school children are more capable, have their own preferences, andsometimes refuse or seek to compromise with parental expectations. This can lead to greater
parent-child conflict, and how conflict is managed by parents further shapes the quality ofparent-child relationships.
Baumrind (1971) identified a model of parentingthat focuses on the level of control/ expectations thatparents have regarding their children and how
warm/responsive they are. This model resulted infour parenting styles. In general, children develop
greater competence and self-confidence when
parents have high, but reasonable expectations forchildren’s behavior, communicate well with them,
are warm, loving and responsive, and use reasoning,rather than coercion as preferred responses tochildren’s misbehavior. This kind of parenting stylehas been described as authoritative (Baumrind,2013). Authoritative parents are supportive andshow interest in their kids’ activities but are not
143

Figure 4.22 Authoritative Parenting

Sourceoverbearing and allow them to make constructive mistakes. Parents allow negotiation whereappropriate, and consequently this type of parenting is considered more democratic.
Authoritarian is the traditional model of parenting in which parents make the rules andchildren are expected to be obedient. Baumrind suggests that authoritarian parents tend to placematurity demands on their children that are unreasonably high and tend to be aloof anddistant. Consequently, children reared in this way may fear rather than respect their parents and,because their parents do not allow discussion, may take out their frustrations on safer targetsperhaps as bullies toward peers.
Permissive parenting involves holding expectations of children that are below what could bereasonably expected from them. Children are allowed to make their own rules and determine
their own activities. Parents are warm and communicative but provide little structure for theirchildren. Children fail to learn self-discipline and may feel somewhat insecure because they do
not know the limits.
Uninvolved parents are disengaged from their children. They do not make demands on theirchildren and are non-responsive. These children can suffer in school and in their relationships
with their peers (Gecas & Self, 1991).
Keep in mind that most parents do not follow any model completely. Real people tend to fall
somewhere in between these styles. Sometimes parenting styles change from one child to thenext or in times when the parent has more or less time and energy for parenting. Parenting styles
can also be affected by concerns the parent has in other areas of his or her life. For example,
parenting styles tend to become more authoritarian when parents are tired and perhaps moreauthoritative when they are more energetic. Sometimes parents seem to change their parenting
approach when others are around, maybe because they become more self-conscious as parents orare concerned with giving others the impression that they are a “tough” parent or an “easygoing” parent. Additionally, parenting styles may reflect the type of parenting someone saw
modeled while growing up. See Table 4.3 for Baumrind’s parenting style descriptions.
Table 4.3 Comparison of Four Parenting Styles

144

Culture: The impact of culture and class cannot be ignored when examining parenting
styles. The model of parenting described above assumes that the authoritative style is the best
because this style is designed to help the parent raise a child who is independent, self-reliant andresponsible. These are qualities favored in “individualistic” cultures such as the United States,
particularly by the middle class. However, in “collectivistic” cultures such as China or Korea,
being obedient and compliant are favored behaviors. Authoritarian parenting has been usedhistorically and reflects cultural need for children to do as they are told. African-American,
Hispanic and Asian parents tend to be more authoritarian than non-Hispanic whites. In societies
where family members’ cooperation is necessary for survival, rearing children who are
independent and who strive to be on their own makes no sense. However, in an economy basedon being mobile in order to find jobs and where one’s earnings are based on education, raising achild to be independent is very important.
In a classic study on social class and parenting styles, Kohn (1977) explains that parents tend toemphasize qualities that are needed for their own survival when parenting their children.
Working class parents are rewarded for being obedient, reliable, and honest in their jobs. They
are not paid to be independent or to question the management; rather, they move up and areconsidered good employees if they show up on time, do their work as they are told, and can becounted on by their employers. Consequently, these parents reward honesty and obedience intheir children. Middle class parents who work as professionals are rewarded for taking initiative,
being self-directed, and assertive in their jobs. They are required to get the job done without
being told exactly what to do. They are asked to be innovative and to work independently. These
parents encourage their children to have those qualities as well by rewarding independence andself-reliance. Parenting styles can reflect many elements of culture.

Spanking
Spanking is often thought of as a rite of passage for children, and this method of discipline
continues to be endorsed by the majority of parents (Smith, 2012). Just how effective isspanking, however, and are there any negative consequences? After reviewing the research,
Smith (2012) states “many studies have shown that physical punishment, including spanking,hitting and other means of causing pain, can lead to increased aggression, antisocial behavior,
physical injury and mental health problems for children” (p. 60). Gershoff, (2008) reviewed
decades of research and recommended that parents and caregivers make every effort to avoid
physical punishment and called for the banning of physical discipline in all U.S. schools.
In a longitudinal study that followed more than 1500 families from 20 U.S. cities, parents’reports of spanking were assessed at ages three and five (MacKenzie, Nicklas, Waldfogel, &Brooks-Gunn, 2013). Measures of externalizing behavior and receptive vocabulary wereassessed at age nine. Results indicated that those children who were spanked at least twice aweek by their mothers scored 2.66 points higher on a measure of aggression and rule-breaking
than those who were never spanked. Additionally, those who were spanked less, still scored 1.17
points higher than those never spanked. When fathers did the spanking, those spanked at least
two times per week scored 5.7 points lower on a vocabulary test than those never spanked. This
study revealed the negative cognitive effects of spanking in addition to the increase in aggressive
behavior.
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Internationally, physical discipline is increasingly being viewed as a violation of children’s
human rights. According to Save the Children (2019), 46 countries have banned the use ofphysical punishment, and the United Nations Committee on the Rights of the Child (2014) calledphysical punishment “legalized violence against children” and advocated that physicalpunishment be eliminated in all settings.
Many alternatives to spanking are advocated by child development specialists and include:• Praising and modeling appropriate behavior• Providing time-outs for inappropriate behavior• Giving choices• Helping the child identify emotions and learning to calm down
• Ignoring small annoyances• Withdrawing privileges

Sibling Relationships
Siblings spend a considerable amount of time with eachother and offer a unique relationship that is not foundwith same-age peers or with adults. Siblings play animportant role in the development of social skills.
Cooperative and pretend play interactions between
younger and older siblings can teach empathy, sharing,and cooperation (Pike, Coldwell, & Dunn, 2005), as wellas, negotiation and conflict resolution (Abuhatoum &Howe, 2013). However, the quality of sibling
relationships is often mediated by the quality of the
Source:parent-child relationship and the psychologicaladjustment of the child (Pike et al., 2005). For instance,
more negative interactions between siblings have been reported in families where parents hadpoor patterns of communication with their children (Brody, Stoneman, & McCoy, 1994).
Children who have emotional and behavioral problems are also more likely to have negativeinteractions with their siblings. However, the psychological adjustment of the child cansometimes be a reflection of the parent-child relationship. Thus, when examining the quality ofsibling interactions, it is often difficult to tease out the separate effect of adjustment from theeffect of the parent-child relationship.
Figure 4.23

While parents want positive interactions between their children, conflicts are going to arise, andsome confrontations can be the impetus for growth in children’s social and cognitive skills. The
sources of conflict between siblings often depend on their respective ages. Dunn and Munn
(1987) revealed that over half of all sibling conflicts in early childhood were disputes aboutproperty rights. By middle childhood this starts shifting toward control over social situation,such as what games to play, disagreements about facts or opinions, or rude behavior (Howe,
Rinaldi, Jennings, & Petrakos, 2002). Researchers have also found that the strategies children
use to deal with conflict change with age, but this is also tempered by the nature of the conflict.
Abuhatoum and Howe (2013) found that coercive strategies (e.g., threats) were preferred when146the dispute centered on property rights, while reasoning was more likely to be used by older
siblings and in disputes regarding control over the social situation. However, younger siblings
also use reasoning, frequently bringing up the concern of legitimacy (e.g., “You’re not the boss”)
when in conflict with an older sibling. This is a very common strategy used by younger siblings
and is possibly an adaptive strategy in order for younger siblings to assert their autonomy(Abuhatoum & Howe, 2013). A number of researchers have found that children who can use
non-coercive strategies are more likely to have a successful resolution, whereby a compromise isreached and neither child feels slighted (Ram & Ross, 2008; Abuhatoum & Howe, 2013). Not
surprisingly, friendly relationships with siblings often lead to more positive interactions withpeers. The reverse is also true. A child can also learn to get along with a sibling, with, as thesong says, “a little help from my friends” (Kramer & Gottman, 1992).

Play
Freud saw play as a means for children to release
Figure 4.24 Which type of play are
pent-up emotions and to deal with emotionallythese two boys engaging in?
distressing situations in a more secure environment.
Vygotsky and Piaget saw play as a way of children
developing their intellectual abilities (Dyer &Moneta, 2006). All three theorists saw play asproviding positive outcomes for children. Parten(1932) observed two to five-year-old children andnoted six types of play: Three labeled as non-social
play (unoccupied, solitary, and onlooker) and three
categorized as social play (parallel, associative, andSourcecooperative). Table 4.4 describes each type of play.
Younger children engage in non-social play morethan those older; by age five associative and cooperative play are the most common forms ofplay (Dyer & Moneta, 2006).
Table 4.4 Parten’s Classification of Types of Play in Preschool Children
Category

Description

Unoccupied PlayChildren’s behavior seems more random and without a specificgoal. This is the least common form of play.
Children play by themselves, do not interact with others, nor are
they engaging in similar activities as the children around them.
Children are observing other children playing. They may commenton the activities and even make suggestions but will not directly
join the play.
Children play alongside each other, using similar toys, but do notdirectly act with each other.
Children will interact with each other and share toys but are notworking toward a common goal.
Children are interacting to achieve a common goal. Children may
take on different tasks to reach that goal.

Solitary Play
Onlooker Play

Parallel Play
Associative Play
Cooperative Play147

Box 4.2 Imaginary Companions
An intriguing occurrence in early childhood is the
emergence of imaginary companions.
Researchers differ in how they define what
qualifies as an imaginary companion. Somestudies include only invisible characters that thechild refers to in conversation or plays with for an
extended period of time. Other researchers also
include objects that the child personifies, such asa stuffed toy or doll, or characters the child
impersonates every day. Estimates of the numberof children who have imaginary companions
varies greatly (from as little as 6% to as high as65%) depending on what is included in thedefinition (Gleason, Sebanc, & Hartup, 2000).

Figure 4.25

SourceLittle is known about why children create
imaginary companions, and more than half of allcompanions have no obvious trigger in the child’s life (Masih, 1978). Imaginary companions are
sometimes based on real people, characters from stories, or simply names the child has heard (Gleason,
et. al., 2000). Imaginary companions often change over time. In their study, Gleason et al. (2000)
found that 40% of the imaginary companions of the children they studied changed, such as developing
superpowers, switching age, gender, or even dying, and 68% of the characteristics of the companion
were acquired over time. This could reflect greater complexity in the child’s “creation” over time
and/or a greater willingness to talk about their imaginary playmates.
In addition, research suggests that contrary to the assumption that children with imaginary companions
are compensating for poor social skills, several studies have found that these children are very sociable(Mauro, 1991; Singer & Singer, 1990; Gleason, 2002). However, studies have reported that children
with imaginary companions are more likely to be first-borns or only-children (Masih, 1978; Gleason etal., 2000, Gleason, 2002). Although not all research has found a link between birth order and theincidence of imaginary playmates (Manosevitz, Prentice, & Wilson, 1973). Moreover, some studies
have found little or no difference in the presence of imaginary companions and parental divorce(Gleason et al., 2000), number of people in the home, or the amount of time children are spending withreal playmates (Masih, 1978; Gleason & Hohmann, 2006).
Do children treat real friends differently? The answer appears to be not really. Young children view
their relationship with their imaginary companion to be as supportive and nurturing as with their real
friends. Gleason has suggested that this might suggest that children form a schema of what is a friend
and use this same schema in their interactions with both types of friends (Gleason, et al., 2000;
Gleason, 2002; Gleason & Hohmann, 2006).

148

Children and the MediaChildren view far more television today than in the
1960s; so much that they have been referred to as
Figure 4.26
Generation M for Media. Almost all American
families have at least one TV set, and half own
three or more (Nielsen Company, 2009). For
children age six and under, two-thirds watch
television every day, usually for two hours(Rideout & Hamel, 2006). Even when involved inother activities, such as playing, there is often a
television on nearby (Christakis, 2009; Kirkorian,Pempek, & Murphy, 2009). Research has
consistently shown that too much television
adversely affects children’s behavior, health, andSourceachievement (Gentile & Walsh, 2002; Robinson,
Wilde, & Navracruz, 2001). Young children areless able to focus on active, hands-on play while the television is on, and background TV cannegatively affect cognitive and language development as well as be linked to attention problems
later in childhood (Schmidt, Pempek, & Kirkorian, 2008; Courage, Murphy, & Goulding, 2010).
An additional concern is the amount of screen time children are getting with smart mobile
devices. While most parents believe that their young children use mobile devices for a variety ofactivities, the children report that they typically use them to play games (Chiong & Schuler,
2010). Studies have reported that young children who have two or more hours per day using
mobile devices show more externalizing behaviors (aggression, tantrums) and inattention(Tamana, et al., 2019), shorter sleep durations and a higher risk of behavioral problems (Wu,2017), and fail to meet developmental milestones in fine and gross motor skills, language, andproblem-solving (Madigan, Browne, Racine, Mori, & Tough, 2019).
Based on research findings, the AAP (2016) suggests that prior to the age of two children should
be engaged in hands-on exploration and social interaction with the real world, rather than thevirtual one. The immaturity of the cognitive functions in infants and toddlers make it difficult
for them to learn from digital media as effectively as they can from caregivers. For instance, it isoften not until 24 months of age that children can learn new words from live-video chatting(Kirkorian, Choi, & Pempek, 2016). Between the ages of 2 and 5 the AAP (2016) suggests thatchildren should be limited to no more than one hour per day of high quality programs that are coviewed with a caregiver to help children to understand what they are viewing. The AAP alsostrongly suggest that parents should avoid using mobile media to soothe their children. The
concern is that using media as a strategy to distract or soothe the child may make it difficult forparents to limit the child’s use of the devices and may inhibit children’s ability to self-regulate
their own emotions.

149

Child Care
In 2018, about 71.5% of mothers of school-aged and 65.1%
Figure 4.27 U.S.
percent of mothers of preschool aged children in the United
Mothers’ Time Spent inStates worked outside the home (Bureau of Labor Statistics,
Child Care 1965-20122019). Since more women have been entering the workplace,there has been a concern that families do not spend as much timewith their children. This, however, is not true. The Economist
Data Team (2017) analyzed data from of ten countries (UnitedStates, Britain, Canada, France, Germany, Denmark, Italy,
Netherlands, Slovenia and Spain) and estimated that the averagemother spent 54 minutes a day caring for children in 1965, but
104 minutes in 2012. Only mothers in France spent last time in2012 than in 1965. Men continue to do less than women at 59
minutes per day in 2012, but they provided more care than in
Source1965 when they averaged only 16 minutes a day. However,differences were found between working-class and middle-classmothers. In 1965 mothers with and without a university education spent about the same amountof time on child care. By 2012 the more educated ones were spending half an hour more perday. See Figure 4.27 for the difference between mothers in the United States who were
university educated (dark blue line) and those who were non-university educated (light blueline).
To evaluate how early child care affects children’s development, the National Institute of Child
Health and Human Development (2006) conducted a longitudinal study. This study is considered
the most comprehensive child care study to date, and it began in 1991 when the children were
one month of age. The study included an economically and ethnically diverse group of 1364
children assessed from 10 sites around the country. By design the study involved single parents,
minority backgrounds, and differing formal education levels. Child care was defined as “anycare provided on a regular basis by someone other than the child’s mother” (p. 4). A regularbasis included more than 10 hours per week. Child care arrangements included: Care from thefather or another relative, care from a caregiver not related to the child in the child’s home, small
group care in the caregiver’s home, and center-based care.
Overall results indicated that children cared for by their mothers did not develop differently thanthose who were cared for by others. Parents and family characteristics were stronger predictorsof child development than child care facilities. Specifically, greater cognitive, language andsocial competence were demonstrated when parents were more educated, had higher incomes,
and provided emotionally supportive and cognitively enriched home environments. When
comparing higher quality child care with lower quality child care differences were noted. Higher
quality care, as measured by adult-to-child ratios, group size, and caregivers’ educational andtraining levels, resulted in higher cognitive performance, better language comprehension andproduction, and higher levels of school readiness. Lower quality care predicted more behavioral
problems and poorer cognitive, language, and school readiness.

150

The higher the teacher to child ratio, themore time the teacher has for
involvement with the children and theless stressed the teacher may be so thatthe interactions can be more relaxed,
stimulating and positive. The morechildren there are in a program, the lessdesirable the program as well. This isbecause the center may be more rigid inrules and structure to accommodate thelarge number of children in thefacility. The physical environment
should be colorful, stimulating, clean,and safe. The philosophy of theorganization and the curriculum
Sourceavailable should be child-centered,positive, and stimulating. Providers
should be trained in early childhood education as well. A majority of states do not require
training for their child care providers. While formal education is not required for a person toprovide a warm, loving relationship to a child, knowledge of a child’s development is useful for
addressing their social, emotional, and cognitive needs in an effective way.
Figure 4.28

By working toward improving the quality of childcare and increasing family-friendly workplacepolicies, such as more flexible scheduling and childcare facilities at places of employment, we
can accommodate families with smaller children and relieve parents of the stress sometimes
associated with managing work and family life.

Child Abuse
The Child Abuse Prevention and Treatment Act (United States Department of Health and Human
Services, 2013) defines Child Abuse and Neglect as: Any recent act or failure to act on the partof a parent or caretaker which results in death, serious physical or emotional harm, sexual
abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious
harm (p. viii). Each state has its own definition of child abuse based on the federal law, and moststates recognize four major types of maltreatment: neglect, physical abuse, psychologicalmaltreatment, and sexual abuse. Each of the forms of child maltreatment may be identified alone,
but they can occur in combination.
Victims of Child Abuse: According to the United States Department of Health and Human
Services (HHS) (2019), during 2017 (the most recent year data has been collected) Child
Protective Services (CPS) agencies received an estimated 4.1 million referrals for abuse
involving approximately 7.5 million children. This is a rate of 31.8 per 1,000 children in thenational population. Professionals made 65.7% of alleged child abuse and neglect reports, andthey included law enforcement (18.3%), educational (19.4%) and social services personnel(11.7%). Nonprofessionals, such as friends, neighbors, and relatives, submitted 17.3% of thereports. Approximately 3.5 million children were the subjects of at least one report.
151

Victims in their first year of life had the highest rate of victimization (25.3 per 1,000 children of
the same age). The majority of victims consisted of three ethnicities: White (44.6%), Hispanic(22.3%), and African-American (20.7%). The greatest percentages of children suffered fromneglect (74.9%) and physical abuse (18.3%), although a child may have suffered from multiple
forms of maltreatment. In 2017 an estimated 1,720 children died from abuse and neglect, and71.8% of all child fatalities were younger than 3 years old. Boys had a higher child fatality rate
(2.68 per 100,000 boys), while girls died of abuse and neglect at a rate of 2.02 per 100,000 girls.
More than 88% of child fatalities were comprised of White (41.9%), African-American (31.5%),
and Hispanic (15.1%) victims (HHS, 2019).
Sexual Abuse: Childhood sexual abuse is defined as any sexual contact between a child and an
adult or a much older child. Incest refers to sexual contact between a child and family
members. In each of these cases, the child is exploited by an older person without regard for thechild's developmental immaturity and inability to understand the sexual behavior (Steele,1986). Research estimates that 1 out of 4 girls and 1 out of 10 boys have been sexually abused(Valente, 2005). The median age for sexual abuse is 8 or 9 years for both boys and girls(Finkelhorn, Hotaling, Lewis, & Smith, 1990). Most boys and girls are sexually abused by amale. Although rates of sexual abuse are higher for girls than for boys, boys may be less likely toreport abuse because of the cultural expectation that boys should be able to take care ofthemselves and because of the stigma attached to homosexual encounters (Finkelhorn et al.,1990). Girls are more likely to be abused by family member and boys by strangers. Sexual abusecan create feelings of self-blame, betrayal, shame and guilt (Valente, 2005). Sexual abuse isparticularly damaging when the perpetrator is someone the child trusts and may lead todepression, anxiety, problems with intimacy, and suicide (Valente, 2005).
Stress on Young Children: Children experience different types of stressors. Normal, everyday
stress can provide an opportunity for young children to build coping skills and poses little risk todevelopment. Even more long-lasting stressful events, such as changing schools or losing a
loved one, can be managed fairly well. Children who experience toxic stress or who live in
extremely stressful situations of abuse over long periods of time can suffer long-lasting
effects. The structures in the midbrain or limbic system, such as the hippocampus and amygdala,can be vulnerable to prolonged stress during early childhood (Middlebrooks & Audage,2008). High levels of the stress hormone cortisol can reduce the size of the hippocampus andaffect the child's memory abilities. Stress hormones can also reduce immunity to disease. The
brain exposed to long periods of severe stress can develop a low threshold making the childhypersensitive to stress in the future.

Adverse Childhood Experiences (ACEs)
The toxic stress that young children endure can have a significant impact on their later lives.
According to Merrick, Ford, Ports, and Guinn (2018), the foundation for lifelong health andwell-being is created in childhood, as positive experiences strengthen biological systems while
adverse experiences can increase mortality and morbidity. All types of abuse, neglect, and otherpotentially traumatic experiences that occur before the age of 18 are referred to as adverse
childhood experiences (ACEs) (CDC, 2019). ACEs have been linked to risky behaviors,chronic health conditions, low life potential and early death, and as the number of ACEs
increase, so does the risk for these results.
152

Figure 4.29

SourceWhen a child experiences strong, frequent, and/or prolonged adversity without adequate adultsupport, the child’s stress response systems can be activated and disrupt the development of thebrain and other organ systems (Harvard University, 2019). Further, ACEs can increase the risk
for stress-related disease and cognitive impairment, well into the adult years. Felitti et al. (1998)
found that those who had experienced four or more ACEs compared to those who had
experienced none, had increased health risks for alcoholism, drug abuse, depression, suicide
attempt, increase in smoking, poor self-rated health, more sexually transmitted diseases, anincrease in physical inactivity and severe obesity. More ACEs showed an increased relationshipto the presence of adult diseases including heart disease, cancer, chronic lung disease, skeletal
fractures, and liver disease. Overall, those with multiple ACEs were likely to have multiple
health risk factors later in life.

153

Figure 4.30 How ACES Affect Children and Adults

SourceSome groups have been found to be at a greater risk for experiencing ACEs. Merrick et al.
(2018) reviewed the results from the 2011-2014 Behavioral Risk Factor Surveillance System,
which included an ACE module consisting of questions adapted from the Centers for Disease
Control and Prevention. Each question was collapsed into one of the eight ACE categories:
physical abuse, emotional abuse, sexual abuse, household mental illness, household substanceuse, household domestic violence, incarcerated household member, and parental separation or
divorce. The results indicated that 25% of the sample had been exposed to three or more ACEs,
and although ACEs were found across all demographic groups, those who identified as Black,
multiracial, lesbian/gay/bisexual, having less than a high school education, being low income,and unemployed experienced significantly higher ACE exposure. Assisting families andproviding children with supportive and responsive adults can help prevent the negative effects of
ACEs.

154

Separating Families at the United States
Figure 4.31 Children in a Detention Center
Border: Thousands of children wereseparated from their parents beginning in
April 2018 as they approached the UnitedStates border by Immigration and Custom
Enforcement (ICE). Children were placed inseparate facilities from their parents when
they were being processed, and they were nottold when they would be reunited. When
enduring stressful situations, separation fromone’s parents can be extremely detrimental toa child (Society for Research in Child
Development (SRCD), 2018). Parental
separations affect children’s stressmanagement systems by changing how the
Sourcebody responds to stress. Long-term stresscan disrupt brain functioning, cognitive
skills, emotional processing, and physiological health. When exposed to stress, children
typically look to their parents for support and care, and parents can reduce children’s stress.
These separated children were already under extreme stress escaping their previous homes, andthen were separated from the individuals who could support them through this process.
Stress from parent separation places children at a higher risk for anxiety, depression, PTSD,
lower IQ, obesity, impaired immune system functioning, and medical conditions (SRCD, 2018).
Even after being reunited, children can experience attachment issues, poorer self-esteem, andphysical and psychological health difficulties. As they age, they continue to exhibit an increased
risk for mental health problems, problems in social interactions, difficulty with adultattachments, poorer stress management, and an increased risk for death. The American
Psychological Association (2019) opposes policies that separate families given the negative
outcomes suffered by children.
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Research in Developmental Disabilities, 32, 768–773.
Wu, X., Tao, S., Rutayisirel, E., Chen, Y., Huang, K., & Tao, F. (2017). The relationship between screen time, nighttime sleep
duration, and behavioural problems in preschool children in China. European Child and Adolescent Psychiatry, 26, 541–
548.
Yoo, J., & Kaushanskaya, M. (2012). Phonological memory in bilinguals and monolinguals. Memory & Cognition, 40, 1314–
1330.
Zachry, A. (2013). 6 Types of Preschool Programs. Retrieved from http://www.parents.com/toddlers-preschoolers/starting preschool/preparing/types-of-preschool-programs/

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Chapter 5: Middle and Late Childhood
Middle and late childhood spans the ages between early childhood and adolescence,
approximately ages 6 to 11. Children gain greater control over the movement of their bodies,
mastering many gross and fine motor skills that eluded the younger child. Changes in the brain
during this age enable not only physical development but contributes to greater reasoning andflexibility of thought. School becomes a big part of middle and late childhood, and it expands
their world beyond the boundaries of their own family. Peers start to take center-stage, often
prompting changes in the parent-child relationship. Peer acceptance also influences children’s
perception of self and may have consequences for emotional development beyond these years.

Learning Objectives: Physical Development in Middle and Late Childhood
•
•
•
•
•

Summarize the overall physical growth
Describe the changes in brain maturation
Describe the positive effects of sports
Describe reasons for a lack of participation in youth sports
Explain current trends regarding being overweight in childhood, the negative
consequences of excess weight, the lack of recognition of being overweight, andinterventions to normalize weight

Physical Development
Overall Physical Growth: Rates of growth generally slow during these years. Typically, a childwill gain about 5-7 pounds a year and grow about 2-3 inches per year (CDC, 2000). They also
tend to slim down and gain muscle strength and lung capacity making it possible to engage instrenuous physical activity for long periods of time. The beginning of the growth spurt, which
occurs prior to puberty, begins two years earlier for females than males. The mean age for the
beginning of the growth spurt for girls is nine, while for boys it is eleven. Children of this age
tend to sharpen their abilities to perform both gross motor skills, such as riding a bike, and fine
motor skills, such as cutting their fingernails. In gross motor skills (involving large muscles)
boys typically outperform girls, while with fine motor skills (small muscles) girls outperform theboys. These improvements in motor skills are related to brain growth and experience during thisdevelopmental period.
Brain Growth: Two major brain growth spurts occur during middle/late childhood (Spreen,
Riser, & Edgell, 1995). Between ages 6 and 8, significant improvements in fine motor skills andeye-hand coordination are noted. Then between 10 and 12 years of age, the frontal lobes become
more developed and improvements in logic, planning, and memory are evident (van der Molen &Molenaar, 1994). Myelination is one factor responsible for these growths. From age 6 to 12, thenerve cells in the association areas of the brain, that is those areas where sensory, motor, andintellectual functioning connect, become almost completely myelinated (Johnson, 2005). This
myelination contributes to increases in information processing speed and the child’s reaction164

time. The hippocampus, responsible for transferring information from the short-term to longterm memory, also show increases in myelination resulting in improvements in memory
functioning (Rolls, 2000). Children in middle to late childhood are also better able to plan,
coordinate activity using both left and right hemispheres of the brain, and to control emotional
outbursts. Paying attention is also improved as the prefrontal cortex matures (Markant &Thomas, 2013).

SportsMiddle childhood seems to be a great time tointroduce children to organized sports, and infact, many parents do. Nearly 3 million
children play soccer in the United States(United States Youth Soccer, 2012). This
activity promises to help children build social
skills, improve athletically and learn a senseof competition. However, it has beensuggested that the emphasis on competition
and athletic skill can be counterproductive andlead children to grow tired of the game andwant to quit. In many respects, it appears thatchildren's activities are no longer children's
activities once adults become involved andSourceapproach the games as adults rather thanchildren. The U. S. Soccer Federation recently advised coaches to reduce the amount of drillingengaged in during practice and to allow children to play more freely and to choose their own
positions. The hope is that this will build on their love of the game and foster their natural
talents.
Figure 5.1

Sports are important for children. Children’s participation in sports has been linked to:•••Higher levels of satisfaction with family and overall quality of life in children
Improved physical and emotional development
Better academic performance

Yet, a study on children’s sports in the United States (Sabo & Veliz, 2008) has found thatgender, poverty, location, ethnicity, and disability can limit opportunities to engage in sports.
Girls were more likely to have never participated in any type of sport (see Figure 5.2). They also
found that fathers may not be providing their daughters as much support as they do their sons.
While boys rated their fathers as their biggest mentor who taught them the most about sports,
girls rated coaches and physical education teachers as their key mentors. Sabo and Veliz also
found that children in suburban neighborhoods had a much higher participation of sports thanboys and girls living in rural or urban centers. In addition, Caucasian girls and boys participatedin organized sports at higher rates than minority children (see Figure 5.3).

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Figure 5.2 Participation in Organized and Team Sports (Percent) by Gender

Girls

Boys
Never
Participated

18
13
69

Never
Participated13
12

Dropped Out
Current
Participation

Dropped Out
Current
Participant

75

Total girls (n=1051). Total boys (n=1081)

Figure 5.3 Percent of students participating in Organized Sports, by Gender, Raceand Ethnicity

Girls

Boys
Caucasian

Caucasian

8

13

17
15

AfricanAmerican
60

AfricanAmerican

16
56

Hispanic

16

Asian

Hispanic
AsianGirls – Caucasian (n=425); African-American (n=106); Hispanic (n=124); Asian (n=55)
Boys – Caucasian (n=435); African-American (n=127); Hispanic (n=123); Asian (n=99)

Finally, Sabo and Veliz asked children who had dropped out of organized sports why they left.
For both girls and boys, the number one answer was that it was no longer any fun (see Table
5.1). According to the Sport Policy and Research Collaborative (SPARC) (2013), almost 1 in 3
children drop out of organized sports, and while there are many factors involved in the decisions
to drop out, one suggestion has been the lack of training that coaches of children’s sports receive
may be contributing to this attrition (Barnett, Smoll & Smith, 1992). Several studies have foundthat when coaches receive proper training, the drop-out rate is about 5% instead of the usual 30%(Fraser-Thomas, Côté, & Deakin, 2005; SPARC, 2013).
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Table 5.1 Top Reasons Dropped Out or Stopped Playing Organized/Team Sports

Girls

Boys

I was not having fun

38%

I was not having fun

39%

I wanted to focus more on
studying and grades36%

I had a health problem or injury

29%

I had a health problem or injury

27%

26%

I wanted to focus more on otherclubs or activities
I did not like or get along with thecoach
I did not like or get along withothers on the team
I was not a good enough player
My family worried about me
getting hurt or injured while
playing sports

22%

I wanted to focus more on studying
and grades
I did not like or get along with thecoach
I wanted to focus more on otherclubs or activities
I did not like or get along withothers on the team
I was not a good enough player
My family worried about me
getting hurt or injured while
playing sports

18%
16%
15%
14%

22%
18%
16%
15%
12%

Source: Sabo, D., & Veliz, P. (2008). Go Out and Play: Youth Sports in America. East Meadows, NY: Women’s Sports
Foundation.

Welcome to the world of esports: According to Discover Esports (2017), esports is a form ofcompetition with the medium being video games. Players use computers or specific video game
consoles to play video games against each other. In addition to playing themselves, children myjust watch others play the video games. The recent SPARC (2016) report on the “State of Play”
in the United States highlights a disturbing trend. One in four children between the ages of 5 and
16 rate playing computer games with their friends as a form of exercise. Over half of males andabout 20% of females, aged 12-19, say they are fans of esports.
Since 2008 there has also been a downward trend in the number of sports children are engaged
in, despite a body of research evidence that suggests that specializing in only one activity canincrease the chances of injury, while playing multiple sports is protective (SPARC, 2016). A
University of Wisconsin study found that 49% of athletes who specialized in a sport experienced
an injury compared with 23% of those who played multiple sports (McGuine, 2016).
Physical Education: For many children, physical education in school is a key component inintroducing children to sports. After years of schools cutting back on physical education
programs, there has been a turn around, prompted by concerns over childhood obesity and therelated health issues. Despite these changes, currently only the state of Oregon and the Districtof Columbia meet PE guidelines of a minimum of 150 minutes per week of physical activity inelementary school and 225 minutes in middle school (SPARC, 2016).

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Childhood Obesity
The decreased participation in school physical education and youth sports is just one of manyfactors that has led to an increase in children being overweight or obese. The current
measurement for determining excess weight is the Body Mass Index (BMI) which expresses therelationship of height to weight. According to the Centers for Disease Control and Prevention(CDC), children’s whose BMI is at or above the 85th percentile for their age are consideredoverweight, while children who are at or above the 95th percentile are considered obese (Lu,2016). In 2015-2016 approximately 13.9% of 2-5 year-olds and 18.4% of 6-11 year-olds wereobese (Hales, Carroll, Fryar, & Ogden, 2017). Excess weight and obesity in children areassociated with a variety of medical and cognitive conditions including high blood pressure,insulin resistance, inflammation, depression, and lower academic achievement (Lu, 2016).
Being overweight has also been linked to
Figure 5.4 Being overweight can be a
impaired brain functioning, which includes
lifelong struggle
deficits in executive functioning, working
memory, mental flexibility, and decision
making (Liang, Matheson, Kaye, &Boutelle, 2014). Children who ate moresaturated fats performed worse on relational
memory tasks, while eating a diet high inomega-3 fatty acids promoted relational
memory skills (Davidson, 2014). Using
animal studies Davidson et al. (2013) foundthat large amounts of processed sugars andsaturated fat weakened the blood-brain
Sourcebarrier, especially in the hippocampus. Thiscan make the brain more vulnerable toharmful substances that can impair its functioning. Another important executive functioning
skill is controlling impulses and delaying gratification. Children who are overweight show lessinhibitory control than normal weight children, which may make it more difficult for them toavoid unhealthy foods (Lu, 2016). Overall, being overweight as a child increases the risk forcognitive decline as one ages.
A growing concern is the lack of recognition from parents that children are overweight or obese.
Katz (2015) referred to this as oblivobesity. Black, Park and Gregson (2015) found that parents
in the United Kingdom (UK) only recognized their children as obese when they were above the
99.7th percentile while the official cut-off for obesity is at the 85th percentile. Oude Luttikhuis,
Stolk, and Sauer (2010) surveyed 439 parents and found that 75% of parents of overweightchildren said the child had a normal weight and 50% of parents of obese children said the child
had a normal weight. For these parents, overweight was considered normal and obesity wasconsidered normal or a little heavy. Doolen, Alpert, and Miller (2009) reported on several studies
from the United Kingdom, Australia, Italy, and the United States, and in all locations, parents
were more likely to misperceive their children’s weight. Black et al. (2015) concluded that as theaverage weight of children rises, what parents consider normal also rises. Needless to say, if
parents cannot identify if their children are overweight they will not be able to intervene andassist their children with proper weight management.
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An added concern is that the children themselves are not accurately identifying if they are
overweight. In a United States sample of 8-15 year-olds, more than 80% of overweight boys and
70% of overweight girls misperceived their weight as normal (Sarafrazi, Hughes, & Borrud,2014). Also noted was that as the socioeconomic status of the children rose, the frequency ofthese misconceptions decreased. It appeared that families with more resources were more
conscious of what defines a healthy weight.
Children who are overweight tend to be rejected, ridiculed, teased and bullied by others(Stopbullying.gov, 2018). This can certainly be damaging to their self-image and popularity. In
addition, obese children run the risk of suffering orthopedic problems such as knee injuries, andthey have an increased risk of heart disease and stroke in adulthood (Lu, 2016). It is hard for achild who is obese to become a non-obese adult. In addition, the number of cases of pediatricdiabetes has risen dramatically in recent years.
Behavioral interventions, including
training children to overcome impulsive
behavior, are being researched to help
overweight children (Lu, 2016).
Practicing inhibition has been shown tostrengthen the ability to resist unhealthy
foods. Parents can help theiroverweight children the best when they
are warm and supportive without using
shame or guilt. Parents can also act likethe child’s frontal lobe until it isdeveloped by helping them makecorrect food choices and praising theirefforts (Liang, et al., 2014). Researchalso shows that exercise, especially
Sourceaerobic exercise, can help improve
cognitive functioning in overweightchildren (Lu, 2016). Parents should take caution against emphasizing diet alone to avoid thedevelopment of any obsession about dieting that can lead to eating disorders. Instead, increasinga child's activity level is most helpful.
Figure 5.5

In 2018 the American Psychological Association (APA) developed a clinical practice guidelinethat recommends family-based, multicomponent behavioral interventions to treat obesity andoverweight in children 2 to 18 (Weir, 2019). The guidelines recommend counseling on diet,physical activity and “teaching parents strategies for goal setting, problem-solving, monitoringchildren’s behaviors, and modeling positive parental behaviors,” (p. 32). Early research results
have shown success using this model compared to controls. Because there is no quick fix forweight loss, the program recommends 26 contact hours with the family. Unfortunately, for manyfamilies cost, location, and time commitment make it difficult for them to receive theinterventions. APA has recommended that behavioral treatment could be delivered in primarycare offices to encourage greater particiapation. APA also recommend that schools andcommunities need to offer more nutritious meals to children and limit sodas and unhealthy foods.
169

Learning Objectives: Cognitive Development in Middle and Late Childhood
•
•
•
•
•
•
•

Describe Piaget’s concrete operational stage and the characteristics of concretethought
Describe information processing research on memory, attention, knowledge base,metacognition, and critical thinking
Describe language development and explain the three types of communication
disorders
Describe the theories of intelligence, including general “g”, triarchic theory, andGardner’s multiple intelligences
Explain how intelligence is measured, the tests used to assess intelligence, theextremes in intelligence, and the concern of bias
Describe how language and culture influence the typical classroom
Identify common disabilities in childhood and the legislation that protects themeducationally

Recall from the last chapter that children in early childhood are in Piaget’s preoperational stage,
and during this stage, children are learning to think symbolically about the world. Cognitive
skills continue to expand in middle and late childhood as thought processes become more logicaland organized when dealing with concrete information. Children at this age understand concepts
such as past, present, and future, giving them the ability to plan and work toward goals.
Additionally, they can process complex ideas such as addition and subtraction and cause-andeffect relationships.

Concrete Operational Thought
From ages 7 to 11, children are in what Piaget referred to as the concrete operational stage ofcognitive development (Crain, 2005). This involves mastering the use of logic in concrete ways.
The word concrete refers to that which is tangible; that which can be seen, touched, or
experienced directly. The concrete operational child is able to make use of logical principles insolving problems involving the physical world. For example, the child can understandprinciples of cause and effect, size, and distance.
The child can use logic to solve problems tied to their own direct experience, but has trouble
solving hypothetical problems or considering more abstract problems. The child uses inductive
reasoning, which is a logical process in which multiple premises believed to be true are
combined to obtain a specific conclusion. For example, a child has one friend who is rude,
another friend who is also rude, and the same is true for a third friend. The child may conclude
that friends are rude. We will see that this way of thinking tends to change during adolescencebeing replaced with deductive reasoning. We will now explore some of the major abilities thatthe concrete child exhibits.

170

Classification: As children's
experiences and vocabularies grow,they build schemata and are able toorganize objects in many different
ways. They also understandclassification hierarchies and canarrange objects into a variety ofclasses and subclasses.
Identity: One feature of concrete
operational thought is theunderstanding that objects havequalities that do not change even if
the object is altered in someway. For instance, mass of an object
does not change by rearranging it. A
piece of chalk is still chalk evenwhen the piece is broken in two.

Figure 5.6 Children in the concrete operational
stage understand how to classify organisms

SourceReversibility: The child learns that some things that have been changed can be returned totheir original state. Water can be frozen and then thawed to become liquid again, but eggs
cannot be unscrambled. Arithmetic operations are reversible as well: 2 + 3 = 5 and 5 – 3 =2. Many of these cognitive skills are incorporated into the school's curriculum throughmathematical problems and in worksheets about which situations are reversible or irreversible.
Conservation: Remember the example in our last chapter of preoperational children thinking
that a tall beaker filled with 8 ounces of water was "more" than a short, wide bowl filled with 8
ounces of water? Concrete operational children can understand the concept of conservation
which means that changing one quality (in this example, height or water level) can becompensated for by changes in another quality (width). Consequently, there is the same amountof water in each container, although one is taller and narrower and the other is shorter and wider.
Decentration: Concrete operational children no longer focus on only one dimension of any
object (such as the height of the glass) and instead consider the changes in other dimensions too(such as the width of the glass). This allows for conservation to occur.
Seriation: Arranging items along a quantitative dimension, such as length or weight, in amethodical way is now demonstrated by the concrete operational child. For example, they can
methodically arrange a series of different-sized sticks in order by length, while younger children
approach a similar task in a haphazard way.
These new cognitive skills increase the child's understanding of the physical world, however
according to Piaget, they still cannot think in abstract ways. Additionally, they do not think insystematic scientific ways. For example, when asked which variables influence the period that apendulum takes to complete its arc and given weights they can attach to strings in order to do

171experiments, most children younger than 12 perform biased experiments from which noconclusions can be drawn (Inhelder & Piaget, 1958).

Information Processing
Children differ in their memory abilities, and these differences predict both their readiness forschool and academic performance in school (PreBler, Krajewski, & Hasselhorn, 2013). During
middle and late childhood children make strides in several areas of cognitive function including
the capacity of working memory, their ability to pay attention, and their use of memory
strategies. Both changes in the brain and experience foster these abilities.
Working Memory: The capacity of working memory expands during middle and late childhood,and research has suggested that both an increase in processing speed and the ability to inhibit
irrelevant information from entering memory are contributing to the greater efficiency ofworking memory during this age (de Ribaupierre, 2002). Changes in myelination and synaptic
pruning in the cortex are likely behind the increase in processing speed and ability to filter out
irrelevant stimuli (Kail, McBride-Chang, Ferrer, Cho, & Shu, 2013).
Children with learning disabilities in math and reading often have difficulties with working
memory (Alloway, 2009). They may struggle with following the directions of an assignment.
When a task calls for multiple steps, children with poor working memory may miss steps
because they may lose track of where they are in the task. Adults working with such children
may need to communicate: Using more familiar vocabulary, using shorter sentences, repeatingtask instructions more frequently, and breaking more complex tasks into smaller moremanageable steps. Some studies have also shown that more intensive training of working
memory strategies, such as chunking, aid in improving the capacity of working memory inchildren with poor working memory (Alloway, Bibile, & Lau, 2013).
Attention: As noted above, the ability to inhibit irrelevant information improves during this age
group, with there being a sharp improvement in selective attention from age six into adolescence(Vakil, Blachstein, Sheinman, & Greenstein, 2009). Children also improve in their ability toshift their attention between tasks or different features of a task (Carlson, Zelazo, & Faja, 2013).
A younger child who is asked to sort objects into piles based on type of object, car versus animal,
or color of object, red versus blue, may have difficulty if you switch from asking them to sort
based on type to now having them sort based on color. This requires them to suppress the priorsorting rule. An older child has less difficulty making the switch, meaning there is greater
flexibility in their attentional skills. These changes in attention and working memory contributeto children having more strategic approaches to challenging tasks.
Memory Strategies: Bjorklund (2005) describes a developmental progression in the acquisition
and use of memory strategies. Such strategies are often lacking in younger children but increasein frequency as children progress through elementary school. Examples of memory strategies
include rehearsing information you wish to recall, visualizing and organizing information,
creating rhymes, such “i” before “e” except after “c”, or inventing acronyms, such as “roygbiv”
to remember the colors of the rainbow. Schneider, Kron-Sperl, and Hünnerkopf (2009) reported
a steady increase in the use of memory strategies from ages six to ten in their longitudinal study(see Table 5.2). Moreover, by age ten many children were using two or more memory strategies
172

Table 5.2 Percent of Children who did
not use any Memory Strategies by Age.

Age
6
7
8
9
10

Percentage
55
44
25
17
13

to help them recall information. Schneider andcolleagues found that there were considerable
individual differences at each age in the use of
strategies, and that children who utilized morestrategies had better memory performance than theirsame aged peers.

Children may experience three deficiencies in theiruse of memory strategies. A mediation deficiency
occurs when a child does not grasp the strategy
being taught, and thus, does not benefit from its use.
If you do not understand why using an acronym
might be helpful, or how to create an acronym, the strategy is not likely to help you. In a
production deficiency the child does not spontaneously use a memory strategy and must be
prompted to do so. In this case, children know the strategy and are more than capable of using it,
but they fail to “produce” the strategy on their own. For example, children might know how tomake a list, but may fail to do this to help them remember what to bring on a family vacation. A
utilization deficiency refers to children using an appropriate strategy, but it fails to aid theirperformance. Utilization deficiency is common in the early stages of learning a new memory
strategy (Schneider & Pressley, 1997; Miller, 2000). Until the use of the strategy becomes
automatic it may slow down the learning process, as space is taken up in memory by the strategy
itself. Initially, children may get frustrated because their memory performance may seem worse
when they try to use the new strategy. Once children become more adept at using the strategy,
their memory performance will improve. Sodian and Schneider (1999) found that new memory
strategies acquired prior to age eight often show utilization deficiencies with there being a
gradual improvement in the child’s use of the strategy. In contrast, strategies acquired after thisage often followed an “all-or-nothing” principle in which improvement was not gradual, but
abrupt.
Knowledge Base: During middle and late childhood, children are able to learn and remember
due to an improvement in the ways they attend to and store information. As children enter schooland learn more about the world, they develop more categories for concepts and learn more
efficient strategies for storing and retrieving information. One significant reason is that they
continue to have more experiences on which to tie new information. In other words, theirknowledge base, knowledge in particular areas that makes learning new information easier,expands (Berger, 2014).
Metacognition: Children in middle and late childhood also have a better understanding of how
well they are performing a task, and the level of difficulty of a task. As they become more
realistic about their abilities, they can adapt studying strategies to meet those needs. Youngchildren spend as much time on an unimportant aspect of a problem as they do on the main point,
while older children start to learn to prioritize and gauge what is significant and what is not. As aresult, they develop metacognition. Metacognition refers to the knowledge we have about ourown thinking and our ability to use this awareness to regulate our own cognitive processes(Bruning, Schraw, Norby, & Ronning, 2004).

173

Critical Thinking: According to Bruning et al. (2004) there is a debate in U.S. education as towhether schools should teach students what to think or how to think. Critical thinking, or adetailed examination of beliefs, courses of action, and evidence, involves teaching children how
to think. The purpose of critical thinking is to evaluate information in ways that help us makeinformed decisions. Critical thinking involves better understanding a problem through gathering,evaluating, and selecting information, and also by considering many possible solutions. Ennis(1987) identified several skills useful in critical thinking. These include: Analyzing arguments,
clarifying information, judging the credibility of a source, making value judgements, anddeciding on an action. Metacognition is essential to critical thinking because it allows us toreflect on the information as we make decisions.

Language Development
Vocabulary: One of the reasons that children can classify objects in so many ways is that they
have acquired a vocabulary to do so. By fifth grade, a child's vocabulary has grown to 40,000
words. It grows at a rate that exceeds that of those in early childhood. This language explosion,
however, differs from that of younger children because it is facilitated by being able to associate
new words with those already known, and because it is accompanied by a more sophisticatedunderstanding of the meanings of a word.
New Understanding: Those in middle and late childhood are also able to think of objects in less
literal ways. For example, if asked for the first word that comes to mind when one hears the word
"pizza", the younger child is likely to say "eat" or some word that describes what is done with apizza. However, the older child is more likely to place pizza in the appropriate category and say"food". This sophistication of vocabulary is also evidenced by the fact that older children telljokes and delight in doing do. They may use jokes that involve plays on words such as "knockknock" jokes or jokes with punch lines. Young children do not understand play on words and tell"jokes" that are literal or slapstick, such as "A man fell down in the mud! Isn't that funny?"
Grammar and Flexibility: Older children are also able to learn new rules of grammar withmore flexibility. While younger children are likely to be reluctant to give up saying "I goed
there", older children will learn this rather quickly along with other rules of grammar.

Communication Disorders
At the end of early childhood, children are often assessed in terms of their ability to speak
properly. By first grade, about 5% of children have a notable speech disorder (Medline Plus,
2016c).
Fluency disorders: Fluency disorders affect the rate of speech. Speech may be labored andslow, or too fast for listeners to follow. The most common fluency disorder is stuttering.
Stuttering is a speech disorder in which sounds, syllables, or words are repeated or last longer
than normal. These problems cause a break in the flow of speech, which is called dysfluency(Medline Plus, 2016b). About 5% of young children, aged two-five, will develop somestuttering that may last from several weeks to several years (Medline Plus, 2016c).
Approximately 75% of children recover from stuttering. For the remaining 25%, stuttering can174persist as a lifelong communication disorder (National Institute on Deafness and otherCommunication Disorders, NIDCD, 2016). This is called developmental stuttering and is themost common form of stuttering. Brain injury, and in very rare instances, emotional trauma may
be other triggers for developing problems with stuttering. In most cases of developmental
stuttering, other family members share the same communication disorder. Researchers haverecently identified variants in four genes that are more commonly found in those who stutter(NIDCD, 2016).
Articulation disorder: An articulation disorder refers to the inability to correctly produce
speech sounds (phonemes) because of imprecise placement, timing, pressure, speed, or flow of
movement of the lips, tongue, or throat (NIDCD, 2016). Sounds can be substituted, left off,
added or changed. These errors may make it hard for people to understand the speaker. They can
range from problems with specific sounds, such as lisping to severe impairment in thephonological system. Most children have problems pronouncing words early on while theirspeech is developing. However, by age three, at least half of what a child says should beunderstood by a stranger. By age five, a child's speech should be mostly intelligible. Parents
should seek help if by age six the child is still having trouble producing certain sounds. It should
be noted that accents are not articulation disorders (Medline Plus, 2016a).
Voice disorders: Disorders of the voice involve problems with pitch, loudness, and quality ofthe voice (American Speech-Language and Hearing Association, 2016). It only becomes adisorder when problems with the voice makes the child unintelligible. In children, voice
disorders are significantly more prevalent in males than in females. Between 1.4% and 6% ofchildren experience problems with the quality of their voice. Causes can be due to structuralabnormalities in the vocal cords and/or larynx, functional factors, such as vocal fatigue fromoveruse, and in rarer cases psychological factors, such as chronic stress and anxiety.

Theories of Intelligence
Figure 5.7 Alfred Binet

Psychologists have long debated how to best conceptualize andmeasure intelligence (Sternberg, 2003). These questions include:
How many types of intelligence are there, the role of nature
versus nurture in intelligence, how intelligence is represented in
the brain, and the meaning of group differences in intelligence.

General (g) versus Specific (s) Intelligences: From 1904-1905
the French psychologist Alfred Binet (1857–1914) and hiscolleague Théodore Simon (1872–1961) began working on
behalf of the French government to develop a measure thatwould identify children who would not be successful with theregular school curriculum. The goal was to help teachers better
educate these students (Aiken, 1994). Binet and Simon developed
Sourcewhat most psychologists today regard as the first intelligence test,
which consisted of a wide variety of questions that included the ability to name objects, definewords, draw pictures, complete sentences, compare items, and construct sentences.
175

Binet and Simon (Binet, Simon, & Town, 1915; Siegler, 1992) believed that the questions
they asked the children all assessed the basic abilities to understand, reason, and makejudgments. It turned out that the correlations among these different types of measures were infact all positive; that is, students who got one item correct were more likely to also get otheritems correct, even though the questions themselves were very different.
On the basis of these results, the psychologist Charles Spearman (1863–1945) hypothesized that
there must be a single underlying construct that all of these items measure. He called theconstruct that the different abilities and skills measured on intelligence tests have in common the
General Intelligence Factor (g). Virtually all psychologists now believe that there is a
generalized intelligence factor, “g”, that relates to abstract thinking and that includes the abilities
to acquire knowledge, to reason abstractly, to adapt to novel situations, and to benefit from
instruction and experience (Gottfredson, 1997; Sternberg, 2003). People with higher general
intelligence learn faster.
Soon after Binet and Simon introduced their test, the American
psychologist Lewis Terman at Stanford University (1877–1956)
developed an American version of Binet’s test that became
known as the Stanford-Binet Intelligence Test. The StanfordBinet is a measure of general intelligence made up of a wide
variety of tasks, including vocabulary, memory for pictures,
naming of familiar objects, repeating sentences, and following
commands.

Figure 5.8 Have you
taken an intelligencetest? © Thinkstock

Although there is general agreement among psychologists that“g” exists, there is also evidence for specific intelligence “s”,
a measure of specific skills in narrow domains. One empiricalresult in support of the idea of “s” comes from intelligencetests themselves. Although the different types of questions docorrelate with each other, some items correlate more highlywith each other than do other items; they form clusters or
clumps of intelligences.

Triarchic Theory: One advocate of the idea of multiple intelligences is the psychologist Robert
Sternberg. Sternberg has proposed a triarchic (three-part) theory of intelligence that proposesthat people may display more or less analytical intelligence, creative intelligence, and practicalintelligence. Sternberg (1985, 2003) argued that traditional intelligence tests assess analyticalintelligence, academic problem solving and performing calculations, but that they do not
typically assess creative intelligence, the ability to adapt to new situations and create new ideas,
and/or practical intelligence, the ability to demonstrate common sense and street-smarts.
As Sternberg proposed, research has found that creativity is not highly correlated with analyticalintelligence (Furnham & Bachtiar, 2008) and exceptionally creative scientists, artists,
mathematicians, and engineers do not score higher on intelligence than do their less, creative
peers (Simonton, 2000).

176

Furthermore, the brain areas that are associated with convergent
thinking, thinking that is directed toward finding the correct
answer to a given problem, are different from those associatedwith divergent thinking, the ability to generate many different
ideas or solutions to a single problem (Tarasova, Volf, &Razoumnikova, 2010). On the other hand, being creative often
takes some of the basic abilities measured by “g”, including theabilities to learn from experience, to remember information, and to
think abstractly (Bink & Marsh, 2000). Ericsson (1998), Weisberg(2006), Hennessey and Amabile (2010) and Simonton (1992)
studied creative people and identified at least five components thatare likely to be important for creativity as listed in Table 5.3

Figure 5.9 How
many uses can you
think of for a paper
clip? Thinkstock ©

Table 5.3 Important Components for Creativity
Component
Expertise
Imaginative Thinking
Risk Taking
Intrinsic Interest
Working in Creative
Environments

Description
Creative people have studied and learned about a topic
Creative people view problems in new and different ways
Creative people take on new, but potentially risky approaches
Creative people take on projects for interest not money
The most creative people are supported, aided, and challenged byother people working on similar projects

The last aspect of the triarchic model, practical intelligence, refers primarily to intelligence thatcannot be gained from books or formal learning. Practical intelligence represents a type of“street smarts” or “common sense” that is learned from life experiences. Although a number oftests have been devised to measure practical intelligence (Sternberg, Wagner, & Okagaki, 1993;
Wagner & Sternberg, 1985), research has not found much evidence that practical intelligence isdistinct from “g” or that it is predictive of success at any particular tasks (Gottfredson, 2003).
Practical intelligence may include, at least in part, certain abilities that help people perform wellat specific jobs, and these abilities may not always be highly correlated with general intelligence(Sternberg et al., 1993).
Theory of Multiple Intelligences: Another champion of the idea of specific types ofintelligences rather than one overall intelligence is the psychologist Howard Gardner (1983,1999). Gardner argued that it would be evolutionarily functional for different people to havedifferent talents and skills and proposed that there are eight intelligences that can bedifferentiated from each other. A potential ninth intelligence; that is, existential still needs
empirical support. Gardner investigated intelligences by focusing on children who were talented
in one or more areas and adults who suffered from strokes that compromised some capacities,
but not others. Gardner also noted that some evidence for multiple intelligences comes from theabilities of autistic savants, people who score low on intelligence tests overall, but who
nevertheless may have exceptional skills in a given domain, such as math, music, art, or in being177able to recite statistics in a given sport (Treffert & Wallace, 2004). In addition to brain damage
and the existence of savants, Gardner identified these 8 intelligences based on other criteria
including a set developmental history and psychometric findings. See Table 5.4 for a list ofGardner’s eight specific intelligences.
Table 5.4 Howard Gardner’s Eight Specific Intelligences
Intelligence

Description

Linguistic

The ability to speak and write well

Logical-mathematical

The ability to use logic and mathematical skills to solve problems

SpatialThe ability to think and reason about objects in three dimensions

MusicalThe ability to perform and enjoy music

Kinesthetic (body)

The ability to move the body in sports, dance, or other physical activities

Interpersonal

The ability to understand and interact effectively with others

Intrapersonal

The ability to have insight into the self

Naturalistic

The ability to recognize, identify, and understand animals, plants, andother living things

Source: Adapted from Gardner, H. (1999). Intelligence reframed: Multiple intelligences for the 21st century. New York, NY:
Basic Books.

The idea of multiple intelligences has
been influential in the field of
education, and teachers have used
these ideas to try to teach differently
to different students. For instance, toteach math problems to students who
have particularly good kinesthetic
intelligence, a teacher might
encourage the students to move theirbodies or hands according to thenumbers. On the other hand, somehave argued that these “intelligences”
sometimes seem more like “abilities”
or “talents” rather than real
intelligence. There is no clear
conclusion about how many
intelligences there are. Are sense of
Figure 5.10 © Thinkstock
humor, artistic skills, dramatic skills,
and so forth also separate intelligences? Furthermore, and again demonstrating the underlying178

power of a single intelligence, the many different intelligences are, in fact, correlated and thus
represent, in part, “g” (Brody, 2003).

Measuring Intelligence: Standardization and the Intelligence Quotient
The goal of most intelligence tests is to measure “g”, the general intelligence factor. Good
intelligence tests are reliable, meaning that they are consistent over time, and also demonstratevalidity, meaning that they actually measure intelligence rather than something else. Because
intelligence is such an important individual difference dimension, psychologists have invested
substantial effort in creating and improving measures of intelligence, and these tests are now
considered the most accurate of all psychological tests. In fact, the ability to accurately assess
intelligence is one of the most important contributions of psychology to everyday public life.
Intelligence changes with age. A 3-year-old who could accurately multiply 183 by 39 would
certainly be intelligent, but a 25-year-old who could not do so would be seen as unintelligent.
Thus, understanding intelligence requires that we know the norms or standards in a given
population of people at a given age. The standardization of a test involves giving it to a large
number of people at different ages and computing the average score on the test at each age
level.
It is important that intelligence tests be standardized on a regular basis, because the overalllevel of intelligence in a population may change over time. The Flynn effect refers to theobservation that scores on intelligence tests worldwide have increased substantially over the
past decades (Flynn, 1999). Although the increase varies somewhat from country to country,
the average increase is about 3 IQ points every 10 years. There are many explanations for the
Flynn effect, including better nutrition, increased access to information, and more familiarity
with multiple-choice tests (Neisser, 1998). Whether people are actually getting smarter,
however, is debatable (Neisser, 1997). Most of the increase in IQ occurred during the second
half of the 20th century. Recent research has found a reversal of the Flynn effect in several
nations around the world, although some nations still show an increase in IQ scores (Dutton,
van der Linden, & Lynn, 2016).
Once the standardization has been accomplished, we have a picture of the average abilities ofpeople at different ages and can calculate a person’s mental age, which is the age at which aperson is performing intellectually. If we compare the mental age of a person to the person’s
chronological age, the result is the Intelligence Quotient (IQ), a measure of intelligence that is
adjusted for age. A simple way to calculate IQ is by using the following formula:
IQ = mental age ÷ chronological age × 100.
Thus a 10-year-old child who does as well as the average 10-year-old child has an IQ of 100 (10÷ 10 × 100), whereas an 8-year-old child who does as well as the average 10-year-old childwould have an IQ of 125 (10 ÷ 8 × 100). Most modern intelligence tests are based on therelative position of a person’s score among people of the same age, rather than on the basis of
this formula, but the idea of an intelligence “ratio” or “quotient” provides a good description of
the score’s meaning.
179

Wechsler Scales: A number of scales are based on the IQ. The Wechsler Adult lntelligence
Scale (WAIS) is the most widely used intelligence test for adults (Watkins, Campbell,
Nieberding, & Hallmark, 1995). The current version of the WAIS, the WAIS-IV, wasstandardized on 2,200 people ranging from 16 to 90 years of age. It consists of 15 different tasks,
each designed to assess intelligence, including working memory, arithmetic ability, spatial
ability, and general knowledge about the world. The WAIS-IV yield scores on four domains:verbal, perceptual, working memory, and processing speed. The reliability of the test is high(more than 0.95), and it shows substantial construct validity. The WAIS-IV is correlated highlywith other IQ tests such as the Stanford-Binet, as well as with criteria of academic and life
success, including college grades, measures of work performance, and occupational level. It also
shows significant correlations with measures of everyday functioning among people withintellectual disabilities.
The Wechsler scale has also been adapted for preschool children in the form of the Wechsler
Primary and Preschool Scale of Intelligence-Fourth Edition (WPPSI-IV) and for older children
and adolescents in the form of the Wechsler Intelligence Scale for Children-Fifth Edition(WISC-V). Figure 5.11 illustrates items from the WAIS.

Figure 5.11 Sample Items from the Wechsler Adult Intelligence Scale(WAIS)

https://www.flickr.com/search/?q=wechsler+scale

Bias: Intelligence tests and psychological definitions of intelligence have been heavily criticizedsince the 1970s for being biased in favor of Anglo-American, middle-class respondents and forbeing inadequate tools for measuring non-academic types of intelligence or talent. Intelligencechanges with experience, and intelligence quotients or scores do not reflect that ability tochange. What is considered smart varies culturally as well, and most intelligence tests do nottake this variation into account. For example, in the West, being smart is associated with being
quick. A person who answers a question the fastest is seen as the smartest, but in some cultures
being smart is associated with considering an idea thoroughly before giving an answer. A wellthought out, contemplative answer is the best answer.

180Extremes of Intelligence: Intellectual Disability and Giftedness
The results of studies assessing the measurement of intelligence show that IQ is distributed in the
population in the form of a normal distribution (or bell curve), which is the pattern of scores
usually observed in a variable that clusters around its average. In a normal distribution, the bulkof the scores fall toward the middle, with fewer scores falling at the extremes. The normal
distribution of intelligence shows that on IQ tests, as well as on most other measures, the majorityof people cluster around the average (in this case, where IQ = 100), and fewer are either very
smart or very dull (see Figure 5.13). Because the standard deviation of an IQ test is about 15,
this means that about 2% of people score above an IQ of 130, often considered the threshold forgiftedness, and about the same percentage score below an IQ of 70, often being considered thethreshold for an intellectual disability.
Although Figure 5.12 presents a single distribution, the actual IQ distribution varies by sex suchthat the distribution for men is more spread out than is the distribution for women. These sex
differences mean that about 20% more men than women fall in the extreme (very smart or verydull) ends of the distribution (Johnson, Carothers, & Deary, 2009). Boys are about five times
more likely to be diagnosed with the reading disability dyslexia than are girls (Halpern, 1992),
and are also more likely to be classified as having an intellectual disability. However, boys arealso about 20% more highly represented in the upper end of the IQ distribution.
Figure 5.12 Distribution of IQ Scores in the General Population

The normal distribution of IQ scores in the general population shows that most people have about average
intelligence, while very few have extremely high or extremely low intelligence.

One end of the distribution of intelligence scores is defined by people with very low IQ.
Intellectual disability (or intellectual developmental disorder) is assessed based on cognitive
capacity (IQ) and adaptive functioning. The severity of the disability is based on adaptivefunctioning, or how well the person handles everyday life tasks. About 1% of the United States
population, most of them males, fulfill the criteria for intellectual developmental disorder, butsome children who are given this diagnosis lose the classification as they get older and better
learn to function in society. A particular vulnerability of people with low IQ is that they may betaken advantage of by others, and this is an important aspect of the definition of intellectual
developmental disorder (Greenspan, Loughlin, & Black, 2001).
181

One cause of intellectual developmental disorder is Down syndrome, a chromosomal disordercaused by the presence of all or part of an extra 21st chromosome. The incidence of Down
syndrome is estimated at approximately 1 per 700 births, and the prevalence increases as themother’s age increases (CDC, 2014). People with Down syndrome typically exhibit a distinctive
pattern of physical features, including a flat nose, upwardly slanted eyes, a protruding tongue, anda short neck (see Figure 5.14).

Figure 5.13 Individuals with Down Syndrome© Thinkstock.

Fortunately, societal attitudes toward
individuals with intellectual
disabilities have changed over the
past decades. Laws such as theAmericans with Disabilities Act(ADA) have made it illegal todiscriminate on the basis of mental
and physical disability, and there has
been a trend to bring people withintellectual disabilities out of
institutions and into our workplaces
and schools.

© Thinkstock

Giftedness refers to children who have an IQ of 130 or higher (Lally & Valentine-French, 2015).
Having extremely high IQ is clearly less of a problem than having extremely low IQ, but there
may also be challenges to being particularly smart. It is often assumed that schoolchildren who
are labeled as “gifted” may have adjustment problems that make it more difficult for them tocreate social relationships. To study gifted children, Lewis Terman and his colleagues (Terman &Oden, 1959) selected about 1,500 high school students who scored in the top 1% on the
Stanford-Binet and similar IQ tests (i.e., who had IQs of about 135 or higher), and tracked themfor more than seven decades (the children became known as the “termites” and are still being
studied today). This study found that these students were not unhealthy or poorly adjusted, butrather were above average in physical health and were taller and heavier than individuals in thegeneral population. The students also had above average social relationships and were less likely
to divorce than the average person (Seagoe, 1975).

Figure 5.14

The popular stereotype of highly
intelligent people as physicallyuncoordinated and unpopular is not true.
© Thinkstock

Terman’s study also found that many of these students
went on to achieve high levels of education and entered
prestigious professions, including medicine, law, andscience. Of the sample, 7% earned doctoral degrees, 4%earned medical degrees, and 6% earned law degrees.
These numbers are all considerably higher than what
would have been expected from a more general
population. Another study of young adolescents who hadeven higher IQs found that these students ended up
attending graduate school at a rate more than 50 times
higher than that in the general population (Lubinski &Benbow, 2006).

182

As you might expect based on our discussion of intelligence, kids who are gifted have higherscores on general intelligence “g”, but there are also different types of giftedness. Some children
are particularly good at math or science, some at automobile repair or carpentry, some at musicor art, some at sports or leadership, and so on. There is a lively debate among scholars about
whether it is appropriate or beneficial to label some children as “gifted and talented” in school
and to provide them with accelerated special classes and other programs that are not available toeveryone. Although doing so may help the gifted kids (Colangelo & Assouline, 2009), it also
may isolate them from their peers and make such provisions unavailable to those who are notclassified as “gifted.”

Education
Remember the ecological systems model (Bronfenbrenner, 1979) that we explored in chapter
one? This model helps us understand an individual by examining the contexts in which theperson lives and the direct and indirect influences on that person's life. School becomes a very
important component of children's lives during middle and late childhood, and parents and theculture contribute to children’s experiences in school as indicated by the ecological systems
model through their interaction with the school.
Gender: The stereotypes held by parents and teachers can influence children’s self-efficacy invarious domains. For example, teachers who hold the view that girls are better at reading(Retelsdorf, Schwartz, & Asbrock, 2015) or boys are better at math (Plante, de la Sablonnière,
Aronson, & Théorêt, 2013) often find that their students’ performance in these areas mirror thesestereotypes, despite the children’s actual ability, or the ability of children in the classrooms ofteachers who do not hold such stereotypes. While not all children will internalize the views ofothers, those who do are more likely to show declines in their performance consistent with thestereotypes (Plante, et al., 2013; Retelsdorf et al., 2015).
Parental Involvement in School: Parents vary in their level of involvement with their children's
schools. Teachers often complain that they have difficulty getting parents to participate in theirchild's education and devise a variety of techniques to keep parents in touch with daily andoverall progress. For example, parents may be required to sign a behavior chart each evening to
be returned to school or may be given information about the school's events through websites
and newsletters. There are other factors that need to be considered when looking at parental
involvement. To explore these, first ask yourself if all parents who enter the school withconcerns about their child be received in the same way?
Horvat (2004) found that teachers seek a particular type of involvement from particular types ofparents. While teachers thought they were open and neutral in their responses to parental
involvement, in reality teachers were most receptive to support, praise and agreement comingfrom parents who were most similar in race and social class with the teachers. Parents who
criticized the school or its policies were less likely to be given voice. Parents who have higher
levels of income, occupational status, and other qualities favored in society have family capital.
This is a form of power that can be used to improve a child's education. Parents who do not havethese qualities may find it more difficult to be effectively involved. The authors suggest thatteachers closely examine their biases against parents. Schools may also need to examine their183

ability to dialogue with parents about school policies in more open ways. Any efforts to improve
effective parental involvement should address these concerns.

Cultural Differences in the Classroom
Bilingualism: In 2013, approximately 20% of school aged
children and adolescents spoke a language other than English in
the home (Camarota & Zeigler, 2014). The majority of bilingual
students speak Spanish, but the rest represent more than threehundred different language groups from around the world. In larger
communities throughout the United States, it is therefore common
for a single classroom to contain students from several language
backgrounds at once. In classrooms, as in other social settings,
bilingualism exists in different forms and degrees. At one extreme
are students who speak both English and another language
fluently; at the other extreme are those who speak only limited
versions of both languages. In between are students who speak
their home (or heritage) language much better than English, as well
Sourceas others who have partially lost their heritage language in theprocess of learning English (Tse, 2001). Commonly, a student may
speak a language satisfactorily, but be challenged by reading or writing it. Whatever the case,each bilingual student poses unique challenges to teachers.
Figure 5.15

The student who speaks both languages fluently has a definite cognitive advantage. As you
might suspect, and research confirms, a fully fluent bilingual student is in a better position toexpress concepts or ideas in more than one way, and to be aware of doing so (Jimenez, Garcia, &Pearson, 1995; Francis, 2006). Unfortunately, the bilingualism of many students is unbalanced in
the sense that they are either still learning English, or else they have lost some earlier ability to
use their original, heritage language. Losing one’s original language is a concern as researchfinds that language loss limits students' ability to learn English as well or as quickly as they
could do. Having a large vocabulary in a first language has been shown to save time in learning
vocabulary in a second language (Hansen, Umeda & McKinney, 2002). Preserving the first
language is important if a student has impaired skill in all languages and therefore needsintervention or help from a speech-language specialist. Research has found, in such cases, thatthe specialist can be more effective if the specialist speaks and uses the first language as well as
English (Kohnert, Yim, Nett, Kan, & Duran, 2005).
Cultures and ethnic groups differ not only in languages, but also in how languages are used.
Since some of the patterns differ from those typical of modern classrooms, they can create
misunderstandings between teachers and students (Cazden, 2001; Rogers, et al., 2005). Consider
these examples:184

Figure 5.16 How do Classrooms Accommodate Different Cultures?

Source•In some cultures, it is considered polite or even intelligent not to speak unless you havesomething truly important to say. Chitchat, or talk that simply affirms a personal tie
between people, is considered immature or intrusive (Minami, 2002). In a classroom, thishabit can make it easier for a child to learn not to interrupt others, but it can also make thechild seem unfriendly.

•

Eye contact varies by culture. In many African American and Latin American
communities, it is considered appropriate and respectful for a child not to look directly at
an adult who is speaking to them (Torres-Guzman, 1998). In classrooms, however,teachers often expect a lot of eye contact (as in “I want all eyes on me!”) and may be
tempted to construe lack of eye contact as a sign of indifference or disrespect.

•

Social distance varies by culture. In some cultures, it is common to stand relatively close
when having a conversation; in others, it is more customary to stand relatively far apart(Beaulieu, 2004). Problems may happen when a teacher and a student prefer different
social distances. A student who expects a closer distance than does the teacher may seem
overly familiar or intrusive, whereas one who expects a longer distance may seem overly
formal or hesitant.

185

•

Wait time varies by culture. Wait time is the gap between the end of one person'scomment or question and the next person's reply or answer. In some cultures wait time isrelatively long, as long as three or four seconds (Tharp & Gallimore, 1989). In others it isa negative gap, meaning that it is acceptable, even expected, for a person to interrupt
before the end of the previous comment. In classrooms the wait time is customarily about
one second; after that, the teacher is likely to move on to another question or to anotherstudent. A student who habitually expects a wait time longer than one second may seem
hesitant, and not be given many chances to speak. A student who expects a negative wait
time, on the other hand, may seem overeager or even rude.

•

In most non-Anglo cultures, questions are intended to gain information, and it is assumed
that a person asking the question truly does not have the information requested (Rogoff,
2003). In most classrooms, however, teachers regularly ask test questions, which arequestions to which the teacher already knows the answer and that simply assess whether astudent knows the answer as well (Macbeth, 2003). The question: “How much is 2 + 2?”
for example, is a test question. If the student is not aware of this purpose, he or she may
become confused, or think that the teacher is surprisingly ignorant. Worse yet, the student
may feel that the teacher is trying deliberately to shame the student by revealing thestudent's ignorance or incompetence to others.

•

Preference for activities that are cooperative
rather than competitive. Many activities in
Figure 5.17
school are competitive, even when teachers
try to de-emphasize the competition. Oncepast the first year or second year of school,
students often become attentive to who
receives the highest marks on anassignment, for example, or who is the best
athlete at various sports or whose
contributions to class discussions gets themost verbal recognition from the teacher(Johnson & Johnson, 1998). A teacher
deliberately organizes important activities orassignments competitively, as in “Let’s see
Sourcewho finishes the math sheet first”.
Classroom life can then become explicitly
competitive, and the competitive atmosphere can interfere with cultivating supportive
relationships among students or between students and the teacher (Cohen, 2004). For
students who give priority to these relationships, competition can seem confusing at best
and threatening at worst. A student may wonder, “What sort of sharing or helping withanswers is allowed?” The answer to this question may be different depending on thecultural background of the student and teacher. What the student views as cooperative
sharing may be seen by the teacher as laziness, freeloading, or even cheating.

186

Box 5.1 What happened to No Child Left Behind?
Children's academic performance is often measured with the use of standardized
tests. Achievement tests are used to measure what a child has already learned.
Achievement tests are often used as measures of teaching effectiveness within a school
setting and as a method to make schools that receive tax dollars (such as public schools,
charter schools, and private schools that receive vouchers) accountable to the government for
their performance. In 2001, President Bush signed into effect Public Law 107-110, better
known as the No Child Left Behind Act mandating that schools administer achievement
tests to students and publish those results so that parents have an idea of their children's
performance. Additionally, the government would have information on the gaps ineducational achievement between children from various social class, racial, and ethnic
groups. Schools that showed significant gaps in these levels of performance were mandated
to work toward narrowing these gaps. Educators criticized the policy for focusing too muchon testing as the only indication of student performance. Target goals were consideredunrealistic and set by the federal government rather than individual states. Because theserequirements became increasingly unworkable for schools, changes to the law wererequested. On December 12, 2015 President Obama signed into law Every Student
Succeeds Act (ESSA) (United States Department of Education, 2017). This law is statedriven and focuses on expanding educational opportunities and improving student outcomes,
including in the areas of high school graduation, drop-out rates, and college attendance.

Children with Disabilities
A Learning Disability (or LD) is a specific impairment of academic learning that interfereswith a specific aspect of schoolwork and that reduces a student's academic performance
significantly. A LD shows itself as a major discrepancy between a student's ability and somefeature of achievement: The student may be delayed in reading, writing, listening, speaking, ordoing mathematics, but not in all of these at once. A learning problem is not considered alearning disability if it stems from physical, sensory, or motor handicaps, or from generalized
intellectual impairment. It is also not an LD if the learning problem really reflects the challengesof learning English as a second language. Genuine LDs are the learning problems left over after
these other possibilities are accounted for or excluded. Typically, a student with an LD has notbeen helped by teachers' ordinary efforts to assist the student when he or she falls behind
academically, though what counts as an “ordinary effort”, of course, differs among teachers,
schools, and students. Most importantly, though, an LD relates to a fairly specific area ofacademic learning. A student may be able to read and compute well enough, for example, but not
be able to write. LDs are by far the most common form of special educational need, accounting
for half of all students with special needs in the United States and approximately 20% of all
students, depending on how the numbers are estimated (National Center for Learning
Disabilities, 2017). Students with LDs are so common, in fact, that most teachers regularly
encounter at least one per class in any given school year, regardless of the grade level they teach.
These difficulties are identified in school because this is when children's academic abilities arebeing tested, compared, and measured. Consequently, once academic testing is no longer
187essential in that person's life (as when they are working rather than going to school) thesedisabilities may no longer be noticed or relevant, depending on the person's job and the extent of
the disability.
Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in thearea of reading. This diagnosis is used for a number of reading difficulties. Common
characteristics are difficulty with phonological processing, which includes the manipulation ofsounds, spelling, and rapid visual/verbal processing. Additionally, the child may reverse letters,
have difficulty reading from left to right, or may have problems associating letters with sounds.
It appears to be rooted in neurological problems involving the parts of the brain active inrecognizing letters, verbally responding, or being able to manipulate sounds. Recent studies
have identified a number of genes that are linked to developing dyslexia (National Institute of
Neurological Disorders and Stroke, 2016). Treatment typically involves altering teaching
methods to accommodate the person's particular problematic area.
Dysgraphia refers to a writing disability that is often associated with dyslexia (Carlson, 2013).
There are different types of dysgraphia, including phonological dysgraphia when the person
cannot sound out words and write them phonetically. Orthographic dysgraphia is demonstrated
by those individuals who can spell regularly spelled words, but not irregularly spelled ones.
Some individuals with dysgraphia experience difficulties in motor control and experience trouble
forming letters when using a pen or pencil.
Figure 5.18

SourceDyscalculia refers to problems in math. Cowan
and Powell (2014) identified several terms used
when describing difficulties in mathematics
including dyscalculia, mathematical learning
disability, and mathematics disorder. All threeterms refer to students with average intelligence
who exhibit poor academic performance inmathematics. When evaluating a group of third
graders, Cowan and Powell (2014) found thatchildren with dyscalculia demonstrated problems
with working memory, reasoning, processing
speed and oral language, all of which are referred
to as domain-general factors. Additionally,
problems with multi-digit skills, including number
system knowledge, were also exhibited.

A child with attention-deficit/hyperactivity disorder (ADHD) shows a constant pattern of
inattention and/or hyperactive and impulsive behavior that interferes with normal
functioning (American Psychological Association (APA), 2013). Some of the signs of
inattention include great difficulty with, and avoidance of, tasks that require sustained
attention (such as conversations or reading), failure to follow instructions (often resulting
in failure to complete school work and other duties), disorganization (difficulty keeping
things in order, poor time management, sloppy and messy work), lack of attention to detail,becoming easily distracted, and forgetfulness. Hyperactivity is characterized by excessive
188

movement, and includes fidgeting or squirming, leaving one’s seat in situations whenremaining seated is expected, having trouble sitting still (e.g., in a restaurant), runningabout and climbing on things, blurting out responses before another person’s question orstatement has been completed, difficulty waiting one’s turn for something, and interrupting
and intruding on others. Frequently, the hyperactive child comes across as noisy andboisterous. The child’s behavior is hasty, impulsive, and seems to occur without muchforethought; these characteristics may explain why adolescents and young adults diagnosed
with ADHD receive more traffic tickets and have more automobile accidents than do others
their age (Thompson, Molina, Pelham, & Gnagy, 2007).
ADHD occurs in about 5% of children (APA,
2013). On the average, boys are 3 times more
likely to have ADHD than are girls;
however, such findings might reflect thegreater propensity of boys to engage inaggressive and antisocial behavior and thus
incur a greater likelihood of being referred to
psychological clinics (Barkley, 2006).
Children with ADHD face severe academic
and social challenges. Compared to their
non-ADHD counterparts, children with
ADHD have lower grades and standardized
Sourcetest scores and higher rates of expulsion,
grade retention, and dropping out (Loe &Feldman, 2007). They also are less well- liked and more often rejected by their peers (Hoza et al.,2005).
Figure 5.19

ADHD can persist into adolescence and adulthood (Barkley, Fischer, Smallish, & Fletcher,2002). A recent study found that 29.3% of adults who had been diagnosed with ADHD decades
earlier still showed symptoms (Barbaresi et al., 2013). Somewhat troubling, this study also
reported that nearly 81% of those whose ADHD persisted into adulthood had experienced atleast one other comorbid disorder, compared to 47% of those whose ADHD did not persist.
Additional concerns when an adult has ADHD include: Worse educational attainment, lower
socioeconomic status, less likely to be employed, more likely to be divorced, and more likely tohave non-alcohol-related substance abuse problems (Klein et al., 2012).
Etiology of ADHD: Family and twin studies indicate that genetics play a significant role inthe development of ADHD. Burt (2009), in a review of 26 studies, reported that the medianrate of concordance for identical twins was .66, whereas the median concordance rate forfraternal twins was .20. The specific genes involved in ADHD are thought to include atleast two that are important in the regulation of the neurotransmitter dopamine (Gizer, Ficks,& Waldman, 2009), suggesting that dopamine may be important in ADHD. Indeed,
medications used in the treatment of ADHD, such as methylphenidate (Ritalin) andamphetamine with dextroamphetamine (Adderall), have stimulant qualities and elevate
dopamine activity. People with ADHD show less dopamine activity in key regions of thebrain, especially those associated with motivation and reward (Volkow et al., 2009), which189

provides support to the theory that dopamine deficits may be a vital factor in thedevelopment this disorder (Swanson et al., 2007).
Brain imaging studies have shown that children with ADHD exhibit abnormalities in theirfrontal lobes, an area in which dopamine is in abundance. Compared to children without
ADHD, those with ADHD appear to have smaller frontal lobe volume, and they show lessfrontal lobe activation when performing mental tasks (Banaschewski et al., 2017). Recall that
one of the functions of the frontal lobes is to inhibit our behavior. Thus, abnormalities in thisregion may go a long way toward explaining the hyperactive, uncontrolled behavior of
ADHD.
Many parents attribute their child’s hyperactivity to sugar. A statistical review of 16
studies, however, concluded that sugar consumption has no effect at all on the behavioral
and cognitive performance of children (Wolraich, Wilson, & White, 1995). Additionally,
although food additives have been shown to increase hyperactivity in non-ADHD children,
the effect is rather small (McCann et al., 2007). Numerous studies, however, have shown asignificant relationship between exposure to nicotine in cigarette smoke during the prenatal
period and ADHD (Linnet et al., 2003; Sourander et al., 2019). Maternal smoking during
pregnancy is also associated with the development of more severe symptoms of the disorder(Thakur et al., 2013). Additionally, low birth weight and prematurity have been correlatedwith ADHD (Banaschewski et al., 2017).
Treatment for ADHD: Recommended treatment for ADHD includes behavioral interventions,
cognitive behavioral therapy, parent and teacher education, recreational programs, and lifestylechanges, such as getting more sleep (Clay, 2013). For some children medication is prescribed.
Parents are often concerned that stimulant medication may result in their child acquiring asubstance use disorder. However, research using longitudinal studies has demonstrated thatchildren diagnosed with ADHD who received pharmacological treatment had a lower risk for
substance abuse problems than those children who did not receive medication (Wilens, Fararone,
Biederman, & Gunawardene, 2003). The risk of substance abuse problems appears to be evengreater for those with ADHD who are un-medicated and also exhibit antisocial tendencies(Marshal & Molina, 2006).
Is the prevalence rate of ADHD increasing? Many people believe that the rates of ADHD
have increased in recent years, and there is evidence to support this contention. In a recent
study, investigators found that the parent-reported prevalence of ADHD among children (4–17
years old) in the United States increased by 22% during a 4-year period, from 7.8% in 2003 to
9.5% in 2007 (CDC, 2010). ADHD may be over-diagnosed by doctors who are too quick to
medicate children as a behavior treatment. There is also greater awareness of ADHD now thanin the past. Nearly everyone has heard of ADHD, and most parents and teachers are aware of its
key symptoms. Thus, parents may be quick to take their children to a doctor if they believe
their child possesses these symptoms, or teachers may be more likely now than in the past to
notice the symptoms and refer the child for evaluation. Further, the use of computers, video
games, iPhones, and other electronic devices has become pervasive among children in theearly 21st century, and these devices could potentially shorten children’s attentions spans.

190

Thus, what might seem like inattention to some parents and teachers could simply reflect
exposure to too much technology.

Children with Disabilities: Legislation
Since the 1970s political and social attitudes have moved increasingly toward including people
with disabilities into a wide variety of “regular” activities. In the United States, the shift is
illustrated clearly in the Federal legislation that was enacted during this time. Three major laws
were passed that guaranteed the rights of persons with disabilities, and of children and students
with disabilities in particular. The third law has had the biggest impact on education.
Rehabilitation Act of 1973, Section 504: This law, the first of its kind, required that individuals
with disabilities be accommodated in any program or activity that receives Federal funding (PL93-112, 1973). Although this law was not intended specifically for education, in practice it hasprotected students' rights in some extra-curricular activities (for older students) and in some childcare or after-school care programs (for younger students). If those programs receive Federal
funding of any kind, the programs are not allowed to exclude children or youths with disabilities,
and they have to find reasonable ways to accommodate the individuals' disabilities.
Americans with Disabilities Act of 1990 (or ADA): This legislation also prohibited
discrimination on the basis of disability, just as Section 504 of the Rehabilitation Act had done
(PL 101-336, 1990). Although the ADA also applies to all people (not just to students), its
provisions are more specific and “stronger” than those of Section 504. In particular, ADA
extends to all employment and jobs, not just those receiving Federal funding. It also specificallyrequires accommodations to be made in public facilities such as with buses, restrooms, andtelephones. ADA legislation is therefore responsible for some of the “minor” renovations inschools that you may have noticed in recent years, like wheelchair-accessible doors, ramps, andrestrooms, and public telephones with volume controls.
Individuals with Disabilities Education Act (or IDEA): As its name implied, this legislation
was more focused on education than either Section 504 or ADA. It was first passed in 1975,
reauthorized in 2004 (PL 108-446, 2004), and most recently amended in 2015 through Public
Law 114-95, as the Every Student Succeeds Act (United States Department of Education, 2017).
In its current form, the law guarantees the following rights related to education for anyone with adisability from birth to age 21. The first two influence schooling in general, but the last threeaffect the work of classroom teachers rather directly:•

Free, appropriate education: An individual or an individual's family should not have to
pay for education simply because the individual has a disability, and the educational
program should be truly educational; i.e., not merely care-taking or babysitting theperson.

•Due process: In case of disagreements between an individual with a disability and theschools or other professionals, there must be procedures for resolving the disagreementsthat are fair and accessible to all parties, including the person himself or herself or the
person's representative.
191

•

Fair evaluation of performance in spite of disability: Tests or other evaluations should
not assume test taking skills that a person with a disability cannot reasonably be expected
to have, such as holding a pencil, hearing or seeing questions, working quickly, or
understanding and speaking orally. Evaluation procedures should be modified to allow
for these differences. This provision of the law applies both to evaluations made byteachers and to school-wide or “high-stakes” testing programs.

•

Education in the “least restrictive environment”: Education for someone with adisability should provide as many educational opportunities and options for the person as
possible, both in the short term and in the long term. In practice this requirement has
meant including students in regular classrooms and school activities as much as possible,
though often not totally.

•

An individualized educational program (IEP): Given that every disability is unique,instructional planning for a person with a disability should be unique or individualized aswell. In practice this provision has led to classroom teachers planning individualized
programs jointly with other professionals (like reading specialists, psychologists, or
medical personnel) as part of a team.

Evaluation and diagnosis can be the first step in helping provide children with disabilities thetype of instruction and resources that will benefit them educationally, but diagnosis and labelingalso have social implications. It is important to consider that children can be misdiagnosed andthat once a child has received a diagnostic label, the child, teachers, and family members may
tend to interpret actions of the child through that label. The label can also influence the child's
self-concept. Consider, for example, a child who is misdiagnosed as learning disabled. That child
may expect to have difficulties in school, lack confidence, and because of these expectations
experience trouble. This self-fulfilling prophecy or tendency to act in such a way as to makewhat you predict will happen, will come true.
This calls our attention to the power that labels can have whether or not they are accurately
applied. It is also important to consider that children's difficulties can change over time; a child
who has problems in school, may improve later or may live under circumstances as an adult
where the problem (such as a delay in math skills or reading skills) is no longer relevant. That
person, however, will still have a label as learning disabled. It should be recognized that thedistinction between abnormal and normal behavior is not always clear; some abnormal behavior
in children is fairly common.

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Learning Objectives: Socioemotional Development in Middle and Late
Childhood
•
•
•
•
•
•
•
•
•
•

Describe Erikson’s fourth stage of industry vs. inferiority
Describe the changes in self-concept, self-esteem, and self-efficacy
Explain Kohlberg’s stages of moral development
Describe the importance of peers, the stages of friendships, peer acceptance, andthe consequences of peer acceptanceDescribe bullying, cyberbullying and the consequences of bullying
Identify the types of families where children reside
Identify the five family tasks
Explain the consequences of divorce on children
Describe the effects of cohabitation and remarriage on children
Describe the characteristics and developmental stages of blended families

Erikson: Industry vs. Inferiority
According to Erikson, children in middle and late childhood are very busy or industrious(Erikson, 1982). They are constantly doing, planning, playing, getting together with friends, andachieving. This is a very active time, and a time when they are gaining a sense of how theymeasure up when compared with peers. Erikson believed that if these industrious children can be
successful in their endeavors, they will get a sense of confidence for future challenges. If not, asense of inferiority can be particularly haunting during middle and late childhood.

Self-Understanding
Self-concept refers to beliefs about general personal identity (Seiffert, 2011). These beliefs
include personal attributes, such as one’s age, physical characteristics, behaviors, andcompetencies. Children in middle and late childhood have a more realistic sense of self than dothose in early childhood, and they better understand their strengths and weaknesses. This can be
attributed to greater experience in comparing their own performance with that of others, and to
greater cognitive flexibility. Children in middle and late childhood are also able to include otherpeoples’ appraisals of them into their self-concept, including parents, teachers, peers, culture,and media. Internalizing others’ appraisals and creating social comparison affect children’s selfesteem, which is defined as an evaluation of one’s identity. Children can have individual
assessments of how well they perform a variety of activities and also develop an overall global
self-assessment. If there is a discrepancy between how children view themselves and what they
consider to be their ideal selves, their self-esteem can be negatively affected.

193

Another important development in selfunderstanding is self-efficacy, which is thebelief that you are capable of carrying out aspecific task or of reaching a specific goal
(Bandura, 1977, 1986, 1997). Large
discrepancies between self-efficacy andability can create motivational problems forthe individual (Seifert, 2011). If a student
believes that he or she can solve
mathematical problems, then the student ismore likely to attempt the mathematics
homework that the teacher assigns.
Unfortunately, the converse is also true. If a
student believes that he or she is incapableof math, then the student is less likely to
Sourceattempt the math homework regardless ofthe student's actual ability in math. Since
self-efficacy is self-constructed, it is possible for students to miscalculate or misperceive theirtrue skill, and these misperceptions can have complex effects on students' motivations. It is
possible to have either too much or too little self-efficacy, and according to Bandura (1997) the
optimum level seems to be either at, or slightly above, true ability.
Figure 5.20 Hopefully these children haveself-efficacy about playing the violin

Kohlberg’s Stages of Moral Development
Kohlberg (1963) built on the work of Piaget and was interested in finding out how our moral
reasoning changes as we get older. He wanted to find out how people decide what is right andwhat is wrong. Just as Piaget believed that children’s cognitive development follows specificpatterns, Kohlberg (1984) argued that we learn our moral values through active thinking andreasoning, and that moral development follows a series of stages. Kohlberg's six stages are
generally organized into three levels of moral reasons. To study moral development, Kohlberg
posed moral dilemmas to children, teenagers, and adults, such as the following:
A man’s wife is dying of cancer and there is only one drug that can save her. The only
place to get the drug is at the store of a pharmacist who is known to overcharge people
for drugs. The man can only pay $1,000, but the pharmacist wants $2,000, and refuses tosell it to him for less, or to let him pay later. Desperate, the man later breaks into thepharmacy and steals the medicine. Should he have done that? Was it right or wrong?
Why? (Kohlberg, 1984)
Level One-Preconventional Morality: In stage one, moral reasoning is based on concepts ofpunishment. The child believes that if the consequence for an action is punishment, then theaction was wrong. In the second stage, the child bases his or her thinking on self-interest andreward. "You scratch my back, I'll scratch yours." The youngest subjects seemed to answer
based on what would happen to the man as a result of the act. For example, they might say theman should not break into the pharmacy because the pharmacist might find him and beat him. Or
they might say that the man should break in and steal the drug and his wife will give him a big194kiss. Right or wrong, both decisions were based on what would physically happen to the man asa result of the act. This is a self-centered approach to moral decision-making. He called thismost superficial understanding of right and wrong preconventional morality. Preconventional
morality focuses on self-interest. Punishment is avoided, and rewards are sought. Adults canalso fall into these stages, particularly when they are under pressure.
Level Two-Conventional Morality: Those tested who based their answers on what otherpeople would think of the man as a result of his act, were placed in Level Two. For instance, theymight say he should break into the store, and then everyone would think he was a good husband,or he should not because it is against the law. In either case, right and wrong is determined bywhat other people think. In stage three, the person wants to please others. At stage four, theperson acknowledges the importance of social norms or laws and wants to be a good member ofthe group or society. A good decision is one that gains the approval of others or one thatcomplies with the law. This he called conventional morality, people care about the effect of
their actions on others. Some older children, adolescents, and adults use this reasoning.
Level Three-Postconventional Morality: Right and wrong are based on social contracts
established for the good of everyone and that can transcend the self and social convention. For
example, the man should break into the store because, even if it is against the law, the wife needs
the drug and her life is more important than the consequences the man might face for breaking
the law. Alternatively, the man should not violate the principle of the right of property because
this rule is essential for social order. In either case, the person's judgment goes beyond what
happens to the self. It is based on a concern for others; for society as a whole, or for an ethicalstandard rather than a legal standard. This level is called postconventional moral development
because it goes beyond convention or what other people think to a higher, universal ethicalprinciple of conduct that may or may not be reflected in the law. Notice that such thinking is thekind Supreme Court justices do all day when deliberating whether a law is moral or ethical,
which requires being able to think abstractly. Often this is not accomplished until a person
reaches adolescence or adulthood. In the fifth stage, laws are recognized as social contracts. The
reasons for the laws, like justice, equality, and dignity, are used to evaluate decisions andinterpret laws. In the sixth stage, individually determined universal ethical principles are weighed
to make moral decisions. Kohlberg said that few people ever reach this stage. The six stages canbe reviewed in Table 5.6.
Although research has supported Kohlberg’s idea that moral reasoning changes from an early
emphasis on punishment and social rules and regulations to an emphasis on more general ethicalprinciples, as with Piaget’s approach, Kohlberg’s stage model is probably too simple. For one,people may use higher levels of reasoning for some types of problems but revert to lower levels
in situations where doing so is more consistent with their goals or beliefs (Rest, 1979). Second, it
has been argued that the stage model is particularly appropriate for Western, rather than nonWestern, samples in which allegiance to social norms, such as respect for authority, may beparticularly important (Haidt, 2001). In addition, there is frequently little correlation between
how we score on the moral stages and how we behave in real life.

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Table 5.6 Lawrence Kohlberg’s Levels of Moral Reasoning
Age

Moral Level

Description

Young children- Preconventional Stage 1: Focus is on self-interest and punishment is avoided. The
man shouldn’t steal the drug, as he may get caught and go to jail.
usually prior to morality
age 9Stage 2: Rewards are sought. A person at this level will argue thatthe man should steal the drug because he does not want to lose hiswife who takes care of him.
Older children, Conventional
adolescents, and morality
most adults

Stage 3: Focus is on how situational outcomes impact others andwanting to please and be accepted. The man should steal the drug
because that is what good husbands do.
Stage 4: People make decisions based on laws or formalized rules.
The man should obey the law because stealing is a crime.

Rare withadolescents andfew adults

Postconventional Stage 5: Individuals employ abstract reasoning to justify behaviors.
morality
The man should steal the drug because laws can be unjust, and you
have to consider the whole situation.
Stage 6: Moral behavior is based on self-chosen ethical principles.
The man should steal the drug because life is more important thanproperty.

Perhaps the most important critique of Kohlberg’s theory is that it may describe the moral
development of males better than it describes that of females. Gilligan (1982) has argued that,
because of differences in their socialization, males tend to value principles of justice and rights,
whereas females value caring for and helping others. Although there is little evidence for agender difference in Kohlberg’s stages of moral development (Turiel, 1998), it is true that girls
and women tend to focus more on issues of caring, helping, and connecting with others than doboys and men (Jaffee & Hyde, 2000).

Friends and Peers
As toddlers, children may begin to show a preference for certain playmates (Ross & Lollis,
1989). However, peer interactions at this age often involve more parallel play rather thanintentional social interactions (Pettit, Clawson, Dodge, & Bates, 1996). By age four, many
children use the word “friend” when referring to certain children and do so with a fair degree ofstability (Hartup, 1983). However, among young children “friendship” is often based on
proximity, such as they live next door, attend the same school, or it refers to whomever they justhappen to be playing with at the time (Rubin, 1980).

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Friendships take on new importance as judges of
Figure 5.21
one's worth, competence, and attractiveness in
middle and late childhood. Friendships provide theopportunity for learning social skills, such as how tocommunicate with others and how to negotiate
differences. Children get ideas from one anotherabout how to perform certain tasks, how to gain
popularity, what to wear or say, and how to act. This
society of children marks a transition from a life
focused on the family to a life concerned withpeers. During middle and late childhood, peers
increasingly play an important role. For example,
Sourcepeers play a key role in a child's self-esteem at thisage as any parent who has tried to console a rejectedchild will tell you. No matter how complimentary and encouraging the parent may be, being
rejected by friends can only be remedied by renewed acceptance. Children’s conceptualization ofwhat makes someone a “friend” changes from a more egocentric understanding to one based on
mutual trust and commitment. Both Bigelow (1977) and Selman (1980) believe that thesechanges are linked to advances in cognitive development.
Bigelow and La Gaipa (1975) outline three stages to children’sconceptualization of friendship.
SourceIn stage one, reward-cost, friendship focuses on mutual activities. Children in early, middle,
and late childhood all emphasize similar interests as the main characteristics of a good friend.
Stage two, normative expectation focuses on conventional morality; that is, the emphasis is ona friend as someone who is kind and shares with you. Clark and Bittle (1992) found that fifth
graders emphasized this in a friend more than third or eighth graders. In the final stage,
empathy and understanding, friends are people who are loyal, committed to the relationship,and share intimate information. Clark and Bittle (1992) reported eighth graders emphasized thismore in a friend. They also found that as early as fifth grade, girls were starting to include asharing of secrets, and not betraying confidences as crucial to someone who is a friend.
Selman (1980) outlines five stages of friendship from early childhood through to adulthood:•

Momentary physical interaction, a friend is someone who you are playing with at thispoint in time. Selman notes that this is typical of children between the ages of three andsix. These early friendships are based more on circumstances (e.g., a neighbor) than on
genuine similarities.

•

One-way assistance, a friend is someone who does nice things for you, such as saving
you a seat on the school bus or sharing a toy. However, children in this stage, do notalways think about what they are contributing to the relationships. Nonetheless, having
a friend is important and children will sometimes put up with a not so nice friend, just to
have a friend. Children as young as five and as old as nine may be in this stage.

•

Fair-weather cooperation, children are very concerned with fairness and reciprocity,and thus, a friend is someone returns a favor. In this stage, if a child does something197

nice for a friend there is an expectation that the friend will do something nice for themat the first available opportunity. When this fails to happen, a child may break off thefriendship. Selman found that some children as young as seven and as old as twelve arein this stage.
•

Intimate and mutual sharing, typically between the ages of eight and fifteen, a friend
is someone who you can tell them things you would tell no one else. Children and teensin this stage no longer “keep score” and do things for a friend because they genuinely
care for the person. If a friendship dissolves in the stage it is usually due to a violationof trust. However, children in this stage do expect their friend to share similar interestsand viewpoints and may take it as a betrayal if a friend likes someone that they do not.

•Autonomous interdependence, a friend is someone who accepts you and that you
accept as they are. In this stage children, teens, and adults accept and even appreciatedifferences between themselves and their friends. They are also not as possessive, sothey are less likely to feel threatened if their friends have other relationships or interests.
Children are typically twelve or older in this stage.

Peer Relationships: Sociometric assessment measures attraction between members of a group,
such as a classroom of students. In sociometric research children are asked to mention the threechildren they like to play with the most, and those they do not like to play with. The number oftimes a child is nominated for each of the two categories (like, do not like) is tabulated. Popularchildren receive many votes in the “like” category, and very few in the “do not like” category.
In contrast, rejected children receive more unfavorable votes, and few favorable ones.
Controversial children are mentioned frequently in each category, with several children liking
them and several children placing them in the do not like category. Neglected children are
rarely mentioned in either category, and the average child has a few positive votes with very few
negative ones (Asher & Hymel, 1981).
Most children want to be liked and accepted by their
Figure 5.22 Withdrawn
friends. Some popular children are nice and have good social
children are targets forskills. These popular-prosocial children tend to do well in schoolbullies
and are cooperative and friendly. Popular-antisocial children
may gain popularity by acting tough or spreading rumors aboutothers (Cillessen & Mayeux, 2004). Rejected children are
sometimes excluded because they are rejected-withdrawn.
These children are shy and withdrawn and are easy targets forbullies because they are unlikely to retaliate when belittled(Boulton, 1999). Other rejected children are rejected-aggressive
and are ostracized because they are aggressive, loud, andconfrontational. The aggressive-rejected children may be actingout of a feeling of insecurity. Unfortunately, their fear of rejection
only leads to behavior that brings further rejection from otherchildren. Children who are not accepted are more likely to
Sourceexperience conflict, lack confidence, and have trouble adjusting(Klima & Repetti, 2008; Schwartz, Lansford, Dodge, Pettit, & Bates, 2014).
198

Long-Term Consequences of Popularity: Childhood popularity researcher Mitch Prinstein has
found that likability in childhood leads to positive outcomes throughout one’s life (as cited in
Reid, 2017). Adults who were accepted in childhood have stronger marriages and work
relationships, earn more money, and have better health outcomes than those who were
unpopular. Further, those who were unpopular as children, experienced greater anxiety,depression, substance use, obesity, physical health problems and suicide. Prinstein found that asignificant consequence of unpopularity was that children were denied opportunities to build
their social skills and negotiate complex interactions, thus contributing to their continued
unpopularity. Further, biological effects can occur due to unpopularity, as social rejection can
activate genes that lead to an inflammatory response.

Bullying
According to Stopbullying.gov (2016), a federal government website managed by the U.S.
Department of Health & Human Services, bullying is defined as unwanted, aggressive behavior
among school aged children that involves a real or perceived power imbalance. Further, theaggressive behavior happens more than once or has the potential to be repeated. There aredifferent types of bullying, including verbal bullying, which is saying or writing mean things,
teasing, name calling, taunting, threatening, or making inappropriate sexual comments. Social
bullying, also referred to as relational bullying, involves spreading rumors, purposefully
excluding someone from a group, or embarrassing someone on purpose. Physical Bullying
involves hurting a person’s body or possessions.
A more recent form of bullying is cyberbullying, which involves electronic technology.
Examples of cyberbullying include sending mean text messages or emails, creating fake profiles,
and posting embarrassing pictures, videos or rumors on social networking sites. Children who
experience cyberbullying have a harder time getting away from the behavior because it can occur
any time of day and without being in the presence of others. Additional concerns ofcyberbullying include that messages and images can be posted anonymously, distributed quickly,
and be difficult to trace or delete. Children who are cyberbullied are more likely to: experiencein-person bullying, be unwilling to attend school, receive poor grades, use alcohol and drugs,
skip school, have lower self-esteem, and have more health problems (Stopbullying.gov, 2016).
The National Center for Education Statistics and Bureau of Justice statistics indicate that in2010-2011, 28% of students in grades 6-12 experienced bullying and 7% experienced
cyberbullying. The 2013 Youth Risk Behavior Surveillance System, which monitors six types ofhealth risk behaviors, indicate that 20% of students in grades 9-12 experienced bullying and 15%
experienced cyberbullying (Stopbullying.gov, 2016).
Those at risk for bullying: Bullying can happen to anyone, but some students are at anincreased risk for being bullied including lesbian, gay, bisexual, transgendered (LGBT) youth,
those with disabilities, and those who are socially isolated. Additionally, those who areperceived as different, weak, less popular, overweight, or having low self-esteem, have a higher
likelihood of being bullied.

199

Figure 5.23

Those who are more likely to bully: Bullies are often
thought of as having low self-esteem, and then bully
others to feel better about themselves. Although this canoccur, many bullies in fact have high levels of selfesteem. They possess considerable popularity and social
power and have well-connected peer relationships.
They do not lack self-esteem, and instead lack empathy
for others. They like to dominate or be in charge ofothers.

Bullied children often do not ask for help:
Unfortunately, most children do not let adults know thatthey are being bullied. Some fear retaliation from the bully, while others are too embarrassed to
ask for help. Those who are socially isolated may not know who to ask for help or believe thatno one would care or assist them if they did ask for assistance. Consequently, it is important forparents and teacher to know the warning signs that may indicate a child is being bullied. These
include: unexplainable injuries, lost or destroyed possessions, changes in eating or sleeping
patterns, declining school grades, not wanting to go to school, loss of friends, decreased selfesteem and/or self-destructive behaviors.
SourceFamily Life
Family Tasks: One of the ways to assess the quality of family life is to consider the tasks offamilies. Berger (2014) lists five family functions:
1. Providing food, clothing and shelter
2. Encouraging learning
3. Developing self-esteem
4. Nurturing friendships with peers
5. Providing harmony and stability
Notice that in addition to providing food, shelter, and clothing, families are responsible forhelping the child learn, relate to others, and have a confident sense of self. Hopefully, the family
will provide a harmonious and stable environment for living. A good home environment is one inwhich the child's physical, cognitive, emotional, and social needs are adequately met. Sometimes
families emphasize physical needs but ignore cognitive or emotional needs. Other times, families
pay close attention to physical needs and academic requirements but may fail to nurture thechild's friendships with peers or guide the child toward developing healthy relationships.
Parents might want to consider how it feels to live in the household as a child. The tasks offamilies listed above are functions that can be fulfilled in a variety of family types-not just intact,
two-parent households.
Parenting Styles: As discussed in the previous chapter, parenting styles affect the relationshipparents have with their children. During middle and late childhood, children spend less time withparents and more time with peers, and consequently parents may have to modify their approach
to parenting to accommodate the child's growing independence. The authoritative style, which200

incorporates reason and engaging in joint decision-making whenever possible may be the mosteffective approach (Berk, 2007). However, Asian-American, African-American, and MexicanAmerican parents are more likely than European-Americans to use an authoritarian style ofparenting. This authoritarian style of parenting that uses strict discipline and focuses onobedience is also tempered with acceptance and warmth on the part of the parents. Children
raised in this manner tend to be confident, successful and happy (Chao, 2001; Stewart & Bond,
2002).
Living Arrangements: Certainly, the living arrangements of children have changed
significantly over the years. In 1960, 92% of children resided with married parents, while only
5% had parents who were divorced or separated and 1% resided with parents who had neverbeen married. By 2008, 70% of children resided with married parents, 15% had parent who weredivorced or separated, and 14% resided with parents who had never married (Pew ResearchCenter, 2010). In 2017, only 65% of children lived with two married parents, while 32% (24million children younger than 18) lived with an unmarried parent (Livingston, 2018). Some 3%of children were not living with any parents, according to the U.S. Census Bureau data.
Most children in unmarried parent households in 2017 were living with a solo mother (21%), but
a growing share were living with cohabiting parents (7%) or a sole father (4%) (see Figure 5.24).
The increase in children living with solo or cohabiting parents was thought to be due to theoverall declines in marriage, as well as increases in divorce. Of concern is that living with only
one parent was associated with a household’s lower economic situation. Specifically, 30% of
solo mothers, 17% of solo fathers, and 16% of families with a cohabitating couple lived inpoverty. In contrast, only 8% of married couples lived below the poverty line (Livingston,2018).
Figure 5.24

201

Figure 5.25

Lesbian and Gay Parenting: Research has
consistently shown that the children of lesbian andgay parents are as successful as those of heterosexual
parents, and consequently efforts are being made toensure that gay and lesbian couples are provided withthe same legal rights as heterosexual couples when
adopting children (American Civil Liberties Union,2016).

Patterson (2013) reviewed more than 25 years ofsocial science research on the development of children
raised by lesbian and gay parents and found noevidence of detrimental effects. In fact, research has
demonstrated that children of lesbian and gay parents
are as well-adjusted overall as those of heterosexual
parents. Specifically, research comparing children
based on parental sexual orientation has not shown
any differences in the development of gender identity,
Sourcegender role development, or sexual orientation.
Additionally, there were no differences between thechildren of lesbian or gay parents and those of heterosexual parents in separation-individuation,
behavior problems, self-concept, locus of control, moral judgment, school adjustment,
intelligence, victimization, and substance use. Further, research has consistently found thatchildren and adolescents of gay and lesbian parents report normal social relationships withfamily members, peers, and other adults. Patterson concluded that there is no evidence tosupport legal discrimination or policy bias against lesbian and gay parents.
Divorce: Using families in the National Institute of Child Health and Human Development(NICHD) Study of Early Child Care and Youth Development, Weaver and Schofield (2015)
found that children from divorced families had significantly more behavior problems than thosefrom a matched sample of children from non-divorced families. These problems were evident
immediately after the separation and also in early and middle adolescence. An analysis ofdivorce factors indicated that children exhibited more externalizing behaviors if the family had
fewer financial resources before the separation. It was hypothesized that the lower income andlack of educational and community resources contributed to the stress involved in the divorce.
Additional factors contributing to children’s behavior problems included a post-divorce homethat was less supportive and stimulating, and a mother that was less sensitive and moredepressed.
Additional concerns include that the child will grieve the loss of the parent they no longer see as
frequently. The child may also grieve about other family members that are no longer
available. Very often, divorce means a change in the amount of money coming into thehousehold. Custodial mothers experience a 25% to 50% drop in their family income, and evenfive years after the divorce they have reached only 94% of their pre-divorce family income(Anderson, 2018). As a result, children experience new constraints on spending or
entertainment. School-aged children, especially, may notice that they can no longer have toys,202

clothing or other items to which they have grown accustomed. Or it may mean that there is lesseating out or being able to afford participation in extracurricular activities. The custodial parent
may experience stress at not being able to rely on child support payments or having the samelevel of income as before. This can affect decisions regarding healthcare, vacations, rents,
mortgages and other expenditures, and the stress can result in less happiness and relaxation in thehome. The parent who has to take on more work may also be less available to the children.
Children may also have to adjust to other changes accompanying a divorce. The divorce mightmean moving to a new home and changing schools or friends. It might mean leaving aneighborhood that has meant a lot to them as well.
Relationships of adult children of divorce are identified as more problematic than those adults
from intact homes. For 25 years, Hetherington and Kelly (2002) followed children of divorce
and those whose parents stayed together. The results indicated that 25% of adults whose parents
had divorced experienced social, emotional, or psychological problems compared with only 10%of those whose parents remained married. For example, children of divorce have more difficulty
forming and sustaining intimate relationships as young adults, are more dissatisfied with theirmarriage, and consequently more likely to get divorced themselves (Arkowitz & Lilienfeld,2013). One of the most commonly cited long-term effects of divorce is that children of divorce
may have lower levels of education or occupational status (Richter & Lemola, 2017). This may
be a consequence of lower income and resources for funding education rather than to divorce per
se. In those households where, economic hardship does not occur, there may be no impact onlong-term economic status (Drexler, 2005).
According to Arkowitz and Lilienfeld (2013), long-term harm from parental divorce is notinevitable, however, and children can navigate the experience successfully. A variety of factors
can positively contribute to the child’s adjustment. For example, children manage better when
parents limit conflict, and provide warmth, emotional support and appropriate discipline.
Further, children cope better when they reside with a well-functioning parent and have access tosocial support from peers and other adults. Those at a higher socioeconomic status may farebetter because some of the negative consequences of divorce are a result of financial hardshiprather than divorce per se (Anderson, 2014; Drexler, 2005). It is important when considering the
research findings on the consequences of divorce for children to consider all the factors that can
influence the outcome, as some of the negative consequences associated with divorce are due topreexisting problems (Anderson, 2014). Although they may experience more problems thanchildren from non-divorced families, most children of divorce lead happy, well-adjusted lives
and develop strong, positive relationships with their custodial parent (Seccombe & Warner,
2004).
Children from single-parent families talk to their mothers more often than children of two-parent
families (McLanahan & Sandefur, 1994). In a study of college-age respondents, Arditti (1999)
found that increasing closeness and a movement toward more democratic parenting styles was
experienced. Others have also found that relationships between mothers and children become
closer and stronger (Guttman, 1993) and suggest that greater equality and less rigid parenting isbeneficial after divorce (Steward, Copeland, Chester, Malley, & Barenbaum, 1997).

203

Certain characteristics of the child can also facilitate post-divorce adjustment. Specifically,children with an easygoing temperament, who problem-solve well, and seek social support
manage better after divorce. A further protective factor for children is intelligence (Weaver &Schofield, 2015). Children with higher IQ scores appear to be buffered from the effects ofdivorce. Children may be given more opportunity to discover their own abilities and gain
independence that fosters self-esteem. If divorce means a reduction in tension, the child may feelrelief. Overall, not all children of divorce suffer negative consequences (Hetherington & Kelly,2002). Furstenberg and Cherlin (1991) believe that the primary factor influencing the way thatchildren adjust to divorce is the way the custodial parent adjusts to the divorce. If that parent isadjusting well, the children will benefit. This may explain a good deal of the variation we find inchildren of divorce.
Is cohabitation and remarriage more difficult than divorce for the child? The remarriage ofa parent may be a more difficult adjustment for a child than the divorce of a parent (Seccombe &Warner, 2004). Parents and children typically have different ideas of how the stepparent shouldact. Parents and stepparents are more likely to see the stepparent's role as that of parent. A moredemocratic style of parenting may become more authoritarian after a parent remarries. Biologicalparents are more likely to continue to be involved with their children jointly when neither parent
has remarried. They are least likely to jointly be involved if the father has remarried and themother has not. Cohabitation can be difficult for children to adjust to because cohabiting
relationships in the United States tend to be short-lived. About 50 percent last less than 2 years(Brown, 2000). The child who starts a relationship with the parent's live-in partner may have tosever this relationship later. Even in long-term cohabiting relationships, once it is over,continued contact with the child is rare.
Blended Families: One in six children (16%)
Figure 5.26 Blended Family
live in blended families (Pew Research Center,2015). As can be seen in Figure 5.27, Hispanic,
black and white children are equally likely to beliving in a blended family. In contrast, childrenof Asian descent are more likely to be living withtwo married parents, often in their firstmarriage. Blended families are not new. In the
1700-1800s there were many blended families,
but they were created because someone died andremarried. Most blended families today are a
result of divorce and remarriage, and suchorigins lead to new considerations. Blended
Sourcefamilies are different from intact families andmore complex in a number of ways that can pose
unique challenges to those who seek to form successful blended family relationships (Visher &Visher, 1985). Children may be a part of two households, each with different rules that can be
confusing.

204

Figure 5.27

Members in blended families may not be as sure that
others care and may require more demonstrations ofaffection for reassurance. For example, stepparents
expect more gratitude and acknowledgment from thestepchild than they would with a biological child.
Stepchildren experience more uncertainty/insecurity intheir relationship with the parent and fear the parents will
see them as sources of tension. Stepparents may feelguilty for a lack of feelings they may initially havetoward their partner's children. Children who are required
to respond to the parent's new mate as though they werethe child's "real" parent often react with hostility,
rebellion, or withdrawal. This occurs especially if there
has not been time for the relationship to develop.

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Chapter 6: Adolescence
Adolescence is a period that begins with puberty and ends with the transition to adulthood(approximately ages 10–18). Physical changes associated with puberty are triggered byhormones. Changes happen at different rates in distinct parts of the brain and increaseadolescents’ propensity for risky behavior. Cognitive changes include improvements in complex
and abstract thought. Adolescents’ relationships with parents go through a period of redefinitionin which adolescents become more autonomous. Peer relationships are important sources of
support, but companionship during adolescence can also promote problem behaviors. Identity
formation occurs as adolescents explore and commit to different roles and ideological positions.
Because so much is happening in these years, psychologists have focused a great deal ofattention on the period of adolescence.

Learning Objectives: Physical Development in Adolescence
•
•
•
•
•
•
•
•

Summarize the overall physical growth
Describe the changes that occur during puberty
Describe the changes in brain maturation
Describe the changes in sleep
Describe gender intensification
Identify nutritional concerns
Describe eating disorders
Explain the prevalence, risk factors, and consequences of adolescent pregnancy

Growth in Adolescence
Puberty is a period of rapid growth and sexual maturation. These changes begin sometime
between eight and fourteen. Girls begin puberty at around ten years of age and boys begin
approximately two years later. Pubertal changes take around three to four years to complete.
Adolescents experience an overall physical growth spurt. The growth proceeds from theextremities toward the torso. This is referred to as distalproximal development. First the hands
grow, then the arms, and finally the torso. The overall physical growth spurt results in 10-11
inches of added height and 50 to 75 pounds of increased weight. The head begins to growsometime after the feet have gone through their period of growth. Growth of the head ispreceded by growth of the ears, nose, and lips. The difference in these patterns of growth resultin adolescents appearing awkward and out-of-proportion. As the torso grows, so does the internalorgans. The heart and lungs experience dramatic growth during this period.
During childhood, boys and girls are quite similar in height and weight. However, genderdifferences become apparent during adolescence. From approximately age ten to fourteen, theaverage girl is taller, but not heavier, than the average boy. After that, the average boy becomes215

both taller and heavier, although individual differences are certainly noted. As adolescents
physically mature, weight differences are more noteworthy than height differences. At eighteen
years of age, those that are heaviest weigh almost twice as much as the lightest, but the tallest
teens are only about 10% taller than the shortest (Seifert, 2012).
Both height and weight can certainly be sensitive issues for some teenagers. Most modern
societies, and the teenagers in them, tend to favor relatively short women and tall men, as well asa somewhat thin body build, especially for girls and women. Yet, neither socially preferredheight nor thinness is the destiny for many individuals. Being overweight, in particular, has
become a common, serious problem in modern society due to the prevalence of diets high in fat
and lifestyles low in activity (Tartamella, Herscher, & Woolston, 2004). The educational systemhas, unfortunately, contributed to the problem as well by gradually restricting the number ofphysical education courses and classes in the past two decades.
Average height and weight are also related somewhat to racial and ethnic background. In
general, children of Asian background tend to be slightly shorter than children of European andNorth American background. The latter in turn tend to be shorter than children from African
societies (Eveleth & Tanner, 1990). Body shape differs slightly as well, though the differences
are not always visible until after puberty. Asian background youth tend to have arms and legs
that are a bit short relative to their torsos, and African background youth tend to have relatively
long arms and legs. The differences are only averages, as there are large individual differences as
well.

Sexual Development
Typically, the growth spurt is followed by the development of sexual maturity. Sexual changes
are divided into two categories: Primary sexual characteristics and secondary sexual
characteristics. Primary sexual characteristics are changes in the reproductive organs. For
males, this includes growth of the testes, penis, scrotum, and spermarche or first ejaculation ofsemen. This occurs between 11 and 15 years of age. For females, primary characteristics include
growth of the uterus and menarche or the first menstrual period. The female gametes, which
are stored in the ovaries, are present at birth, but are immature. Each ovary contains about
400,000 gametes, but only 500 will become mature eggs (Crooks & Baur, 2007). Beginning at
puberty, one ovum ripens and is released about every 28 days during the menstrual cycle. Stressand higher percentage of body fat can bring menstruation at younger ages.
Male Anatomy: Males have both internal and external genitalia that are responsible forprocreation and sexual intercourse. Males produce their sperm on a cycle, and unlike the female's
ovulation cycle, the male sperm production cycle is constantly producing millions of spermdaily. The main male sex organs are the penis and the testicles, the latter of which produce
semen and sperm. The semen and sperm, as a result of sexual intercourse, can fertilize an ovum
in the female's body; the fertilized ovum (zygote) develops into a fetus which is later born as achild.

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Figure 6.1 Male Reproductive System

SourceFemale Anatomy: Female
external genitalia is collectively
known as the vulva, which
includes the mons veneris, labia
majora, labia minora, clitoris,
vaginal opening, and urethral
opening. Female internal
reproductive organs consist of
the vagina, uterus, fallopian
tubes, and ovaries. The uterus
hosts the developing fetus,
produces vaginal and uterine
secretions, and passes the male's
sperm through to the fallopian
tubes while the ovaries release
the eggs. A female is born with
Sourceall her eggs already produced.
The vagina is attached to theuterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes.
Females have a monthly reproductive cycle; at certain intervals the ovaries release an egg, which
passes through the fallopian tube into the uterus. If, in this transit, it meets with sperm, the sperm
might penetrate and merge with the egg, fertilizing it. If not fertilized, the egg is flushed out of
the system through menstruation.
Figure 6.2 Female Reproductive System

217

Secondary sexual characteristics are visible physicalchanges not directly linked to reproduction but signal
sexual maturity. For males this includes broader shoulders
and a lower voice as the larynx grows. Hair becomescoarser and darker, and hair growth occurs in the pubicarea, under the arms and on the face. For females, breast
development occurs around age 10, although fulldevelopment takes several years. Hips broaden, and pubic
and underarm hair develops and also becomes darker andcoarser.

Figure 6.3 First time shaving

SourceAcne: An unpleasant consequence of the hormonal changes in puberty is acne, defined as
pimples on the skin due to overactive sebaceous (oil-producing) glands (Dolgin, 2011). These
glands develop at a greater speed than the skin ducts that discharges the oil. Consequently, theducts can become blocked with dead skin and acne will develop. According to the University ofCalifornia at Los Angeles Medical Center (2000), approximately 85% of adolescents develop
acne, and boys develop acne more than girls because of greater levels of testosterone in theirsystems (Dolgin, 2011). Experiencing acne can lead the adolescent to withdraw socially,
especially if they are self-conscious about their skin or teased (Goodman, 2006).
Effects of Pubertal Age: The age of puberty is getting younger for children throughout theworld. According to Euling et al. (2008) data are sufficient to suggest a trend toward an earlier
breast development onset and menarche in girls. A century ago the average age of a girl’s first
period in the United States and Europe was 16, while today it is around 13. Because there is noclear marker of puberty for boys, it is harder to determine if boys are maturing earlier too. In
addition to better nutrition, less positive reasons associated with early puberty for girls include
increased stress, obesity, and endocrine disrupting chemicals.
Cultural differences are noted with Asian-American girls, on average, developing last, while
African American girls enter puberty the earliest. Hispanic girls start puberty the second earliest,
while European-American girls rank third in their age of starting puberty. Although AfricanAmerican girls are typically the first to develop, they are less likely to experience negative
consequences of early puberty when compared to European-American girls (Weir, 2016).
Research has demonstrated mental health problems linked to children who begin puberty earlier
than their peers. For girls, early puberty is associated with depression, substance use, eating
disorders, disruptive behavior disorders, and early sexual behavior (Graber, 2013). Early
maturing girls demonstrate more anxiety and less confidence in their relationships with family
and friends, and they compare themselves more negatively to their peers (Weir, 2016).
Problems with early puberty seem to be due to the mismatch between the child’s appearance andthe way she acts and thinks. Adults especially may assume the child is more capable than she
actually is, and parents might grant more freedom than the child’s age would indicate. For girls,
the emphasis on physical attractiveness and sexuality is emphasized at puberty and they may lackeffective coping strategies to deal with the attention they may receive.

218

Figure 6.4

Additionally, mental health problems are more likely to occur when
the child is among the first in his or her peer group to develop.
Because the preadolescent time is one of not wanting to appear
different, early developing children stand out among their peer groupand gravitate toward those who are older. For girls, this results inthem interacting with older peers who engage in risky behaviors suchas substance use and early sexual behavior (Weir, 2016).

Boys also see changes in their emotional functioning at puberty.
According to Mendle, Harden, Brooks-Gunn, and Graber (2010),
while most boys experienced a decrease in depressive symptoms
during puberty, boys who began puberty earlier and exhibited a rapid
Sourcetempo, or a fast rate of change, actually increased in depressive
symptoms. The effects of pubertal tempo were stronger than those ofpubertal timing, suggesting that rapid pubertal change in boys may be a more important risk
factor than the timing of development. In a further study to better analyze the reasons for thischange, Mendle, Harden, Brooks-Gunn and Graber (2012) found that both early maturing boys
and rapidly maturing boys displayed decrements in the quality of their peer relationships as they
moved into early adolescence, whereas boys with more typical timing and tempo development
actually experienced improvements in peer relationships. The researchers concluded that thetransition in peer relationships may be especially challenging for boys whose pubertal maturationdiffers significantly from those of others their age. Consequences for boys attaining early
puberty were increased odds of cigarette, alcohol, or another drug use (Dudovitz, et al., 2015).
Gender Role Intensification: At about the same
Figure 6.5time that puberty accentuates gender, roledifferences also accentuate for at least someteenagers. Some girls who excelled at math orscience in elementary school, may curb their
enthusiasm and displays of success at thesesubjects for fear of limiting their popularity or
attractiveness as girls (Taylor, Gilligan, &Sullivan, 1995; Sadker, 2004). Some boys who
were not especially interested in sports previously
may begin dedicating themselves to athletics toaffirm their masculinity in the eyes of others.
Some boys and girls who once worked together
Sourcesuccessfully on class projects may no longer feel
comfortable doing so, or alternatively may now seek to be working partners, but for social rather
than academic reasons. Such changes do not affect all youngsters equally, nor affect any one
youngster equally on all occasions. An individual may act like a young adult on one day, butmore like a child the next.

Adolescent Brain
The brain undergoes dramatic changes during adolescence. Although it does not get larger, itmatures by becoming more interconnected and specialized (Giedd, 2015). The myelination and219

development of connections between neurons continues. This results in an increase in the whitematter of the brain and allows the adolescent to make significant improvements in their thinking
and processing skills. Different brain areas become myelinated at different times. For example,
the brain’s language areas undergo myelination during the first 13 years. Completed insulationof the axons consolidates these language skills but makes it more difficult to learn a second
language. With greater myelination, however, comes diminished plasticity as a myelin coating
inhibits the growth of new connections (Dobbs, 2012).
Even as the connections between neurons are strengthened, synaptic pruning occurs more thanduring childhood as the brain adapts to changes in the environment. This synaptic pruningcauses the gray matter of the brain, or the cortex, to become thinner but more efficient (Dobbs,
2012). The corpus callosum, which connects the two hemispheres, continues to thicken allowing
for stronger connections between brain areas. Additionally, the hippocampus becomes morestrongly connected to the frontal lobes, allowing for greater integration of memory andexperiences into our decision making.
The limbic system, which regulates emotion
and reward, is linked to the hormonal changes
that occur at puberty. The limbic system isalso related to novelty seeking and a shift
toward interacting with peers. In contrast, theprefrontal cortex which is involved in thecontrol of impulses, organization, planning,and making good decisions, does not fully
develop until the mid-20s. According toGiedd (2015) the significant aspect of thelater developing prefrontal cortex and early
development of the limbic system is the“mismatch” in timing between the two. The
Sourceapproximately ten years that separates thedevelopment of these two brain areas can result in risky behavior, poor decision making, andweak emotional control for the adolescent. When puberty begins earlier, this mismatch extends
even further.
Figure 6.6 Limbic System

Teens often take more risks than adults and according to research it is because they weigh risks
and rewards differently than adults do (Dobbs, 2012). For adolescents the brain’s sensitivity to
the neurotransmitter dopamine peaks, and dopamine is involved in reward circuits, so thepossible rewards outweighs the risks. Adolescents respond especially strongly to social rewards
during activities, and they prefer the company of others their same age. Chein et al. (2011)
found that peers sensitize brain regions associated with potential rewards. For example,
adolescent drivers make risky driving decisions when with friends to impress them, and teens aremuch more likely to commit crimes together in comparison to adults (30 and older) who commit
them alone (Steinberg et al., 2017). In addition to dopamine, the adolescent brain is affected byoxytocin which facilitates bonding and makes social connections more rewarding. With both
dopamine and oxytocin engaged, it is no wonder that adolescents seek peers and excitement intheir lives that could end up actually harming them.
220Because of all the changes that occur in the adolescent brain, the chances for abnormal
development can occur, including mental illness. In fact, 50% of the mental illness occurs by theage 14 and 75% occurs by age 24 (Giedd, 2015). Additionally, during this period ofdevelopment the adolescent brain is especially vulnerable to damage from drug exposure. For
example, repeated exposure to marijuana can affect cellular activity in the endocannabinoid
system. Consequently, adolescents are more sensitive to the effects of repeated marijuana
exposure (Weir, 2015).
However, researchers have also focused on the highly adaptive qualities of the adolescent brain
which allow the adolescent to move away from the family towards the outside world (Dobbs,
2012; Giedd, 2015). Novelty seeking and risk taking can generate positive outcomes including
meeting new people and seeking out new situations. Separating from the family and moving into
new relationships and different experiences are actually quite adaptive for society.

Adolescent Sleep
According to the National Sleep Foundation (NSF) (2016), adolescents need about 8 to 10 hoursof sleep each night to function best. The most recent Sleep in America poll in 2006 indicatedthat adolescents between sixth and twelfth grade were not getting the recommended amount of
sleep. On average adolescents only received 7 ½ hours of sleep per night on school nights withyounger adolescents getting more than older ones (8.4 hours for sixth graders and only 6.9 hours
for those in twelfth grade). For the older adolescents, only about one in ten (9%) get an optimal
amount of sleep, and they are more likely to experience negative consequences the following
day. These include feeling too tired or sleepy, being cranky or irritable, falling asleep in school,
having a depressed mood, and drinking caffeinated beverages (NSF, 2016). Additionally, they
are at risk for substance abuse, car crashes, poor academic performance, obesity, and a weakened
immune system (Weintraub, 2016).
Troxel et al. (2019) found that insufficient sleep in adolescents is a predictor of risky sexual
behaviors. Reasons given for this include that those adolescents who stay out late, typicallywithout parental supervision, are more likely to engage in a variety of risky behaviors, including
risky sex, such as not using birth control or using substances before/during sex. An alternative
explanation for risky sexual behavior is that the lack of sleep negatively affects impulsivity anddecision-making processes.
Figure 6.7

SourceWhy do adolescents not get adequate sleep? In addition
to known environmental and social factors, including work,
homework, media, technology, and socializing, theadolescent brain is also a factor. As adolescent go throughpuberty, their circadian rhythms change and push back their
sleep time until later in the evening (Weintraub, 2016).
This biological change not only keeps adolescents awake atnight, it makes it difficult for them to wake up. When they
are awake too early, their brains do not function optimally.
Impairments are noted in attention, academic achievement,
and behavior while increases in tardiness and absenteeism
are also seen.
221

To support adolescents’ later sleeping schedule, the Centers for Disease Control and Prevention
recommended that school not begin any earlier than 8:30 a.m. Unfortunately, over 80% of
American schools begin their day earlier than 8:30 a.m. with an average start time of 8:03 a.m.
(Weintraub, 2016). Psychologists and other professionals have been advocating for later schooltimes, and they have produced research demonstrating better student outcomes for later start
times. More middle and high schools have changed their start times to better reflect the sleep
research. However, the logistics of changing start times and bus schedules are proving too
difficult for some schools leaving many adolescent vulnerable to the negative consequences of
sleep deprivation. Troxel et al. (2019) cautions that adolescents should find a middle groundbetween sleeping too little during the school week and too much during the weekends. Keeping
consistent sleep schedules of too little sleep will result in sleep deprivation but oversleeping on
weekends can affect the natural biological sleep cycle making it harder to sleep on weekdays.

Adolescent Sexual Activity
By about age ten or eleven, most children experience increased sexual attraction to others that
affects social life, both in school and out (McClintock & Herdt, 1996). By the end of highschool, more than half of boys and girls report having experienced sexual intercourse at least
once, though it is hard to be certain of the proportion because of the sensitivity and privacy of theinformation. (Center for Disease Control, 2004; Rosenbaum, 2006).
Adolescent Pregnancy: As
can be seen in Figure 6.8, in2018 females aged 15–19
years experienced a birth rate
(live births) of 17.4 per 1,000
women. The birth rate forteenagers has declined by
58% since 2007 and 72%
since 1991, the most recent
peak (Hamilton, Joyce,
Martin, & Osterman, 2019).
It appears that adolescents
seem to be less sexuallyactive than in previous years,
and those who are sexuallyactive seem to be using birthcontrol (CDC, 2016).

Figure 6.8

SourceRisk Factors for Adolescent Pregnancy: Miller, Benson, and Galbraith (2001) found thatparent/child closeness, parental supervision, and parents' values against teen intercourse (orunprotected intercourse) decreased the risk of adolescent pregnancy. In contrast, residing indisorganized/dangerous neighborhoods, living in a lower SES family, living with a single parent,222

having older sexually active siblings or pregnant/parenting teenage sisters, early puberty, andbeing a victim of sexual abuse place adolescents at an increased risk of adolescent pregnancy.
Consequences of Adolescent Pregnancy: After the child is born life can be difficult for ateenage mother. Only 40% of teenagers who have children before age 18 graduate from highschool. Without a high school degree her job prospects are limited, and economic independence
is difficult. Teen mothers are more likely to live in poverty, and more than 75% of all unmarriedteen mother receive public assistance within 5 years of the birth of their first child.
Approximately, 64% of children born to an unmarried teenage high-school dropout live inpoverty. Further, a child born to a teenage mother is 50% more likely to repeat a grade in school
and is more likely to perform poorly on standardized tests and drop out before finishing highschool (March of Dimes, 2012).
Research analyzing the age that men father their first child and how far they complete theireducation have been summarized by the Pew Research Center (2015) and reflect the research forfemales. Among dads ages 22 to 44, 70% of those with less than a high school diploma say they
fathered their first child before the age of 25. In comparison, less than half (45%) of fathers withsome college experience became dads by that age. Additionally, becoming a young father occurs
much less for those with a bachelor’s degree or higher as just 14% had their first child prior toage 25. Like men, women with more education are likely to be older when they become
mothers.

Eating Disorders
Although eating disorders can occur in children and adults,
they frequently appear during the teen years or young
adulthood (National Institute of Mental Health (NIMH),
2016). Eating disorders affect both genders, although rates
among women are 2½ times greater than amongmen. Similar to women who have eating disorders, menalso have a distorted sense of body image, including
muscle dysmorphia, which is an extreme desire toincrease one’s muscularity (Bosson, Vandello, & Buckner,2019). The prevalence of eating disorders in the UnitedStates is similar among Non-Hispanic Whites, Hispanics,
African-Americans, and Asians, with the exception thatanorexia nervosa is more common among Non-Hispanic
Whites (Hudson, Hiripi, Pope, & Kessler, 2007; Wade,
Keski-Rahkonen, & Hudson, 2011).

Figure 6.9

SourceRisk Factors for Eating Disorders: Because of the high mortality rate, researchers are looking
into the etiology of the disorder and associated risk factors. Researchers are finding that eating
disorders are caused by a complex interaction of genetic, biological, behavioral, psychological,
and social factors (NIMH, 2016). Eating disorders appear to run in families, and researchers areworking to identify DNA variations that are linked to the increased risk of developing eating
disorders. Researchers from King’s College London (2019) found that the genetic basis of223

anorexia overlaps with both metabolic and body measurement traits. The genetic factors also
influence physical activity, which may explain the high activity level of those with anorexia.
Further, the genetic basis of anorexia overlaps with other psychiatric disorders. Researchers havealso found differences in patterns of brain activity in women with eating disorders in comparison
with healthy women.
The main criteria for the most common eating disorders: Anorexia nervosa, bulimia nervosa,and binge-eating disorder are described in the Diagnostic and Statistical Manual of Mental
Disorders-Fifth Edition (DSM-5) (American Psychiatric Association, 2013) and listed in Table
6.1.
Table 6.1 DSM-5 Eating Disorders
Anorexia Nervosa• Restriction of energy intake leading to a significantly low
body weight• Intense fear of gaining weight• Disturbance in one’s self-evaluation regarding bodyweightBulimia Nervosa• Recurrent episodes of binge eating• Recurrent inappropriate compensatory behaviors toprevent weight gain, including purging, laxatives, fastingor excessive exercise• Self-evaluation is unduly affected by body shape andweightBinge-Eating• Recurrent episodes of binge eating
Disorder• Marked distress regarding binge eating• The binge eating is not associated with the recurrent useof inappropriate compensatory behavior

Health Consequences of Eating Disorders: For those suffering from anorexia, healthconsequences include an abnormally slow heart rate and low blood pressure, which increases therisk for heart failure. Additionally, there is a reduction in bone density (osteoporosis), muscle
loss and weakness, severe dehydration, fainting, fatigue, and overall weakness. Anorexia
nervosa has the highest mortality rate of any psychiatric disorder (Arcelus, Mitchell, Wales, &Nielsen, 2011). Individuals with this disorder may die from complications associated withstarvation, while others die of suicide. In women, suicide is much more common in those withanorexia than with most other mental disorders.
The binge and purging cycle of bulimia can affect the digestives system and lead to electrolyte
and chemical imbalances that can affect the heart and other major organs. Frequent vomiting cancause inflammation and possible rupture of the esophagus, as well as tooth decay and staining
from stomach acids. Lastly, binge eating disorder results in similar health risks to obesity,
including high blood pressure, high cholesterol levels, heart disease, Type II diabetes, and gall
bladder disease (National Eating Disorders Association, 2016).

224

Eating Disorders Treatment: To treat
Figure 6.10
eating disorders, adequate nutrition andstopping inappropriate behaviors, such as
purging, are the foundations of treatment.
Treatment plans are tailored to individual
needs and include medical care, nutritionalcounseling, medications (such as
antidepressants), and individual, group,
and/or family psychotherapy (NIMH, 2016).
For example, the Maudsley Approach has
parents of adolescents with anorexia
nervosa be actively involved in their child’s
treatment, such as assuming responsibility
for feeding the child. To eliminate bingeSource
eating and purging behaviors, cognitive
behavioral therapy (CBT) assists sufferers by identifying distorted thinking patterns andchanging inaccurate beliefs.

Learning Objectives: Cognitive Development in Adolescence
•
•
•
•
•
•

Describe Piaget’s formal operational stage and the characteristics of formal
operational thought
Describe adolescent egocentrism
Describe Information Processing research on attention and memory
Describe the developmental changes in language
Describe the various types of adolescent education
Identify changes in high school drop-out rates based on gender and ethnicity

Piaget’s Formal Operational Stage
During the formal operational stage, adolescents are able to understand abstract principles
which have no physical reference. They can now contemplate such abstract constructs as beauty,
love, freedom, and morality. The adolescent is no longer limited by what can be directly seen orheard. Additionally, while younger children solve problems through trial and error, adolescents
demonstrate hypothetical-deductive reasoning, which is developing hypotheses based on whatmight logically occur. They are able to think about all the possibilities in a situation beforehand,
and then test them systematically (Crain, 2005). Now they are able to engage in true scientificthinking.
Formal operational thinking also involves accepting hypothetical situations. Adolescents
understand the concept of transitivity, which means that a relationship between two elements iscarried over to other elements logically related to the first two, such as if A<B and B<C, then225A<C (Thomas, 1979). For example, when asked: If Maria is shorter than Alicia and Alicia isshorter than Caitlyn, who is the shortest? Adolescents are able to answer the question correctlyas they understand the transitivity involved.
Does everyone reach formal operations? According to Piaget, most people attain some degreeof formal operational thinking, but use formal operations primarily in the areas of their strongest
interest (Crain, 2005). In fact, most adults do not regularly demonstrate formal operational
thought, and in small villages and tribal communities, it is barely used at all. A possible
explanation is that an individual’s thinking has not been sufficiently challenged to demonstrateformal operational thought in all areas.
Figure 6.11
Adolescent Egocentrism: Once adolescents can understand abstract
thoughts, they enter a world of hypothetical possibilities and demonstrateegocentrism or a heightened self-focus. The egocentricity comes from
attributing unlimited power to their own thoughts (Crain, 2005). Piaget
believed it was not until adolescents took on adult roles that they would be
able to learn the limits to their own thoughts.
David Elkind (1967) expanded on the concept of Piaget’s adolescent
Sourceegocentricity. Elkind theorized that the physiological changes that occur
during adolescence result in adolescents being primarily concerned withthemselves. Additionally, since adolescents fail to differentiate between what others are thinking
and their own thoughts, they believe that others are just as fascinated with their behavior andappearance. This belief results in the adolescent anticipating the reactions of others, andconsequently constructing an imaginary audience. “The imaginary audience is the adolescent’s
belief that those around them are as concerned and focused on their appearance as they
themselves are” (Schwartz, Maynard, & Uzelac, 2008, p. 441). Elkind thought that theimaginary audience contributed to the self-consciousness that occurs during early adolescence.
The desire for privacy and reluctance to share personal information may be a further reaction tofeeling under constant observation by others. Alternatively, recent research has indicated that theimaginary audience is not imaginary. Specifically, adolescents and adults feel that they are often
under scrutiny by others, especially if they are active on social media (Yau & Reich, 2018).
Another important consequence of adolescent egocentrism is the personal fable or belief that
one is unique, special, and invulnerable to harm. Elkind (1967) explains that because
adolescents feel so important to others (imaginary audience) they regard themselves and their
feelings as being special and unique. Adolescents believe that only they have experienced strong
and diverse emotions, and therefore others could never understand how they feel. This
uniqueness in one’s emotional experiences reinforces the adolescent’s belief of invulnerability,
especially to death. Adolescents will engage in risky behaviors, such as drinking and driving or
unprotected sex, and feel they will not suffer any negative consequences. Elkind believed thatadolescent egocentricity emerged in early adolescence and declined in middle adolescence,
however, recent research has also identified egocentricity in late adolescence (Schwartz, et al.,2008).

226

Consequences of Formal Operational Thought: As adolescents are now able to think
abstractly and hypothetically, they exhibit many new ways of reflecting on information (Dolgin,2011). For example, they demonstrate greater introspection or thinking about one’s thoughts
and feelings. They begin to imagine how the world could be which leads them to become
idealistic or insisting upon high standards of behavior. Because of their idealism, they may
become critical of others, especially adults in their life. Additionally, adolescents candemonstrate hypocrisy, or pretend to be what they are not. Since they are able to recognize
what others expect of them, they will conform to those expectations for their emotions andbehavior seemingly hypocritical to themselves. Lastly, adolescents can exhibit pseudostupidity.
This is when they approach problems at a level that is too complex, and they fail because thetasks are too simple. Their new ability to consider alternatives is not completely under control
and they appear “stupid” when they are in fact bright, just not experienced.

Information Processing
Cognitive Control: As noted in earlier chapters, executive functions, such as attention, increases
in working memory, and cognitive flexibility have been steadily improving since earlychildhood. Studies have found that executive function is very competent in adolescence.
However, self-regulation, or the ability to control impulses, may still fail. A failure in selfregulation is especially true when there is high stress or high demand on mental functions(Luciano & Collins, 2012). While high stress or demand may tax even an adult’s self-regulatory
abilities, neurological changes in the adolescent brain may make teens particularly prone to morerisky decision making under these conditions.
Inductive and Deductive
Figure 6.12
Reasoning: Inductive
reasoning emerges inchildhood and occurs when
specific observations, or
specific comments fromthose in authority, may be
used to draw general
conclusions. This issometimes referred to as“bottom-up-processing”.
However, in inductive
reasoning the veracity of theinformation that created thegeneral conclusion does notguarantee the accuracy ofthat conclusion. For instance, a child who has only observed thunder on summer days may
conclude that it only thunders in the summer. In contrast, deductive reasoning emerges inadolescence and refers to reasoning that starts with some overarching principle and based on
this proposes specific conclusions. This is sometimes referred to as “top-down-processing”.
Deductive reasoning guarantees a truthful conclusion if the premises on which it is based areaccurate.
227

Intuitive versus Analytic Thinking: Cognitive psychologists often refer to intuitive andanalytic thought as the Dual-Process Model; the notion that humans have two distinct networks
for processing information (Albert & Steinberg, 2011). Intuitive thought is automatic,
unconscious, and fast (Kahneman, 2011), and it is more experiential and emotional. In contrast,
analytic thought is deliberate, conscious, and rational. While these systems interact, they are
distinct (Kuhn, 2013). Intuitive thought is easier and more commonly used in everyday life. It isalso more commonly used by children and teens than by adults (Klaczynski, 2001). The
quickness of adolescent thought, along with the maturation of the limbic system, may make teens
more prone to emotional intuitive thinking than adults.

Education
In early adolescence, the transition from elementary school to middle school can be difficult for
many students, both academically and socially. Crosnoe and Benner (2015) found that somestudents became disengaged and alienated during this transition which resulted in negative longterm consequences in academic performance and mental health. This may be because middle
school teachers are seen as less supportive than elementary school teachers (Brass, McKellar,
North, & Ryan, 2019). Similarly, the transition to high school can be difficult. For example,
high schools are larger, more bureaucratic, less personal, and there are less opportunities forteachers to get to know their students (Eccles & Roeser, 2016).
Peers: Certainly, the beliefs and expectations about academic success supported by anadolescent’s family play a significant role in the student’s achievement and school engagement.
However, research has also focused on the importance of peers in an adolescent’s school
experience. Specifically, having friends who are high-achieving, academically motivated andengaged promotes motivation and engagement in the adolescent, while those whose friends areunmotivated, disengaged, and low achieving promotes the same feelings (Shin & Ryan, 2014;
Vaillancourt, Paiva, Véronneau, & Dishion, 2019).
Gender: Crosnoe and Benner (2015) found that female students earn better grades, try harder,
and are more intrinsically motivated than male students. Further, Duchesne, Larose, and Feng(2019) described how female students were more oriented toward skill mastery, used a variety oflearning strategies, and persevered more than males. However, more females exhibit worries andanxiety about school, including feeling that they must please teachers and parents. These worries
can heighten their effort but lead to fears of disappointing others. In contrast, males are more
confident and do not value adult feedback regarding their academic performance (Brass et al.,2019). There is a subset of female students who identify with sexualized gender stereotypes(SGS), however, and they tend to underperform academically. These female students endorse
the beliefs that “girls” should be sexy and not smart. Nelson and Brown (2019) found that female
students who support SGS, reported less desire to master skills and concepts, were more
skeptical of the usefulness of an education, and downplayed their intelligence.
Life of a high school student: On average, high school teens spend approximately 7 hours each
weekday and 1.1 hours each day on the weekend on educational activities. This includes
attending classes, participating in extracurricular activities (excluding sports), and doing
homework (Office of Adolescent Health, 2018). High school males and females spend about the228

same amount of time in class, doing homework, eating and drinking, and working. However,they do spend their time outside of these activities in different ways.
• High school males. On average, high school males spend about one more hour per day on
media and communications activities than females on both weekdays (2.9 vs. 1.8 hours)
and weekend days (4.8 vs. 3.8 hours). They also spend more time playing sports on both
weekdays (0.9 vs. 0.5 hours) and weekend days (1.2 vs. 0.5 hours). On weekdays, highschool males get an hour more of sleep than females (9.2 vs. 8.2 hours, on average).
• High school females. On an average weekday, high school females spend more time thanboys on both leisure activities (1.7 vs. 1.1 hours) and religious activities (0.1 vs. 0.0
hours). High school females also spend more time on grooming on both weekdays andweekend days (1.1 vs. 0.7 hours, on average for both weekdays and weekend days).
High School Dropouts: The status dropout rate refers to the percentage of 16 to 24 year-olds
who are not enrolled in school and do not have high school credentials (either a diploma or anequivalency credential such as a General Educational Development [GED] certificate). The
dropout rate is based on sample surveys of the civilian, noninstitutionalized population, which
excludes persons in prisons, persons in the military, and other persons not living in households.
The dropout rate among high school students has declined from a rate of 12% in 1990, to 6.1% in2016 (U.S. Department of Education, 2018). The rate is lower for Whites than for Blacks, andthe rates for both Whites and Blacks are lower than the rate for Hispanics. However, the gap
between Whites, Blacks, and Hispanics have narrowed (see Figure 6.13).
Figure 6.13 Percentage of high school dropouts among persons 16 through 24 years old(status dropout rate), by race/ethnicity: October 1976 through 2016

229

The dropout rate for males in 1990 was 12%, where it stayed until 2000. Thereafter the rate has
dropped to 7.1% in 2016. The dropout rate for females in 1990 was 12%, and it has dropped to
5.1% in 2016 (U.S. Department of Education, 2018).
Reasons for Dropping Out of School: Garcia et al. (2018) reviewed the research on why
students dropped out of school and identified several major obstacles to school completion.
These included: Adolescents who resided in foster care or were part of the juvenile justicesystem. In fact, being confined in a juvenile detention facility practically guaranteed that a
student would not complete school. Having a physical or mental health condition, or the need forspecial educational services, adversely affected school completion. Being maltreated due toabuse or neglect and/or being homeless also contributed to dropping out of school. Additonally,adolescent-specific factors, including race, ethnicity and age, as well as family-specificcharacteristics, such as poverty, single parenting, large family size, and stressful transitions, allcontributed to an increased likelihood of dropping-out of school. Lastly, community factors, suchas unsafe neighborhoods, gang activity, and a lack of social services increased the number ofschool dropouts.

School Based Preparatory Experiences
According to the U. S. Department of Labor (2019), to perform at optimal levels in all education
settings, all youth need to participate in educational programs grounded in standards, clear
performance expectations and graduation exit options based upon meaningful, accurate, andrelevant indicators of student learning and skills. These should include:
•
•
•
•
•
•
•

Academic programs that are based on clear state standards
Career and technical education programs that are based on professional and industry
standards
Curricular and program options based on universal design of school, work and communitybased learning experiences
Learning environments that are small and safe, including extra supports such as tutoring, as
necessary
Supports from and by highly qualified staff;
Access to an assessment system that includes multiple measures, andGraduation standards that include options.

Teenagers and Working
Many adolescents work either summer jobs, or during the school year. Holding a job may offer
teenagers extra funds, the opportunity to learn new skills, ideas about future careers, and perhaps
the true value of money. However, there are numerous concerns about teenagers working,especially during the school year. A long-standing concern is that that it “engenders precocious
maturity of more adult-like roles and problem behaviors” (Staff, VanEseltine, Woolnough,Silver, & Burrington, 2011, p. 150).

230

Figure 6.14

SourceSeveral studies have found that working more than 20hours per week can lead to declines in grades, a generaldisengagement from school (Staff, Schulenberg, &Bachman, 2010; Lee & Staff, 2007; Marsh & Kleitman,2005), an increase in substance abuse (Longest &Shanahan, 2007), engaging in earlier sexual behavior,and pregnancy (Staff et al., 2011). However, like many
employee groups, teens have seen a drop in the numberof jobs. The summer jobs of previous generations havebeen on a steady decline, according to the United States
Department of Labor, Bureau of Labor Statistics (2016).
See Figure 6.15 for recent trends.

Figure: 6.15

Teenage Drivers
Driving gives teens a sense of freedom and independence from their parents. It can also free uptime for parents as they are not shuttling teens to and from school, activities, or work. The
National Highway Traffic Safety Administration (NHTSA) reports that in 2014 young drivers(15 to 20 year-olds) accounted for 5.5% (11.7 million) of the total number of drivers (214
million) in the US (National Center for Statistics and Analysis (NCSA), 2016).

231

However, almost 9% of all drivers involved in fatal crashes
Figure 6.16
that year were young drivers (NCSA, 2016), and according to
the National Center for Health Statistics (2014), motor
vehicle accidents are the leading cause of death for 15 to 20
year-olds. “In all motorized jurisdictions around the world,young, inexperienced drivers have much higher crash rates
than older, more experienced drivers” (NCSA, 2016, p. 1). A
teen’s risk of an accident is especially high during the firstmonths of receiving a license (CDC, 2018a). The rate of fatal
crashes is twice as high for young males as for young females Source(CDC, 2018a), although for both genders the rate was highest
for the 15-20 years-old age group. For young males, the rate for fatal crashes was approximately
46 per 100,000 drivers, compared to 20 per 100,000 drivers for young females. The NHTSA(NCSA, 2016) reported that of the young drivers who were killed and who had alcohol in theirsystem, 81% had a blood alcohol count past what was considered the legal limit. Fatal crashes
involving alcohol use were higher among young men than young women. The NHTSA also
found that teens were less likely to use seat belt restraints if they were driving under the
influence of alcohol, and that restraint use decreased as the level of alcohol intoxication
increased. Overall, teens have the lowest rate of seat belt use. In a 2017 CDC survey, only 59%
of teens reported that they always wore a seat belt when riding as a passenger (CDC, 2018b).
Crash data shows that almost half of teenage passengers who die in a car crash were not wearing
a seat belt (Insurance Institute for Highway Safety, 2017).
In a AAA study of non-fatal, but moderate to severe motor vehicle accidents in 2014, more thanhalf involved young male drivers 16 to 19 years of age (Carney, McGehee, Harland, Weiss, &Raby, 2015). In 36% of rear-end collisions, teen drivers were following cars too closely to beable to stop in time, and in single-vehicle accidents, driving too fast for weather and roadconditions was a factor in 79% of crashes involving teens. Distraction was also a factor in nearly
60% of the accidents involving teen drivers. Fellow passengers, often also teenagers (84% of thetime), and cell phones were the top two sources of distraction, respectively. This data suggested
that having another teenager in the car increased the risk of an accident by 44% (Carney et al.,2015). According to the NHTSA, 10% of drivers aged 15 to 19 years involved in fatal crashes
were reported to be distracted at the time of the crash; the highest figure for any age group(NCSA, 2016). Distraction coupled with inexperience has been found to greatly increase the riskof an accident (Klauer et al., 2014). Finally, despite all the public service announcements
warning of the dangers of texting while driving, four out of ten teens report having engaged inthis within the past 12 months (CDC, 2018b).
The NHTSA did find that the number of accidents has been on a decline since 2005. They
attribute this to greater driver training, more social awareness to the challenges of driving forteenagers, and to changes in laws restricting the drinking age. The NHTSA estimates that theraising of the legal drinking age to 21 in all 50 states and the District of Columbia has saved
30,323 lives since 1975. The CDC also credits graduated driver licenses (GDL) for reducing thenumber of accidents. While GDL programs vary widely, a comprehensive program has a longer
practice period, requires greater parental participation, and limits newly licensed drivers fromdriving under certain high-risk conditions (CDC, 2018a).
232

Learning Objectives: Psychosocial Development in Adolescence
•
•
•
•
•
•
•

Describe the changes in self-concept and self-esteem in adolescence
Summarize Erikson’s fifth psychosocial task of identity versus role confusion
Describe Marcia’s four identity statuses
Summarize the three stages of ethnic identity development
Describe the parent-teen relationship
Describe the role of peers
Describe dating relationships

Self-concept and Self-esteem in Adolescence
In adolescence, teens continue to develop their self-concept. Their ability to think of thepossibilities and to reason more abstractly may explain the further differentiation of the self
during adolescence. However, the teen’s understanding of self is often full of contradictions.
Young teens may see themselves as outgoing but also withdrawn, happy yet often moody, andboth smart and completely clueless (Harter, 2012). These contradictions, along with the teen’s
growing recognition that their personality and behavior seem to change depending on who they
are with or where they are, can lead the young teen to feel like a fraud. With their parents they
may seem angrier and sullen, with their friends they are more outgoing and goofier, and at work
they are quiet and cautious. “Which one is really me?” may be the refrain of the young teenager.
Harter (2012) found that adolescents emphasize traits such as being friendly and considerate
more than do children, highlighting their increasing concern about how others may see them.
Harter also found that older teens add values and moral standards to their self-descriptions.
As self-concept differentiates, so too does self-esteem. In addition to the academic, social,appearance, and physical/athletic dimensions of self-esteem in middle and late childhood, teens
also add perceptions of their competency in romantic relationships, on the job, and in closefriendships (Harter, 2006). Self-esteem often drops when children transition from one school
setting to another, such as shifting from elementary to middle school, or junior high to highschool (Ryan, Shim, & Makara, 2013). These drops are usually temporary, unless there are
additional stressors such as parental conflict, or other family disruptions (De Wit, Karioja, Rye,
& Shain, 2011). Self-esteem rises from mid to late adolescence for most teenagers, especially ifthey feel competent in their peer relationships, their appearance, and athletic abilities (Birkeland,
Melkivik, Holsen, & Wold, 2012).

Erikson: Identity vs. Role Confusion
Erikson believed that the primary psychosocial task of adolescence was establishing an identity.
Teens struggle with the question “Who am I?” This includes questions regarding theirappearance, vocational choices and career aspirations, education, relationships, sexuality,
political and social views, personality, and interests. Erikson saw this as a period of confusionand experimentation regarding identity and one’s life path. During adolescence we experience233

psychological moratorium, where teens put on hold commitment to an identity while exploring
the options. The culmination of this exploration is a more coherent view of oneself. Those who
are unsuccessful at resolving this stage may either withdraw further into social isolation or
become lost in the crowd. However, more recent research, suggests that few leave this age
period with identity achievement, and that most identity formation occurs during young
adulthood (Côtè, 2006).
Expanding on Erikson’s theory, James Marcia (2010) identified four identity statuses that
represent the four possible combinations of the dimension of commitment and exploration (seeTable 6.2).
Table 6.2 Marcia’s Four Identity Statuses
Exploration
Commitment to an
Identity

AbsentAbsentIdentity Diffusion

Present
Identity Moratorium

Present

Identity Foreclosure

Identity Achievement

The least mature status, and one common in many children, is identity diffusion. Identity
diffusion is a status that characterizes those who have neither explored the options, nor made acommitment to an identity. Those who persist in this identity may drift aimlessly with little
connection to those around them or have little sense of purpose in life.
Figure 6.17

Those in identity foreclosure have made a commitment toan identity without having explored the options. Someparents may make these decisions for their children and do
not grant the teen the opportunity to make choices. In otherinstances, teens may strongly identify with parents andothers in their life and wish to follow in their footsteps.
Identity moratorium is a status that describes those whoare activity exploring in an attempt to establish an identity
but have yet to have made any commitment. This can be ananxious and emotionally tense time period as the adolescentexperiments with different roles and explores various
beliefs. Nothing is certain and there are many questions, but
few answers.
Identity achievement refers to those who after exploration
have made a commitment. This is a long process and is notoften achieved by the end of adolescence.

SourceDuring high school and the college years, teens and young
adults move from identity diffusion and foreclosure towardmoratorium and achievement. The biggest gains in the234development of identity are in college, as college students are exposed to a greater variety ofcareer choices, lifestyles, and beliefs. This is likely to spur on questions regarding identity. A
great deal of the identity work we do in adolescence and young adulthood is about values andgoals, as we strive to articulate a personal vision or dream for what we hope to accomplish in the
future (McAdams, 2013).
Developmental psychologists have researched several different areas of identity development
and some of the main areas include:
Religious identity: The religious views of teens are often similar to that of their families (KimSpoon, Longo, & McCullough, 2012). Most teens may question specific customs, practices, orideas in the faith of their parents, but few completely reject the religion of their families.
Political identity: The political ideology of teens is also influenced by their parents’ politicalbeliefs. A new trend in the 21st century is a decrease in party affiliation among adults. Many
adults do not align themselves with either the democratic or republican party but view
themselves as more of an “independent”. Their teenage children are often following suit or
become more apolitical (Côtè, 2006).
Vocational identity: While adolescents in earlier generations envisioned themselves as working
in a particular job, and often worked as an apprentice or part-time in such occupations as
teenagers, this is rarely the case today. Vocational identity takes longer to develop, as most of
today’s occupations require specific skills and knowledge that will require additional educationor are acquired on the job itself. In addition, many of the jobs held by teens are not in
occupations that most teens will seek as adults.
Gender identity: Acquiring a gender identity is becoming an increasingly prolonged task as
attitudes and norms regarding gender keep changing. The roles appropriate for males andfemales are evolving, and the lack of a gender binary allow adolescents more freedom to explore
various aspects of gender. Some teens may foreclose on a gender identity as a way of dealing
with this uncertainty, and they may adopt more stereotypic male or female roles (Sinclair &Carlsson, 2013).
Sexual identity: According to Carroll (2016), by age 14 most adolescents become interested in
intimate relationships, and they may begin sexual experimentation. Many adolescent feelpressure to express interest in opposite-sex relationships, even if they are not ready to do so. Thispressure can be especially stressful for those adolescents who are gay, lesbian, bisexual orquestioning their sexual identity. Many non-heterosexual adolescents struggle with negative peer
and family reactions during their exploration. A lack of parental acceptance, especially, canadversely affect the gay, lesbian or bisexual adolescent’s emerging sexual identity and can resultin feelings of depression. In contrast, adolescents whose familes support their sexual identity
have better health outcomes.
Ethnic identity refers to how people come to terms with who they are based on their ethnic or
racial ancestry. “The task of ethnic identity formation involves sorting out and resolving
positive and negative feelings and attitudes about one’s own ethnic group and about other groups
and identifying one’s place in relation to both” (Phinney, 2006, p. 119). When groups differ instatus in a culture, those from the non-dominant group have to be cognizant of the customs and235values of those from the dominant culture. The
reverse is rarely the case. This makes ethnic
identity far less salient for members of thedominant culture. In the United States, those ofEuropean ancestry engage in less exploration of
ethnic identity, than do those of non-European
ancestry (Phinney, 1989). However, according
to the U.S. Census (2012) more than 40% of
Americans under the age of 18 are from ethnic
minorities. For many ethnic minority teens,
discovering one’s ethnic identity is an importantpart of identity formation.

Figure 6.18

SourcePhinney’s model of ethnic identity formation is based on Erikson’s and Marcia’s model ofidentity formation (Phinney, 1990; Syed & Juang, 2014). Through the process of explorationand commitment, individual’s come to understand and create an ethic identity. Phinney suggests
three stages or statuses with regard to ethnic identity:
1. Unexamined Ethnic Identity: Adolescents and adults who have not been exposed toethnic identity issues may be in the first stage, unexamined ethnic identity. This is often
characterized with a preference for the dominant culture, or where the individual has
given little thought to the question of their ethnic heritage. This is similar to diffusion in
Marcia’s model of identity. Included in this group are also those who have adopted theethnicity of their parents and other family members with little thought about the issues
themselves, similar to Marcia’s foreclosure status (Phinney, 1990).
2. Ethnic Identity Search: Adolescents and adults who are exploring the customs, culture,and history of their ethnic group are in the ethnic identity search stage, similar to
Marcia’s moratorium status (Phinney, 1990). Often some event “awakens” a teen or
adult to their ethnic group; either a personal experience with prejudice, a highly profiledcase in the media, or even a more positive event that recognizes the contribution ofsomeone from the individual’s ethnic group. Teens and adults in this stage will immersethemselves in their ethnic culture. For some, “it may lead to a rejection of the values ofthe dominant culture” (Phinney, 1990, p. 503).
3. Achieved Ethnic Identity: Those who have actively explored their culture are likely tohave a deeper appreciation and understanding of their ethnic heritage, leading to progress
toward an achieved ethnic identity (Phinney, 1990). An achieved ethnic identity does notnecessarily imply that the individual is highly involved in the customs and values of theirethnic culture. One can be confident in their ethnic identity without wanting to maintainthe language or other customs.
The development of ethnic identity takes time, with about 25% of tenth graders from ethnic
minority backgrounds having explored and resolved the issues (Phinney, 1989). The more
ethnically homogeneous the high school, the less identity exploration and achievement (UmanaTaylor, 2003). Moreover, even in more ethnically diverse high schools, teens tend to spend moretime with their own group, reducing exposure to other ethnicities. This may explain why, for236

many, college becomes the time of ethnic identity exploration. “[The] transition to college may
serve as a consciousness-raising experience that triggers exploration” (Syed & Azmitia, 2009, p.
618).
It is also important to note that those who do achieve ethnic identity may periodically reexamine
the issues of ethnicity. This cycling between exploration and achievement is common not only
for ethnic identity formation, but in other aspects of identity development (Grotevant, 1987) andis referred to as MAMA cycling or moving back and forth between moratorium andachievement.
Bicultural/Multiracial Identity: Ethnic minorities must wrestle with the question of how, andto what extent, they will identify with the culture of the surrounding society and with the cultureof their family. Phinney (2006) suggests that people may handle it in different ways. Some may
keep the identities separate, others may combine them in some way, while others may rejectsome of them. Bicultural identity means the individual sees himself or herself as part of boththe ethnic minority group and the larger society. Those who are multiracial, that is whoseparents come from two or more ethnic or racial groups, have a more challenging task. In somecases, their appearance may be ambiguous. This can lead to others constantly asking them tocategorize themselves. Phinney (2006) notes that the process of identity formation may startearlier and take longer to accomplish in those who are not mono-racial.
Negative Identity: A negative identity is the adoption of norms and values that are theopposite of one’s family and culture, and it is assumed to be one of the more problematic
outcomes of identity development in young people (Hihara, Umemura, & Sigimura, 2019).
Those with a negative identity hold dichotomous beliefs, and consequently divide the world into
two categories (e.g., friend or foe, good or bad). Hihara et al. suggest that this may be because
teens with a negative identity cannot integrate information and beliefs that exist in both theirinner and outer world. In addition, those with a negative identity are generally hostile andcynical toward society, often because they do not trust the world around them. These beliefs
may lead teens to engage in delinquent and criminal behavior and prevent them from engaging in
more positive acts that could be beneficial to society.

Parents and Teens: Autonomy and Attachment
While most adolescents get along with their parents, they do spend less time with them(Smetana, 2011). This decrease in the time spent with families may be a reflection of ateenager’s greater desire for independence or autonomy. It can be difficult for many parents todeal with this desire for autonomy. However, it is likely adaptive for teenagers to increasingly
distance themselves and establish relationships outside of their families in preparation for
adulthood. This means that both parents and teenagers need to strike a balance between
autonomy, while still maintaining close and supportive familial relationships.
Children in middle and late childhood are increasingly granted greater freedom regarding
moment-to-moment decision making. This continues in adolescence, as teens are demanding
greater control in decisions that affect their daily lives. This can increase conflict between
parents and their teenagers. For many adolescents this conflict centers on chores, homework,
curfew, dating, and personal appearance. These are all things many teens believe they should237

manage that parents previously had considerable control over. Teens report more conflict with
their mothers, as many mothers believe they should still have some control over many of theseareas, yet often report their mothers to be more encouraging and supportive (Costigan, Cauce, &Etchison, 2007). As teens grow older, more compromise is reached between parents andteenagers (Smetana, 2011). Parents are more controlling of daughters, especially early maturing
girls, than they are sons (Caspi, Lynam, Moffitt, & Silva, 1993). In addition, culture andethnicity also play a role in how restrictive parents are with the daily lives of their children(Chen, Vansteenkiste, Beyers, Soensens, & Van Petegem, 2013).
Having supportive, less conflict ridden relationships with parents also benefits teenagers.
Research on attachment in adolescence find that teens who are still securely attached to theirparents have less emotional problems (Rawatlal, Kliewer & Pillay, 2015), are less likely toengage in drug abuse and other criminal behaviors (Meeus, Branje & Overbeek, 2004), and havemore positive peer relationships (Shomaker & Furman, 2009).

Peers
As children become adolescents, they usually begin spending more time with their peers and lesstime with their families, and these peer interactions are increasingly unsupervised by adults.
Children’s notions of friendship often focus on shared activities, whereas adolescents’ notions offriendship increasingly focus on intimate exchanges of thoughts and feelings. Duringadolescence, peer groups evolve from primarily single-sex to mixed-sex. Adolescents within apeer group tend to be similar to one another in behavior and attitudes, which has been explained
as a function of homophily, that is, adolescents who are similar to one another choose to spend
time together in a “birds of a feather flock together” way. Adolescents who spend time together
also shape each other’s behavior and attitudes.
Figure 6.19

[Image: Garry Knight]

238

Peers can serve both positive and negative functions during adolescence. Negative peer pressure
can lead adolescents to make riskier decisions or engage in more problematic behavior than theywould alone or in the presence of their family. For example, adolescents are much more likely todrink alcohol, use drugs, and commit crimes when they are with their friends than when they arealone or with their family. One of the most widely studied aspects of adolescent peer influence is
known as deviant peer contagion (Dishion & Tipsord, 2011), which is the process by whichpeers reinforce problem behavior by laughing or showing other signs of approval that thenincrease the likelihood of future problem behavior.
However, peers also serve as an important source of social support and companionship duringadolescence, and adolescents with positive peer relationships are happier and better adjusted thanthose who are socially isolated or have conflictual peer relationships.
Crowds are an emerging level of peer relationships in adolescence. In contrast to friendships,
which are reciprocal dyadic relationships, and cliques, which refer to groups of individuals whointeract frequently, crowds are characterized more by shared reputations or images than actualinteractions (Brown & Larson, 2009). These crowds reflect different prototypic identities, suchas jocks or brains, and are often linked with adolescents’ social status and peers’ perceptions of
their values or behaviors.

Romantic Relationships
Adolescence is the developmental period during which romantic relationships typically firstemerge. By the end of adolescence, most American teens have had at least one romantic
relationship (Dolgin, 2011). However, culture does play a role as Asian Americans and Latinas
are less likely to date than other ethnic groups (Connolly, Craig, Goldberg, & Pepler, 2004).
Dating serves many purposes for teens, including having fun, companionship, status,
socialization, sexual experimentation, intimacy, and partner selection for those in lateadolescence (Dolgin, 2011).
There are several stages in the dating process beginning with engaging in mixed-sex group
activities in early adolescence (Dolgin, 2011). The same-sex peer groups that were common
during childhood expand into mixed-sex peer groups that are more characteristic of adolescence.
Romantic relationships often form in the context of these mixed-sex peer groups (Connolly,
Furman, & Konarski, 2000). Interacting in mixed-sex groups is easier for teens as they areamong a supportive group of friends, can observe others interacting, and are kept safe from a too
early intimate relationship. By middle adolescence teens are engaging in brief, casual dating orin group dating with established couples (Dolgin, 2011). Then in late adolescence dating
involves exclusive, intense relationships. These relationships tend to be long-lasting andcontinue for a year or longer, however, they may also interfere with friendships.

239

Figure 6.20

SourceAlthough romantic relationships duringadolescence are often short-lived rather thanlong-term committed partnerships, theirimportance should not be minimized.
Adolescents spend a great deal of time focusedon romantic relationships, and their positive
and negative emotions are more tied toromantic relationships, or lack thereof, than tofriendships, family relationships, or school(Furman & Shaffer, 2003). Romantic
relationships contribute to adolescents’
identity formation, changes in family and peer
relationships, and emotional and behavioral
adjustment.

Furthermore, romantic relationships are centrally connected to adolescents’ emerging sexuality.
Parents, policymakers, and researchers have devoted a great deal of attention to adolescents’sexuality, in large part because of concerns related to sexual intercourse, contraception, andpreventing teen pregnancies. However, sexuality involves more than this narrow focus. For
example, adolescence is often when individuals who are lesbian, gay, bisexual, or transgender
come to perceive themselves as such (Russell, Clarke, & Clary, 2009). Thus, romantic
relationships are a domain in which adolescents experiment with new behaviors and identities.
However, a negative dating relationship can adversely affect an adolescent’s development. Soller(2014) explored the link between relationship inauthenticity and mental health. Relationshipinauthenticity refers to an incongruence between thoughts/feelings and actions within arelationship. Desires to gain partner approval and demands in the relationship may negatively
affect an adolescent’s sense of authenticity. Soller found that relationship inauthenticity was
positively correlated with poor mental health, including depression, suicidal ideation and suicide
attempts, especially for females.
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United States Department of Education. (2018). Trends in high school dropout and completion rates in thej United Stases: 2018.
Retrieved from https://nces.ed.gov/pubs2019/2019117.pdf
United States Department of Labor, Bureau of Labor Statistics (2016). Employment projections. Retrieved fromhttp://www.bls.gov/emp/ep_chart_001.htm
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University of California at Los Angeles Medical Center. (2000). Acne. Retrieved from http://www.mednet.ucla.edu
Vaillancourt, M. C., Paiva, A. O., Véronneau, M., & Dishion, T. (2019). How do individual predispositions and family dynamics
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Wade, T. D., Keski‐Rahkonen, A., & Hudson, J. I. (2011). Epidemiology of eating disorders. Textbook of Psychiatric
Epidemiology, Third Edition, 343-360.
Weintraub, K. (2016). Young and sleep deprived. Monitor on Psychology, 47(2), 46-50.
Weir, K. (2015). Marijuana and the developing brain. Monitor on Psychology, 46(10), 49-52.
Weir, K. (2016). The risks of earlier puberty. Monitor on Psychology, 47(3), 41-44.
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Chapter 7: Emerging and Early Adulthood
Historically, early adulthood spanned from approximately 18 (the end of adolescence) until 40 to
45 (beginning of middle adulthood). More recently, developmentalists have divided this age
period into two separate stages: Emerging adulthood followed by early adulthood. Althoughthese age periods differ in their physical, cognitive, and social development, overall the age
period from 18 to 45 is a time of peak physical capabilities and the emergence of more mature
cognitive development, financial independence, and intimate relationships.

Learning Objectives: Emerging Adulthood
•
•
•
•
•

Explain emerging adulthood
Explain how emerging adulthood differs from adolescence and adulthood
Describe economic and cultural variations of emerging adulthood
Identify the markers of adulthood
Identify where emerging and early adults currently live

Emerging Adulthood Defined
Emerging adulthood is the period between the late teens and early twenties; ages 18-25, althoughsome researchers have included up to age 29 in the definition (Society for the Study of Emerging
Adulthood, 2016). Jeffrey Arnett (2000) argues that emerging adulthood is neither adolescence
nor is it young adulthood. Individuals in this age period have left behind the relative dependencyof childhood and adolescence but have not yet taken on the responsibilities of adulthood.
“Emerging adulthood is a time of life when many different directions remain possible, whenlittle about the future is decided for certain, when the scope of independent exploration of life’s
possibilities is greater for most people than it will be at any other period of the life course”(Arnett, 2000, p. 469). Arnett identified five characteristics of emerging adulthood that
distinguished it from adolescence and young adulthood (Arnett, 2006).
•

It is the age of identity exploration. In 1950, Erik Erikson proposed that it was duringadolescence that humans wrestled with the question of identity. Yet, even Erikson (1968)
commented on a trend during the 20th century of a “prolonged adolescence” inindustrialized societies. Today, most identity development occurs during the late teensand early twenties rather than adolescence. It is during emerging adulthood that people
are exploring their career choices and ideas about intimate relationships, setting thefoundation for adulthood.

•

Arnett also described this time period as the age of instability (Arnett, 2000; Arnett,
2006). Exploration generates uncertainty and instability. Emerging adults change jobs,
relationships, and residences more frequently than other age groups.

246

•

This is also the age of self-focus. Being self-focused is not the same as being “selfcentered.” Adolescents are more self-centered than emerging adults. Arnett reports thatin his research, he found emerging adults to be very considerate of the feelings of others,
especially their parents. They now begin to see their parents as people not just parents,
something most adolescents fail to do (Arnett, 2006). Nonetheless, emerging adults
focus more on themselves, as they realize that they have few obligations to others andthat this is the time where they can do what they want with their life.

•

This is also the age of feeling inFigure 7.1
between. When asked if they feellike adults, more 18 to 25 year-olds
answer “yes and no” than do teens oradults over the age of 25 (Arnett,
2001). Most emerging adults havegone through the changes of puberty,
are typically no longer in high school,
and many have also moved out of
their parents’ home. Thus, they nolonger feel as dependent as they did asteenagers. Yet, they may still be
Sourcefinancially dependent on their parents
to some degree, and they have notcompletely attained some of the indicators of adulthood, such as finishing their education,
obtaining a good full-time job, being in a committed relationship, or being responsible forothers. It is not surprising that Arnett found that 60% of 18 to 25 year-olds felt that insome ways they were adults, but in some ways, they were not (Arnett, 2001).

•

Emerging adulthood is the age of possibilities. It is a time period of optimism as more 18
to 25 year-olds feel that they will someday get to where they want to be in life. Arnett(2000, 2006) suggests that this optimism is because these dreams have yet to be tested.
For example, it is easier to believe that you will eventually find your soul mate when you
have yet to have had a serious relationship. It may also be a chance to change directions,for those whose lives up to this point have been difficult. The experiences of children
and teens are influenced by the choices and decisions of their parents. If the parents are
dysfunctional, there is little a child can do about it. In emerging adulthood, people canmove out and move on. They have the chance to transform their lives and move awayfrom unhealthy environments. Even those whose lives were happier and more fulfillingas children, now have the opportunity in emerging adulthood to become independent andmake decisions about the direction they would like their life to take.

Socioeconomic Class and Emerging Adulthood: The theory of emerging adulthood was
initially criticized as only reflecting upper middle-class, college-attending young adults in the
United States and not those who were working class or poor (Arnett, 2016). Consequently,
Arnett reviewed results from the 2012 Clark University Poll of Emerging Adults, whose
participants were demographically similar to the United States population. Results primarily
indicated consistencies across aspects of the theory, including positive and negative perceptions
247

of the time-period and views on education, work, love, sex, and marriage. Two significant
differences were found, the first being that emerging adults from lower socioeconomic classes
identified more negativity in their emotional lives, including higher levels of depression.
Secondly, those in the lowest socioeconomic group were more likely to agree that they had notbeen able to find sufficient financial support to obtain the education they believed they needed.
Overall, Arnett concluded that emerging adulthood exists wherever there is a period between theend of adolescence and entry into adult roles, but acknowledging social, cultural, and historicalcontexts was also important.

Cultural Variations
The five features proposed in the theory of emerging adulthood originally were based on
research involving about Americans between ages 18 and 29 from various ethnic groups, social
classes, and geographical regions (Arnett, 2004, 2016). To what extent does the theory of
emerging adulthood apply internationally?
Figure 7.2

Source

The answer to this question depends greatly on what part of theworld is considered. Demographers make a useful distinction
between the developing countries that comprise the majority of
the world’s population and the economically developed
countries that are part of the Organization for Economic Cooperation and Development (OECD), including the UnitedStates, Canada, Western Europe, Japan, South Korea,
Australia, and New Zealand. The current population of OECD
countries (also called developed countries) is 1.2 billion, about
18% of the total world population (United Nations
Development Programme, 2011). The rest of the humanpopulation resides in developing countries, which have much
lower median incomes, much lower median educational
attainment, and much higher incidence of illness, disease, andearly death. Let us consider emerging adulthood in otherOECD countries as little is known about the experiences of 1825 year-olds in developing countries.

The same demographic changes as described above for the United States have taken place inother OECD countries as well. This is true of participation in postsecondary education, as well as
median ages for entering marriage and parenthood (UNdata, 2010). However, there is also
substantial variability in how emerging adulthood is experienced across OECD countries. Europe
is the region where emerging adulthood is longest and most leisurely. The median ages forentering marriage and parenthood are near 30 in most European countries (Douglass, 2007).
Europe today is the location of the most affluent, generous, and egalitarian societies in the world,in fact, in human history (Arnett, 2007). Governments pay for tertiary education, assist young
people in finding jobs, and provide generous unemployment benefits for those who cannot findwork. In northern Europe, many governments also provide housing support. Emerging adults in
European societies make the most of these advantages, gradually making their way to adulthood
during their twenties while enjoying travel and leisure with friends.
248

The lives of Asian emerging adults in developed countries, such as Japan and South Korea, are insome ways similar to the lives of emerging adults in Europe and in some ways strikingly
different. Like European emerging adults, Asian emerging adults tend to enter marriage andparenthood around age 30 (Arnett, 2011). Like European emerging adults, Asian emerging adults
in Japan and South Korea enjoy the benefits of living in affluent societies with generous social
welfare systems that provide support for them in making the transition to adulthood, including
free university education and substantial unemployment benefits.
However, in other ways, the experience of emerging adulthood in Asian OECD countries ismarkedly different than in Europe. Europe has a long history of individualism, and today’s
emerging adults carry that legacy with them in their focus on self-development and leisureduring emerging adulthood. In contrast, Asian cultures have a shared cultural historyemphasizing collectivism and family obligations.
Although Asian cultures have become moreindividualistic in recent decades, as aconsequence of globalization, the legacy ofcollectivism persists in the lives of emerging
adults. They pursue identity explorations andself-development during emerging adulthood,
like their American and European counterparts,
but within narrower boundaries set by theirsense of obligations to others, especially theirparents (Phinney & Baldelomar, 2011). For
example, in their views of the most importantcriteria for becoming an adult, emerging adults
Is your culture one that promotes romantic relationships forin the United States and Europe consistently
emerging adults? Or does it encourage you to wait tillrank financial independence among the mostyou’re older? What would it be like to live in the opposite
important markers of adulthood. In contrast,
culture? [Image: Patrick Rodwell]emerging adults with an Asian cultural
background especially emphasize becoming capable of supporting parents financially as among
the most important criteria (Arnett, 2003; Nelson, Badger, & Wu, 2004). This sense of family
obligation may curtail their identity explorations in emerging adulthood to some extent, as they
pay more heed to their parents’ wishes about what they should study, what job they should take,and where they should live than emerging adults do in the West (Rosenberger, 2007).
Figure 7.3

When Does Adulthood Begin?
According to Rankin and Kenyon (2008), historically the process of becoming an adult was moreclearly marked by rites of passage. For many, marriage and parenthood were considered entry
into adulthood. However, these role transitions are no longer considered the important markersof adulthood (Arnett, 2001). Economic and social changes have resulted in more young adults
attending college (Rankin & Kenyon, 2008) and a delay in marriage and having children (Arnett& Taber, 1994; Laursen & Jensen-Campbell, 1999) Consequently, current research has foundfinancial independence and accepting responsibility for oneself to be the most important markersof adulthood in Western culture across age (Arnett, 2001) and ethnic groups (Arnett, 2004).
249

In looking at college students’ perceptions of adulthood, Rankin and Kenyon (2008) found thatsome students still view rites of passage as important markers. College students who had placed
more importance on role transition markers, such as parenthood and marriage, belonged to afraternity/sorority, were traditionally aged (18–25), belonged to an ethnic minority, were of a
traditional marital status; i.e., not cohabitating, or belonged to a religious organization,
particularly for men. These findings supported the view that people holding collectivist or more
traditional values place more importance on role transitions as markers of adulthood. In contrast,
older college students and those cohabitating did not value role transitions as markers ofadulthood as strongly.

Young Adults Living Arrangements

Figure 7.4

In 2014, for the first time in more than 130 years,
adults 18 to 34 were more likely to be living in theirparents’ home than they were to be living with aspouse or partner in their own household (Fry, 2016).
The current trend is that young Americans are notchoosing to settle down romantically before age 35.
Since 1880, living with a romantic partner was themost common living arrangement among young adults.
In 1960, 62% of America’s 18- to 34-year-olds were
living with a spouse or partner in their own household,while only 20% were living with their parents.
Figure 7.5

SourceBy 2014, 31.6% of early adults were living with aspouse or partner in their own household, while
32.1% were living in the home of their parent(s).
Another 14% of early adults lived alone, were asingle parent, or lived with one or more roommates.
The remaining 22% lived in the home of anotherfamily member (such as a grandparent, in-law, or
sibling), a non-relative, or in group quarters (e.g.,college dormitories). Comparing ethnic groups, 36%of black and Hispanic early adults lived at home,while 30% of white young adults lived at home.
As can be seen in Figure 7.5, gender differences inliving arrangements are also noted in that young men
were living with parents at a higher rate than young
women. In 2014, 35% of young me were residing
with their parents, while 28% were living with aspouse or partner in their own household. Young
women were more likely to be living with a spouseor partner (35%) than living with their parents(29%). Additionally, more young women (16%) than
young men (13%) were heading up a householdwithout a spouse or partner, primarily because250women are more likely to be single parents living with their children. Lastly, young men (25%)
were more likely than young women (19%) to be living in the home of another family member, a
non-relative, or in some type of group quarters (Fry, 2016).
What are some factors that help explain these changes in living arrangements? First, early
adults are postponing marriage or choosing not to marry or cohabitate. Lack of employment andlower wages have especially contributed to males residing with their parents. Men who areemployed are less likely to live at home. Wages for young men (adjusting for inflation) havebeen falling since 1970 and correlate with the rise in young men living with their parents. The
recent recession and recovery (2007-present) has also contributed to the increase in early adults
living at home. College enrollments increased during the recession, which further increased
early adults living at home. However, once early adults possess a college degree, they are more
likely to establish their own households (Fry, 2016).

Learning Objectives: Physical Development in Emerging and Early
Adulthood
•
•
•
•
•
•
•
•
•
•
•

Summarize the overall physical growth in early adulthood
Describe statistics, possible causes, and consequences of obesity
Explain how early adulthood is a healthy, yet risky time of life
Identify the risk factors for substance use
Describe the changes in brain maturation
Describe gender in adulthood, including gender minorities and stress
Define sexuality and explain the female and male reproductive systems
Describe the brain areas and hormones responsible for sexual behavior
Identify sexually transmitted infections
Describe cultural views related to sexuality
Describe research on sexual orientation

The Physiological Peak
People in their mid-twenties to mid-forties are considered to be in early adulthood. By the time
we reach early adulthood, our physical maturation is complete, although our height and weight
may increase slightly. Those in their early twenties are probably at the peak of their
physiological development, including muscle strength, reaction time, sensory abilities, andcardiac functioning. The reproductive system, motor skills, strength, and lung capacity are all
operating at their best. Most professional athletes are at the top of their game during this stage,
and many women have children in the early-adulthood years (Boundless, 2016).
The aging process actually begins during early adulthood. Around the age of 30, many changes
begin to occur in different parts of the body. For example, the lens of the eye starts to stiffen andthicken, resulting in changes in vision (usually affecting the ability to focus on close objects).
251Sensitivity to sound decreases; this happens twice as quickly for men as for women. Hair canstart to thin and become gray around the age of 35, although this may happen earlier for someindividuals and later for others. The skin becomes drier and wrinkles start to appear by the end of
early adulthood. This includes a decline in response time and the ability to recover quickly fromphysical exertion. The immune system also becomes less adept at fighting off illness, andreproductive capacity starts to decline (Boundless, 2016).

Obesity
Although at the peak of physical health, a concern for early adults is the current rate of obesity.
Results from the National Center for Health Statistics indicated that an estimated 70.7% of U.S.
adults aged 20 and over were overweight in 2012 (CDC, 2015b) and by 2016, 39.8% wereconsidered obese (Hales, Carroll, Fryar, & Ogden, 2017)). Body mass index (BMI), expressed
as weight in kilograms divided by height in meters squared (kg/m2), is commonly used to classify
overweight (BMI 25.0–29.9), obesity (BMI greater than or equal to 30.0), and extreme obesity(BMI greater than or equal to 40.0). The current statistics are an increase from the 2013-2014
statistics that indicated that an estimated 35.1% were obese, and 6.4% extremely obese (Fryar,
Carroll, & Ogden, 2014). The CDC also indicated that one’s 20s are the prime time to gain
weight as the average person gains one to two pounds per year from early adulthood into middle
adulthood. The average man in his 20s weighs around 185 pounds and by his 30s weighsapproximately 200 pounds. The average American woman weighs 162 pounds in her 20s and
170 pounds in her 30s.
The American obesity crisis is also reflected
Figure 7.6 Waist Circumference
worldwide (Wighton, 2016). In 2014, global obesity
rates for men were measured at 10.8% and among
women 14.9%. This translates to 266 million obese
men and 375 million obese women in the world, andmore people were identified as obese thanunderweight. Although obesity is seen throughout
the world, more obese men and women live in China
and the USA than in any other country. Figure 7.6
illustrates how waist circumference is also used as ameasure of obesity. Figure 7.7 demonstrates thepercentage growth for youth (2-19 years) and adults(20-60+ years) identified as obese between 1999 and2016.
Causes of Obesity: According to the Centers for
Disease Control and Prevention (CDC) (2016), obesity
originates from a complex set of contributing factors,
including one’s environment, behavior, and genetics. Societal factors include culture, education,
food marketing and promotion, the quality of food, and the physical activity environment
available. Behaviors leading to obesity include diet, the amount of physical activity, andmedication use. Lastly, there does not appear to be a single gene responsible for obesity. Rather,
research has identified variants in several genes that may contribute to obesity by increasing
hunger and food intake. Another genetic explanation is the mismatch between today’senvironment and "energy-thrifty genes" that multiplied in the distant past, when food sources
Source252

were unpredictable. The genes that helped our ancestors survive occasional famines are now
being challenged by environments in which food is plentiful all the time. Overall, obesity most
likely results from complex interactions among the environment and multiple genes.
Figure 7.7 Adult and Youth Obesity Trends (1999-2016)

SourceObesity
Health Consequences: Obesity is considered to be one of the leading causes of death in
the United States and worldwide. Additionally, the medical care costs of obesity in the UnitedStates were estimated to be $147 billion in 2008. According to the CDC (2016) compared tothose with a normal or healthy weight, people who are obese are at increased risk for many
serious diseases and health conditions including:

•
•
•
•
•
•
•
•
•
•
•
•
•

All-causes of death (mortality)
High blood pressure (Hypertension)
High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
Type 2 diabetes
Coronary heart disease
StrokeGallbladder disease
Osteoarthritis (a breakdown of cartilage and bone within a joint)
Sleep apnea and breathing problems
Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)Low quality of life
Mental illness, such as clinical depression, anxiety, and other mental disorders
Body pain and difficulty with physical functioning
253

A Healthy, But Risky Time
Doctor’s visits are less frequent in early adulthood than for those in midlife and late adulthood
and are necessitated primarily by injury and pregnancy (Berger, 2005). However, the top fivecauses of death in emerging and early adulthood are non-intentional injury (including motor
vehicle accidents), homicide, and suicide with cancer and heart disease completing the list
(Heron, & Smith, 2007). Rates of violent death (homicide, suicide, and accidents) are highest
among young adult males, and vary by race and ethnicity. Rates of violent death are higher in the
United States than in Canada, Mexico, Japan, and other selected countries. Males are 3 times
more likely to die in auto accidents than are females (Frieden, 2011).
Alcohol Abuse: A significant contributing factor to risky behavior is alcohol. According to the2014 National Survey on Drug Use and Health (National Institute on Alcohol Abuse andAlcoholism (NIAAA), 2016) 88% of people ages 18 or older reported that they drank alcohol atsome point in their lifetime; 71% reported that they drank in the past year; and 57% reported
drinking in the past month. Additionally, 6.7% reported that they engaged in heavy drinking in
the past month. Heavy drinking is defined as drinking five or more drinks on the same occasion
on each of five or more days in the past 30 days. Nearly 88,000 people (approximately 62,000
men and 26,000 women) die from alcohol-related causes annually, making it the fourth leading
preventable cause of death in the United States. In 2014, alcohol-impaired driving fatalities
accounted for 9,967 deaths (31% of overall driving fatalities).
The NIAAA defines binge drinking when blood alcohol concentration levels reach 0.08 g/dL.
This typically occurs after four drinks for women and five drinks for men in approximately twohours. In 2014, 25% of people ages 18 or older reported that they engaged in binge drinking in
the past month. According to the NIAAA (2015) “Binge drinking poses serious health andsafety risks, including car crashes, drunk-driving arrests, sexual assaults, and injuries. Over thelong term, frequent binge drinking can damage the liver and other organs,” (p. 1).
Alcohol and College Students: Results from the 2014 survey demonstrated a difference
between the amount of alcohol consumed by college students and those of the same age who are
not in college (NIAAA, 2016). Specifically, 60% of full-time college students’ ages 18–22
drank alcohol in the past month compared with 51.5% of other persons of the same age not incollege. In addition, 38% of college students’ ages 18–22 engaged in binge drinking; that is, fiveor more drinks on one occasion in the past month, compared with 33.5% of other persons of thesame age. Lastly, 12% of college students’ (ages 18–22) engaged in heavy drinking; that is,binge drinking on five or more occasions per month, in the past month. This compares with
9.5% of other emerging adults not in college.
The consequences for college drinking are staggering, and the NIAAA (2016) estimates that eachyear the following occur:•••

1,825 college students between the ages of 18 and 24 die from alcohol-related
unintentional injuries, including motor-vehicle crashes.
696,000 students between the ages of 18 and 24 are assaulted by another student who has
been drinking.
Roughly 1 in 5 college students meet the criteria for an Alcohol Use Disorder.
254

•
•

About 1 in 4 college students report academic consequences from drinking, including
missing class, falling behind in class, doing poorly on exams or papers, and receiving
lower grades overall. (p. 1)
97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexualassault or date rape.

The role alcohol plays in predicting acquaintance rape on college campuses is of particularconcern. “Alcohol use in one the strongest predictors of rape and sexual assault on college
campuses,” (Carroll, 2016, p. 454). Krebs, Lindquist, Warner, Fisher and Martin (2009) foundthat over 80% of sexual assaults on college campuses involved alcohol. Being intoxicatedincreases a female’s risk of being the victim of date or acquaintance rape (Carroll,2007). Females are more likely to blame themselves and to be blamed by others if they were
intoxicated when raped. College students view perpetrators who were drinking as lessresponsible, and victims who were drinking as more responsible for the assaults (Untied,
Orchowski, Mastroleo, & Gidycz, 2012).
Factors Affecting College
Students’ Drinking: Several
factors associated with college life
affect a student’s involvementwith alcohol (NIAAA, 2015).
These include the pervasive
availability of alcohol,inconsistent enforcement ofunderage drinking laws,
unstructured time, coping withstressors, and limited interactions
with parents and other adults.
Due to social pressures to conformand expectations when enteringcollege, the first six weeks ofSourcefreshman year are an especiallysusceptible time for students. Additionally, more drinking occurs in colleges with active
Greek systems and athletic programs. Alcohol consumption is lowest among students livingwith their families and commuting, while it is highest among those living in fraternities andsororities.
Figure 7.8

College Strategies to Curb Drinking: Strategies to address college drinking involve theindividual-level and campus community as a whole. Identifying at-risk groups, such as firstyear students, members of fraternities and sororities, and athletes has proven helpful inchanging students’ knowledge, attitudes, and behavior regarding alcohol (NIAAA, 2015).
Interventions include education and awareness programs, as well as intervention by healthprofessionals. At the college-level, reducing the availability of alcohol has proven effective bydecreasing both consumption and negative consequences.

255

Non-Alcohol Substance Use: Illicit drug use
Figure 7.9
peaks between the ages of 19 and 22 and thenbegins to decline. Additionally, 25% of those
who smoke cigarettes, 33% of those who smoke
marijuana, and 70% of those who abuse cocaine
began using after age 17 (Volkow, 2004).
Emerging adults (18 to 25) are the largest
abusers of prescription opioid pain relievers,anti-anxiety medications, and Attention Deficit
Hyperactivity Disorder medication (National
Institute on Drug Abuse, 2015). In 2016, opioid
misuse within the past 12 months was reported
by 3.6% of 12-17 year-olds and was twice as
Sourcehigh among those 18-25 (Office of Adolescent
Health, 2019). In 2014 more than 1700 emerging
adults died from a prescription drug overdose. This is an increase of four times since 1999.
Additionally, for every death there were 119 emergency room visits.
Daily marijuana use is at the highest level inthree decades (National Institute on Drug
Abuse, 2015). For those in college, 2014 data
indicate that 6% of college students smoke
marijuana daily, while only 2% smoked daily
in 1994. For noncollege students of the sameage, the daily percentage is twice as high(approximately 12%). Additionally,
according to a recent survey by the National
Institute of Drug Abuse (2018), daily cigarettesmoking is lower for those in college incomparison to non-college groups (see Figure7.10).

Figure 7.10

Rates of violent death are influenced bysubstance use which peaks during emerging
Sourceand early adulthood. Drugs impair judgment,
reduce inhibitions, and alter mood, all ofwhich can lead to dangerous behavior. Reckless driving, violent altercations, and forced sexual
encounters are some examples. Drug and alcohol use increase the risk of sexually transmitted
infections because people are more likely to engage in risky sexual behavior when under the
influence. This includes having sex with someone who has had multiple partners, having anal sex
without the use of a condom, having multiple partners, or having sex with someone whose
history is unknown. Lastly, as previously discussed, drugs and alcohol ingested during
pregnancy have a teratogenic effect on the developing embryo and fetus.

256

Gender
As previously discussed in chapter 4, gender is the cultural, social and psychological meanings
associated with masculinity and feminity. A person’s sense of self as a member of a particulargender is known as gender identity. Because gender is considered a social construct, meaningthat it does not exist naturally, but is instead a concept that is created by cultural and societal
norms, there are cultural variations on how people express their gender identity. For example, in
American culture, it is considered feminine to wear a dress or skirt. However, in many Middle
Eastern, Asian, and African cultures, dresses or skirts (often referred to as sarongs, robes, or
gowns) can be considered masculine. Similarly, the kilt worn by a Scottish male does not makehim appear feminine in his culture.
For many adults, the drive to adhere to masculine and feminine gender roles, or the societal
expectations associated with being male or female, continues throughout life. In American
culture, masculine roles have traditionally been associated with strength, aggression, anddominance, while feminine roles have traditionally been associated with passivity, nurturing, andsubordination. Men tend to outnumber women in professions such as law enforcement, themilitary, and politics, while women tend to outnumber men in care-related occupations such as
childcare, healthcare, and social work. These occupational roles are examples of stereotypical
American male and female behavior, derived not from biology or genetics, but from our culture's
traditions. Adherence to these roles may demonstrate fulfillment of social expectations, however,not necessarily personal preferences (Diamond, 2002).
Consequently, many adults are challenging gender labels and roles, and the long-standing
gender binary; that is, categorinzing humans as only female and male, has been undermined bycurrent psychological research (Hyde, Bigler, Joel, Tate, & van Anders, 2019). The term gender
now encompasses a wide range of possible identities, including cisgender, transgender, agender,
genderfluid, genderqueer, gender nonconforming, bigender, pangender, ambigender, nongendered, intergender, and Two-spirit which is a modern umbrella term used by someindigenous North Americans to describe gender-variant individuals in their communities(Carroll, 2016). Hyde et al. (2019) advocates for a conception of gender that stresses multiplicity
and diversity and uses multiple categories that are not mutually exclusive.
Gender Minority Discrimination: Gendernonconforming people are much more likely toexperience harassment, bullying, and violence
based on their gender identity; they also
experience much higher rates of discrimination in
housing, employment, healthcare, and education(Borgogna, McDermott, Aita, & Kridel, 2019;
National Center for Transgender Equality, 2015).
Transgender individuals of color face additional
financial, social, and interpersonal challenges, incomparison to the transgender community as awhole, as a result of structural racism. Blacktransgender people reported the highest level of257

Figure 7.11 Transgender Flag

Sourcediscrimination among all transgender individuals of color. As members of several intersecting
minority groups, transgender people of color, and transgender women of color in particular, areespecially vulnerable to employment discrimination, poor health outcomes, harassment, andviolence. Consequently, they face even greater obstacles than white transgender individuals andcisgender members of their own race.
Gender Minority Status and Mental Health: Using data fromover 43,000 college students, Borgona et al. (2019) examinedmental health differences among several gender groups,
including those identifying as cisgender, transgender and gendernonconforming. Results indicated that participants who
identified as transgender and gender nonconforming hadsignificantly higher levels of anxiety and depression than those
identifying as cisgender. Bargona et al. explained the higher
rates of anxiety and depression using the minority stress model,
which states that an unaccepting social environment results inboth external and internal stress which contributes to poorer
mental health. External stressors include discrimination,harassment, and prejudice, while internal stressors include
negative thoughts, feelings and emotions resulting from one’s
Sourceidentity. Borgona et al. recommends that mental health services
that are sensitive to both gender minority and sexual minority statatus be available.
Figure 7.12

The transgender children discussed in chapter 4 may, when they become an adult, alter theirbodies through medical interventions, such as surgery and hormonal therapy, so that their
physical being is better aligned with gender identity. However, not all transgender individuals
choose to alter their bodies or physically transition. Many will maintain their original anatomy
but may present themselves to society as a different gender, often by adopting the dress,
hairstyle, mannerisms, or other characteristics typically assigned to a certain gender. It is
important to note that people who cross-dress, or wear clothing that is traditionally assigned tothe opposite gender, such as transvestites, drag kings, and drag queens, do not necessarily
identify as transgender (though some do). People often confuse the term transvestite, which isthe practice of dressing and acting in a style or manner traditionally associated with another sex(APA, 2013) with transgender. Cross-dressing is typically a form of self-expression,entertainment, or personal style, and not necessarily an expression about one's gender identity.

Sexuality
Human sexuality refers to people's sexual interest in and attraction to others, as well as theircapacity to have erotic experiences and responses. Sexuality may be experienced and expressedin a variety of ways, including thoughts, fantasies, desires, beliefs, attitudes, values, behaviors,
practices, roles, and relationships. These may manifest themselves in biological, physical,
emotional, social, or spiritual aspects. The biological and physical aspects of sexuality largely
concern the human reproductive functions, including the human sexual-response cycle and thebasic biological drive that exists in all species. Emotional aspects of sexuality include bonds
between individuals that are expressed through profound feelings or physical manifestations of258

love, trust, and care. Social aspects deal with the effects of human society on one's sexuality,
while spirituality concerns an individual's spiritual connection with others through sexuality.
Sexuality also impacts, and is impacted by cultural, political, legal, philosophical, moral, ethical,
and religious aspects of life.
The Sexual Response Cycle: Sexual motivation, often referred to as libido, is a person's overallsexual drive or desire for sexual activity. This motivation is determined by biological,
psychological, and social factors. In most mammalian species, sex hormones control the ability
to engage in sexual behaviors. However, sex hormones do not directly regulate the ability tocopulate in primates (including humans); rather, they are only one influence on the motivation to
engage in sexual behaviors. Social factors, such as work and family, also have an impact, as dointernal psychological factors like personality and stress. Sex drive may also be affected byhormones, medical conditions, medications, lifestyle stress, pregnancy, and relationship issues.
The sexual response cycle is a model that describes the physiological responses that take place
during sexual activity. According to Kinsey, Pomeroy, and Martin (1948), the cycle consists offour phases: excitement, plateau, orgasm, and resolution. The excitement phase is the phase inwhich the intrinsic (inner) motivation to pursue sex arises. The plateau phase is the period of
sexual excitement with increased heart rate and circulation that sets the stage for orgasm.
Orgasm is the release of tension, and the resolution period is the unaroused state before thecycle begins again.
The Brain and Sex: The brain is the structure that translates the nerve impulses from the skininto pleasurable sensations. It controls nerves and muscles used during sexual behavior. The
brain regulates the release of hormones, which are believed to be the physiological origin ofsexual desire. The cerebral cortex, which is the outer layer of the brain that allows for thinking
and reasoning, is believed to be the origin of sexual thoughts and fantasies. Beneath the cortex isthe limbic system, which consists of the amygdala, hippocampus, cingulate gyrus, and septal
area. These structures are where emotions and feelings are believed to originate, and they areimportant for sexual behavior.
The hypothalamus is the most important part of the brain for sexual functioning. This is thesmall area at the base of the brain consisting of several groups of nerve-cell bodies that receives
input from the limbic system. Studies with lab animals have shown that destruction of certain
areas of the hypothalamus causes complete elimination of sexual behavior. One of the reasonsfor the importance of the hypothalamus is that it controls the pituitary gland, which secretes
hormones that control the other glands of the body.

259

Figure 7.13

SourceHormones: Several important sexual hormones are secreted by the pituitary gland. Oxytocin,
also known as the hormone of love, is released during sexual intercourse when an orgasm isachieved. Oxytocin is also released in females when they give birth or are breast feeding; it isbelieved that oxytocin is involved with maintaining close relationships. Both prolactin andoxytocin stimulate milk production in females. Follicle-stimulating hormone (FSH) is
responsible for ovulation in females by triggering egg maturity; it also stimulates sperm
production in males. Luteinizing hormone (LH) triggers the release of a mature egg in females
during the process of ovulation.
In males, testosterone appears to be a major contributing factor to sexual motivation.
Vasopressin is involved in the male arousal phase, and the increase of vasopressin during
erectile response may be directly associated with increased motivation to engage in sexual
behavior.
The relationship between hormones and female sexual motivation is not as well understood,
largely due to the overemphasis on male sexuality in Western research. Estrogen andprogesterone typically regulate motivation to engage in sexual behavior for females, withestrogen increasing motivation and progesterone decreasing it. The levels of these hormones
rise and fall throughout a woman's menstrual cycle. Research suggests that testosterone,
oxytocin, and vasopressin are also implicated in female sexual motivation in similar ways as they
are in males, but more research is needed to understand these relationships.
Sexual Responsiveness Peak: Men and women tend to reach their peak of sexual
responsiveness at different ages. For men, sexual responsiveness tends to peak in the late teensand early twenties. Sexual arousal can easily occur in response to physical stimulation or
fantasizing. Sexual responsiveness begins a slow decline in the late twenties and into the thirties,
260

although a man may continue to be sexually active. Through time, a man may require more
intense stimulation in order to become aroused. Women often find that they become moresexually responsive throughout their 20s and 30s and may peak in the late 30s or early 40s. Thisis likely due to greater self-confidence and reduced inhibitions about sexuality.
Sexually Transmitted Infections: Sexually transmitted infections (STIs), also referred to as
sexually transmitted diseases (STDs) or venereal diseases (VDs), are illnesses that have asignificant probability of transmission by means of sexual behavior, including vaginal
intercourse, anal sex, and oral sex. Some STIs can also be contracted by sharing intravenous
drug needles with an infected person, as well as through childbirth or breastfeeding.
Common STIs include:
•
•
•
•
•
•
•

chlamydia;
herpes (HSV-1 and HSV-2);
human papillomavirus (HPV);
gonorrhea;
syphilis;
trichomoniasis;
HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency
syndrome).

According to the Centers for Disease Control and Prevention (CDC) (2014), there was anincrease in the three most common types of STDs in 2014. These include 1.4 million cases ofchlamydia, 350,000 cases of gonorrhea, and 20,000 cases of syphilis. Those most affected by
STDS include those younger, gay/bisexual males, and females. The most effective way toprevent transmission of STIs is to practice safe sex and avoid direct contact of skin or fluids
which can lead to transfer with an infected partner. Proper use of safe-sex supplies (such as malecondoms, female condoms, gloves, or dental dams) reduces contact and risk and can be effectivein limiting exposure; however, some disease transmission may occur even with these barriers.
Societal Views on Sexuality: Society's views on sexuality are influenced by everything fromreligion to philosophy, and they have changed throughout history and are continuously evolving.
Historically, religion has been the greatest influence on sexual behavior in the United States;
however, in more recent years, peers and the media have emerged as two of the strongest
influences, particularly among American teens (Potard, Courtois, & Rusch, 2008).
Mass media in the form of television, magazines, movies, and music continues to shape what isdeemed appropriate or normal sexuality, targeting everything from body image to products
meant to enhance sex appeal. Media serves to perpetuate a number of social scripts about sexual
relationships and the sexual roles of men and women, many of which have been shown to haveboth empowering and problematic effects on people's (especially women's) developing sexual
identities and sexual attitudes.
Cultural Differences: In the West, premarital sex is normative by the late teens, more than adecade before most people enter marriage. In the United States and Canada, and in northern andeastern Europe, cohabitation is also normative; most people have at least one cohabiting261

partnership before marriage. In southern Europe, cohabiting is still taboo, but premarital sex istolerated in emerging adulthood. In contrast, both premarital sex and cohabitation remain rare
and forbidden throughout Asia. Even dating is discouraged until the late twenties, when it would
be a prelude to a serious relationship leading to marriage. In cross-cultural comparisons, about
three fourths of emerging adults in the United States and Europe report having had premarital
sexual relations by age 20, versus less than one fifth in Japan and South Korea (Hatfield &Rapson, 2006).
Sexual Orientation: A person's sexual orientation is their emotional and sexual attraction to aparticular gender. It is a personal quality that inclines people to feel romantic or sexual attraction(or a combination of these) to persons of a given sex or gender. According to the American
Psychological Association (APA) (2016), sexual orientation also refers to a person's sense ofidentity based on those attractions, related behaviors, and membership in a community of others
who share those attractions. Sexual orientation is independent of gender; for example, atransgender person may identify as heterosexual, homosexual, bisexual, pansexual, polysexual,asexual, or any other kind of sexuality, just like a cisgender person.
Sexual Orientation on a Continuum: Sexuality
researcher Alfred Kinsey was among the first toconceptualize sexuality as a continuum rather than astrict dichotomy of gay or straight. To classify thiscontinuum of heterosexuality and homosexuality,
Kinsey et al. (1948) created a seven-point rating scalethat ranged from exclusively heterosexual to
exclusively homosexual. Research done over several
decades has supported this idea that sexual orientation
ranges along a continuum, from exclusive attraction tothe opposite sex/gender to exclusive attraction to thesame sex/gender (Carroll, 2016).

Figure 7.14

However, sexual orientation now can be defined in
Sourcemany ways. Heterosexuality, which is often referred toas being straight, is attraction to individuals of the
opposite sex/gender, while homosexuality, being gay
or lesbian, is attraction to individuals of one's own
sex/gender. Bisexuality was a term traditionally used
to refer to attraction to individuals of either male orfemale sex, but it has recently been used in nonbinarymodels of sex and gender (i.e., models that do not
Sourceassume there are only two sexes or two genders) torefer to attraction to any sex or gender. Alternative
terms such as pansexuality and polysexuality have also been developed, referring to attraction
to all sexes/genders and attraction to multiple sexes/genders, respectively (Carroll, 2016).
Asexuality refers to having no sexual attraction to any sex/gender. According to Bogaert (2015)
about one percent of the population is asexual. Being asexual is not due to any physical262

problems, and the lack of interest in sex does not cause the individual any distress. Asexuality is
being researched as a distinct sexual orientation.
Development of Sexual Orientation: According to current scientific understanding, individuals
are usually aware of their sexual orientation between middle childhood and early adolescence.
However, this is not always the case, and some do not become aware of their sexual orientation
until much later in life. It is not necessary to participate in sexual activity to be aware of these
emotional, romantic, and physical attractions; people can be celibate and still recognize theirsexual orientation. Some researchers argue that sexual orientation is not static and inborn but isinstead fluid and changeable throughout the lifespan.
There is no scientific consensus regarding the exact reasons why an individual holds a particularsexual orientation. Research has examined possible biological, developmental, social, andcultural influences on sexual orientation, but there has been no evidence that links sexual
orientation to only one factor (APA, 2016). However, biological explanations, that include
genetics, birth order, and hormones will be explored further as many scientists support biologicalprocesses occurring during the embryonic and and early postnatal life as playing the main role insexual orientation (Balthazart, 2018).
Figure 7.15

SourceGenetics: Using both twin and familial studies,
heredity provides one biological explanation forsame-sex orientation. Bailey and Pillard (1991)
studied pairs of male twins and found that theconcordance rate for identical twins was 52%,
while the rate for fraternal twins was only 22%.
Bailey, Pillard, Neale, and Agyei (1993) studied
female twins and found a similar difference with aconcordance rate of 48% for identical twins and
16% for fraternal twins. Schwartz, Kim,
Kolundzija, Rieger, & Sanders (2010) found thatgay men had more gay male relatives than straightmen, and sisters of gay men were more likely to belesbians than sisters of straight men.

Fraternal Birth Order: The fraternal birth order effect indicates that the probability of a boy
identifying as gay increases for each older brother born to the same mother (Balthazart, 2018;
Blanchard, 2001). According to Bogaret et al. “the increased incidence of homosexuality inmales with older brothers results from a progressive immunization of the mother against a malespecific cell-adhesion protein that plays a key role in cell-cell interactions, specifically in theprocess of synapse formation,” (as cited in Balthazart, 2018, p. 234). A meta-analysis indicatedthat the fraternal birth order effect explains the sexual orientation of between 15% and 29% of
gay men.
Hormones: Excess or deficient exposure to hormones during prenatal development has also
been theorized as an explanation for sexual orientation. One-third of females exposed toabnormal amounts of prenatal androgens, a condition called congenital adrenal hyperplasia(CAH), identify as bisexual or lesbian (Cohen-Bendahan, van de Beek, & Berenbaum, 2005). In
263

contrast, too little exposure to prenatal androgens may affect male sexual orientation by not
masculinizing the male brain (Carlson, 2011).
Sexual Orientation Discrimination: The United States is heteronormative, meaning thatsociety supports heterosexuality as the norm. Consider, for example, that homosexuals are often
asked, "When did you know you were gay?" but heterosexuals are rarely asked, "When did you
know you were straight?" (Ryle, 2011). Living in a culture that privileges heterosexuality has asignificant impact on the ways in which non-heterosexual people are able to develop and express
their sexuality.
Open identification of one's sexual
orientation may be hindered byhomophobia which encompasses
a range of negative attitudes andfeelings toward homosexuality or
people who are identified or
perceived as being lesbian, gay,bisexual, or transgender (LGBT).
It can be expressed as antipathy,
contempt, prejudice, aversion, or
hatred; it may be based on
irrational fear and is sometimes
related to religious beliefs (Carroll,2016). Homophobia is observablein critical and hostile behavior,such as discrimination andviolence on the basis of sexual
orientations that are nonheterosexual. Recognized types ofhomophobia include
Sourceinstitutionalized homophobia,
such as religious and state-sponsored homophobia, and internalized homophobia in whichpeople with same-sex attractions internalize, or believe, society's negative views and/or hatred ofthemselves.
Figure 7.16

Sexual minorities regularly experience stigma, harassment, discrimination, and violence basedon their sexual orientation (Carroll, 2016). Research has shown that gay, lesbian, and bisexual
teenagers are at a higher risk of depression and suicide due to exclusion from social groups,
rejection from peers and family, and negative media portrayals of homosexuals (Bauermeister etal., 2010). Discrimination can occur in the workplace, in housing, at schools, and in numerous
public settings. Much of this discrimination is based on stereotypes and misinformation. Major
policies to prevent discrimination based on sexual orientation have only come into effect in the
United States in the last few years.
The majority of empirical and clinical research on LGBT populations are done with largely
white, middle-class, well-educated samples. This demographic limits our understanding of more264

marginalized sub-populations that are also affected by racism, classism, and other forms of
oppression. In the United States, non-Caucasian LGBT individuals may find themselves in a
double minority, in which they are not fully accepted or understood by Caucasian LGBT
communities and are also not accepted by their own ethnic group (Tye, 2006). Many people
experience racism in the dominant LGBT community where racial stereotypes merge withgender stereotypes.

Learning Objectives: Cognitive Development in Emerging and Early
Adulthood
•
•
•
•
•
•

Distinguish between formal and postformal thought
Describe dialectical thought
Describe the changes in educational attainment and the costs of education
Describe the benefits of education beyond high school
Describe the stages in career development, millennial employment, and NEETS
Describe sexism and how it affects pay, hiring, employment, and education

Beyond Formal Operational Thought: Postformal Thought
As mentioned in chapter 6, according to Piaget’s theory adolescents acquire formal operational
thought. The hallmark of this type of thinking is the ability to think abstractly or to consider
possibilities and ideas about circumstances never directly experienced. Thinking abstractly is
only one characteristic of adult thought, however. If you compare a 15 year-old with someone intheir late 30s, you would probably find that the latter considers not only what is possible, but also
what is likely. Why the change? The adult has gained experience and understands why
possibilities do not always become realities. They learn to base decisions on what is realistic andpractical, not idealistic, and can make adaptive choices. Adults are also not as influenced bywhat others think. This advanced type of thinking is referred to as Postformal Thought(Sinnott, 1998).
Dialectical Thought: In addition to moving toward more practical considerations, thinking inearly adulthood may also become more flexible and balanced. Abstract ideas that the adolescentbelieves in firmly may become standards by which the adult evaluates reality. Adolescents tend
to think in dichotomies; ideas are true or false; good or bad; and there is no middle
ground. However, with experience, the adult comes to recognize that there is some right andsome wrong in each position, some good or some bad in a policy or approach, some truth andsome falsity in a particular idea. This ability to bring together salient aspects of two opposing
viewpoints or positions is referred to as dialectical thought and is considered one of the mostadvanced aspects of postformal thinking (Basseches, 1984). Such thinking is more realistic
because very few positions, ideas, situations, or people are completely right or wrong. So, forexample, parents who were considered angels or devils by the adolescent eventually become justpeople with strengths and weaknesses, endearing qualities, and faults to the adult.

265

Does everyone reach postformal or even formal operational thought? Formal operational
thought involves being able to think abstractly; however, this ability does not apply to all
situations or all adults. Formal operational thought is influenced by experience andeducation. Some adults lead lives in which they are not challenged to think abstractly about theirworld. Many adults do not receive any formal education and are not taught to think abstractly
about situations they have never experienced. Further, they are also not exposed to conceptual
tools used to formally analyze hypothetical situations. Those who do think abstractly may beable to do so more easily in some subjects than others. For example, psychology majors may beable to think abstractly about psychology but be unable to use abstract reasoning in physics or
chemistry. Abstract reasoning in a particular field requires a knowledge base we might not havein all areas. Consequently, our ability to think abstractly often depends on our experiences.

Education
According to the National Center for Higher Education Management Systems (NCHEMS)(2016a, 2016b, 2016c, 2016d), in the United States:• 84% of 18 to 24 year olds and 88% of those 25 and older have a high school diploma or
its equivalent• 36% of 18 to 24 year olds and 7% of 25 to 49 year olds attend college• 59% of those 25 and older have completed some college• 32.5% of those 25 and older have a bachelor’s degree or higher, with slightly more
women (33%) than men (32%) holding a college degree (Ryan & Bauman, 2016).
The rate of college attainment has grown more slowly in the United States than in a number ofother nations in recent years (OCED, 2014). This may be due to fact that the cost of attaining a
degree is higher in the U.S. than in many other nations.
In 2017, 65% of college seniors who graduated from private and public nonprofit colleges had
student loan debt, and nationally owed an average of $28,650, a 1% decline from 2016 (TheInstitute for College Access & Success (TICAS), 2018). See Figure 7.17 for yearly comparisons.

Figure 7.17 Average Debt Borrowed of Graduating Seniors

Adapted from TICAS, 2018266

According to the most recent TICAS annual report, the rate of debt varied widely across states,
as well as between colleges. The after graduation debt ranged from 18,850 in Utah to $38,500 in
Connecticut. Low-debt states are mainly in the West, and high-debt states in the Northeast. In
recent years there has been a concern about students carrying more debt and being more likely todefault when attending for-profit institutions. In 2016, students at for-profit schools borrowed anaverage of $39,900, which was 41% higher than students at non-profit schools that year. In
addition, 30% of students attending for-profit colleges default on their federal student loans. In
contrast, the default level of those who attended public institutions is only 4% (TICAS, 2018).
Table 7.1 Select State Data on Student Debt (2017)

State

Average
Debt

Rank

Proportion
with Debt

Illinois

29,214

24

61%

Wisconsin

29,56921

64%

Michigan

31,298

11

58%

Indiana

29,561

22

57%

Utah (lowest)

18,85038%

Connecticut(highest)
TICSA, 2017 Data

38,500

57%

College student debt has becomea key issue at both the state andfederal political level, and somestates have been taking steps toincrease spending and grants to
help students with the cost ofcollege. However, 15% of theClass of 2017’s college debt was
owed to private lenders (TICAS,
2018). Such debt has lessconsumer protection, fewer
options for repayment, and istypically negotiated at a higher
interest rate. See Table 7.1 for adebt comparison of 6 U.S. States.

Graduate School: Larger amounts of student debt actually occur at the graduate level(Kreighbaum, 2019). In 2019, the highest average debts were concentrated in the medical fields.
Average median debt for graduate programs included:• $42,335 for a master’s degree• $95,715 for a doctoral degree• $141,000 for a professional degree
Worldwide, over 80% of college educated adults are employed, compared with just over 70% of
those with a high school or equivalent diploma, and only 60% of those with no high school
diploma (OECD, 2015). Those with a college degree will earn more over the course of their life
time. Moreover, the benefits of college education go beyond employment and finances. The
OECD found that around the world, adults with higher educational attainment were more likely
to volunteer, felt they had more control over their lives, and thus were more interested in theworld around them. Studies of U.S. college students find that they gain a more distinct identityand become more socially competent, less dogmatic and ethnocentric compared to those not incollege (Pascarella, 2006).
Is college worth the time and investment? College is certainly a substantial investment eachyear, with the financial burden falling on students and their families in the U.S., and mainly by
the government in many other nations. Nonetheless, the benefits both to the individual and thesociety outweighs the initial costs. As can be seen in Figure 7.18, those in America with the mostadvanced degrees earn the highest income and have the lowest unemployment.
267

Figure 7.18

SourceCareer Development and Employment
Work plays a significant role in the lives of people, and emerging and early adulthood is the time
when most of us make choices that will establish our careers. Career development has a numberof stages:
•
•
•

•

Stage One: As children we may select careers based on what appears glamorous or
exciting to us (Patton & McMahon, 1999). There is little regard in this stage for whether
we are suited for our occupational choices.
Stage Two: In the second stage, teens include their abilities and limitations, in addition to
the glamour of the occupation when narrowing their choices.
Stage Three: Older teens and emerging adults narrow their choices further and begin toweigh more objectively the requirements, rewards, and downsides to careers, along withcomparing possible careers with their own interests, values, and future goals (Patton &McMahon, 1999). However, some young people in this stage “fall-into” careers simply
because these were what were available at the time, because of family pressures to pursue
particular paths, or because these were high paying jobs, rather than from an intrinsic
interest in that career path (Patton & McMahon, 1999).
Stage Four: Super (1980) suggests that by our mid to late thirties, many adults settle intheir careers. Even though they might change companies or move up in their position,
there is a sense of continuity and forward motion in their career. However, some people268

at this point in their working life may feel trapped, especially if there is little opportunity
for advancement in a more dead-end job.
How have things changed for Millennials compared with previous generations of early
adults? In recent years, young adults are more likely to find themselves job-hopping, andperiodically returning to school for further education and retraining than in prior generations.
However, researchers find that occupational interests remain fairly stable. Thus, despite themore frequent change in jobs, most people are generally seeking jobs with similar interests rather
than entirely new careers (Rottinghaus, Coon, Gaffey & Zytowski, 2007). As of 2016,
millennials became the largest generation in the labor force (Fry, 2018) (See Figure 7.19).
Figure 7.19

Recent research also suggests that Millennials are looking for something different in their placeof employment. According to a recent Gallup poll report (2016), Millennials want more than apaycheck, they want a purpose. Unfortunately, only 29% of Millennials surveyed by Gallup
reported that they were “engaged” at work. In fact, they report being less engaged than Gen
Xers and Baby Boomers; with 55% of Millennials saying they are not engaged at all with theirjob. This indifference to their workplace may explain the greater tendency to switch jobs. With
their current job giving them little reason to stay, they are more likely to take any newopportunity to move on. Only half of Millennials saw themselves working at the same company
a year later. Gallup estimates that this employment turnover and lack of engagement costs
businesses $30.5 billion a year.
NEETs: Around the world, teens and young adults were some of the hardest hit by the
economic downturn in recent years (Desilver, 2016). Consequently, a number of young people
have become NEETs, neither employed nor in education or training. While the number ofyoung people who are NEETs has declined more recently, there is concern that “without
assistance, economically inactive young people won’t gain critical job skills and will never fully
integrate into the wider economy or achieve their full earning potential” (Desilver, 2016, para.
3). In parts of the world where the rates of NEETs are persistently high, there is also concern that269

having such large numbers of young adults with little opportunity may increase the chances ofsocial unrest.
Table 7.2 Percentage of Females and Males
between the Ages of 15-29 who are NEETs in
Select Nations

Females Males Overall
Australia
CanadaDenmark
FranceGermany
Italy
MexicoRussiaSwedenTurkeyUnitedKingdom
United Statesof America

12.80
11.83
11.86
17.75
11.27
26.94
34.21
16.28
8.42
39.90
13.95

9.14
12.46
11.67
15.34
7.60
23.38
7.90
8.66
7.69
15.08
10.50

10.9
12.2
11.8
16.5
9.3
25.1
21.2
12.4
8
27.2
12.2

15.69

10.89

13.3

In the United States, in 2017 over 13% of
15 to 29 year-olds were neither employed
nor in school, (Organisation for Economic
Cooperation and Development, (OECD),
2019). This is down from 2013, whenapproximately 18.5% of this age group fit
the category (Desilver, 2016). More young
women than men in the United States findthemselves unemployed and not in schoolor training for a job. Additionally, most
NEETs have high school or less education,
and Asians are less likely to be NEETs thanany other ethnic group in the US (Desilver,2016).
The rate of NEETs varies around the world,with higher rates found in nations that havebeen the hardest hit by economic
recessions, and government austerity
measures. The number of NEETs also
varies widely between the genders,
although females are more likely to be
NEETs in all nations (see Table 7.2).

Adapted from OCED 2019

What role does gender play on career and employment? Gender also has an impact on career
choices. Despite the rise in the number of women who work outside of the home, there are somecareer fields that are still pursued more by men than women. Jobs held by women still tend tocluster in the service sector, such as education, nursing, and child-care worker. While in more
technical and scientific careers, women are greatly outnumbered by men. Jobs that have been
traditionally held by women tend to have lower status, pay, benefits, and job security (Bosson, etal., 2019). In recent years, women have made inroads into fields once dominated by males, andtoday women are almost as likely as men to become medical doctors or lawyers. Despite thesechanges, women are more likely to have lower-status, and thus less pay than men in these
professions. For instance, women are more likely to be a family practice doctor than a surgeon or
are less likely to make partner in a law firm (Ceci & Williams, 2007).

SexismSexism or gender discrimination is prejudice or discrimination based on a person's sex orgender (Bosson, Vandello, & Buckner, 2019). Sexism can affect any sex that is marginalized or
oppressed in a society; however, it is particularly documented as affecting females. It has been
linked to stereotypes and gender roles and includes the belief that males are intrinsically superior
to other sexes and genders. Extreme sexism may foster sexual harassment, rape, and other forms
of sexual violence.
270

Sexism can exist on a societal level, such as in hiring, employment opportunities, and education.
In the United States, women are less likely to be hired or promoted in male-dominatedprofessions, such as engineering, aviation, and construction (Blau, Ferber, & Winkler, 2010;
Ceci & Williams, 2011). In many areas of the world, young girls are not given the same access tonutrition, healthcare, and education as boys. Sexism also includes people’s expectations of how
members of a gender group should behave. For example, women are expected to be friendly,
passive, and nurturing; when a woman behaves in an unfriendly or assertive manner, she may bedisliked or perceived as aggressive because she has violated a gender role (Rudman, 1998). In
contrast, a man behaving in a similarly unfriendly or assertive way might be perceived as strong
or even gain respect in some circumstances.
Occupational sexism involves discriminatory
practices, statements, or actions, based on a person's
sex, that occur in the workplace. One form ofoccupational sexism is wage discrimination. In 2008,
the Organisation for Economic Co-operation andDevelopment (OECD) found that while female
employment rates have expanded, and gender
employment and wage gaps have narrowed nearly
everywhere, on average women still have a 20
percent less chance to have a job. The Council of
Economic Advisors (2015) found that despite
women holding 49.3% of the jobs, they are paid only
78 cents for every $1.00 a man earns. It also foundSourcethat despite the fact that many countries, including
the U.S., have established anti-discrimination laws,
these laws are difficult to enforce. A recent example of significant wage inequality occurredamong athletes.
Figure 7.20

2019 Women’s World Cup: The world witnessed the tremendous athleticism and soccer skills
demonstrated by female players from 24 different countries during the 2019 Women’s World
Cup. Amid the cheering at the end of the final match between the United States and theNetherlands, were chants of “equal pay” (Channick, 2019). Throughout the tournament,
attention was focused on the discrepancy between what male soccer players earned compared to
the female players. In winning the World Cup, the American women’s team earned $4 million aspart of a $30 million prize pool (Peterson, 2019). In contrast, the French men’s team, who won
the Men’s World Cup in 2018, earned $38 million as part of the $400 million prize pool. The
Federation of Association Football (FIFA) promised to double the prize money to $60 million forthe 2023 Women’s World Cup, but that still lags far behind the $440 million that will be givenout for the Men’s World Cup in 2022. In the United States, the women’s soccer team generates
more revenue and receives higher TV ratings than the men’s team, yet the women get paid

271

Figure 7.21 Megan Rapinoe andAlex Morgan of the UnitedStates Women’s Soccer Teamsignificantly less. By winning the 2019 Women’s World
Cup, each woman should receive $200,000, yet if theAmerican men had won the 2018 Men’s World Cup, eachwould have received $1.1 million (Hess, 2019). Because ofthis discrepancy, in March 2019, 28 members of thewomen’s team filed a lawsuit against the United States
Soccer Federation for gender discrimination and unequalpay (Channick, 2019).

Factors Affecting Wage Inequality: There are many
possible explanations for the wage gap. It has been argued
in the past that education may account for the wage gap.
However, the wage gap exists at every of education level(Bosson et al., 2019). Men with less than high school to
men with graduate degree earn more than women with thesame level of education. In addition, women now attain
more associates, bachelor’s, and master’s degrees than men,and very similar levels of professional degrees andPhoto: Christopher Simon/Getty-AFP
doctorates, according to a recent Census survey (U.S.
Census Bureau, 2019). As the wage gap still exists in mostoccupations it cannot be the explanation. Instead, occupational segregation is a likely contributor
to the overall wage gap, as women tend to work in very different occupations than men, andthose jobs tend to have lower wages. In addition, the entry of women into a field tends to reduce
the wages and prestige of the job. Mandel (2013) found that jobs typically held by men who saw
the biggest influx of women into those careers, also saw the biggest drop in wages.
Sticky floors, which keep low-wage
workers, who are more likely to be
Wage Gap
women and minorities, from being102
promoted contribute to lower wages(Bosson, et al. 2019). Women are99
disproportionately in low-paid
94.1
occupations, such as clerical, childcare,
90.4
and service workers (Hegewisch & Ellis,
86.82015). They also get paid less than men
84.5
in the same jobs, as can be seen in Table
83.9
7.3. This is a list of some of the top jobs
83
held by women (e.g., maid, social
82.8
worker, nurse) and top jobs held by men
80.8(e.g., software developer, janitor, police
76.9
officer) in the United States. The second
73.7
column shows women’s earnings as a
71.2
percentage of the earnings of men in
Adapted from Hegewisch & Ellis (2015).
those careers. In only one occupation are
women paid more than men on average; stock clerk. Men are not only being paid more in moremasculine jobs, but also in jobs typically held by women.
Table 7.3 The Gender Wage Gap
Occupation
Stock clerk, order filler
Maid, housekeeping cleaner
Social worker
Registered nurse
Customer service representative
Secretary/administrative assistant
Software developer
Office supervisor
Waitress/waiter
Accountant, auditor
Janitor, building cleaner
Driver/sales worker/truck driver
Police and sheriff’s patrol officer272

Other factors include that more than half of men report having negotiated their salary when being
hired, compared with 12% of women (Babcock, Gelfand, Small, & Stayn, 2006). However,people perceive women who negotiate more negatively then they do men, as assertive women,
but not men, are more likely to be penalized. Women are also more likely to have interruptionsin their careers either through the birth of children, or relocation due to a change in theirpartner’s job. Women are also less likely to relocate for the sake of their families when a betterjob offer comes along, and employers know this. It has been suggested that one reason why
males may be offered more money is to keep them from leaving (Baldridge, Eddleston, & Vega,
2006). Aditionally, men are more likely to work overtime.
Barriers to Positions of Power: There are a few barriers to women achieving positions of
power. The glass ceiling is the invisible barrier that keeps women and minorities from rising tohigher positions regardless of their qualifications (Bosson et al., 2019). Women hold only 4.5%of CEO positions and 14% of top executive positions around the world (Noland, Moran, &Kotschwar, 2016). In addition, Noland and colleagues found that in a study of nearly 22,000
companies worldwide, in 77% of those firms only 30% of women held an executive position or
board seat. There were only 11 companies, or 0.05% of all the firms studied, where women held
all the executive positions and board seats. Some researchers see the root cause of this situationin the tacit discrimination based on gender, conducted by current top executives and corporate
directors, who are primarily male.
Often the barriers to achieving one’s goals are not obvious. For instance, some argue that thegender role stereotypes cast managerial positions as “masculine”. Unfortunately, when women
do rise to positions of power it is often at a time when a company or country is faced with amajor crisis. This is called the glass cliff, and it refers to women and minorities being placed inleadership positions when the risk of failure is high. For instance, female lawyers are more likely
than their male counterparts to lead a high-risk cases, and female politicians are more likely to berecommended to run in unwinnable seats (Bruckmuller, Ryan, Floor, & Haslam, 2014).
Worldwide Gender Parity: The World Economic Forum (2017) introduced The Global Gender
Gap Report in 2006 as way of tracking gender based disparities between men and women in theworld. The most recent report in 2017 analyzed 144 countries on gender equality in the areas of:
economic participation and opportunity, educational attainment, health and survival, and politicalempowerment. Countries are then ranked to create global awareness of the challenges posed bygender gaps in different areas of the world. A parity rating of 100% would mean that females andmales achieved equality on these measures. Results indicated:• 68% gender parity was found worldwide across the four areas. Specifically, there was
96% parity in health outcomes, 95% parity in educational attainment, 58% parity ineconomic participation, and only 23% parity in political empowerment.
• The top spots were held by smaller Western European countries, particularly the Nordic
countries as Iceland (88% parity), Norway (83% parity) and Finland (82% parity)
occupied the top three positions.
• The United States ranked 49th with 72% gender parity.
• Following the current trends, it will take 100 years for global gender parity.
• Improving gender parity is expected to provide significant economic gains for a country
and closing the occupational gender gaps would be one way to achieve this.
273

Learning Objectives: Psychosocial Development in Emerging and Early
Adulthood
•
•
•
•
•
•
•
•
•

Describe the relationship between infant and adult temperament
Explain personality in early adulthood
Explain the five factor model of personality
Describe adult attachment styles
Describe Erikson’s stage of intimacy vs. isolation
Identify the factors affecting attraction
Differentiate among the types of love
Describe adult lifestyles, including singlehood, cohabitation and marriage
Describe the factors that influence parenting

Temperament and Personality in Adulthood
If you remember from chapter 3, temperament is defined as the innate characteristics of theinfant, including mood, activity level, and emotional reactivity, noticeable soon after birth. Does
one’s temperament remain stable through the lifespan? Do shy and inhibited babies grow up to
be shy adults, while the sociable child continues to be the life of the party? Like mostdevelopmental research the answer is more complicated than a simple yes or no. Chess andThomas (1987), who identified children as easy, difficult, slow-to-warm-up or blended, foundthat children identified as easy grew up to became well-adjusted adults, while those who
exhibited a difficult temperament were not as well-adjusted as adults. Kagan (2002) studied thetemperamental category of inhibition to the unfamiliar in children. Infants exposed to
unfamiliarity reacted strongly to the stimuli and cried loudly, pumped their limbs, and had anincreased heart rate. Research has indicated that these highly reactive children showtemperamental stability into early childhood, and Bohlin and Hagekull (2009) found that shyness
in infancy was linked to social anxiety in adulthood.
An important aspect of this research on inhibition was looking at the response of the amygdala,which is important for fear and anxiety, especially when confronted with possible threatening
events in the environment. Using functional magnetic resonance imaging (FMRIs) young adults
identified as strongly inhibited toddlers showed heightened activation of the amygdala whencompared to those identified as uninhibited toddlers (Davidson & Begley, 2012).
The research does seem to indicate that temperamental stability holds for many individuals
through the lifespan, yet we know that one’s environment can also have a significant impact.
Recall from our discussion on epigenesis or how environmental factors are thought to change
gene expression by switching genes on and off. Many cultural and environmental factors canaffect one’s temperament, including supportive versus abusive child-rearing, socioeconomic
status, stable homes, illnesses, teratogens, etc. Additionally, individuals often choose
environments that support their temperament, which in turn further strengthens them (Cain,2012). In summary, because temperament is genetically driven, genes appear to be the major274

reason why temperament remains stable into adulthood. In contrast, the environment appears
mainly responsible for any change in temperament (Clark & Watson, 1999).
Everybody has their own unique personality; that is, their characteristic manner of thinking,feeling, behaving, and relating to others (John, Robins, & Pervin, 2008). Personality traits referto these characteristic, routine ways of thinking, feeling, and relating to others. Personality
integrates one’s temperament with cultural and environmental influences. Consequently, there
are signs or indicators of these traits in childhood, but they become particularly evident when the
person is an adult. Personality traits are integral to each person’s sense of self, as they involve
what people value, how they think and feel about things, what they like to do, and, basically,
what they are like most every day throughout much of their lives.

Table 7.4 Descriptions of the Big Five Personality Traits
Dimension

Description

Examples of behaviors predicted by the trait

Openness toexperience

A general appreciation for art,
emotion, adventure, unusual ideas,
imagination, curiosity, and variety
of experience

Individuals who are highly open to experience tend to havedistinctive and unconventional decorations in their home.
They are also likely to have books on a wide variety of
topics, a diverse music collection, and works of art on
display.

Conscientiousness A tendency to show selfdiscipline, act dutifully, and aim
for achievement

Individuals who are conscientious have a preference forplanned rather than spontaneous behavior.

Extraversion

The tendency to experience
positive emotions and to seek out
stimulation and the company ofothersExtroverts enjoy being with people. In groups they like totalk, assert themselves, and draw attention to themselves.

AgreeablenessA tendency to be compassionate
and cooperative rather thansuspicious and antagonistic toward
others; reflects individual
differences in general concern forsocial harmony

Agreeable individuals value getting along with others.
They are generally considerate, friendly, generous, helpful,and willing to compromise their interests with those ofothers.

Neuroticism

The tendency to experience
negative emotions, such as anger,
anxiety, or depression; sometimes
called “emotional instability”

Those who score high in neuroticism are more likely tointerpret ordinary situations as threatening and minor
frustrations as hopelessly difficult. They may have trouble
thinking clearly, making decisions, and coping effectively
with stress.

Adapted from John, Naumann, and Soto (2008)

Five-Factor Model: There are hundreds of different personality traits, and all of these traits canbe organized into the broad dimensions referred to as the Five-Factor Model (John, Naumann, &275

Soto, 2008). These five broad domains include: Openness, Conscientiousness, Extraversion,
Agreeableness, and Neuroticism (Think OCEAN to remember). This applies to traits that you
may use to describe yourself. Table 7.4 provides illustrative traits for low and high scores on thefive domains of this model of personality.
Does personality change throughout adulthood? Previously the answer was no, butcontemporary research shows that although some people’s personalities are relatively stable overtime, others’ are not (Lucas & Donnellan, 2011; Roberts & Mroczek, 2008). Longitudinal studies
reveal average changes during adulthood in the expression of some traits (e.g., neuroticism andopenness decrease with age and conscientiousness increases) and individual differences in thesepatterns due to idiosyncratic life events (e.g., divorce, illness). Longitudinal research alsosuggests that adult personality traits, such as conscientiousness, predict important life outcomes
including job success, health, and longevity (Friedman et al., 1993; Roberts, Kuncel, Shiner,
Caspi, & Goldberg, 2007).
The Harvard Health Letter (2012) identifies research correlations between conscientiousness andlower blood pressure, lower rates of diabetes and stroke, fewer joint problems, being less likely
to engage in harmful behaviors, being more likely to stick to healthy behaviors, and more likely
to avoid stressful situations. Conscientiousness also appears related to career choices,friendships, and stability of marriage. Lastly, a person possessing both self-control andorganizational skills, both related to conscientiousness, may withstand the effects of aging betterand have stronger cognitive skills than one who does not possess these qualities.

Attachment in Young Adulthood
Table 7.5
Which of the following best describes you in your romantic relationships?

SecureAvoidant

Anxious/Ambivalent

I find it relatively easy to get close to others and am comfortabledepending on them and having them depend on me. I don’t often worry
about being abandoned or about someone getting too close to me.
I am somewhat uncomfortable being close to others; I find it difficult totrust them completely, difficult to allow myself to depend on them. I am
nervous when anyone gets too close, and often, love partners want me tobe more intimate than I feel comfortable being.
I find that others are reluctant to get as close as I would like. I often
worry that my partner doesn’t really love me or won’t stay with me. I
want to merge completely with another person, and this sometimes scares
people away.

SourceHazan and Shaver (1987) described the attachment styles of adults, using the same three generalcategories proposed by Ainsworth’s research on young children: secure, avoidant, andanxious/ambivalent. Hazan and Shaver developed three brief paragraphs describing the three
adult attachment styles. Adults were then asked to think about romantic relationships they werein and select the paragraph that best described the way they felt, thought, and behaved in these
relationships (See Table 7.5).
276

Bartholomew (1990) challenged the categorical view of attachment in adults and suggested that
adult attachment was best described as varying along two dimensions; attachment related-anxiety
and attachment-related avoidance. Attachment-related anxiety refers to the extent to which an
adult worries about whether their partner really loves them. Those who score high on thisdimension fear that their partner will reject or abandon them (Fraley, Hudson, Heffernan, &Segal, 2015). Attachment-related avoidance refers to whether an adult can open up to others,
and whether they trust and feel they can depend on others. Those who score high on attachmentrelated avoidance are uncomfortable with opening up and may fear that such dependency may
limit their sense of autonomy (Fraley et al., 2015). According to Bartholomew (1990) this would
yield four possible attachment styles in adults; secure, dismissing, preoccupied, and fearfulavoidant (see Figure 7.22)
Securely attached adults scorelower on both dimensions. They
are comfortable trusting theirpartners and do not worry
excessively about their partner’s
love for them. Adults with adismissing style score low on
attachment-related anxiety, buthigher on attachment-related
avoidance. Such adults dismiss
the importance of relationships.
They trust themselves, but do
not trust others, thus do notshare their dreams, goals, andfears with others. They do notdepend on other people and feel
uncomfortable when they haveto do so.

Figure 7.22 Four-Category Model with the TwoDimensions of Attachment

Source: Adapted from Fraley, et al., 2015. p. 355

Those with a preoccupied attachment are low in attachment-related avoidance, but high in
attachment-related anxiety. Such adults are often prone to jealousy and worry that their partner
does not love them as much as they need to be loved. Adults whose attachment style is fearfulavoidant score high on both attachment-related avoidance and attachment-related anxiety. These
adults want close relationships, but do not feel comfortable getting emotionally close to others.
They have trust issues with others and often do not trust their own social skills in maintaining
relationships.
Research on attachment in adulthood has found that:•••

Adults with insecure attachments report lower satisfaction in their relationships (Butzer,& Campbell, 2008; Holland, Fraley, & Roisman, 2012).
Those high in attachment-related anxiety report more daily conflict in their relationships(Campbell, Simpson, Boldry, & Kashy, 2005).
Those with avoidant attachment exhibit less support to their partners (Simpson, Rholes,
Oriña, & Grich, 2002).
277

•
•
•
•

Young adults show greater attachment-related anxiety than do middle-aged or older
adults (Chopik, Edelstein, & Fraley, 2013).
Some studies report that young adults show more attachment-related avoidance(Schindler, Fagundes, & Murdock, 2010), while other studies find that middle-aged
adults show higher avoidance than younger or older adults (Chopik et al., 2013).
Young adults with more secure and positive relationships with their parents make thetransition to adulthood more easily than do those with more insecure attachments (Fraley,2013).
Young adults with secure attachments and authoritative parents were less likely to be
depressed than those with authoritarian or permissive parents or who experienced an
avoidant or ambivalent attachment (Ebrahimi, Amiri, Mohamadlou, & Rezapur, 2017).

Do people with certain attachment styles attract those with similar styles? When people areasked what kinds of psychological or behavioral qualities they are seeking in a romantic partner,a large majority of people indicate that they are seeking someone who is kind, caring,
trustworthy, and understanding, that is the kinds of attributes that characterize a “secure”
caregiver (Chappell & Davis, 1998). However, we know that people do not always end up withothers who meet their ideals. Are secure people more likely to end up with secure partners, and,vice versa, are insecure people more likely to end up with insecure partners? The majority of theresearch that has been conducted to date suggests that the answer is “yes.” Frazier, Byer, Fischer,
Wright, and DeBord (1996) studied the attachment patterns of more than 83 heterosexual couples
and found that, if the man was relatively secure, the woman was also likely to be secure.
One important question is whether these findings exist because (a) secure people are more likely
to be attracted to other secure people, (b) secure people are likely to create security in theirpartners over time, or (c) some combination of these possibilities. Existing empirical researchstrongly supports the first alternative. For example, when people have the opportunity to interact
with individuals who vary in security in a speed-dating context, they express a greater interest in
those who are higher in security than those who are more insecure (McClure, Lydon, Baccus, &Baldwin, 2010). However, there is also some evidence that people’s attachment styles mutuallyshape one another in close relationships. For example, in a longitudinal study, Hudson, Fraley,
Vicary, and Brumbaugh (2012) found that, if one person in a relationship experienced a change
in security, his or her partner was likely to experience a change in the same direction.
Figure 7.23

[Image: skeeze]

Do early experiences as children shape adultattachment? The majority of research on this issue isretrospective; that is, it relies on adults’ reports of what
they recall about their childhood experiences. This kind ofwork suggests that secure adults are more likely todescribe their early childhood experiences with theirparents as being supportive, loving, and kind (Hazan &Shaver, 1987). A number of longitudinal studies are
emerging that demonstrate prospective associations
between early attachment experiences and adultattachment styles and/or interpersonal functioning in
adulthood. For example, Fraley, Roisman, Booth278

LaForce, Owen, and Holland (2013) found in a sample of more than 700 individuals studied
from infancy to adulthood that maternal sensitivity across development prospectively predictedsecurity at age 18. Simpson, Collins, Tran, and Haydon (2007) found that attachment security,
assessed in infancy in the strange situation, predicted peer competence in grades one to three,which, in turn, predicted the quality of friendship relationships at age 16, which, in turn,predicted the expression of positive and negative emotions in their adult romantic relationships atages 20 to 23.
It is easy to come away from such findings with the mistaken assumption that early experiences“determine” later outcomes. To be clear, attachment theorists assume that the relationshipbetween early experiences and subsequent outcomes is probabilistic, not deterministic. Having
supportive and responsive experiences with caregivers early in life is assumed to set the stage forpositive social development, but that does not mean that attachment patterns are set in stone. In
short, even if an individual has far from optimal experiences in early life, attachment theory
suggests that it is possible for that individual to develop well-functioning adult relationships
through a number of corrective experiences, including relationships with siblings, other family
members, teachers, and close friends. Security is best viewed as a culmination of a person’s
attachment history rather than a reflection of his or her early experiences alone. Those earlyexperiences are considered important, not because they determine a person’s fate, but because
they provide the foundation for subsequent experiences.

Relationships with Parents and Siblings
In early adulthood the parent-child relationship has to transition toward a relationship between
two adults. This involves a reappraisal of the relationship by both parents and young adults.
One of the biggest challenges for parents, especially during emerging adulthood, is coming toterms with the adult status of their children. Aquilino (2006) suggests that parents who are
reluctant or unable to do so may hinder young adults’ identity development. This problem
becomes more pronounced when young adults still reside with their parents. Arnett (2004)
reported that leaving home often helped promote psychological growth and independence inearly adulthood.
Sibling relationships are one of the longest-lasting bonds in people’s lives. Yet, there is little
research on the nature of sibling relationships in adulthood (Aquilino, 2006). What is known isthat the nature of these relationships change, as adults have a choice as to whether they will
maintain a close bond and continue to be a part of the life of a sibling. Siblings must make thesame reappraisal of each other as adults, as parents have to with their adult children. Research
has shown a decline in the frequency of interactions between siblings during early adulthood, aspresumably peers, romantic relationships, and children become more central to the lives ofyoung adults. Aquilino (2006) suggests that the task in early adulthood may be to maintainenough of a bond so that there will be a foundation for this relationship in later life. Those whoare successful can often move away from the “older-younger” sibling conflicts of childhood,
toward a more equal relationship between two adults. Siblings that were close to each other inchildhood are typically close in adulthood (Dunn, 1984, 2007), and in fact, it is unusual for
siblings to develop closeness for the first time in adulthood. Overall, the majority of adult sibling
relationships are close (Cicirelli, 2009).
279

Erikson: Intimacy vs. Isolation
Erikson’s (1950, 1968) sixth stage focuses on establishing intimate relationships or risking social
isolation. Intimate relationships are more difficult if one is still struggling with identity.
Achieving a sense of identity is a life-long process, as there are periods of identity crisis andstability. However, once identity is established intimate relationships can be pursued. These
intimate relationships include acquaintanceships and friendships, but also the more important
close relationships, which are the long-term romantic relationships that we develop with anotherperson, for instance, in a marriage (Hendrick & Hendrick, 2000).

Factors influencing Attraction
Figure 7.24 Birds of a
Feather Flock Together

Because most of us enter into a close relationship at some point, it
is useful to know what psychologists have learned about the
principles of liking and loving. A major interest of psychologists
is the study of interpersonal attraction, or what makes people
like, and even love, each other.
Similarity: One important factor in attraction is a perceived
similarity in values and beliefs between the partners (Davis &Rusbult, 2001). Similarity is important for relationships because it
is more convenient if both partners like the same activities andbecause similarity supports one’s values. We can feel better about
ourselves and our choice of activities if we see that our partner
also enjoys doing the same things that we do. Having others likeand believe in the same things we do makes us feel validated inour beliefs. This is referred to as consensual validation and is an
important aspect of why we are attracted to others.

Source:Self-Disclosure: Liking is also enhanced by self-disclosure, the tendency to communicate
frequently, without fear of reprisal, and in an accepting and empathetic manner. Friends arefriends because we can talk to them openly about our needs and goals and because they listen
and respond to our needs (Reis & Aron, 2008). However, self-disclosure must be balanced. If we
open up about our concerns that are important to us, we expect our partner to do the same inreturn. If the self-disclosure is not reciprocal, the relationship may not last.
Proximity: Another important determinant of liking is proximity, or the extent to which people
are physically near us. Research has found that we are more likely to develop friendships withpeople who are nearby, for instance, those who live in the same dorm that we do, and even withpeople who just happen to sit nearer to us in our classes (Back, Schmukle, & Egloff, 2008).
Proximity has its effect on liking through the principle of mere exposure, which is the tendency
to prefer stimuli (including, but not limited to people) that we have seen more frequently. The
effect of mere exposure is powerful and occurs in a wide variety of situations. Infants tend tosmile at a photograph of someone they have seen before more than they smile at a photograph of280

someone they are seeing for the first time (Brooks-Gunn & Lewis, 1981), and people prefer sideto-side reversed images of their own faces over their normal (nonreversed) face, whereas theirfriends prefer their normal face over the reversed one (Mita, Dermer, & Knight, 1977). This is
expected on the basis of mere exposure, since people see their own faces primarily in mirrors,
and thus are exposed to the reversed face more often.
Mere exposure may well have an evolutionary basis. We have an initial fear of the unknown, but
as things become familiar, they seem more similar and safer, and thus produce more positive
affect and seem less threatening and dangerous (Harmon-Jones & Allen, 2001; Freitas, Azizian,Travers, & Berry, 2005). When the stimuli are people, there may well be an added effect. Familiar
people become more likely to be seen as part of the ingroup rather than the outgroup, and thismay lead us to like them more. Zebrowitz and her colleagues found that we like people of ourown race in part because they are perceived as similar to us (Zebrowitz, Bornstad, & Lee, 2007).

Friendships
In our twenties, intimacy needs may be met in friendships rather than with partners. This isespecially true in the United States today as many young adults postpone making long-term
commitments to partners, either in marriage or in cohabitation. The kinds of friendships sharedby women tend to differ from those shared by men (Tannen, 1990). Friendships between men are
more likely to involve sharing information, providing solutions, or focusing on activities rather
than discussion problems or emotions. Men tend to discuss opinions or factual information or
spend time together in an activity of mutual interest. Friendships between women are more likely
to focus on sharing weaknesses, emotions, or problems. Women talk about difficulties they arehaving in other relationships and express their sadness, frustrations, and joys. These differencesin approaches lead to problems when men and women come together. She may want to vent
about a problem she is having; he may want to provide a solution and move on to some
activity. But when he offers a solution, she thinks he does not care. Friendships between men andwomen become more difficult because of the unspoken question about whether the friendships
will lead to a romantic involvement. Consequently, friendships may diminish once a person has apartner or single friends may be replaced with couple friends.

Love

Figure 7.25

Sternberg (1988) suggests that there are threemain components of love: Passion, intimacy, andcommitment (see Figure 7.25). Love relationships
vary depending on the presence or absence ofeach of these components. Passion refers to theintense, physical attraction partners feel toward
one another. Intimacy involves the ability theshare feelings, psychological closeness andpersonal thoughts with the other. Commitment is
the conscious decision to stay together. Passion
can be found in the early stages of a relationship,
but intimacy takes time to develop because it is281

Sternberg’s Triarchic Theory of Love

Sourcebased on knowledge of the partner. Once intimacy has been established, partners may resolve tostay in the relationship. Although many would agree that all three components are important to a
relationship, many love relationships do not consist of all three. Let's look at other possibilities.
Liking: In this relationship, intimacy or knowledge of the other and a sense of closeness ispresent. Passion and commitment, however, are not. Partners feel free to be themselves anddisclose personal information. They may feel that the other person knows them well and can behonest with them and let them know if they think the person is wrong. These partners arefriends. However, being told that your partner “thinks of you as a friend” can be a devastating
blow if you are attracted to them and seeking a romantic involvement.
Infatuation: Perhaps, this is Sternberg's version of "love at first sight". Infatuation consists of animmediate, intense physical attraction to someone. A person who is infatuated finds it hard to
think of anything but the other person. Brief encounters are played over and over in one's head; it
may be difficult to eat and there may be a rather constant state of arousal. Infatuation is rather
short-lived, however, lasting perhaps only a matter of months or as long as a year or so. It tends
to be based on physical attraction and an image of what one “thinks” the other is all about.
Fatuous Love: However, some people who have a strong physical attraction push forcommitment early in the relationship. Passion and commitment are aspects of fatuous
love. There is no intimacy and the commitment is premature. Partners rarely talk seriously or
share their ideas. They focus on their intense physical attraction and yet one, or both, is also
talking of making a lasting commitment. Sometimes this is out of a sense of insecurity and adesire to make sure the partner is locked into the relationship.
Empty Love: This type of love may be found later in a relationship or in a relationship that wasformed to meet needs other than intimacy or passion, including financial needs, childrearing
assistance, or attaining/maintaining status. Here the partners are committed to staying in therelationship for the children, because of a religious conviction, or because there are noalternatives. However, they do not share ideas or feelings with each other and have no physicalattraction for one another.
Romantic Love: Intimacy and passion are components of romantic love, but there is nocommitment. The partners spend much time with one another and enjoy their closeness, but havenot made plans to continue. This may be true because they are not in a position to make suchcommitments or because they are looking for passion and closeness and are afraid it will die out
if they commit to one another and start to focus on other kinds of obligations.
Companionate Love: Intimacy and commitment are the hallmarks of companionate love.
Partners love and respect one-another and they are committed to staying together. However, their
physical attraction may have never been strong or may have just died out overtime. Nevertheless, partners are good friends and committed to one another.
Consummate Love: Intimacy, passion, and commitment are present in consummate love. This isoften perceived by western cultures as “the ideal” type of love. The couple shares passion; thespark has not died, and the closeness is there. They feel like best friends, as well as lovers, andthey are committed to staying together.

282

Adult Lifestyles
Singlehood: Being single is the most common lifestyle for people in their early 20s, and there
has been an increase in the number of adults staying single. In 1960, only about 1 in 10 adults
age 25 or older had never been married, in 2012 that had risen to 1 in 5 (Wang & Parker, 2014).
While just over half (53%) of unmarried adults say they would eventually like to get married, 32
percent are not sure, and 13 percent do not want to get married. It is projected that by the timecurrent young adults reach their mid-40s and 50s, almost 25% of them may not have married.
The U.S. is not the only country to see a rise in the number of single adults.
Table 7.6 lists some of the reasons young
adults give for staying single. In addition,
Table 7.6 Reasons for Staying Single
adults are marrying later in life,
Have not met the right person
30%
cohabitating, and raising children outside
Do
not
have
financialstability27%
of marriage in greater numbers than inprevious generations. Young adults also
Not ready to settle down
22%
have other priorities, such as education,
Too young to marry22%
and establishing their careers. This may
Based on Data from Wang & Parker (2014) Pew Research Center
be reflected by changes in attitudes about
the importance of marriage. In a recent Pew Research survey of Americans, respondents wereasked to indicate which of the following statements came closer to their own views:••“Society is better off if people make marriage and having children a priority”“Society is just as well off if people have priorities other than marriage and children”

Slightly more adults endorsed the second statement (50%) than those who chose the first (46%),
with the remainder either selecting neither, both equally, or not responding (Wang & Parker,2014). Young adults age 18-29 were more likely to endorse this view than adults age 30 to 49;
67 percent and 53 percent respectively. In contrast, those age 50 or older were more likely toendorse the first statement (53 percent).
Figure 7.26

SourceHooking Up: United States demographic changes havesignificantly affected the romantic relationships among
emerging and early adults. As previously described, theage for puberty has declined, while the times for one’s
first marriage and first child have been pushed to older
ages. This results in a “historically unprecedented time
gap where young adults are physiologically able toreproduce, but not psychologically or socially ready tosettle down and begin a family and child rearing,”(Garcia, Reiber, Massey, & Merriwether, 2012, p.
172). Consequently, according to Bogle (2007, 2008)
traditional forms of dating have shifted to more casual
hookups that involve uncommitted sexual encounters.

283

Even though most research on hooking up involves college students, 70% of sexually active 1221 year olds reported having had uncommitted sex during the past year (Grello, Welsh, Harper,& Dickson, 2003). Additionally, Manning, Giordano and Longmore (2006) found that 61% ofsexually active seventh, ninth, and eleventh graders reported being involved in a sexual
encounter outside of a dating relationship.
Friends with Benefits: Hookups are different than those relationships that involve continued
mutual exchange. These relationships are often referred to as Friends with Benefits (FWB) or“Booty Calls.” These relationships involve friends having casual sex without commitment.
Hookups do not include a friendship relationship. Bisson and Levine (2009) found that 60% of
125 undergraduates reported a FWB relationship. The concern with FWB is that one partner
may feel more romantically invested than the other (Garcia et al., 2012).
Hooking up Gender Differences: When asked about their motivation for hooking up, bothmales and females indicated physical gratification, emotional gratification, and a desire to initiate
a romantic relationship as reasons (Garcia & Reiber, 2008). Although males and females are
more similar than different in their sexual behaviors, a consistent finding among the research isthat males demonstrate a greater permissiveness to casual sex (Oliver & Hyde, 1993). In anotherstudy involving 16,288 individuals across 52 nations, males reported a greater desire of sexual
partner variety than females, regardless of relationship status or sexual orientation (Schmitt et al.,2003). This difference can be attributed to gender role expectations for both males and females
regarding sexual promiscuity. Additionally, the risks of sexual behavior are higher for females
and include unplanned pregnancy, increased sexually transmitted diseases, and susceptibility tosexual violence (Garcia et al., 2012).
Although hooking up relationships have become normalized for emerging adults, some research
indicates that the majority of both sexes would prefer a more traditional romantic relationship(Garcia et al., 2012). Additionally, Owen and Fincham (2011) surveyed 500 college students
with experience with hookups, and 65% of women and 45% of men reported that they hoped
their hookup encounter would turn into a committed relationship. Further, 51% of women and
42% of men reported that they tried to discuss the possibility of starting a relationship with their
hookup partner. Casual sex has also been reported to be the norm among gay men, but they too
indicate a desire for romantic and companionate relationships (Clarke & Nichols, 1972).
Emotional Consequences of Hooking up: Concerns regarding hooking up behavior certainly
are evident in the research literature. One significant finding is the high comorbidity of hooking
up and substance use. Those engaging in non-monogamous sex are more likely to have usedmarijuana, cocaine, and alcohol, and the overall risks of sexual activity are drastically increased
with the addition of alcohol and drugs (Garcia et al., 2012). Regret has also been expressed, andthose who had the most regret after hooking up also had more symptoms of depression (Welsh,
Grello, & Harper, 2006). Hook ups were also found to lower self-esteem, increase guilt, andfoster feelings of using someone or feeling used. Females displayed more negative reactions
than males, and this may be due to females identifying more emotional involvement in sexual
encounters than males.
Hooking up can best be explained by a biological, psychological, and social perspective.
Research indicates that emerging adults feel it is necessary to engage in hooking up behavior as
part of the sexual script depicted in the culture and media. Additionally, they desire sexual284

gratification. However, they also want a more committed romantic relationship and may feel
regret with uncommitted sex.
Online Dating: The ways people are finding love has changed with the advent of the Internet.
Nearly 50 million Americans have tried an online dating website or mobile app (Bryant &Sheldon, 2017). Online dating has also increased dramatically among those age 18 to 24.
Today, one in five emerging adults report using a mobile dating app, while in 2013 only 5% did,and 27% report having used online dating, almost triple the rate in 2013 (Smith & Anderson,2016).
Figure 7.27

According to a recent survey of couples who met online versus offline (Brown, 2019), those who
met online tended to have slightly different levels of education, and political views from theirpartners, but, the biggest difference was that they were much more likely to come from different
racial and ethnic backgrounds (see Figure 7.27). This is not surprising as the average age of thecouples who met online was 36, while the average age of couple who met offline was 51. Young
adults are more likely to a relationship with people who are different from them, regardless of
how they met.
As Finkel, Burnette, and Scissors (2007) found, social networking sites and the Internet perform
three important tasks. Specifically, sites provide individuals with access to a database of otherindividuals who are interested in meeting someone. Dating sites generally reduce issues ofproximity, as individuals do not have to be close in proximity to meet. Also, they provide a
medium in which individuals can communicate with others. Finally, some Internet dating
websites advertise special matching strategies, based on factors such as personality, hobbies, and285

interests, to identify the “perfect match” for people looking for love online. Social networking
sites have provided opportunities for meeting others you would not have normally met.
However, social networking sites can also be forums for unsuspecting people to be duped, as the
person may not be who he or she says.
Online communication differs from face-to-face interaction in a number of ways. In face-to-facemeetings, people have many cues upon which to base their first impressions. A person’s looks,
voice, mannerisms, dress, scent, and surroundings all provide information in face-to-facemeetings, but in computer-mediated meetings, written messages are the only cues
provided. Fantasy is used to conjure up images of voice, physical appearance, mannerisms, andso forth. The anonymity of online involvement makes it easier to become intimate without fearof interdependence. When online, people tend to disclose more intimate details about themselvesmore quickly. A shy person can open up without worrying about whether or not the partner isfrowning or looking away. Someone who has been abused may feel safer in virtual relationships.
It is easier to tell one’s secrets because there is little fear of loss. One can find a virtual partner
who is warm, accepting, and undemanding (Gwinnell, 1998), and exchanges can be focusedmore on emotional attraction than physical appearance.
To evaluate what individuals are looking for online, Menkin, Robles, Wiley and Gonzaga (2015)
reviewed data from an eHarmony.com relationship questionnaire completed by a cross-sectional
representation of 5,434 new users. Their results indicated that users consistently valued
communication and characteristics, such as personality and kindness over sexual attraction.
Females valued communication over sexual attraction, even more when compared to males, andolder users rated sexual attraction as less important than younger users. Alterovitz and
Mendelsohn (2011) analyzed 600 Internet personal ads across the lifespan and found that men
sought physical attractiveness and offered status related information more than women, while
women were more selective than men and sought status more than men. These findings wereconsistent with previous research on gender differences regarding the importance ofphysical/sexual attraction.
Catfishing and other forms of scamming is an increasing concern for those who use dating andsocial media sites and apps. Catfishing refers to “a deceptive activity involving the creation of a
fake online profile for deceptive purposes” (Smith, Smith, & Blazka, 2017, p. 33). Notre Dame
University linebacker Manti Ta’o fell victim to a catfishing scam. The young woman “Kekua”
who he had struck up an online relationship with was a hoax, and he was not the first person tohave been scammed by this fictitious woman. A number of US states have passed legislation toaddress online impersonation, from stealing the information and creating a fake account of a real
person to the creation of a fictitious persona with the intent to defraud or harm others (National
Conference of State Legislatures, 2017).
Cohabitation: In American society, as well as in a number of other cultures, cohabitation has
become increasingly commonplace (Gurrentz, 2018). For many emerging adults, cohabitation
has become more commonplace than marriage, as can be seen in Figures 7.28. While marriage
is still a more common living arrangement for those 25-34, cohabitation has increased, whilemarriage has declined, as can be seen in Figure 7.29. Gurrentz also found that cohabitation varies
by socioeconomic status. Those who are married tend to have higher levels of education, andthus higher earnings, or earning potential.
286

Copen, Daniels, andMosher (2013) found thatfrom 1995 to 2010 the
median length of the
cohabitation relationship
had increased regardlessof whether the
relationship resulted in
marriage, remained intact,or had since dissolved.
In 1995 the median lengthof the cohabitation
relationship was 13
months, whereas it was 22months by 2010.
Cohabitation for all
racial/ethnic groups,
except for Asian women
increased between 1995
and 2010 (see Table 7.7).
Forty percent of the
cohabitations transitioned
into marriage within three
years, 32% were still
cohabitating, and 27% of
cohabitating relationships
had dissolved within thethree years.

Figure 7.28

Figure 7.29

Table 7.7 Percentage of Women by
race/ethnicity whose first union was
cohabitation
Hispanic
White
Black
Asian

1995
30%
35%
35%
22%

2006-2010
47%
49%
49%
22%

Based on Data from Copen et al., 2013.

Three explanations have been given for the rise of
cohabitation in Western cultures. The first notesthat the increase in individualism and secularism,
and the resulting decline in religious observance,
has led to greater acceptance and adoption of
cohabitation (Lesthaeghe & Surkyn, 1988).
Moreover, the more people view cohabitating
couples, the more normal this relationshipbecomes, and the more couples who will thencohabitate. Thus, cohabitation is both a cause andthe effect of greater cohabitation.

A second explanation focuses on the economic changes. The growth of industry and themodernization of many cultures has improved women’s social status, leading to greater gender287

equality and sexual freedom, with marriage no longer being the only long-term relationshipoption (Bumpass, 1990). A final explanation suggests that the change in employment
requirements, with many jobs now requiring more advanced education, has led to a competition
between marriage and pursuing post-secondary education (Yu & Xie, 2015). This might accountfor the increase in the age of first marriage in many nations. Taken together, the greater
acceptance of premarital sex, and the economic and educational changes would lead to atransition in relationships. Overall, cohabitation may become a step in the courtship process ormay, for some, replace marriage altogether.
Similar increases in cohabitation have also occurred in other industrialized countries. For
example, rates are high in Great Britain, Australia, Sweden, Denmark, and Finland. In fact, morechildren in Sweden are born to cohabiting couples than to married couples. The lowest rates of
cohabitation in industrialized countries are in Ireland, Italy, and Japan (Benokraitis, 2005).
Cohabitation in Non-Western Cultures, The Philippines and China: Similar to other nations,young people in the Philippines are more likely to delay marriage, to cohabitate, and to engage inpremarital sex as compared to previous generations (Williams, Kabamalan, & Ogena, 2007).
Despite these changes, many young people are still not in favor of these practices. Moreover,there is still a persistence of traditional gender norms as there are stark differences in theacceptance of sexual behavior out of wedlock for men and women in Philippine society. Youngmen are given greater freedom. In China, young adults are cohabitating in higher numbers thanin the past (Yu & Xie, 2015). Unlike many Western cultures, in China adults with higher, rather
than lower, levels of education are more likely to cohabitate. Yu and Xie suggest this may be
due to seeing cohabitation as being a more “innovative” behavior and that those who are more
highly educated may have had more exposure to Western culture.
Marriage Worldwide: Cohen (2013) reviewed data assessing most of the world’s countries andfound that marriage has declined universally during the last several decades. This decline has
occurred in both poor and rich countries, however, the countries with the biggest drops in
marriage were mostly rich: France, Italy, Germany, Japan and the U.S. Cohen states that the
decline is not only due to individuals delaying marriage, but also because of high rates of nonmarital cohabitation. Delayed or reduced marriage is associated with higher income and lower
fertility rates that are reflected worldwide.
Marriage in the United States: In 1960, 72% of adults age 18 or older were married, in 2010
this had dropped to barely half (Wang & Taylor, 2011). At the same time, the age of firstmarriage has been increasing for both men and women. In 1960, the average age for firstmarriage was 20 for women and 23 for men. By 2010 this had increased to 26.5 for women andnearly 29 for men (see Figure 7.30). Many of the explanations for increases in singlehood andcohabitation previously given can also account for the drop and delay in marriage.

288

Figure 7.30 Marriage in the U.S.

Same-Sex Marriage: In June 26, 2015, the UnitedStates Supreme Court ruled that the Constitution
guarantees same-sex marriage. The decision indicatedthat limiting marriage to only heterosexual couples
violated the 14th amendment’s guarantee of equal
protection under the law. This ruling occurred 11 years
after same-sex marriage was first made legal in
Massachusetts, and at the time of the high court
decision, 36 states and the District of Columbia hadlegalized same sex marriage. Worldwide, 29 countries
currently have national laws allowing gays and lesbians
Photo Courtesy Salvor Gissurardottir
to marry (Pew Research Center, 2019). As can be seenin Table 7.8, these countries are located mostly in Europe and the Americas.
Figure 7.31

Table 7.8 Pew Research Center: Countries That Allow Gay Marriage and the Year Passed
Argentina (2010)

Colombia (2016)

Germany (2017)

The Netherlands (2000)

Spain (2005)

Australia (2017)

Denmark (2012)

Greenland (2015)

New Zealand (2013)

Sweden (2009)

Austria (2019)

Ecuador (2019)

Iceland (2010)

Norway (2009)

Taiwan (2019)

Belgium (2003)

England / Wales (2013)

Ireland (2015)

Portugal (2010)

United States (2015)

Brazil (2013)

Finland (2015)

Luxembourg (2014)

Scotland (2014)

Uruguay (2013)

Canada (2005)

France (2013)

Malta (2017)

South Africa (2006)

Countries Where Gay Marriage is Legal in Some Jurisdictions
Mexico (2009)

Pew Research Center

289

Cultural Influences on Marriage: Many cultures have both explicit and unstated rules thatspecify who is an appropriate mate. Consequently, mate selection is not completely left to theindividual. Rules of endogamy indicate the groups we should marry within and those we should
not marry in (Witt, 2009). For example, many cultures specify that people marry within theirown race, social class, age group, or religion. Endogamy reinforces the cohesiveness of thegroup. Additionally, these rules encourage homogamy or marriage between people who sharesocial characteristics. The majority of marriages in the U. S. are homogamous with respect torace, social class, age and to a lesser extent, religion. Homogamy is also seen in couples withsimilar personalities and interests.
Arranged Marriages and Elopement: Historically, marriage was not a personal choice, but one
made by one’s family. Arranged marriages often ensured proper transference of a family’s
wealth and the support of ethnic and religious customs. Such marriages were a marriage offamilies rather than of individuals. In Western Europe, starting in the 18th century the notion of
personal choice in a marital partner slowly became the norm. Arranged marriages were seen as“traditional” and marriages based on love “modern”. Many of these early “love” marriages wereobtained by eloping (Thornton, 2005).
Around the world, more and more young couples are choosing their partners, even in nations
where arranged marriages are still the norm, such as India and Pakistan. Desai and Andrist(2010) found that only 5% of the women they surveyed, aged 25-49, had a primary role inchoosing their partner. Only 22% knew their partner for more than one month before they were
married. However, the younger cohort of women was more likely to have been consulted by theirfamilies before their partner was chosen than were the older cohort, suggesting that family views
are changing about personal choice. Allendorf (2013) reports that this 5% figure may also
underestimate young people’s choice, as only women were surveyed. Many families in India are
increasingly allowing sons veto power over the parents’ choice of his future spouse, and somefamilies give daughters the same say.
Marital Arrangements in India: As the number of arranged marriages in India is declining,
elopement is increasing. Allendorf’s (2013) study of a rural village in India, describes theelopement process. In many cases the female leaves her family home and goes to the male’s
home, where she stays with him and his parents. After a few days, a member of his family will
inform her family of her whereabouts and gain consent for the marriage. In other cases, where
the couple anticipate some degree of opposition to the union, the couple may run away without
the knowledge of either family, often going to a relative of the male. After a few days, the couple
comes back to the home of his parents, where at that point consent is sought from both families.
Although, in some cases families may sever all ties with their child or encourage him or her toabandon the relationship, typically, they agree to the union as the couple have spent time
together overnight. Once consent has been given, the couple lives with his family and areconsidered married. A more formal ceremony takes place a few weeks or months later.
Arranged marriages are less common in the more urban regions of India than they are outside of
the cities. In rural regions, often the family farm is the young person’s only means of
employment. Thus, going against family choices may carry bigger consequences. Young people
who live in urban centers have more employment options. As a result, they are often lesseconomically dependent on their families, and may feel freer to make their own choices.
Thornton (2005) suggests these changes are also being driven by mass media, international290

travel, and general Westernization of ideas. Besides India, China, Nepal, and several nations inSoutheast Asia have seen a decline in the number of arranged marriages, and an increase inelopement or couples choosing their own partners with their families’ blessings (Allendorf,2013).
Predictors of Marital Harmony: Advice on how to improve one’s marriage is centuries
old. One of today’s experts on marital communication is John Gottman. Gottman (1999) differsfrom many marriage counselors in his belief that having a good marriage does not depend oncompatibility. Rather, the way that partners communicate to one another is crucial. At the
University of Washington in Seattle, Gottman has measured the physiological responses of
thousands of couples as they discuss issues of disagreement. Fidgeting in one’s chair, leaningcloser to or further away from the partner while speaking, and increases in respiration and heart
rate are all recorded and analyzed along with videotaped recordings of the partners’
exchanges. Gottman believes he can accurately predict whether or not a couple will stay together
by analyzing their communication. In marriages destined to fail, partners engage in the “marriage
killers”: Contempt, criticism, defensiveness, and stonewalling. Each of these undermines thepoliteness and respect that healthy marriages require. Stonewalling, or shutting someone out, isthe strongest sign that a relationship is destined to fail.
Gottman, Carrere, Buehlman, Coan, and Ruckstuhl (2000) researched the perceptions newlyweds
had about their partner and marriage. The Oral History Interview used in the study, which looks
at eight variables in marriage including: Fondness/affection, we-ness, expansiveness/
expressiveness, negativity, disappointment, and three aspects of conflict resolution (chaos,volatility, glorifying the struggle), was able to predict the stability of the marriage with 87%
accuracy at the four to six year-point and 81% accuracy at the seven to nine year-point. Gottman(1999) developed workshops for couples to strengthen their marriages based on the results of theOral History Interview. Interventions include increasing the positive regard for each other,strengthening their friendship, and improving communication and conflict resolution patterns.
Accumulated Positive Deposits: When there is a positive balance of relationship deposits thiscan help the overall relationship in times of conflict. For instance, some research indicates that ahusband’s level of enthusiasm in everyday marital interactions was related to a wife’s affectionin the midst of conflict (Driver & Gottman, 2004), showing that being pleasant and making
deposits can change the nature of conflict. Also, Gottman and Levenson (1992) found that
couples rated as having more pleasant interactions, compared with couples with less pleasantinteractions, reported marital problems as less severe, higher marital satisfaction, better physicalhealth, and less risk for divorce. Finally, Janicki, Kamarck, Shiffman, and Gwaltney (2006)
showed that the intensity of conflict with a spouse predicted marital satisfaction, unless there wasa record of positive partner interactions, in which case the conflict did not matter as much.
Again, it seems as though having a positive balance through prior positive deposits helps to keep
relationships strong even in the midst of conflict.

Intimate Partner Abuse
Violence in romantic relationships is a significant concern for women in early adulthood as
females aged 18 to 34 generally experience the highest rates of intimate partner violence.
291

According to the most recent Violence Policy Center (2018) study, more than 1,800 women weremurdered by men in 2016. The study found that nationwide, 93% of women killed by men weremurdered by someone they knew, and guns were the most common weapon used. The national
rate of women murdered by men in single victim/single offender incidents dropped 24%, from1.57 per 100,000 in 1996 to 1.20 per 100,000 in 2016. However, since reaching a low of 1.08 per
100,000 women in 2014, the 2016 rate increased 11%.
Intimate partner violence is often divided into situational couple violence, which is the violence
that results when heated conflict escalates, and intimate terrorism, in which one partner
consistently uses fear and violence to dominate the other (Bosson, et al., 2019). Men and womenequally use and experience situational couple violence, while men are more likely to use intimate
terrorism than are women. Consistent with this, a national survey described below, found thatfemale victims of intimate partner violence experience different patterns of violence, such as
rape, severe physical violence, and stalking than male victims, who most often experienced moreslapping, shoving, and pushing.
The last National Intimate Partner and Sexual
Violence Survey (NISVS) was conducted in 2015
(Smith et al., 2018). The NISVS examines theprevalence of intimate partner violence, sexual
violence, and stalking among women and men in the
United States over the respondent's lifetime andduring the 12 months before the interview. A totalof 5,758 women and 4,323 men completed thesurvey. Based on the results, women aredisproportionately affected by intimate partner
violence, sexual violence, and stalking. Results
included:
•
•
•
•
•
•
•
•

Figure 7.32

SourceNearly 1 in 3 women and 1 in 6 men experienced some form of contact sexual violence
during their lifetime.
Nearly 1 in 5 women and 1 in 39 men have been raped in their lifetime.
Approximately 1 in 6 women and 1 in 10 men experienced sexual coercion (e.g., sexualpressure from someone in authority, or being worn down by requests for sex).
Almost 1 in 5 women have been the victim of severe physical violence by an intimate
partner, while 1 in 7 men have experienced the same.
1 in 6 women have been stalked during their lifetime, compared to 1 in 19 men.
More than 1 in 4 women and more than 1 in 10 men have experienced contact sexual
violence, physical violence, or stalking by an intimate partner and reported significant
short- or long-term impacts, such as post-traumatic stress disorder symptoms and injury.
An estimated 1 in 3 women experienced at least one act of psychological aggression by
an intimate partner during their lifetime.
Men and women who experienced these forms of violence were more likely to reportfrequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor
physical health, and poor mental health than men and women who did not experience
these forms of violence.
292

Parenthood
Parenthood is undergoing changes in the United States and elsewhere in the world. Children areless likely to be living with both parents, and women in the United States have fewer children
than they did previously. The average fertility rate of women in the United States was about
seven children in the early 1900s and has remained relatively stable at 2.1 since the 1970s(Hamilton, Martin, & Ventura, 2011; Martinez, Daniels, & Chandra, 2012). Not only are parents
having fewer children, the context of parenthood has also changed. Parenting outside of marriage
has increased dramatically among most socioeconomic, racial, and ethnic groups, althoughcollege-educated women are substantially more likely to be married at the birth of a child thanare mothers with less education (Dye, 2010).
People are having children at older ages, too. This is not
surprising given that many of the age markers for adulthood
have been delayed, including marriage, completing education,
establishing oneself at work, and gaining financial
independence. In 2014 the average age for American first-time
mothers was 26.3 years (CDC, 2015a). The birth rate forwomen in their early 20s has declined in recent years, while
the birth rate for women in their late 30s has risen. In 2011,
40% of births were to women ages 30 and older. For Canadian
women, birth rates are even higher for women in their late 30s
than in their early 20s. In 2011, 52% of births were to womenages 30 and older, and the average first-time Canadian motherwas 28.5 years old (Cohn, 2013). Improved birth control
methods have also enabled women to postpone motherhood.
Despite the fact that young people are more often delaying
Sourcechildbearing, most 18- to 29-year-olds want to have children
and say that being a good parent is one of the most important things in life (Wang & Taylor,2011).
Figure 7.33

Influences on Parenting: Parenting is a complex process in which parents and children
influence on another. There are many reasons that parents behave the way they do. The multiple
influences on parenting are still being explored. Proposed influences on parenting include:
Parent characteristics, child characteristics, and contextual can sociocultural characteristics.
(Belsky, 1984; Demick, 1999).
Parent Characteristics: Parents bring unique traits and qualities to the parenting relationshipthat affect their decisions as parents. These characteristics include the age of the parent, gender,
beliefs, personality, developmental history, knowledge about parenting and child development,
and mental and physical health. Parents’ personalities affect parenting behaviors. Mothers andfathers who are more agreeable, conscientious, and outgoing are warmer and provide morestructure to their children. Parents who are more agreeable, less anxious, and less negative also
support their children’s autonomy more than parents who are anxious and less agreeable (Prinzie,
Stams, Dekovic, Reijntes, & Belsky, 2009). Parents who have these personality traits appear tobe better able to respond to their children positively and provide a more consistent, structured
environment for their children.
293

Parents’ developmental histories, or theirexperiences as children, also affect theirparenting strategies. Parents may learn parenting
practices from their own parents. Fathers whose
own parents provided monitoring, consistent andage-appropriate discipline, and warmth weremore likely to provide this constructive
parenting to their own children (Kerr, Capaldi,
Pears, & Owen, 2009). Patterns of negative
parenting and ineffective discipline also appear
from one generation to the next. However,parents who are dissatisfied with their own
parents’ approach may be more likely to change
their parenting methods with their own children.

Figure 7.34

SourceChild Characteristics: Parenting is bidirectional. Not only do parents affect their children,
children influence their parents. Child characteristics, such as gender, birth order, temperament,
and health status, affect parenting behaviors and roles. For example, an infant with an easytemperament may enable parents to feel more effective, as they are easily able to soothe the childand elicit smiling and cooing. On the other hand, a cranky or fussy infant elicits fewer positive
reactions from his or her parents and may result in parents feeling less effective in the parentingrole (Eisenberg et al., 2008). Over time, parents of more difficult children may become morepunitive and less patient with their children (Clark, Kochanska, & Ready, 2000; Eisenberg et al.,
1999; Kiff, Lengua, & Zalewski, 2011). Parents who have a fussy, difficult child are lesssatisfied with their marriages and have greater challenges in balancing work and family roles(Hyde, Else-Quest, & Goldsmith, 2004). Thus, child temperament, as previously discussed inchapter 3, is one of the child characteristics that influences how parents behave with theirchildren.
Another child characteristic is the gender of the child. Parents respond differently to boys andgirls. Parents often assign different household chores to their sons and daughters. Girls are more
often responsible for caring for younger siblings and household chores, whereas boys are more
likely to be asked to perform chores outside the home, such as mowing the lawn (Grusec,
goodnow, & Cohen, 1996). Parents also talk differently with their sons and daughters, providing
more scientific explanations to their sons and using more emotion words with their daughters(Crowley, Callanan, Tenenbaum, & Allen, 2001).
Contextual Factors and Sociocultural Characteristics: The parent–child relationship does notoccur in isolation. Sociocultural characteristics, including economic hardship, religion, politics,
neighborhoods, schools, and social support, also influence parenting. Parents who experience
economic hardship are more easily frustrated, depressed, and sad, and these emotional
characteristics affect their parenting skills (Conger & Conger, 2002). Culture also influences
parenting behaviors in fundamental ways. Although promoting the development of skills
necessary to function effectively in one’s community is a universal goal of parenting, the specificskills necessary vary widely from culture to culture. Thus, parents have different goals for their294

children that partially depend on their culture (Tamis-LeMonda et al., 2008). Parents vary in
how much they emphasize goals for independence and individual achievements, maintaining
harmonious relationships, and being embedded in a strong network of social relationships. Other
important contextual characteristics, such as the neighborhood, school, and social networks, also
affect parenting, even though these settings do not always include both the child and the parent(Brofenbrenner, 1989). Culture is also a contributing contextual factor, as discussed previously
in chapter four. For example, Latina mothers who perceived their neighborhood as moredangerous showed less warmth with their children, perhaps because of the greater stressassociated with living a threatening environment (Gonzales et al., 2011). The different influences
are shown in Figure 7.35.
Figure 7.35 Influences on Parenting

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Chapter 8: Middle Adulthood
Middle adulthood, or midlife, refers to the period of the lifespan between early adulthood andlate adulthood. Although ages and tasks are culturally defined, the most common age definitionis from 40-45 to 60-65. This may be the least studied time of the lifespan, and research on thisdevelopmental period is relatively new as many aspects of midlife are still being explored. In the
United States, the large Baby Boom cohort (those born between 1946 and 1964) are now midlife
adults (and some even late adults) and this has led to increased interest in this developmental
stage. We do know that this stage reflects both developmental gains and losses and that there areconsiderable individual differences, but there is still much to learn about this age group.

Learning Objectives: Physical Development in Middle Adulthood
•
•
•
•
•
•
•
•

Explain the difference between primary and secondary aging
Describe sensory changes that occur during middle adulthood
Identify health concerns in middle adulthood
Explain what occurs during the climacteric for females and males
Describe sexuality during middle adulthood
Explain the importance of sleep and consequences of sleep deprivation
Describe the importance of exercise and nutrition for optimal health
Describe brain functioning in middle adulthood

Each person experiences age-related physical changes based on many factors: biological factors,
such as molecular and cellular changes, and oxidative damage are called primary aging, while
aging that occurs due to controllable factors, such as an unhealthy lifestyle including lack ofphysical exercise and poor diet, is called secondary aging (Busse, 1969). These factors areshown in Figure 8.1
Getting out of shape is not an
inevitable part of aging; it isprobably due to the fact that middleaged adults become less physically
active and have experienced greater
stress. Smoking tobacco, drinking
alcohol, poor diet, stress, physicalinactivity, and chronic disease, suchas diabetes or arthritis, reduceoverall health. However, there arethings can be done to combat manyof these changes by adopting
healthier lifestyles.

Figure 8.1 Contributors to Aging

Source307

Physical Changes
Hair: When asked to imagine someone in middle adulthood, we often picture someone with the
beginnings of wrinkles and gray or thinning hair. What accounts for these physical changes?
Hair color is due to a pigment called melanin which is produced by hair follicles (Martin, 2014).
With aging, the hair follicles produce less melanin, and this causes the hair to become gray. Haircolor typically starts turning lighter at the temples, but eventually all the hair will become white.
For many, graying begins in the 30s, but it is largely determined by your genes. Gray hair occurs
earlier in white people and later in Asians.
Genes also determine how much hair remains on
Figure 8.2 Andre Agassi
your head. Almost everyone has some hair loss withaging, and the rate of hair growth slows with aging.
Many hair follicles stop producing new hairs andhair strands become smaller. Men begin showing
signs of balding by 30 and some are nearly bald by
60. Male-pattern baldness is related to testosterone
and is identified by a receding hairline followed byhair loss at the top of the head. Figure 8.2 shows
tennis champion Andre Agassi’s characteristic malepatterned baldness. Women can also develop femalepatterned baldness as their hair becomes less dense
and the scalp becomes visible (Martin, 2014).
Sudden hair loss, however, can be a symptom of ahealth problem.
SourceSkin: Skin continues to dry out and is prone to more wrinkling, particularly on the sensitive facearea. Wrinkles, or creases in the skin, are a normal part of aging. As we get older, our skin dries
and loses the underlying layer of fat, so our face no longer appears smooth. Loss of muscle tone
and thinning skin can make the face appear flabby or drooping. Although wrinkles are a naturalpart of aging and genetics plays a role, frequent sun exposure and smoking will cause wrinkles toappear sooner. Dark spots and blotchy skin also occur as one ages and are due to exposure to
sunlight (Moskowitz, 2014). Blood vessels become more apparent as the skin continues to dry
and get thinner.
Sarcopenia: The loss of muscle mass and strength that occurs with aging is referred to as
sarcopenia (Morley, Baumgartner, Roubenoff, Mayer, & Nair, 2001). Sarcopenia is thought tobe a significant factor in the frailty and functional impairment that occurs when older. The
decline of growth and anabolic hormones, especially testosterone, and decreased physicalactivity have been implicated as causes of sarcopenia (Proctor, Balagopal, & Nair, 1998). Thisdecline in muscle mass can occur as early as 40 years of age and contributes significantly to adecrease in life quality, increase in health care costs, and early death in older adults (Karakelides& Nair, 2005). Exercise is certainly important to increase strength, aerobic capacity, and muscle
protein synthesis, but unfortunately it does not reverse all the age-related changes that occur. The
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muscle-to-fat ratio for both men and women also changes throughout middle adulthood, with anaccumulation of fat in the stomach area.
Lungs: The lungs serve two functions: Supply oxygen and remove carbon dioxide. Thinning of
the bones with age can change the shape of the rib cage and result in a loss of lung expansion.
Age related changes in muscles, such as the weakening of the diaphragm, can also reduce lungcapacity. Both of these changes will lower oxygen levels in the blood and increase the levels ofcarbon dioxide. Experiencing shortness of breath and feeling tired can result (NIH, 2014b). In
middle adulthood, these changes and their effects are often minimal, especially in people who are
non-smokers and physically active. However, in those with chronic bronchitis, or who haveexperienced frequent pneumonia, asthma other lung related disorders, or who are smokers, theeffects of these normal age changes can be more pronounced.

Sensory Changes
Vision: A normal change of the eye due
to age is presbyopia, which is Latin for“old vision.” It refers to a loss ofelasticity in the lens of the eye thatmakes it harder for the eye to focus on
objects that are closer to the person.
When we look at something far away,
the lens flattens out; when looking at
nearby objects tiny muscle fibers aroundthe lens enable the eye to bend the lens.
With age these muscles weaken and canno longer accommodate the lens to focus
the light. Anyone over the age of 35 is
at risk for developing presbyopia.
According to the National Eye Institute(NEI) (2016), signs that someone may
have presbyopia include:
•
•
•
•
•

Figure 8.3 Interior of the Human Eye

Hard time reading small print
Having to hold reading material
Sourcefarther than arm’s distance
Problems seeing objects that are close
Headaches
Eyestrain

Another common eye problem people experience as they age are floaters, little spots or“cobwebs” that float around the field of vision. They are most noticeable if you are looking at
the sky on a sunny day, or at a lighted blank screen. Floaters occur when the vitreous, a gel-like
substance in the interior of the eye, slowly shrinks. As it shrinks, it becomes somewhat stringy,
and these strands can cast tiny shadows on the retina. In most cases, floaters are harmless, moreof an annoyance than a sign of eye problems. However, floaters that appear suddenly, or thatdarken and obscure vision can be a sign of more serious eye problems, such a retinal tearing,309

infection, or inflammation. People who are very nearsighted (myopic), have diabetes, or who
have had cataract surgery are also more likely to have floaters (NEI, 2009).
During midlife, adults may begin to notice a drop in scotopic sensitivity, the ability to see indimmer light. By age 60, the retina receives only one third as much light as it did at age 20,
making working in dimmer light more difficult (Jackson & Owsley, 2000). Night vision is also
affected as the pupil loses some of its ability to open and close to accommodate drastic changes
in light. Eyes become more sensitive to glare from headlights and street lights making it difficult
to see people and cars, and movements outside of our direct line of sight (NIH, 2016c).
Finally, some people experience dry eye syndrome, which occurs when the eye does notproduce tears properly, or when the tears evaporate too quickly because they are not the correct
consistency (NEI, 2013). While dry eye can affect people at any age, nearly 5 million Americans
over the age of 50 experience dry eye. It affects women more than men, especially after
menopause. Women who experienced an early menopause may be more likely to experience dry
eye, which can cause surface damage to the eye.
Hearing: Hearing problems increase
Figure 8.4
during middle adulthood. According to a
Incidence of Hearing Impairment in UK
recent UK study (Dawes et al., 2014), theAdultsrate of hearing problems in their sample
doubled between the ages of 40 and 55 and25
tripled by age 64. Similar statistics arefound in U.S. samples of middle-aged
20
adults. Prior to age 40, about 5.5% of
15adults report hearing problems. This jumps
10
to 19% among 40 to 69 year-olds(American Psychological Association,52016). Middle-aged adults may experience0more problems understanding speech when
40-44 45-49 50-54 55-59 60-64 65-69
in noisy environments, in comparison to
Adapted from Dawes, et al., (2014).
younger adults (Füllgrabe, Moore, & Stone,
2015; Neidleman, Wambacq, Besing,Spitzer, & Koehnke, 2015). As we age we also lose the ability to hear higher frequencies(Humes, Kewley-Port, Fogerty, & Kinney, 2010). Hearing changes are more common among
men than women, but males may underestimate their hearing problems (Uchida, Nakashima,Ando, Niino, & Shimokata, 2003). For many adults, hearing loss accumulates after years of
being exposed to intense noise levels. Men are more likely to work in noisy occupations. Hearing
loss is also exacerbated by cigarette smoking, high blood pressure, diabetes, and stroke. Most
hearing loss could be prevented by guarding against being exposed to extremely noisy
environments.

310

Health Concerns
Heart Disease: According to the most recent National Vital Statistics Reports (Kochanek,
Murphy, Xu, & Arias, 2019) heart disease continues to be the number one cause of death forAmericans as it claimed 23% of those who died in 2017. It is also the number one cause of deathworldwide (World Health Organization, 2018). Heart disease develops slowly over time andtypically appears in midlife (Hooker & Pressman, 2016).
Heart disease can include heart defects and heart rhythm problems, as well as narrowed, blocked,
or stiffened blood vessels referred to as cardiovascular disease. The blocked blood vessels
prevent the body and heart from receiving adequate blood. Atherosclerosis, or a buildup of fatty
plaque in the arteries, is the most common cause of cardiovascular disease. The plaque buildup
thickens the artery walls and restricts the blood flow to organs and tissues. Cardiovasculardisease can lead to a heart attack, chest pain (angina), or stroke (Mayo Clinic, 2014a). Figure 8.5
illustrates atherosclerosis.
Symptoms of cardiovasculardisease differ for men andwomen. Males are more likely
to suffer chest pain, while
women are more likely todemonstrate shortness ofbreath, nausea, and extreme
fatigue. Symptoms can also
include pain in the arms, legs,
neck, jaw, throat, abdomen orback (Mayo Clinic, 2014a).

Figure 8.5 Atherosclerosis

According to the Mayo Clinic(2014a) there are many risk
factors for developing heartdisease, including medical
conditions, such as high bloodpressure, high cholesterol,diabetes, and obesity. Otherrisk factors include:

Source•••••Advanced Age-increased risk for narrowed arteries and weakened or thickened heart
muscle.
Sex-males are at greater risk, but a female’s risk increases after menopause.
Family History-increased risk, especially if male parent or brother developed heart.
disease before age 55 or female parent or sister developed heart disease before age 65.
Smoking-nicotine constricts blood vessels and carbon monoxide damages the inner
lining.
Poor Diet-a diet high in fat, salt, sugar, and cholesterol.
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•
•
•

Excessive Alcohol Consumption-alcohol can raise the level of bad fats in the blood andincrease blood pressure
Stress-unrelieved stress can damage arteries and worsen other risk factors.
Poor Hygiene-establishing good hygiene habits can prevent viral or bacterial infections
that can affect the heart. Poor dental care can also contribute to heart disease.

Complications of heart disease can include heart failure, when the heart cannot pump enoughblood to the meet the body’s needs, and a heart attack, such as when a blood clot blocks the
blood flow to the heart. This blockage can damage or destroy a part of the heart muscle, andatherosclerosis is a factor in a heart attack. Treatment for heart disease includes medication,
surgery, and lifestyle changes including exercise, healthy diet, and refraining from smoking.
Sudden cardiac arrest is the unexpected loss of heart functioning, breathing, and consciousness,often caused by an arrhythmia or abnormal heartbeat. The heart beat may be too quick, too slow,
or irregular. With a healthy heart, it is unlikely for a fatal arrhythmia to develop without an
outside factor, such as an electric shock or illegal drugs. If not treated immediately, sudden
cardiac arrest can be fatal and result in sudden cardiac death.
Hypertension, or high blood pressure, is a serious health problem that occurs when the bloodflows with a greater force than normal. One in three American adults (70 million people) havehypertension and only half have it under control (Nwankwo, Yoon, Burt, & Gu, 2013). It canstrain the heart, increase the risk of heart attack and stroke, or damage the kidneys (CDC, 2014a).
Uncontrolled high blood pressure in early and middle adulthood can also damage the brain’s
white matter (axons) and may be linked to cognitive problems later in life (Maillard et al., 2012).
Normal blood pressure is under 120/80 (see Table 8.1). The first number is the systolicpressure, which is the pressure in the blood vessels when the heart beats. The second number isthe diastolic pressure, which is the pressure in the blood vessels when the heart is at rest. Highblood pressure is sometimes referred to as the silent killer, as most people with hypertension
experience no symptoms. Making positive lifestyle changes can often reduce blood pressure.
Table 8.1 Blood Pressure Levels
NormalElevated
Hypertension Stage 1
Hypertension Stage 2

Systolic Pressure
Under 120120-129130-139>140

Diastolic Pressure
Under 80
Under 80
80-89
>90

Source: adapted from American Heart Association (2017)

Risk factors for high blood pressure include:
•
•
•
•
•

Family history of hypertension
Diet that is too high in sodium, often found in processed foods, and too low in potassium
Sedentary lifestyle and Obesity
Too much alcohol consumption
Tobacco use, as nicotine raises blood pressure (CDC, 2014b).
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Cancer: After heart disease, cancer was the second leading cause of death for Americans in2017 as it accounted for 21.3% of all deaths (Kochanek et al., 2016). According to the National
Institutes of Health (2015), cancer is the name given to a collection of related diseases in which
the body’s cells begin to divide without stopping and spread into surrounding tissues. These
extra cells can divide, and form growths called tumors, which are typically masses of tissue.
Cancerous tumors are malignant, which means they can invade nearby tissues. When removed
malignant tumors may grow back. Unlike malignant tumors, benign tumors do not invade nearby
tissues. Benign tumors can sometimes be quite large, and when removed usually do not growback. Although benign tumors in the body are not cancerous, benign brain tumors can be life
threatening.
Cancer cells can prompt nearby normal cells to form blood vessels that supply the tumors withoxygen and nutrients, which allows them to grow. These blood vessels also remove waste
products from the tumors. Cancer cells can also hide from the immune system, a network oforgans, tissues, and specialized cells that protects the body from infections and other conditions.
Lastly, cancer cells can metastasize, which means they can break from where they first formed,
called the primary cancer, and travel through the lymph system or blood to form new tumors inother parts of the body. This new metastatic tumor is the same type as the primary tumor(National Institutes of Health, 2015). Figure 8.6 illustrates how cancers can metastasize.
Cancer can start almost anywherein the human body. While normal
cells mature into very distinct cell
types with specific functions,cancer cells do not and continue todivide without stopping. Further,cancer cells are able to ignore thesignals that normally tell cells tostop dividing or to begin a process
known as programmed cell death
which the body uses to get rid ofunneeded cells. With the growthof cancer cells, normal cells are
crowded out and the body isunable to work the way it is
supposed to. For example, thecancer cells in lung cancer form
tumors which interfere with thefunctioning of the lungs and how
oxygen is transported to the rest of
the body.

Figure 8.6

SourceThere are more than 100 types of cancer. The American Cancer Society assemblies a list of themost common types of cancers in the United States. To qualify for the 2016 list, the estimatedannual incidence had to be 40, 000 cases or more. The most common type of cancer on the list isbreast cancer, with more than 249,000 new cases expected in 2016. The next most common
313

cancers are lung cancer and prostate cancer. Table 8.2 lists the estimated number of new casesand deaths for each common cancer type for 2019 (American Cancer Society, 2019).

Table 8.2 2019 Estimates of Cancer Types
Cancer Type
Bladder
Breast (Female – Male)Colon
Kidney and Renal Pelvis
Leukemia (All Types)
Lung (Including Bronchus)
Melanoma
Non-Hodgkin Lymphoma
Pancreatic
Prostate
Thyroid
UterineEstimated New Cases
80,470268,600-2670
101,42073,82061,780228,150
32,11074,20056,770174,650
52,07075,050Estimated Deaths
17,67041,760-500
51,02014,77022,840142,670
12,96019,97045,75031,6202,170
16,410SourceCholesterol is a waxy fatty substance carried by lipoprotein molecules in the blood. It is createdby the body to create hormones and digest fatty foods and is also found in many foods. Your
body needs cholesterol, but too much can cause heart disease and stroke. Two important kindsof cholesterol are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). A third
type of fat is called triglycerides. Your total cholesterol score is based on all three types of lipids(see Table 8.3). Total cholesterol is calculated by adding HDL plus LDL plus 20% of the
Triglycerides.
LDL cholesterol makes up the majorityof the body’s cholesterol, however, it isoften referred to as “bad” cholesterol
Normalbecause at high levels it can form
Total Cholesterol
Less than 200mg/dl*
plaque in the arteries leading to heart
LDL
Less than 100mg/dl
attack and stroke. HDL cholesterol,
HDL
40mg/dl or higher
often referred to as “good” cholesterol,
Triglycerides
Less than 150mg/dl
absorbs cholesterol and carries it back
*Cholesterol levels are measured in milligrams (mg) of
to the liver, where it is then flushedcholesterol per deciliter (dl) of blood.
from the body. Higher levels of HDL
can reduce the risk of heart attack andSource: adapted from CDC (2015).
stroke. Triglycerides are a type of fat in
the blood used for energy. High levels of triglycerides can also increase your risk for heartdisease and stroke when coupled with high LDL and low HDL. All adults 20 or older shouldhave their cholesterol checked. In early adulthood, doctors may check every few years if thenumbers have previously been normal, and there are no other signs of heart disease. In middle
adulthood, this may become part of the annual check-up (CDC, 2015).
Table 8.3 Normal Levels of Cholesterol

314

Risk factors for high cholesterol include: A family history for high cholesterol, diabetes, a diethigh in saturated fats, trans fat, and cholesterol, physical inactivity, and obesity. Almost 32% ofAmerican adults have high LDL cholesterol levels, and the majority do not have it under control,
nor have they made lifestyle changes (CDC, 2015).
Diabetes (Diabetes Mellitus) is a disease in which the body does not control the amount of
glucose in the blood. This disease occurs when the body
Figure 8.7
does not make enough insulin or does not use it the way
it should (NIH, 2016a). Insulin is a type of hormone thathelps glucose in the blood enter cells to give themenergy. In adults, 90% to 95% of all diagnosed cases ofdiabetes are type 2 (American Diabetes Association(ADA), 2016). Type 2 diabetes usually begins withinsulin resistance, a disorder in which the cells in themuscles, liver, and fat tissue do not use insulin properly(CDC, 2014d). As the need for insulin increases, cells
Source (CDC, 2014d).
in the pancreas gradually lose the ability to produce
enough insulin. In some Type 2 diabetics, pancreatic
beta cells will cease functioning, and the need for insulin injections will become necessary.
Some people with diabetes experience insulin resistance with only minor dysfunction of the beta
cell secretion of insulin. Other diabetics experience only slight insulin resistance, with theprimary cause being a lack of insulin secretion (CDC, 2014d).
One in three adults are estimated to have prediabetes, and 9 in 10 of them do not know.
According to the CDC (2014d) without intervention, 15% to 30% of those with prediabetes willdevelop diabetes within 5 years. In 2015, 30.2 million people (9.4% of the population) were
living with diabetes in America, mostly adults age 18 and up (CDC, 2017). Table 8.4 shows thenumbers in millions and percentage of adults, by age and gender, with both diagnosed andundiagnosed diabetes. The median age of diagnosis is 54 (CDC, 2014d). During middle
adulthood, the number of people with diabetes dramatically increases; with 4.3 million livingwith diabetes prior to age 45, to over 13 million between the ages of 45 to 64; a four-foldincrease. Men are slightly more likely to experience diabetes than are women.
Table 8.4 Estimated Number and Percentage of Adults age 18 and over with Diabetes
in 2015 According to the CDC

315

Figure 8.8 Ethnic Differences in Diabetes Diagnosis

Diabetes also affects ethnic and racial groups differently. Non-Hispanic Whites are less likely to
be diagnosed with diabetes than are Asian Americans, Hispanics, non-Hispanic Blacks, andAmerican Indians/Alaskan Natives. However, these general figures hide the variations withinthese groups. For instance, the rate of diabetes was less for Central, South, and Cuban
Americans than for Mexican Americans and Puerto Ricans, and less for Alaskan Natives than theAmerican Indians of southern Arizona (CDC, 2017). Additionally, educational attainment,
which is linked to one’s economic level, is correlated with diabetes. Percentages includes: Less
than a high shool degree (21.6%), high school degree (9.5%), and more than a high school
degree (7.2%).
The risk factors for diabetes include:
•
•
•
•
•
•
•

Those over age 45
Obesity
Family history of diabetes
History of gestational diabetes (see Chapter 2)
Race and ethnicity
Physical inactivity
Diet.

Diabetes has been linked to numerous health complications. Adults with diabetes are 1.7 times
more likely to have cardiovascular disease, 1.8 times more likely to experience a heart attack,and 1.5 times more likely to experience stroke than adults without diabetes. Diabetes can cause
blindness and other eye problems. Between 40%-45% of Americans with diabetes have somedegree of diabetic retinopathy, which is damage to the small blood vessels in the retina that
may lead to loss of vision (NEI, 2015). More than 4% showed advanced diabetic retinopathy.
Diabetes is linked as the primary cause of almost half (44%) of new cases of kidney failure eachyear. About 60% of non-traumatic limb amputations occur in people with diabetes. Diabetes
has been linked to hearing loss, tinnitus (ringing in the ears), gum disease, and neuropathy (nerve
disease) (CDC, 2014d).
316

Typical tests for diabetes include a fasting glucose test and the A1C (See Table 8.5). Fasting
glucose levels should be under 100mg/dl (ADA, 2016). The A1C provides information about the
average levels of blood glucose over the last 3 months (NIH, 2014a). The A1C should be under
5.7, where a 5.0 = 97mg/dl and a 6.0 = 126 mg/dl (ADA, 2016).
Table 8.5 Diagnostic Blood Tests for Diabetes
NormalPrediabetes
Fasting Glucose
Below 100mg/dl
100-125mg/dl
A1C
Under 5.7
5.7-6.9

Diabetes
126mg/dl +7+

Adapted from the American Diabetes Association (2016)

Metabolic Syndrome is a cluster of several cardiometabolic risk factors, including large waist
circumference, high blood pressure, and elevated triglycerides, LDL, and blood glucose levels,
which can lead to diabetes and heart disease (Crist et al., 2012). The prevalence of metabolic
syndrome in the U.S. is approximately 34% and is especially high among Hispanics and African
Americans (Ford, Li, & Zhao, 2010). Prevalence increases with age, peaking in one’s 60s (Fordet al., 2010). Metabolic syndrome increases morbidity from cardiovascular disease and diabetes(Hu et al., 2004; Malik, 2004). Hu and colleagues found that even having one or two of the risk
factors for metabolic syndrome increased the risk of mortality. Crist et al. (2012) found that
increasing aerobic activity and reducing weight led to a drop in many of the risk factors of
metabolic syndrome, including a reduction in waist circumference and blood pressure, and anincrease in HDL cholesterol.
Rheumatoid arthritis (RA) is an inflammatory disease that causes pain, swelling, stiffness, andloss of function in the joints (NIH, 2016b). RA occurs when the immune system attacks themembrane lining the joints (see Figure 8.8). RA is the second most common form of arthritis
after osteoarthritis, which is the normal wear and tear on the joints discussed in chapter 9. Unlike
osteoarthritis, RA is symmetric in its attack of the body, thus, if one shoulder is affected so is the
Figure 8.9

Source317

other. In addition, those with RA may experience fatigue and fever. Below are the common
features of RA (NIH, 2016b).
Features of Rheumatoid Arthritis
•
•
•
•
•
•
•
•

Tender, warm, swollen joints
Symmetrical pattern of affected joints
Joint inflammation often affecting the wrist and finger joints closest to the hand
Joint inflammation sometimes affecting other joints, including the neck, shoulders,elbows, hips, knees, ankles, and feet
Fatigue, occasional fevers, a loss of energy
Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest
Symptoms that last for many years
Variability of symptoms among people with the disease.

About 1.5 million people (approximately 0.6%) of Americans experience rheumatoid arthritis. It
occurs across all races and age groups, although the disease often begins in middle adulthood andoccurs with increased frequency in older people. Like some other forms of arthritis, rheumatoid
arthritis occurs much more frequently in women than in men. About two to three times as many
women as men have the disease (NIH, 2016b). The lifetime risk for RA for women is 3.6% and1.7% for men (Crowson, et al., 2011).
Genes play a role in the development of RA. However, individual genes by themselves confer
only a small risk of developing the disease, as some people who have these particular genes
never develop RA. Scientists think that something must occur to trigger the disease process inpeople whose genetic makeup makes them susceptible to rheumatoid arthritis. For instance, somescientists also think hormonal factors may be involved. In women who experience RA, thesymptoms may improve during pregnancy and flare after pregnancy. Women who use oral
contraceptives may increase their likelihood of developing RA. This suggests hormones, or
possibly deficiencies or changes in certain hormones, may increase the risk of developing RA ina genetically susceptible person (NIH, 2016b).
Rheumatoid arthritis can affect virtually every area of a person’s life, and it can interfere with thejoys and responsibilities of work and family life. Fortunately, current treatment strategies allow
most people with RA to lead active and productive lives. Pain-relieving drugs and medications
can slow joint damage and establishing a balance between rest and exercise can also lessen thesymptoms of RA (NIH, 2016b).
Fatty liver disease (hepatic steatosis) refers to the accumulation of fat in the liver. The liver
normally contains little fat, and anything below 5% of liver weight is considered normal. Thisdisease is present in 33% of American adults. In the past the main cause of fat accumulation in
the liver was due to excessive alcohol consumption, often eventually leading to cirrhosis andliver failure. Today, increased caloric intake, especially resulting in obesity, and little physicalactivity are the main causes. Mild to moderate levels of hepatic steatosis can be reversed throughhealthy lifestyle changes (Nassir, Rector, Hammoud, & Ibdah, 2015).

318

Digestive Issues
Heartburn, also called acid indigestion or pyrosis, is acommon digestive problem in adults and is the result of
stomach acid backing up into the esophagus. Prolonged
contact with the digestive juices injures the lining of theesophagus and causes discomfort. Heartburn that occurs
more frequently may be due to gastroesophageal reflux
disease or GERD. Normally the lower sphincter muscle in
the esophagus keeps the acid in the stomach from entering
the esophagus. In GERD this muscle relaxes too frequently
and the stomach acid flows into the esophagus. In the U.S.,
60 million people experience heartburn at least once amonth, and 15 million experience it every day. Prolonged
problems with heartburn can lead to more serious
complications, including esophageal cancer, one of the mostlethal forms of cancer in the U.S. Problems with heartburn
can be linked to eating fatty or spicy foods, caffeine,smoking, and eating before bedtime (American College of
Gastroenterology, 2016a).

Figure 8.10
Digestive System

SourceGallstones are hard particles, including fatty materials, bile
pigments, and calcium deposits, that can develop in the gallbladder. Ranging in size from a grainof sand to a golf ball, they typically take years to develop, but in some people have developed
over the course of a few months. About 75% of gallstones do not create any symptoms, but thosethat do may cause sporadic upper abdominal pain when stones block bile or pancreatic ducts. Ifstones become lodged in the ducts, it may necessitate surgery or other medical intervention as it
could become life-threatening if left untreated (American College of Gastroenterology, 2016b).
Gallstones are present in about 20% of women and 10% of men over the age of 55 (American
College of Gastroenterology, 2016b). Risk factors include a family history of gallstones, dietshigh in calories and refined carbohydrates (such as, white bread and rice), diabetes, metabolic
syndrome, Crohn’s disease, and obesity, which increases the cholesterol in the bile and thusincreases the risk of developing gallstones (NIH, 2013).

Sleep
According to the American Academy of Sleep Medicine (Kasper, 2015) adults require at least 7
hours of sleep per night to avoid the health risks associated with chronic sleep deprivation. Less
than 6 hours and more than 10 hours is also not recommended for those in middle adulthood(National Sleep Foundation, 2015). Not surprisingly, many Americans do not receive the 7-9hours of sleep recommended. In 2013, only 59% of U.S. adults met that standard, while in 1942,
84% did (Jones, 2013). This means 41% of Americans receive less than the recommended
amount of nightly sleep. Additional results included that in 1993, 67% of Americans felt they
were getting enough sleep, but in 2013 only 56% felt they received as much sleep as needed.
Additionally, 43% of Americans in 2013 believed they would feel better with more sleep.
319

Sleep problems: According to the Sleep in America poll (National Sleep Foundation, 2015), 9%of Americans report being diagnosed with a sleep disorder, and of those 71% have sleep apnea
and 24% suffer from insomnia. Pain is also a contributing factor in the difference between theamount of sleep Americans say they need and the amount they are getting. An average of 42
minutes of sleep debt occur for those with chronic pain, and 14 minutes for those who havesuffered from acute pain in the past week. Stress and overall poor health are also key
components of shorter sleep durations and worse sleep quality. Those in midlife with lower life
satisfaction experienced greater delay in the onset of sleep than those with higher life
satisfaction. Delayed onset of sleep could be the result of worry and anxiety during midlife, andimprovements in those areas should improve sleep. Lastly, menopause can affect a woman’s
sleep duration and quality (National Sleep Foundation, 2016).
Table 8.6 Presence of Children and Sleep
Demographic

Sleep Less than 7 hours

Single Mothers

43.5%

Mothers with Partner

31.2%

Women without Children

29.7%

Single Fathers

37.5%

Fathers with Partner

34.1%

Men without Children

32.3%

Adapted from data from CDC (2016)Children in the home andsleep: As expected, having
children at home affects theamount of sleep one receives.
According to a 2016 National
Center for Health Statistics
analysis (CDC, 2016) having
children decreases the amountof sleep an individual receives,
however, having a partner can
improve the amount of sleep
for both males and females.
Table 8.6 illustrates thepercentage of individuals notreceiving seven hours of sleep
per night based on parental
role.

Negative consequences of insufficient sleep:
Figure 8.11 The Importance of Sleep
There are many consequences of too little sleep,
and they include physical, cognitive, andemotional changes. Sleep deprivation suppresses
immune responses that fight off infection, andcan lead to obesity, memory impairment, andhypertension (Ferrie et al., 2007; Kushida,2005). Insufficient sleep is linked to anincreased risk for colon cancer, breast cancer,
heart disease and type 2 diabetes (Pattison,2015). A lack of sleep can increase stress ascortisol (a stress hormone) remains elevatedSourcewhich keeps the body in a state of alertness andhyperarousal which increases blood pressure.
Sleep is also associated with longevity. Dew et al. (2003) found that older adults who had bettersleep patterns also lived longer. During deep sleep a growth hormone is released which
stimulates protein synthesis, breaks down fat that supplies energy, and stimulates cell division.
320

Consequently, a decrease in deep sleep contributes to less growth hormone being released andsubsequent physical decline seen in aging (Pattison, 2015).
Sleep disturbances can also impair glucose functioning in middle adulthood. Caucasian, African
American, and Chinese non-shift-working women aged 48–58 years who were not taking
insulin-related medications, participated in the Study of Women's Health across the Nation(SWAN) Sleep Study and were subsequently examined approximately 5 years later (Taylor etal., 2016). Body mass index (BMI) and insulin resistance were measured at two time points.
Results indicated that irregular sleep schedules, including highly variable bedtimes and staying
up much later than usual, are associated in midlife women with insulin resistance, which is an
important indicator of metabolic health, including diabetes risk. Diabetes risk increases in
midlife women, and irregular sleep schedules may be an important reason because irregularbedtime schedules expose the body to varying levels of light, which is the most important timingcue for the body’s circadian clock. By disrupting circadian timing, bedtime variability may
impair glucose metabolism and energy homeostasis.

Exercise, Nutrition, and Weight
The impact of exercise: Exercise is a powerful way to combat the changes we associate withaging. Exercise builds muscle, increases metabolism, helps control blood sugar, increases bonedensity, and relieves stress. Unfortunately, fewer than half of midlife adults exercise and only
about 20 percent exercise frequently and strenuously enough to achieve health benefits. Manystop exercising soon after they begin an exercise program, particularly those who are very
overweight. The best exercise programs are those that are engaged in regularly, regardless of theactivity. A well-rounded program that is easy to follow includes walking and weighttraining. Having a safe, enjoyable place to walk can make the difference in whether or not
someone walks regularly. Weight lifting and stretching exercises at home can also be part of aneffective program. Exercise is particularly helpful in reducing stress in midlife. Walking,jogging, cycling, or swimming can release the tension caused by stressors. Learning relaxation
techniques can also have healthful benefits. Exercise can be thought of as preventative healthcare. Promoting exercise for the 78 million "baby boomers" may be one of the best ways toreduce health care costs and improve quality of life (Shure & Cahan, 1998).
According to the Office of Disease Prevention and Health Promotion (2008), the following are
exercise guidelines for adults:
•
•

•
•

Adults should avoid being inactive. Any activity will result in some health benefits.
For substantial health benefits, adults should engage in at least 150 minutes per week ofmoderate intensity exercise OR at least 75 minutes of vigorous intensity aerobic activity.
Aerobic activity should occur for at least 10 minutes and preferably spread throughout
the week.
For more extensive health benefits, adults can increase their aerobic activity to 300
minutes per week of moderate intensity OR 150 minutes per week of vigorous intensity
aerobic activity.
Adults should also participate in muscle-strengthening activities that are moderate orhigh intensity and involve all major muscle groups on two or more days per week.
321

Nutritional concerns: Aging brings about a reduction in the number of calories a person
requires (see Table 8.7 for estimated caloric needs in middle-aged adults). Many Americans
respond to weight gain by dieting. However, eating less does not typically mean eating right andpeople often suffer vitamin and mineral deficiencies as a result. All adults need to be especiallycognizant of the amount of sodium, sugar, and fat they are ingesting.
Table 8.7 Estimated Calorie Needs per Day, by Age, Sex, & Physical Activity Level

Age

[a]

Sedentary

Males
Moderately
Active[b]Active[c]

Sedentary

36-40
2400
2600
2800
1800
41-45
2200
2600
2800
1800
46-50
2200
2400
2800
1800
51-55
2200
2400
2800
1600
56-60
2200
2400
2600
1600
61-65
2000
2400
2600
1600
Source: Adapted from 2015-2020 Dietary Guidelines for Americans[a]Females[d]Moderately
Active [b]Active [c]

2000
2000
2000
1800
1800
1800

2200
2200
2200
2200
2200
2000

[a]

Sedentary means a lifestyle that includes only the physical activity of independent living
Moderate activity means a lifestyle that includes physical activity equivalent to walking more than 1.5 to 3
miles per day at 3 or 4 miles per hour, in addition to the activities of independent living.
[c]
Active means a lifestyle that includes physical activity of walking more than 3 miles per day at 3 or 4 miles
per hour, in addition to the activities of independent living.
[d]
Estimates for females do not include women who are pregnant or breastfeeding[b]

Excess Sodium: According to dietary guidelines, adults should consume less than 2,300mg (1teaspoon) per day of sodium. The American Heart Association (2016) reports that the averagesodium intake among Americans is 3440mg per day. Processed foods are the main culprits ofexcess sodium. High sodium levels in the diet is correlated with increased blood pressure, and its
reduction does show corresponding drops in blood pressure. Adults with high blood pressure arestrongly encouraged to reduce their sodium intake to 1500mg (U.S. Department of Health andHuman Services & U.S. Department of Agriculture (USHHS & USDA), 2015).
Excess Fat: Dietary guidelines also suggests that adults should consume less than 10 percent ofcalories per day from saturated fats. The American Heart Association (2016) says optimally weshould aim for a dietary pattern that achieves 5% to 6% of calories from saturated fat. In a 2000
calorie diet that is about 120 calories from saturated fat. In the average American diet about
34.3% of the diet comes from fat, with 15.0% from saturated fat (Berglund et al., 1999). Dietshigh in fat not only contribute to weight gain, but have been linked to heart disease, stroke, andhigh cholesterol.
Added Sugar: According to the recent Dietary Guidelines for Americans (USHHS & USDA,
2015) eating healthy means adults should consume less than 10 percent of calories per day fromadded sugars. Yet, currently about 15% of the calories in the American adult diet come fromadded sugars, or about 22 teaspoons of sugar per day (NIH, 2014c). Excess sugar not only
contributes to weight gain, but diabetes and other health problems.
322

Metabolism and Weight Gain: One of the common complaints of midlife adults is weight gain,
especially the accumulation of fat in the abdomen, which is often referred to as the middle-aged
spread (Lachman, 2004). Men tend to gain fat on their upper abdomen and back, while womentend to gain more fat on theirwaist and upper arms. Many
Figure 8.12 Exercise is Very Important in Middle Ageadults are surprised at thisweight gain because theirdiets have not changed,
however, their metabolism
has slowed during midlife.
Metabolism is the process bywhich the body converts foodand drink into energy. The
calories consumed are
combined with oxygen to
release the energy needed tofunction (Mayo Clinic,
2014b). People who havemore muscle burn morecalories, even at rest, and thus
Sourcehave a higher metabolism.

However, as you get older, the amount of muscle decreases. Consequently, fat accounts formore of one’s weight in midlife. and fat slows down the number of calories burned. To
compensate, midlife adults have to increase their level of exercise, eat less, and watch theirnutrition to maintain their earlier physique.
Obesity: As discussed in the early adulthood chapter, obesity is a significant health concern for
adults throughout the world, and especially America. Obesity rates continue to increase and thecurrent rate for those 40-59 is 42.8%, which is the highest percentage per age group (CDC,2017). Being overweight is associated with a myriad of health conditions including diabetes,
high blood pressure, and heart disease. New research is now linking obesity to Alzheimer’s
disease. Chang et al. (2016) found that being overweight in midlife was associated with earlier
onset of Alzheimer’s disease. The study looked at 1,394 men and women who were part of theBaltimore Longitudinal Study of Aging. Their average age was around 60, and they were
followed for 14 years. Results indicated that people with the highest body mass index, or BMI,
at age 50 were more likely to develop Alzheimer’s disease. In fact, each one-point increase in
BMI was associated with getting Alzheimer’s six to seven months earlier. Those with the highest
BMIs also had more brain changes typical of Alzheimer’s, even if they did not have symptomsof the disease. Scientists speculate that fat cells may produce harmful chemicals that promoteinflammation in blood vessels throughout the body, including in the brain. The conclusion of thestudy was that a healthy BMI at midlife may delay the onset of Alzheimer’s disease.
Concluding Thoughts: Many of the changes that occur in midlife can be easily compensatedfor, such as buying glasses, exercising, and watching what one eats. However, the percentage of323

middle adults who have a significant health concern has increased in the past 15 years.
According to the 2016 United Health Foundation’s America’s Health Rankings Senior Report,
the next generation of seniors will be less healthy than the current seniors (United HealthFoundation, 2016). The study compared the health of middle-aged Americans (50-64 years ofage) in 2014 to middle-aged Americans in 1999. Results indicated that in the past 15 years theprevalence of diabetes has increased by 55% and the prevalence of obesity has increased by
25%. At the state level, Massachusetts ranked first for healthy seniors, while Louisiana ranked
last. Illinois ranked 36th, while Wisconsin scored higher at 13th.
What can we conclude from this information? Lifestyle has a strong impact on the health statusof midlife adults, and it becomes important for midlife adults to take preventative measures toenhance physical well-being. Those midlife adults who have a strong sense of mastery andcontrol over their lives, who engage in challenging physical and mental activity, who engage inweight bearing exercise, monitor their nutrition, receive adequate sleep, and make use of social
resources are most likely to enjoy a plateau of good health through these years (Lachman, 2004).

Climacteric
The climacteric, or the midlife transition when fertility declines, is biologically based but
impacted by the environment. During midlife, men may experience a reduction in their ability toreproduce. Women, however, lose their ability to reproduce once they reach menopause.
Female Sexual and Reproductive Health: Perimenopause refers to a period of transition inwhich a woman's ovaries stop releasing eggs and the level of estrogen and progesterone
production decreases. Menopause is defined as 12 months without menstruation. The averageage of menopause is approximately 51, however, many women begin experiencing symptoms intheir 40s. These symptoms occur during perimenopause, which can occur 2 to 8 years before
menopause (Huang, 2007). A woman may first begin to notice that her periods are more or lessfrequent than before. After a year without menstruation, a woman is considered menopausal
and no longer capable of reproduction.
Symptoms: The symptoms that occur during perimenopause and menopause are typicallycaused by the decreased production of estrogen and progesterone (North American Menopause
Society, 2016). The shifting hormones can contribute to the inability to fall asleep. Additionally,
the declining levels of estrogen may make a woman more susceptible to environmental factors
and stressors which disrupt sleep. A hot flash is a surge of adrenaline that can awaken the brain
from sleep. It often produces sweat and a change of temperature that can be disruptive to sleepand comfort levels. Unfortunately, it may take time for adrenaline to recede and allow sleep tooccur again (National Sleep Foundation, 2016).
The loss of estrogen also affects vaginal lubrication which diminishes and becomes waterier andcan contribute to pain during intercourse. The vaginal wall also becomes thinner, and lesselastic. Estrogen is also important for bone formation and growth, and decreased estrogen cancause osteoporosis resulting in decreased bone mass. Depression, irritability, and weight gain
are often associated with menopause, but they are not menopausal (Avis, Stellato & Crawford,
2001; Rossi, 2004). Weight gain can occur due to an increase in intra-abdominal fat followed bya loss of lean body mass after menopause (Morita et al., 2006). Consequently, women may need324

to change their lifestyle tocounter any weight gain.
Depression and mood swings are
more common during menopause
in women who have priorhistories of these conditions
rather than those who have not.
Additionally, the incidence ofdepression and mood swings is
not greater among menopausal
women than non-menopausal
women. Figure 8.12 identifies
symptoms experienced by
women during menopause,
however, women vary greatly inthe extent to which these
symptoms are experienced. Most
American women go throughmenopause with few problems(Carroll, 2016). Overall,menopause is not seen as
universally distressing (Lachman,2004).

Figure 8.13

SourceHormone Replacement Therapy: Concerns about the effects of hormone replacement haschanged the frequency with which estrogen replacement and hormone replacement therapies
have been prescribed for menopausal women. Estrogen replacement therapy was once commonlyused to treat menopausal symptoms. However, more recently, hormone replacement therapy has
been associated with breast cancer, stroke, and the development of blood clots (NIH,
2007). Most women do not have symptoms severe enough to warrant estrogen or hormone
replacement therapy. If so, they can be treated with lower doses of estrogen and monitored withmore frequent breast and pelvic exams. There are also some other ways to reduce
symptoms. These include avoiding caffeine and alcohol, eating soy, remaining sexually active,
practicing relaxation techniques, and using water-based lubricants during intercourse.
Menopause and Ethnicity: In a review of studies that mentioned menopause, symptoms varied
greatly across countries, geographic regions, and even across ethnic groups within the same
region (Palacios, Henderson, & Siseles, 2010). For example, the Study of Women's Healthacross the Nation (SWAN) examined 14,906 white, African American, Hispanic, JapaneseAmerican, and Chinese American women's menopausal experiences (Avis et al., 2001). After
controlling for age, educational level, general health status, and economic stressors, white
women were more likely to disclose symptoms of depression, irritability, forgetfulness, andheadaches compared to women in the other racial/ethnic groups. African American womenexperienced more night sweats, but this varied across research sites. Finally, Chinese Americanand Japanese American reported fewer menopausal symptoms when compared to the women in
the other groups. Overall, the Chinese and Japanese group reported the fewest symptoms, while
325

white women reported more mental health symptoms and African American women reported
more physical symptoms.
Cultural Differences: Cultural influences seem to also
play a role in the way menopause is experienced. Further,
the prevalence of language specific to menopause is an
important indicator of the occurrence of menopausal
symptoms in a culture. Hmong tribal women living inAustralia and Mayan women report that there is no word for"hot flashes" and both groups did not experience these
symptoms (Yick-Flanagan, 2013). When asked about
physical changes during menopause, the Hmong womenreported lighter or no periods. They also reported noemotional symptoms and found the concept of emotionaldifficulties caused by menopause amusing (Thurston &Vissandjee, 2005). Similarly, a study with First Nation
Sourcewomen in Canada found there was no single word for"menopause" in the Oji-Cree or Ojibway languages, withwomen referring to menopause only as "that time when periods stop" (Madden, St Pierre-Hansen& Kelly, 2010).
Figure 8.14

While some women focus on menopause as a loss of youth, womanhood, and physicalattractiveness, career-oriented women tend to think of menopause as a liberating experience.
Japanese women perceive menopause as a transition from motherhood to a more whole person,
and they no longer feel obligated to fulfill certain expected social roles, such as the duty to be amother (Kagawa-Singer, Wu, & Kawanishi, 2002). In India, 94% of women said they welcomed
menopause. Aging women gain status and prestige and no longer have to go through selfimposed menstrual restrictions, which may contribute to Indian women’s experiences (Kaur,
Walia, & Singh, 2004). Overall, menopause signifies many different things to women aroundthe world and there is no typical experience. Further, normalizing rather than pathologizing
menopause is supported by research and women’s experiences.
Male Sexual and Reproductive Health: Although males can continue to father children
throughout middle adulthood, erectile dysfunction (ED) becomes more common. Erectile
dysfunction refers to the inability to achieve an erection or an inconsistent ability to achieve anerection (Swierzewski, 2015). Intermittent ED affects as many as 50% of men between the agesof 40 and 70. About 30 million men in the United States experience chronic ED, and thepercentages increase with age. Approximately 4% of men in their 40s, 17% of men in their 60s,
and 47% of men older than 75 experience chronic ED.
Causes for ED are primarily due to medical conditions, including diabetes, kidney disease,alcoholism, and atherosclerosis (build-up of plaque in the arteries). Plaque is made up of fat,cholesterol, calcium and other substances found in the blood. Over time plaque builds up,
hardens, and restricts the blood flow in the arteries (NIH, 2014d). This build-up limits the flowof oxygenated blood to organs and the penis. Overall, diseases account for 70% of chronic ED,
while psychological factors, such as stress, depression and anxiety account for 10%-20% of allcases. Many of these causes are treatable, and ED is not an inevitable result of aging.
326

Figure 8.15 Medical Check-ups are Important for Men

SourceMen during middle adulthood may also experience prostate enlargement, which can interferewith urination, and deficient testosterone levels which decline throughout adulthood, but
especially after age 50. If testosterone levels decline significantly, it is referred to as
andropause or late-onset hypogonadism. Identifying whether testosterone levels are low isdifficult because individual blood levels vary greatly. Low testosterone is not a concern unless it
accompanied by negative symptoms such as low sex drive, ED, fatigue, loss of muscle, loss ofbody hair, or breast enlargement. Low testosterone is also associated with medical conditions,such as diabetes, obesity, high blood pressure, and testicular cancer. The effectiveness of
supplemental testosterone is mixed, and long term testosterone replacement therapy for men can
increase the risk of prostate cancer, blood clots, heart attack and stroke (WebMD, 2016). Most
men with low testosterone do not have related problems (Berkeley Wellness, 2011).

The Climacteric and Sexuality
Sexuality is an importantpart of people's lives at any
age, and many older adults
are very interested in staying
sexually active (Dimah &Dimah, 2004). According to
the National Survey of
Sexual Health and Behavior(NSSHB) (Center for Sexual
Health Promotion, 2010),
74% of males and 70% of
females aged 40-49 engaged
in vaginal intercourse during
the previous year, while
58% of males and 51% offemales aged 50-59 did so.

Figure 8.16

Source327

Despite these percentages indicating that middle adults are sexually active, age-related physicalchanges can affect sexual functioning. For women, decreased sexual desire and pain during
vaginal intercourse because of menopausal changes have been identified (Schick et al., 2010). A
woman may also notice less vaginal lubrication during arousal which can affect overall pleasure(Carroll, 2016). Men may require more direct stimulation for an erection and the erection may bedelayed or less firm (Carroll, 2016). As previously discussed men may experience erectile
dysfunction or experience a medical conditions (such as diabetes or heart disease) that impact
sexual functioning. Couples can continue to enjoy physical intimacy and may engage in moreforeplay, oral sex, and other forms of sexual expression rather than focusing as much on sexualintercourse.
Risk of pregnancy continues until a woman has been without menstruation for at least 12
months, however, and couples should continue to use contraception. People continue to be at riskof contracting sexually transmitted infections, such as genital herpes, chlamydia, and genital
warts. In 2014, 16.7% of the country’s new HIV diagnoses (7,391 of 44,071) were among people
50 and older, according to the Centers for Disease Control and Prevention (2014e). This was anincrease from 15.4% in 2005. Practicing safe sex is important at any age, but unfortunately
adults over the age of 40 have the lowest rates of condom use (Center for Sexual Health
Promotion, 2010). This low rate of condom use suggests the need to enhance education efforts
for older individuals regarding STI risks and prevention. Hopefully, when partners understandhow aging affects sexual expression, they will be less likely to misinterpret these changes as alack of sexual interest or displeasure in the partner and more able to continue to have satisfying
and safe sexual relationships.

Brain Functioning
The brain at midlife has been shown to not only maintain many of the abilities of young adults,
but also gain new ones. Some individuals in middle age actually have improved cognitive
functioning (Phillips, 2011). The brain continues to demonstrate plasticity and rewires itself in
middle age based on experiences. Research has demonstrated that older adults use more of theirbrains than younger adults. In fact, older adults who perform the best on tasks are more likely todemonstrate bilateralization than those who perform worst. Additionally, the amount of whitematter in the brain, which is responsible for forming connections among neurons, increases into
the 50s before it declines.
Emotionally, the middle aged brain is calmer, less neurotic, more capable of managing emotions,and better able to negotiate social situations (Phillips, 2011). Older adults tend to focus more on
positive information and less on negative information than those younger. In fact, they also
remember positive images better than those younger. Additionally, the older adult’s amygdala
responds less to negative stimuli. Lastly, adults in middle adulthood make better financial
decisions, which seems to peak at age 53, and show better economic understanding. Although
greater cognitive variability occurs among middle adults when compared to those both younger
and older, those in midlife with cognitive improvements tend to be more physically, cognitively,
and socially active.

328

Learning Objectives: Cognitive Development in Middle Adulthood
•
•
•
•
•
•
•

Describe crystalized versus fluid intelligence
Describe research from the Seattle Longitudinal Study
Explain the importance of flow to creativity and life satisfaction
Describe how middle adults are turning to college for advanced training
Describe the difference between an expert and a novice
Describe the changes in the U.S. work force, especially among middle adults
Explain the importance of leisure to mental health and a successful retirement

Crystalized versus Fluid IntelligenceIntelligence is influenced by heredity, culture, social contexts, personal choices, and certainly
age. One distinction in specific intelligences noted in adulthood, is between fluid intelligence,
which refers to the capacity to learn new ways of solving problems and performing activities
quickly and abstractly, and crystallized intelligence, which refers to the accumulated knowledgeof the world we have acquired throughout our lives (Salthouse, 2004). These intelligences are
distinct, and crystallized intelligence increases with age, while fluid intelligence tends to decrease
with age (Horn, Donaldson, & Engstrom, 1981; Salthouse, 2004).
Research demonstrates that older adults have more crystallized intelligence as reflected insemantic knowledge, vocabulary, and language. As a result, adults generally outperform younger
people on measures of history, geography, and even on crossword puzzles, where thisinformation is useful (Salthouse, 2004). It is this superior knowledge, combined with a slower andmore complete processing style, along with a more sophisticated understanding of the workings
Figure 8.17

Adapted from Horn, Donaldson and Engstrom (1981)329

of the world around them, that gives older adults the advantage of “wisdom” over the advantagesof fluid intelligence which favor the young (Baltes, Staudinger, & Lindenberger, 1999; Scheibe,
Kunzmann, & Baltes, 2009).
The differential changes in crystallized versus fluid intelligence help explain why older adults do
not necessarily show poorer performance on tasks that also require experience (i.e., crystallized
intelligence), although they show poorer memory overall. A young chess player may think more
quickly, for instance, but a more experienced chess player has more knowledge to draw on.
Seattle Longitudinal Study: The Seattle Longitudinal Study has tracked the cognitive abilities
of adults since 1956. Every seven years the current participants are evaluated, and new
individuals are also added. Approximately 6000 people have participated thus far, and 26 people
from the original group are still in the study today. Current results demonstrate that middle-aged
adults perform better on four out of six cognitive tasks than those same individuals did when
they were young adults. Verbal memory, spatial skills, inductive reasoning (generalizing fromparticular examples), and vocabulary increase with age until one’s 70s (Schaie, 2005; Willis &Shaie, 1999). However, numerical computation and perceptual speed decline in middle and lateadulthood (see Figure 8.18).
Figure 8.18 Seattle Longitudinal Study ages 25 to 88

Cognitive skills in the aging brain have been studied extensively in pilots, and similar to the
Seattle Longitudinal Study results, older pilots show declines in processing speed and memory
capacity, but their overall performance seems to remain intact. According to Phillips (2011)
researchers tested pilots age 40 to 69 as they performed on flight simulators. Older pilots took
longer to learn to use the simulators but performed better than younger pilots at avoiding
collisions.

330

Flow is the mental state of being completely present and fully absorbed in a task
(Csikszentmihalyi, 1990). When in a state of flow, the individual is able to block outside
distractions and the mind is fully open to producing. Additionally, the person is achieving great
joy or intellectual satisfaction from the activity and accomplishing a goal. Further, when in astate of flow, the individual is not concerned with extrinsic rewards. Csikszentmihalyi (1996)
used his theory of flow to research how some people exhibit high levels of creativity as hebelieved that a state of flow is an important factor to creativity (Kaufman & Gregoire, 2016).
Other characteristics of creative people identified by Csikszentmihalyi (1996) include curiosityand drive, a value for intellectual endeavors, and an ability to lose our sense of self and feel apart of something greater. In addition, he believed that the tortured creative person was a mythand that creative people were very happy with their lives. According to Nakamura andCsikszentmihalyi (2002) people describe flow as the height of enjoyment. The more theyexperience it, the more they judge their lives to be gratifying. The qualities that allow for flow
are well-developed in middle adulthood.
Tacit knowledge is knowledge that is pragmatic or practical and learned through experiencerather than explicitly taught, and it also increases with age (Hedlund, Antonakis, & Sternberg,
2002). Tacit knowledge might be thought of as "know-how" or "professional instinct." It is
referred to as tacit because it cannot be codified or written down. It does not involve
academic knowledge, rather it involves being able to use skills and to problem-solve in practicalways. Tacit knowledge can be understood in the workplace and used by blue collar workers,
such as carpenters, chefs, and hair dressers.

Middle Adults Returning to Education
Midlife adults in the
United States often findthemselves in college
classrooms. In fact, the rateof enrollment for older
Americans enteringcollege, often part-time orin the evenings, is rising
faster than traditionallyaged students. Students
over age 35, accounted for
17% of all college andgraduate students in 2009,
and are expected tocomprise 19% of that total
by 2020 (Holland, 2014).
In some cases, older
students are developing
Sourceskills and expertise inorder to launch a second
career, or to take their career in a new direction. Whether they enroll in school to sharpen
particular skills, to retool and reenter the workplace, or to pursue interests that have previously
Figure 8.19 Middle Adults in College

331been neglected, older students tend to approach the learning process differently than younger
college students (Knowles, Holton, & Swanson, 1998).
The mechanics of cognition, such as working memory and speed of processing, gradually declinewith age. However, they can be easily compensated for through the use of higher order cognitive
skills, such as forming strategies to enhance memory or summarizing and comparing ideas rather
than relying on rote memorization (Lachman, 2004). Although older students may take a bit
longer to learn material, they are less likely to forget it quickly. Adult learners tend to look forrelevance and meaning when learning information. Older adults have the hardest time learningmaterial that is meaningless or unfamiliar. They are more likely to ask themselves, "Why is thisimportant?" when being introduced to information or when trying to memorize concepts orfacts. Older adults are more task-oriented learners and want to organize their activity aroundproblem-solving.
Rubin et al. (2018) surveyed university students aged 17-70 regarding their satisfaction andapproach to learning in college. Results indicated that older students were more independent,
inquisitive, and motivated intrinsically compared to younger students. Additionally, older
women processed information at a deeper learning level and expressed more satisfaction with
their education.
To address the educational needs of those over 50, The American Association of Community
Colleges (2016) developed the Plus 50 Initiative that assists community college in creating or
expanding programs that focus on workforce training and new careers for the plus-50
population. Since 2008 the program has provided grants for programs to 138 community
colleges affecting over 37, 000 students. The participating colleges offer workforce training
programs that prepare 50 plus adults for careers in such fields as early childhood educators,
certified nursing assistants, substance abuse counselors, adult basic education instructors, andhuman resources specialists. These training programs are especially beneficial as 80% of people
over the age of 50 say they will retire later in life than their parents or continue to work inretirement, including in a new field.

Gaining Expertise: The Novice and the Expert
Expertise refers to specialized skills and knowledge that pertain to a particular topic or activity.
In contrast, a novice is someone who has limited experiences with a particular task. Everyone
develops some level of “selective” expertise in things that are personally meaningful to them,such as making bread, quilting, computer programming, or diagnosing illness. Expert thought isoften characterized as intuitive, automatic, strategic, and flexible.
•

Intuitive: Novices follow particular steps and rules when problem solving, whereas
experts can call upon a vast amount of knowledge and past experience. As a result, theiractions appear more intuitive than formulaic. Novice cooks may slavishly follow therecipe step by step, while chefs may glance at recipes for ideas and then follow their own
procedure.

•

Automatic: Complex thoughts and actions become more routine for experts. Theirreactions appear instinctive over time, and this is because expertise allows us to process332

information faster and more effectively (Crawford & Channon, 2002).
•

Strategic: Experts have more effective strategies than non-experts. For instance, whileboth skilled and novice doctors generate several hypotheses within minutes of an
encounter with a patient, the more skilled clinicians’ conclusions are likely to be moreaccurate. In other words, they generate better hypotheses than the novice. This is because
they are able to discount misleading symptoms and other distractors and hone in on themost likely problem the patient is experiencing (Norman, 2005). Consider how your notetaking skills may have changed after being in school over a number of years. Chances
are you do not write down everything the instructor says, but the more central ideas. You
may have even come up with your own short forms for commonly mentioned words in acourse, allowing you to take down notes faster and more efficiently than someone who
may be a novice academic note taker.

•

Flexible: Experts in all fields are more curious and creative; they enjoy a challenge andexperiment with new ideas or procedures. The only way for experts to grow in theirknowledge is to take on more challenging, rather than routine tasks.

Expertise takes time. It is a long-process resulting from experience and practice (Ericsson,
Feltovich, & Prietula, 2006). Middle-aged adults, with their store of knowledge and experience,
are likely to find that when faced with a problem they have likely faced something similar
before. This allows them to ignore the irrelevant and focus on the important aspects of the issue.
Expertise is one reason why many people often reach the top of their career in middle adulthood.
However, expertise cannot fully make-up for all losses in general cognitive functioning as weage. The superior performance of older adults in comparison to younger novices appears to betask specific (Charness & Krampe, 2006). As we age, we also need to be more deliberate in ourpractice of skills in order to maintain them. Charness and Krampe (2006) in their review of theliterature on aging and expertise, also note that the rate of return for our effort diminishes as weage. In other words, increasing practice does not recoup the same advances in older adults as
similar efforts do at younger ages.

Work at Midlife
Who is the U.S. workforce? The civilian, non-institutionalized workforce; the population of
those aged 16 and older, who are employed has steadily declined since it reached its peak in thelate 1990s, when 67% of the civilian workforce population was employed. In 2012 the rate had
dropped to 64% and by 2019 it declined to 62.9% (Bureau of Labor Statistics, 2019). The U.S.
population is expected to grow more slowly based on census projections for the next few years.
Those new entrants to the labor force, adults age 16 to 24, are the only population of adults thatwill shrink in size over the next few years by nearly half a percent, while those age 55 and up
will grow by 2.3% over current rates, and those age 65 to 74 will grow by nearly 4% (Monthly
Labor Review (MLR), 2013). In 1992, 26% of the population was 55+, by 2022 it is projected to
be 38%. Table 8.8 shows the rates of employment by age. In 2002, baby boomers were between
the ages of 38 to 56, the prime employment group. In 2012, the youngest baby boomers were 48
and the oldest had just retired (age 66). These changes might explain some of the steady decline
in work participation as this large population cohort ages out of the workforce.
333

In 2012, 53% of the workforce was male. For both genders and for most age groups the rate ofparticipation in the labor force has declined from 2002 to 2012, and it is projected to decline
further by 2022. The exception is among the older middle-age groups (the baby boomers), andespecially for women 55 and older.
Table 8.8
Percentage of the non-institutionalized civilian workforce employed by gender & age.
Males
Females
2002
2012
2022*
2002
2012
16-19
47.5
34
27.8
47.3
34.6
20-24
80.7
74.5
69.9
72.1
67.4
25-34
92.4
89.5
88.8
75.1
74.1
35-44
92.1
90.7
90.4
76.4
74.8
45-54
88.5
86.1
85.1
76
74.7
55-59
78
78
77.8
63.8
67.3
60-64
57.6
60.5
64.3
44.1
50.4
16+ totals
74.1
70.2
67.6
59.6
57.7
*Projected rates of employment (adapted from Monthly Labor Review, 2013).

2022*
26.7
64.7
73.4
73.3
74.9
73.3
55.6
56

Hispanic males have the highest rate of participation in the labor force. In 2012, 76% of
Hispanic males, compared with 71% of White, 72% of Asian, and 64% of Black men ages 16 orolder were employed. Among women, Black women were more likely to be participating in theworkforce (58%) compared with almost 57% of Hispanic and Asian, and 55% of White females.
The rates for all racial and ethnic groups are expected to decline by 2022 (MLR, 2013).
Climate in the Workplace for Middle-aged Adults: A number of studies have found that job
satisfaction tends to peak in middle adulthood (Besen, Matz-Costa, Brown, Smyer, & PittCatsouphers, 2013; Easterlin, 2006). This satisfaction stems from not only higher wages, but
often greater involvement in decisions that affect the workplace as they move from worker tosupervisor or manager. Job satisfaction is also influenced by being able to do the job well, andafter years of experience at a job many people are more effective and productive. Anotherreason for this peak in job satisfaction is that at midlife many adults lower their expectations andgoals (Tangri, Thomas, & Mednick, 2003). Middle-aged employees may realize they havereached the highest they are likely to in their career. This satisfaction at work translates into
lower absenteeism, greater productivity, and less job hopping in comparison to younger adults(Easterlin, 2006).
However, not all middle-aged adults are happy in the work place. Women may find themselves
up against the glass ceiling. This may explain why females employed at large corporations aretwice as likely to quit their jobs as are men (Barreto, Ryan, & Schmitt, 2009). Another problem
older workers may encounter is job burnout, defined as unsuccessfully managed work placestress (World Health Organization, 2019). Burnout consists of:•••

Feelings of energy depletion or exhaustion
Increased mental distance from one’s job, or feelings of job negativism or cynicism
Reduced professional efficacy
334

American workers may
experience more burnout than
do workers in many otherdeveloped nations, because
most developed nations
guarantee by law a set numberof paid vacation days
(International Labour
Organization, ILO, 2011), theUnited States does not (U.S.
Department of Labor, 2016).

Figure 8.20 Average Annual Hours Actually Worked
per Worker
Australia
CanadaDenmark
FranceGermanyJapan
MexicoSpain
SwedenRussiaUnited Kingdom
United States

1665
1706
1457
1482
1371
1719
2246
1691
1612
1978
1674
1790

Not all employees are covered
under overtime pay laws (U.S.
0
500
1000
1500
2000
2500
Department of Labor, 2016).
This is important when you
Hours
considered that the 40-hourwork week is a myth for most Americans. Only 4 in 10 U.S. workers work the typical 40-hourwork week. The average work week for many is almost a full day longer (47 hours), with 39%
working 50 or more hours per week (Saad, 2014). In comparision to workers in many otherdeveloped nations, American workers work more hours per year (Organisation for Economic
Cooperation and Development, OECD, 2016). As can be seen in Figure 8.20, Americans work
more hours than most European nations, especially western and northern Europe, althouigh theywork less hours than workers in other nations, especially Mexico.
Challenges in the Workplace for Middleaged Adults: In recent years middle aged
adults have been challenged by economic
downturns, starting in 2001, and again in
2008. Fifty-five percent of adults reported
some problems in the workplace, such as
fewer hours, pay-cuts, having to switch topart-time, etc., during the most recent
economic recession (see Figure 8.21, Pew
Research Center, 2010a). While young
adults took the biggest hit in terms of levelsof unemployment, middle-aged adults also
saw their overall financial resources suffer
as their retirement nest eggs disappeared andhouse values shrank, while foreclosuresincreased (Pew Research Center, 2010b).
Not surprisingly this age group reported thatthe recession hit them worse than did otherage groups, especially those age 50-64.
Middle aged adults who find themselves
unemployed are likely to remain
unemployed longer than those in early

Figure 8.21

335

adulthood (U.S. Government Accountability Office, 2012). In the eyes of employers, it may be
more cost effective to hire a young adult, despite their limited experience, as they would bestarting out at lower levels of the pay scale. In addition, hiring someone who is 25 and has many
years of work ahead of them versus someone who is 55 and will likely retire in 10 years may
also be part of the decision to hire a younger worker (Lachman, 2004). American workers arealso competing with global markets and changes in technology. Those who are able to keep up
with all these changes or are willing to uproot and move around the country or even the world
have a better chance of finding work. The decision to move may be easier for people who areyounger and have fewer obligations to others.

LeisureAs most developed nations restrict the number of hours an employer can demand that an
employee work per week, and require employers to offer paid vacation time, what do middle
aged adults do with their time off from work and duties, referred to as leisure? Around the world
the most common leisure activity in both early and middle adulthood is watching television(Marketing Charts Staff, 2014). On average, middle aged adults spend 2-3 hours per day
watching TV (Gripsrud, 2007) and watching TV accounts for more than half of all the leisuretime (see Figure 8.22).
Figure 8.22

In the United States, men spend about 5 hours more per week in leisure activities, especially on
weekends, than do women (Drake, 2013; U.S. Bureau of Labor Statistics, 2016). The leisure gap
336between mothers and fathers is slightly smaller, about 3 hours a week, than among those withoutchildren under age 18 (Drake, 2013). Those age 35-44 spend less time on leisure activities thanany other age group, 15 or older (U.S. Bureau of Labor Statistics, 2016). This is not surprising as
this age group are more likely to be parents and still working up the ladder of their career, sothey may feel they have less time for leisure.
Americans have less leisure time than people in many other developed nations. As you readearlier, there are no laws in many job sectors guaranteeing paid vacation time in the UnitedStates (see Figure 8.23). Ray, Sanes and Schmitt (2013) report that several other nations also
provide additional time off for young and older workers and for shift workers. In the UnitedStates, those in higher paying jobs and jobs covered by a union contract are more likely to have
paid vacation time and holidays (Ray & Schmitt, 2007).
Figure 8.23 Legally Mandated Time Off

But do U.S. workers take their time off? According to Project Time-Off (2016), 55% of U.S.
workers in 2015 did not take all of their paid vacation and holiday leave. A large percentage ofthis leave is lost. It cannot be rolled-over into the next year or paid out. A total of 658 million
vacation days, or an average of 2 vacation days per worker was lost in 2015. The reasons mostoften given for not taking time off was worry that there would be a mountain of work to return to(40%), concern that no one else could do the job (35%), not being able to afford a vacation(33%), feeling it was harder to take time away when you have or are moving up in the company(33%), and not wanting to seem replaceable (22%). Since 2000, more American workers arewilling to work for free rather than take the time that is allowed to them. A lack of support fromtheir boss and even their colleagues to take a vacation is often a driving force in deciding to337

forgo time off. In fact, 80% of the respondents to the survey above said they would take timeaway if they felt they had support from their boss. Two-thirds reported that they hear nothing,mixed messages, or discouraging remarks about taking their time off. Almost a third (31%) feelthey should contact their workplace, even while on vacation.
The benefits of taking time away from work: Several studies have noted the benefits of taking
time away from work. It reduces job stress burnout (Nimrod, Kleiber, & Berdychevesky, 2012),
improves both mental health (Qian, Yarnal, & Almeida, 2013) and physical health (Stern &Konno, 2009), especially if that leisure time also includes moderate physical activity (Lee et al.,2015). Leisure activities can also improve productivity and job satisfaction (Kühnel &Sonnentag, 2011) and help adults deal with balancing family and work obligations (Lee, et al.,2015).

Learning Objectives: Psychosocial Development in Middle Adulthood
•
•
•
•
•
•
•
•
•

Explain the controversy surrounding the concept of a midlife crisis
Explain the sources of stress confronting adults in midlife and the strategies to cope
Summarize Erikson’s seventh psychosocial task of generativity vs stagnation
Describe the relationships middle-aged adults have with their children, parents, andother family members
Describe singlehood, marriage, divorce, and remarriage at midlife
Describe the contemporary roles of grandparents
Describe friendships at midlife
Explain how women are uniquely affected at midlife
Explain the role of religion at midlife

There are many socioemotional changes that occur in how middle-aged adults perceive
themselves. While people in their early 20s may emphasize how old they are to gain respect or to
be viewed as experienced, by the time people reach their 40s they tend to emphasize how young
they are. For instance, few 40 year olds cut each other down for being so young stating: "You're
only 43? I'm 48!” A previous focus on the future gives way to an emphasis on the present.
Neugarten (1968) notes that in midlife, people no longer think of their lives in terms of how longthey have lived. Rather, life is thought of in terms of how many years are left.

Midlife Crisis?
In 1978 Daniel Levinson published a book entitled The Seasons of a Man’s Life in which hepresented a theory of development in adulthood. Levinson’s work was based on in-depth
interviews with 40 men between the ages of 35-45. Levinson (1978) indicated that adults go
through stages and have an image of the future that motivates them. This image is called “thedream” and for the men interviewed, it was a dream of how their career paths would progress
and where they would be at midlife. According to Levinson the midlife transition (40-45) was a338

time of reevaluating previous commitments; making dramatic changes if necessary; giving
expression to previously ignored talents or aspirations; and feeling more of a sense of urgency
about life and its meaning. By the time the men entered middle adulthood (45-50), they believed
they committed to the new choices made and placed one’s energies into these commitments.
Levinson believed that a midlife crisis was a normal part of development as the person is moreaware of how much time has gone by and how much time is left. The future focus of early
adulthood gives way to an emphasis on the present in midlife, and the men interviewed had
difficulty reconciling the “dream” they held about the future with the reality they experienced.
Consequently, they felt impatient and were no longer willing to postpone the things they had
always wanted to do. Although Levinson believed his research demonstrated the existence of a
midlife crisis, his study has been criticized for his research methods, including small sample size,
similar ages, and concerns about a cohort effect. In fact, other research does not support his
theory of the midlife crisis.
Vaillant (2012) believed that it was the cross-sectional design of Levinson’s study that led to theerroneous conclusion of an inevitable midlife crisis. Instead, he believed that longitudinalstudies of an individual’s entire life was needed to determine the factors associated with
optimum health and potential. Vaillant was one of the main researchers in the 75 year-old
Harvard Study of Adult Development, and he considered a midlife crisis to be a rare occurrence
among the participants (Vaillant, 1977). Additional findings of this longitudinal study will be
discussed in the next chapter on late adulthood.
Most research suggests that most people in the United States today do not experience a midlife
crisis. Results of a 10-year study conducted by the MacArthur Foundation Research Network on
Successful Midlife Development, based on telephone interviews with over 3,000 midlife adults,suggest that the years between 40 and 60 are ones marked by a sense of well-being. Only 23% of
their participants reported experiencing a midlife crisis. The crisis tended to occur among thehighly educated and was triggered by a major life event rather than out of a fear of aging(Research Network on Successful Midlife Development, 2007).

StressFigure 8.24 Are you Stressed?

StressWe all know that stress plays a major role in our mental
and physical health, but what exactly is stress? The
term stress is defined as a pattern of physical andpsychological responses in an organism after it
perceives a threatening event that disturbs its
homeostasis and taxes its abilities to cope with theevent (Hooker & Pressman, 2016). Stress was originallyderived from the field of mechanics where it is used todescribe materials under pressure. The word was firstused in a psychological manner by researcher Hans
Selye, who was examining the effect of an ovarian
hormone that he thought caused sickness in a sample ofrats. Surprisingly, he noticed that almost any injected339

hormone produced this same sickness. He smartly realized that it was not the hormone underinvestigation that was causing these problems, but instead the aversive experience of being
handled and injected by researchers led to high physiological arousal, and eventually to healthproblems like ulcers.
Selye (1946) coined the term
stressor to label a stimulus that
had this effect on the body (thatis, causing stress). He
developed a model of the stressresponse called the General
Adaptation Syndrome, which
is a three-phase model ofstress, which includes amobilization of physiologicalresources phase, a coping
phase, and an exhaustion phase(i.e., when an organism fails tocope with the stress adequately
and depletes its resources).
Figure 8.25 illustrates theGeneral Adaptation Syndrome.

Figure 8.25 General Adaptation Syndrome

SourcePsychologists have studied stress in a myriad of ways, and it is not just major life stressor (e.g., afamily death, a natural disaster) that increase the likelihood of getting sick. Stress can result fromnegative events, chronically difficult situations, a biological fight-or-flight response, and as
clinical illness, such as post-traumatic stress disorder (PTSD). Even small daily hassles, likegetting stuck in traffic or fighting with your friend, can raise your blood pressure, alter yourstress hormones, and even suppress your immune system function (DeLongis, Folkman, &Lazarus, 1988; Twisk, Snel, Kemper, & van Machelen, 1999). Stress continues to be one of themost important and well-studied psychological correlates of illness, because excessive stresscauses potentially damaging wear and tear on the body and can influence almost any disease
process.
Dispositions and Stress: Negative dispositions and personality traits have been strongly tied toan array of health risks. One of the earliest negative trait-to-health connections was discovered in
the 1950s by two cardiologists. They made the interesting discovery that there were common
behavioral and psychological patterns among their heart patients that were not present in other
patient samples. This pattern included being competitive, impatient, hostile, and time urgent.
They labeled it Type A Behavior. Importantly, it was found to be associated with double therisk of heart disease as compared with Type B Behavior (absence of Type A behaviors)(Friedman & Rosenman, 1959). Since the 1950s, researchers have discovered that it is thehostility and competitiveness components of Type A that are especially harmful to heart health340

(Iribarren et al., 2000; Matthews, Glass, Rosenman, & Bortner, 1977; Miller, Smith, Turner,
Guijarro, & Hallet, 1996). Hostile individuals are quick to get upset, and this angry arousal candamage the arteries of the heart. In addition, given their negative personality style, hostile people
often lack a heath-protective supportive social network.
Social Relationships and Stress: Research has shown thatthe impact of social isolation on our risk for disease and deathis similar in magnitude to the risk associated with smoking
regularly (Holt-Lunstad, Smith, & Layton, 2010; House,Landis, & Umberson, 1988). In fact, the importance of social
relationships for our health is so significant that somescientists believe our body has developed a physiologicalsystem that encourages us to seek out our relationships,
especially in times of stress (Taylor et al., 2000). Social
integration is the concept used to describe the number ofsocial roles that you have (Cohen & Willis, 1985). For
example, you might be a daughter, a basketball team member,a Humane Society volunteer, a coworker, and a student.
Maintaining these different roles can improve your health via
encouragement from those around you to maintain a healthy
lifestyle. Those in your social network might also provide
you with social support (e.g., when you are under stress).
This support might include emotional help (e.g., a hug when
you need it), tangible help (e.g., lending you money), or
Sourceadvice. By helping to improve health behaviors and reducestress, social relationships can have a powerful, protective impact on health, and in some cases,
might even help people with serious illnesses stay alive longer (Spiegel, Kraemer, Bloom, &Gottheil, 1989).
Figure 8.26 Social support
is important for handlingstressCaregiving and Stress: A disabled child, spouse, parent, or other family member is part of the
lives of some midlife adults. According to the National Alliance for Caregiving (2015), 40
million Americans provide unpaid caregiving. The typical caregiver is a 49 year-old female
currently caring for a 69 year-old female who needs care because of a long-term physicalcondition. Looking more closely at the age of the recipient of caregiving, the typical caregiver
for those 18-49 years of age is a female (61%) caring mostly for her own child (32%) followed
by a spouse or partner (17%). When looking at older recipients (50+) who receive care, thetypical caregiver is female (60%) caring for a parent (47%) or spouse (10%).
Caregiving places enormous stress on the caregiver. Caregiving for a young or adult child withspecial needs was associated with poorer global health and more physical symptoms among bothfathers and mothers (Seltzer, Floyd, Song, Greenberg, & Hong, 2011). Marital relationships arealso a factor in how the caring affects stress and chronic conditions. Fathers who werecaregivers identified more chronic health conditions than non-caregiving fathers, regardless ofmarital quality. In contrast, caregiving mothers reported higher levels of chronic conditions
when they reported a high level of marital strain (Kang & Marks, 2014). Age can also make a341

difference in how one is affected by the stress of caring for a child with special needs. Using datafrom the Study of Midlife in the Unites States, Ha, Hong, Seltzer and Greenberg (2008) foundthat older parents were significantly less likely to experience the negative effects of having adisabled child than younger parents. They concluded that an age-related weakening of the stressoccurred over time. This follows with the greater emotional stability noted at midlife.
Currently 25% of adult children, mainly baby boomers, provide personal or financial care to aparent (Metlife, 2011). Daughters are more likely to provide basic care and sons are more likely
to provide financial assistance. Adult children 50+ who work and provide care to a parent are
more likely to have fair or poor health when compared to those who do not provide care. Some
adult children choose to leave the work force, however, the cost of leaving the work force early
to care for a parent is high. For females, lost wages and social security benefits equals $324,044,
while for men it equals $283,716 (Metlife, 2011). This loss can jeopardize the adult child’s
financial future. Consequently, there is a need for greater workplace flexibility for working
caregivers.
Spousal Care: Certainly, caring for a disabled spouse would be a difficult experience that could
negatively affect one’s health. However, research indicates that there can be positive healtheffect for caring for a disabled spouse. Beach, Schulz, Yee and Jackson (2000) evaluated healthrelated outcomes in four groups: Spouses with no caregiving needed (Group 1), living with adisabled spouse but not providing care (Group 2), living with a disabled spouse and providing
care (Group 3), and helping a disabled spouse while reporting caregiver strain, including
elevated levels of emotional and physical stress (Group 4). Not surprisingly, the participants inGroup 4 were the least healthy and identified poorer perceived health, an increase in health-risk
behaviors, and an increase in anxiety and depression symptoms. However, those in Group 3 who
provided care for a spouse, but did not identify caregiver strain, actually identified decreased
levels of anxiety and depression compared to Group 2 and were actually similar to those inGroup 1. It appears that greater caregiving involvement was related to better mental health aslong as the caregiving spouse did not feel strain. The beneficial effects of helping identified by
the participants were consistent with previous research (Krause, Herzog, & Baker, 1992; Schulz
et al., 1997).
When caring for a disabled spouse, gender differences
Figure 8.27 Caregiving for females
have also been identified. Female caregivers of ais associated with greater stressspouse with dementia experienced more burden, hadpoorer mental and physical health, exhibited increased
depressive symptomatology, took part in fewer healthpromoting activities, and received fewer hours of help
than male caregivers (Gibbons et al., 2014). This
study was consistent with previous research findingsthat women experience more caregiving burden thanmen, despite similar caregiving situations (Torti,
Gwyther, Reed, Friedman, & Schulman, 2004;
Yeager, Hyer, Hobbs, & Coyne, 2010). Explanations
Sourcefor why women do not use more external support,
which may alleviate some of the burden, include
women’s expectations that they should assume caregiving roles (Torti et al, 2004) and their342

concerns with the opinions of others (Arai, Sugiura, Miura, Washio, & Kudo, 2000). Also
contributing to women’s poorer caregiving outcomes is that disabled males are more aggressive
than females, especially males with dementia who display more physical and sexual aggression
toward their caregivers (Eastley & Wilcock, 1997; Zuidema, de Jonghe, Verhey, & Koopmans,
2009). Female caregivers are certainly at risk for negative consequences of caregiving, andgreater support needs to be available to them.
Stress Management: On a scale from 1 to 10, those Americans aged 39-52 rated their stress at
5.3, and those aged 53-71 rated their stress at 3.9 (American Psychological Association, 2017).
The most common sources of stress included the future of our nation, money, work, current
political climate, and violence and crime. Given that these sources of our stress are often difficult
to change, a number of interventions have been designed to help reduce the aversive responses toduress, especially related to health. For example, relaxation activities and forms of meditation aretechniques that allow individuals to reduce their stress via breathing exercises, muscle relaxation,and mental imagery. Physiological arousal from stress can also be reduced via biofeedback, atechnique where the individual is shown bodily information that is not normally available tothem (e.g., heart rate), and then taught strategies to alter this signal. This type of intervention
has even shown promise in reducing heart and hypertension risk, as well as other serious
conditions (Moravec, 2008; Patel, Marmot, & Terry, 1981). Reducing stress does not have to becomplicated. For example, exercise is a great stress reduction activity (Salmon, 2001) that has amyriad of health benefits.
Coping Strategies: Coping is often classified into
Figure 8.28 How do you cope withtwo categories: Problem-focused coping or
stress when stuck in traffic?
emotion-focused coping (Carver, Scheier, &Weintraub, 1989). Problem-focused coping isthought of as actively addressing the event that is
causing stress in an effort to solve the issue athand. For example, say you have an important
exam coming up next week. A problem-focusedstrategy might be to spend additional time over the
weekend studying to make sure you understand allof the material. Emotion-focused coping, on theother hand, regulates the emotions that come with
Sourcestress. In the above examination example, thismight mean watching a funny movie to take yourmind off the anxiety you are feeling. In the short term, emotion-focused coping might reduce
feelings of stress, but problem-focused coping seems to have the greatest impact on mental
wellness (Billings & Moos, 1981; Herman-Stabl, Stemmler, & Petersen, 1995). That being said,
when events are uncontrollable (e.g., the death of a loved one), emotion-focused coping directed
at managing your feelings, at first, might be the better strategy. Therefore, it is always important
to consider the match of the stressor to the coping strategy when evaluating its plausible benefits.

343

Erikson: Generativity vs Stagnation
According to Erikson (1950, 1982) generativity encompasses procreativity, productivity, andcreativity. This stage includes the generation of new beings, new products, and new ideas, aswell as self-generation concerned with further identity development. Erikson believed that thestage of generativity, during which one established a family and career, was the longest of all thestages. Individuals at midlife are primarily concerned with leaving a positive legacy ofthemselves, and parenthood is the primary generative type. Erikson understood that work andfamily relationships may be in conflict due to the obligations and responsibilities of each, but hebelieved it was overall a positive developmental time. In addition to being parents and working,Erikson also described individuals being involved in the community during this stage. A senseof stagnation occurs when one is not active in generative matters, however, stagnation canmotive a person to redirect energies into more meaningful activities.
Erikson identified “virtues” for each of his eight stages, and the virtue emerging when one
achieves generativity is “Care”. Erikson believed that those in middle adulthood should “takecare of the persons, the products, and the ideas one has learned to care for” (Erikson, 1982, p.
67). Further, Erikson believed that the strengths gained from the six earlier stages are essential
for the generational task of cultivating strength in the next generation. Erikson further argued
that generativity occurred best after the individual had resolved issues of identity and intimacy(Peterson & Duncan, 2007).
Research has demonstrated that generative adults
Figure 8.29 Generativity at Midlife
possess many positive characteristics, including
good cultural knowledge and healthy adaptation to
the world (Peterson & Duncan, 2007). Using the
Big 5 personality traits, generative women and menscored high on conscientiousness, extraversion,agreeableness, openness to experience, and low onneuroticism (de St. Aubin & McAdams, 1995;
Peterson, Smirles, & Wentworth, 1997).
Additionally, women scoring high in generativity at
age 52, were rated high in positive personality
characteristics, satisfaction with marriage andSourcemotherhood, and successful aging at age 62(Peterson & Duncan, 2007). Similarly, men rated higher in generativity at midlife wereassociated with stronger global cognitive functioning (e.g., memory, attention, calculation),stronger executive functioning (e.g., response inhibition, abstract thinking, cognitive flexibility),and lower levels of depression in late adulthood (Malone, Liu, Vaillant, Rentz, & Waldinger,2016).
Erikson (1982) indicated that at the end of this demanding stage, individuals may withdraw as
generativity is no longer expected in late adulthood. This releases elders from the task of caretaking or working. However, not feeling needed or challenged may result in stagnation, andconsequently one should not fully withdraw from generative tasks as they enter Erikson’s laststage in late adulthood.
344

Midlife Relationships
The sandwich generation refers to adults who have at least one parent age 65 or older and areeither raising their own children or providing support for their grown children. According to a
recent Pew Research survey, 47% of
Figure 8.30
middle-aged adults are part of thissandwich generation (Parker & Patten,2013). In addition, 15% of middle-aged
adults are providing financial support toan older parent while raising or
supporting their own children (see Figure8.30). According to the same survey,
almost half (48%) of middle-aged adults,
have supported their adult children in thepast year, and 27% are the primary sourceof support for their grown children.
Seventy-one percent of the sandwich
generation is age 40-59, 19% wereyounger than 40, and 10% were 60 orolder. Hispanics are more likely to find themselves supporting two generations; 31% haveparents 65 or older and a dependent child, compared with 24% of whites and 21% of blacks(Parker & Patten, 2013). Women are more likely to take on the role of care provider for older
parents in the U.S. and Germany (Pew Research, 2015). About 20% of women say they havehelped with personal care, such as getting dressed or bathing, of aging parents in the past year,
compared with 8% of men in the U.S. and 4% in Germany. In contrast, in Italy men are just as
likely (25%) as women (26%) to have provided personal care.
The Pew survey found that almost 33% of the
sandwich-generation adults were more likely
to say they always feel rushed, while only
23% of other adults said this. However, thesurvey suggests that those who were
supporting both parents and children reported
being just as happy as those middle-aged
adults who did not find themselves in the
sandwich generation (Parker & Patten, 2013).
Adults who are supporting both parents andchildren did report greater financial strain(see Figure 8.31). Only 28% reported thatthey were living comfortably versus 41% of
those who were not also supporting theirparents. Almost 33% were just making ends
meet, compared with 17% of those who did
not have the additional financial burden of
aging parents.

Figure 8.31

345

Kinkeeping: At midlife adults may find themselves as a kinkeeper. In all families there is aperson or persons who keep the family connected and who promote solidarity and continuity inthe family (Brown & DeRycke, 2010). Who in your own family do you count on to organize
family gatherings? Who knows the history of your family? Who do people turn to in your family
for advice and support? Who works to strengthen the bonds between members of your family?
These are your family’s kinkeepers, and they are usually women (Leach & Braithwaite, 1996;
Brown & DeRycke, 2010). Leach and Braithwaite found that 86% of their respondents named awoman as their family’s kinkeeper, and Brown and DeRycke found that mothers, maternal
grandmothers, and paternal grandmothers were more likely to be a family’s kinkeeper than werefathers, young adult children, and grandfathers combined. Brown and DeRycke also found thatamong young adults, women were more likely to be a kinkeeper than were young adult men.
Kinkeeping can be a source of distress when it interferes with other obligations (Gerstel &Gallagher, 1993). Gerstel and Gallagher found that on average, kinkeepers provide almost a fullweek of work each month to kinkeeping (almost 34 hours). They also found that the more
activities the kinkeeper took on, and the more kin they helped the more stress and higher thelevels of depression a kinkeeper experienced. However, unlike other studies on kinkeeping,
Gerstel and Gallagher also included a number of activities that would be considered more“caregiving,” such as providing transportation, making repairs, providing meals, etc. in addition
to the usual activities of kinkeeping.
Empty nest: The empty nest, or post-parental period refers to the time period when children aregrown up and have left home (Dennerstein, Dudley & Guthrie, 2002). For most parents thisoccurs during midlife. This time is recognized as a “normative event” as parents are aware that
their children will become adults and eventually leave home (Mitchell & Lovegreen, 2009). The
empty nest creates complex emotions, both positive and negative, for many parents. Some
theorists suggest this is a time of role loss for parents, others suggest it is one of role strain relief(Bouchard, 2013).
The role loss hypothesis predicts that when people lose an important role in their life theyexperience a decrease in emotional well-being. It is from this perspective that the concept of theempty nest syndrome emerged, which refers to great emotional distress experienced byparents, typically mothers, after children have left home. The empty nest syndrome is linked tothe absence of alternative roles for the parent in which they could establish their identity(Borland, 1982). In Bouchard’s (2013) review of the research, she found that few parents
reported loneliness or a big sense of loss once all their children had left home.
In contrast, the role stress relief hypothesis suggests that the empty nest period should lead tomore positive changes for parents, as the responsibility of raising children has been lifted. The
role strain relief hypothesis was supported by many studies in Bouchard’s (2013) review. A
consistent finding throughout the research literature is that raising children has a negative impact
on the quality of martial relationships (Ahlborg, Misvaer, & Möller, 2009; Bouchard, 2013).
Most studies have reported that martial satisfaction often increases during the launching phase of
the empty nest period, and that this satisfaction endures long after the last child has left home
(Gorchoff, John, & Helson, 2008).
However, most of the research on the post-parental period has been with American parents. A
number of studies in China suggest that empty-nesters, especially in more rural areas of China,346

report greater loneliness and depression than their counterparts with children still at home (Wu etal., 2010). Family support for the elderly by their children is a cherished Chinese tradition (Wong& Leung, 2012). With children moving from the rural communities to the larger cities foreducation and employment this may explain the more pessimistic reaction of Chinese parents
than in American samples. The loss of an adult child in a rural region may mean a loss of family
income for aging parents. Empty-nesters in urban regions of China did not report the same
degree of distress (Su et al., 2012), suggesting that it not so much the event of children leaving,
but the additional hardships this may place on aging parents.
Boomerang Kids: As you read in Chapter 7, young
adults are living with their parents for a longer durationand in greater numbers than previous generations. In
addition to those in early adulthood who are not leaving
the home of their parents, there are also young adults who
are returning after having lived independently outside thehome, and these are called boomerang kids. Figure 8.32
shows the number of American young people 25-35 who
were living at home based on their generation (Fry,2017). Figure 8.33 shows that more young adults 18-34
in Europe are also living with their parents (Desilver,2016). Many of the same financial reasons that are
influencing young people’s decisions to delay exit fromthe home of their parents are underlying their decisions toreturn home. In addition, to financial reasons, someboomerang kids are returning because of emotional
distress, such as mental health issues (Sandberg-Thoma,
Snyder, & Jang, 2015).

Figure 8.32

What is the effect on parents when their adult children
return home? Certainly, there is considerable researchthat shows that the stress of raising children can have anegative impact on parents’ well-being, and that whenchildren leave home many couples experience less stress and greater life satisfaction (see thesection on the empty nest). Early research in the 1980s and 1990s supported the notion thatboomerang children, along with those who were failing to exit the home, placed greater financial
hardship on the parents, and the parents reported more negative perceptions of this living
arrangement (Aquilino, 1991). Recent surveys suggest that today’s parents are more tolerant of
this, perhaps because this is becoming a more normative experience than in the past. Moreover,children who return are more likely to have had good relationships with their parents growing up,
so there may be less stress between parents and their adult children who return (Sandberg-Thoma
et al., 2015). Parents of young adults who have moved back home because of economic reasons
report that they are just as satisfied with their life as are parents whose adult children are still
living independently (Parker, 2012). Parker found that adult children age 25 and older are more
likely to contribute financially to the family or complete chores and other household duties.
Parker also found that living in a multigenerational household may be acting as an economic
safety net for young adults. In comparison to young adults who were living outside of the home,
those living with their parents were less likely to be living in poverty (17% versus 10%).
347

So far, we have considered the impact that
adult children who have returned home orhave yet to leave the nest have on the livesof middle-aged parents. What about theeffect on parents who have adult children
dealing with personal problems, such as
alcoholism, chronic health concerns,
mental health issues, trouble with the law,poor social relationships, or academic or
job related problems, even if they are notliving at home? The life course
perspective proposes the idea of linked
lives (Greenfield & Marks, 2006). The
notion that people in important
relationships, such as children andparents, mutually influence each other’sdevelopmental pathways. In previous
chapters you have read about the effects
that parents have on their children’sdevelopment, but this relationship isbidirectional. The problems faced bychildren, even when those children are
adults, influence the lives of their parents.
Greenfield and Marks found in their studyof middle-aged parents and their adultchildren, those parents whose children
were dealing with personal problems
reported more negative affect, lower self-acceptance, poorer parent-child interactions, and morefamily relationship stress. The more problems the adult children were facing, the worse the lives
and emotional health of their parents, with single parents faring the worst.
Figure 8.33

Middle Adult Lifestyles
Singlehood: According to a Pew Research study, 16 per 1,000 adults age 45 to 54 and 7 per1000 age 55 and over have never-married in the U. S. (Wang & Parker, 2014). However, someof them may be living with a partner. In addition, some singles at midlife may be single throughdivorce or widowhood. DePaulo (2014) has challenged the idea that singles, especially thealways single, fair worse emotionally and in health when compared to those married. DePaulosuggests there is a bias in how studies examine the benefits of marriage. Most studies focus oncomparisons between married versus not married, which do not include a separate comparison
between those always single, and those who are single because of divorce or widowhood. Her
research has found that those who are married may be more satisfied with life than the divorced
or widowed, but there is little difference between married and always single, especially whencomparing those who are recently married with those who have been married for four or more
years. It appears that once the initial blush of the honeymoon wears off, those who are wedded
are no happier or healthier than those who remained single. This might also suggest that there
may be problems with how the “married” category is also seen as one homogeneous group.
348

Online Dating: Montenegro (2003) surveyed over 3,000 singles aged 40–69, and almost half ofthe participants reported their most important reason for dating was to have someone to talk to or
do things with. Additionally, sexual fulfillment was also identified as an important goal for
many. Alterovitz & Mendelsohn (2013) reviewed online personal ads for men and women overage 40 and found that romantic activities and sexual interests were mentioned at similar rates
among the middle-age and young-old age groups, but less for the old-old age group.
Marriage: As you read in Chapter
Figure 8.34
7, there has been a number ofchanges in the marriage rate as more
people are cohabitating, more aredeciding to stay single, and more are
getting married at a later age. As
you can see in Figure 8.34, 48% of
adults age 45-54 are married; either
in their first marriage (22%) or haveremarried (26%). This makes
marriage the most common
relationship status for middle-aged
adults in the United States. Maritalsatisfaction tends to increase formany couples in midlife as children
are leaving home (Landsford,
Antonucci, Akiyama, & Takahashi,2005). Not all researchers agree.
They suggest that those who are
unhappy with their marriage arelikely to have gotten divorced bynow, making the quality of marriages later in life only look more satisfactory (Umberson,
Williams, Powers, Chen, & Campbell, 2005).
Divorce: Livingston (2014) found that 27% of adults age 45 to 54 were divorced (see Figure8.32). Additionally, 57% of divorced adults were women. This reflects the fact that men are
more likely to remarry than are women. Two-thirds of divorces are initiated by women (AARP,
2009). Most divorces take place within the first 5 to 10 years of marriage. This time line reflects
people’s initial attempts to salvage the relationship. After a few years of limited success, thecouple may decide to end the marriage. It used to be that divorce after having been married for
20 or more years was rare, but in recent years the divorce rate among more long-term marriages
has been increasing. Brown and Lin (2013) note that while the divorce rate in the U.S. has
declined since the 1990s, the rate among those 50 and older has doubled. They suggest several
reasons for the “graying of divorce”. There is less stigma attached to divorce today than in thepast. Some older women are out-earning their spouses, and thus may be more financially capableof supporting themselves, especially as most of their children have grown. Finally, given
increases in human longevity, the prospect of living several more years or decades with anincompatible spouse may prompt middle-aged and older adults to leave the marriage.

349

Gottman and Levenson (2000) found that the divorces in early adulthood were angrier andconflictual, with each partner blaming the other for the failures in the marriage. In contrast, theyfound that at midlife divorces tended to be more about having grown apart, or a cooling off ofthe relationship. A survey by AARP (2009) found that men and women had diverse motivations
for getting a divorce. Women reported concerns about the verbal and physical abusiveness of
their partner (23%), drug/alcohol abuse (18%), and infidelity (17%). In contrast, men mentioned
they had simply fallen out of love (17%), no longer shared interests or values (14%), andinfidelity (14%). Both genders felt their marriage had been over long before the decision to
divorce was made, with many of the middle-aged adults in the survey reporting that they stayed
together because they were still raising children. Females also indicated that they remained intheir marriage due to financial concerns, including the loss of health care (Sohn, 2015).
However, only 1 in 4 adults regretted their decision to divorce.
The effects of divorce are varied. Overall, young adults struggle more with the consequences ofdivorce than do those at midlife, as they have a higher risk of depression or other signs ofproblems with psychological adjustment (Birditt & Antonucci, 2013). Divorce at midlife is morestressful for women. In the AARP (2009) survey, 44% of middle-aged women mentioned
financial problems after divorcing their spouse, in comparison only 11% of men reported suchdifficulties. However, a number women who divorce in midlife report that they felt a great
release from their day-to-day sense of unhappiness. Hetherington and Kelly (2002) found thatamong the divorce enhancers, those who had used the experience to better themselves and seek
more productive intimate relationships, and the competent loners, those who used their divorce
experience to grow emotionally, but who choose to stay single, the overwhelming majority were
women.
Dating Post-Divorce: Most divorced adults have dated by one year after filing for divorce(Anderson et al., 2004; Anderson & Greene, 2011). One in four recent filers report having beenin or were currently in a serious relationship, and over half were in a serious relationship by one
year after filing for divorce. Not surprisingly, younger adults were more likely to be dating thanwere middle aged or older adults, no doubt due to the larger pool of potential partners fromwhich they could to draw. Of course, these relationships will not all end in marriage. Teachman(2008) found that more than two thirds of women under the age of 45 had cohabited with apartner between their first and second marriages.
Dating for adults with children can be more of a challenge. Courtships are shorter in remarriage
than in first marriages. When couples are "dating", there is less going out and more time spent in
activities at home or with the children. So the couple gets less time together to focus on theirrelationship. Anxiety or memories of past relationships can also get in the way. As one
Talmudic scholar suggests "when a divorced man marries a divorced woman, four go to bed."(Secombe & Warner, 2004).
Post-divorce parents gatekeep, that is, they regulate the flow of information about their new
romantic partner to their children, in an attempt to balance their own needs for romance withconsideration regarding the needs and reactions of their children. Anderson et al. (2004) foundthat almost half (47%) of dating parents gradually introduce their children to their dating partner,
giving both their romantic partner and children time to adjust and get to know each other. Many
parents who use this approach do so to avoid their children having to keep meeting someone newuntil it becomes clearer that this relationship might be more than casual. It might also help if the350

adult relationship is on firmer ground so it can weather any initial push back from children when
it is revealed. Forty percent are open and transparent about the new relationship at the outset with
their children. Thirteen percent do not reveal the relationship until it is clear that cohabitationand or remarriage is likely. Anderson and colleagues suggest that practical matters influencewhich gatekeeping method parents may use. Parents may be able to successfully shield theirchildren from a parade of suitors if there is reliable childcare available. The age andtemperament of the child, along with concerns about the reaction of the ex-spouse, may also
influence when parents reveal their romantic relationships to their children.
Rates of remarriage: The rate for remarriage, like the rate for marriage, has been declining
overall. In 2013 the remarriage rate was approximately 28 per 1,000 adults 18 and older. This
represents a 44% decline since 1990 and a 16% decline since 2008 (Payne, 2015). Brown and
Lin (2013) found that the rate of remarriage dropped more for younger adults than middle aged
and older adults, and Livingston (2014) found that as we age we are more likely to haveremarried (see Figure 8.35). This is not surprising as it takes some time to marry, divorce, andthen find someone else to marry. However, Livingston found that unlike those younger than 55,
those 55 and up are remarrying at a higher rate than in the past. In 2013, 67% of adults 55-64
and 50% of adults 65 and older had remarried, up from 55% and 34% in 1960, respectively.
Figure 8.35

Men have a higher rate of remarriage at every age
group starting at age 25 (Payne, 2015). Livingston(2014) reported that in 2013, 64% of divorced or
widowed men compared with 52% of divorced or
widowed women had remarried. However, this gender
gap has narrowed over time. Even though more men
still remarry, they are remarrying at a slower rate. In
contrast, women are remarrying today more than they
did in 1980. This gender gap has closed mostly among
young and middle aged adults, but still persists among
those 65 and older.
In 2012, Whites who were previously married weremore likely to remarry than were other racial and ethnic
groups (Livingston, 2014). Moreover, the rate ofremarriage has increased among Whites, while the rateof remarriage has declined for other racial and ethnic
groups. This increase is driven by White women, whose
rate of remarriage has increased, while the rate for
White males has declined.

Success of Remarriage: Reviews are mixed as to the happiness and success of remarriages.
While some remarriages are more successful, especially if the divorce motivated the adult toengage in self-improvement and personal growth (Hetherington & Kelly, 2002), a number ofdivorced adults end up in very similar marriages the second or third time around (Hetherington& Kelly, 2002). Remarriages have challenges that are not found in first marriages that may
create additional stress in the marital relationship. There can often be a general lack of clarity infamily roles and expectations when trying to incorporate new kin into the family structure, evendetermining the appropriate terms for these kin, along with their roles can be a challenge.
351

Partners may have to navigate carefully their role when dealing with their partners’ children. Allof this may lead to greater dissatisfaction and even resentment among family members. Even
though remarried couples tend to have more realistic expectations for marriage, they tend to beless willing to stay in unhappy situations. The rate of divorce among remarriages is higher thanamong first marriages (Payne, 2015), which can add additional burdens, especially whenchildren are involved.
Children’s Influence on Repartnering: Does having children affect whether a parent
remarries? Goldscheider and Sassler (2006) found children residing with their mothers reduces
the mothers’ likelihood of marriage, only with respect to marrying a man without children.
Further, having children in the home appears to increase single men’s likelihood of marrying awoman with children (Stewart, Manning, & Smock, 2003). There is also some evidence that
individuals who participated in a stepfamily while growing up may feel better prepared forstepfamily living as adults. Goldscheider and Kaufman (2006) found that having experienced
family divorce as a child is associated with a greater willingness to marry a partner with children.
When children are present after divorce, one of
the challenges the adults encounter is how
much influence the child will have whenselecting a new partner. Greene, Anderson,
Hetherington, Forgatch, and DeGarmo (2003)
identified two types of parents. The childfocused parent allows the child’s views,
reactions, and needs to influence therepartnering. In contrast, the adult-focusedparent expects that their child can adapt andshould accommodate to parental wishes.
Anderson and Greene (2011) found thatdivorced custodial mothers identified as more
Sourceadult focused tended to be older, moreeducated, employed, and more likely to havebeen married longer. Additionally, adult focused mothers reported having less rapport with theirchildren, spent less time in joint activities with their children, and the child reported lower
rapport with their mothers. Lastly, when the child and partner were resisting one another, adultfocused mothers responded more to the concerns of the partner, while the child focused mothers
responded more to the concerns of the child. Understanding the implications of these twodiffering perspectives can assist parents in their attempts to repartner.
Figure 8.36

Grandparents
In addition to maintaining relationships with their children and aging parents, many people inmiddle adulthood take on yet another role, becoming a grandparent. The role of grandparent
varies around the world. In multigenerational households, grandparents may play a greater rolein the day-to-day activities of their grandchildren. While this family dynamic is more common
in Latin America, Asia, and Africa, it has been on the increase in the U.S. (Pew Research Center,2010).

352

The degree of grandparent involvement
also depends on the proximity of the
grandparents’ home to the grandchildren.
In developed nations, the greater mobilityof the society can mean that grandparents
may live long distances from their
grandchildren. Technology has brought
grandparents and their more distantgrandchildren together. Sorenson andCooper (2010) found that many of the
grandfathers they interviewed would text,
email, or Skype with their grandchildren inorder to stay in touch.

Figure 8.37

SourceCherlin and Furstenberg (1986) described three styles of grandparents. Thirty percent ofgrandparents were remote as they rarely saw their grandchildren. Usually they lived far awayfrom the grandchildren but may also have had a distant relationship. Contact was typically madeon special occasions, such as holidays or birthdays. Fifty-five percent of grandparents were
described as companionate as they did things with their grandchildren but had little authority orcontrol over them. They preferred to spend time with them without interfering in parenting. They
were more like friends to their grandchildren. Fifteen percent of grandparents were described as
involved as they took a very active role in their grandchild’s life. The involved grandparent had
frequent contact with and authority over the grandchild, and their grandchildren might even have
lived with them. Grandmothers, more so than grandfathers, played this role. In contrast, moregrandfathers than grandmothers saw their role as family historian and family advisor (Neugarten
and Weinstein, 1964).
Bengtson (2001) suggests that grandparents adopt different styles with different grandchildren,and over time may change styles as circumstances in the family change. Today moregrandparents are the sole care providers for grandchildren or may step in at times of crisis. With
these changes grandparents are redefining how they see their role in the family with fewer
adopting a more formal role (Hayslip, Henderson & Shore, 2003).
Early research on grandparents has routinely focused on grandmothers, with grandfathers often
becoming invisible members of the family (Sorensen & Cooper, 2010). Yet, grandfathers stressthe importance of their relationships with their grandchildren as strongly as do grandmothers(Waldrop et al., 1999). For some men, this may provide them with the opportunity to engage inactivities that their occupations, as well as their generation’s views of fatherhood andmasculinity, kept them from engaging in with their own children (Sorenson & Cooper, 2010).
Many of the grandfathers in Sorenson and Cooper’s study felt that being a grandfather was easier
and a lot more enjoyable. Even among grandfathers that took on a more involved role, there wasstill a greater sense that they could be more light-hearted and flexible in their interactions with
their grandchildren. Many grandfathers reported that they were more openly affectionate with
their grandchildren than they had been with their own children.
353

Friendships
Adults of all ages who reported having a confidante or close friend with whom they could sharepersonal feelings and concerns, believed these friends contributed to a sense of belonging,security, and overall wellbeing (Dunér & Nordstrom, 2007). Having a close friend is a factor insignificantly lower odds of psychiatric morbidity including depression and anxiety (Harrison,
Barrow, Gask, & Creed, 1999; Newton et al., 2008). The availability of a close friend has also
been shown to lessen the adverse effects of stress on health (Kouzis & Eaton, 1998; Hawkley etal., 2008; Tower & Kasl, 1995). Additionally, poor social connectedness in adulthood is
associated with a larger risk of premature mortality than cigarette smoking, obesity, andexcessive alcohol use (Holt-Lunstad, Smith, & Layton, 2010).
Female friendships and social
support networks at midlife
Figure 8.38
contribute significantly to a
woman’s feeling of life
satisfaction and well-being(Borzumato-Gainey, Kennedy,
McCabe, & Degges-White,2009). Degges-White and Myers(2006) found that women who
have supportive people in theirlife experience greater life
satisfaction than do those wholive a more solitary life. A
friendship network or the
Sourcepresence of a confidant haveboth been identified for their importance to women's mental health (Baruch & Brooks-Gunn,
1984). Unfortunately, with numerous caretaking responsibilities at home, it may be difficult for
women to find time and energy to enhance the friendships that provide an increased sense of life
satisfaction (Borzumato-Gainey et al., 2009). Emslie, Hunt and Lyons (2013) found that for men
in midlife, the shared consumption of alcohol was important to creating and maintaining malefriends. Drinking with friends was justified as a way for men to talk to each other, provide social
support, relax, and improve mood. Although the social support provided when men drink
together can be helpful, the role of alcohol in male friendships can lead to health damaging
behavior from excessive drinking.
The importance of social relationships begins in early adulthood by laying down a foundation forstrong social connectedness and facilitating comfort with intimacy (Erikson, 1959). To
determine the impact of the quantity and quality of social relationships in young adulthood on
middle adulthood, Carmichael, Reis, and Duberstein (2015) assessed individuals at age 50 on
measures of social connection (types of relationships and friendship quality) and psychologicaloutcomes (loneliness, depression, psychological well-being). Results indicated that the quantityof social interactions at age 20 and the quality, not quantity, of social interaction at age 30
predicted midlife social interactions. Those individuals who had high levels of social
information seeking (quantity) at age 20 followed by less quantity in social relationships but
greater emotional closeness (quality), resulted in positive psychosocial adjustment at midlife.
354

Continuing to socialize widely in one’s 30s appeared to negatively affect the development of
intimacy, and consequently resulted in worse psychological outcomes at age 50.
Internet Friendships: What influence does the Internet have on friendships? It is not surprisingthat people use the Internet with the goal of meeting and making new friends (Fehr, 2008;
McKenna, 2008). Researchers have wondered if the issue of not being face-to-face reduces theauthenticity of relationships, or if the Internet really allows people to develop deep, meaningfulconnections. Interestingly, research has demonstrated that virtual relationships are often as
intimate as in-person relationships; in fact, Bargh and colleagues found that online relationships
are sometimes more intimate (Bargh, McKenna, & Fitsimons, 2002). This can be especially true
for those individuals who are more socially anxious and lonely as such individuals are more
likely to turn to the Internet to find new and meaningful relationships (McKenna, Green, &Gleason, 2002). McKenna and colleagues suggest that for people who have a hard time meetingand maintaining relationships, due to shyness, anxiety, or lack of face-to-face social skills, theInternet provides a safe, nonthreatening place to develop and maintain relationships. Similarly,
Benford (2008) found that for high-functioning autistic individuals, the Internet facilitatedcommunication and relationship development with others, which would have been more difficultin face-to-face contexts, leading to the conclusion that Internet communication could be
empowering for those who feel frustrated when communicating face to face.
Workplace Friendships: Friendships often take root in the workplace, due to the fact thatpeople are spending as much, or more, time at work than they are with their family and friends(Kaufman & Hotchkiss, 2003). Often, it is through these relationships that people receive
mentoring and obtain social support and resources, but they can also experience conflicts and thepotential for misinterpretation when sexual attraction is an issue. Indeed, Elsesser and Peplau(2006) found that many workers reported that friendships grew out of collaborative work
projects, and these friendships made their days more pleasant.
In addition to those benefits,
Riordan and Griffeth (1995)
found that people who worked in
an environment where
friendships could develop and be
maintained were more likely toreport higher levels of job
satisfaction, job involvement,
and organizational commitment,
and they were less likely to leavethat job. Similarly, a Gallup poll
revealed that employees who had
close friends at work were almost
50% more satisfied with theirjobs than those who did not(Armour, 2007).

Figure 8.39

Source355

Women in Midlife
In Western society, aging for women is much more stressful than for men as society emphasizes
youthful beauty and attractiveness (Slevin, 2010). The description that aging men are viewed as“distinguished” and aging women are viewed as “old” is referred to as the double standard ofaging (Teuscher & Teuscher, 2006). Since women have traditionally been valued for theirreproductive capabilities, they may be considered old once they are postmenopausal. In contrast,
men have traditionally been valued for their achievements, competence and power, and therefore
are not considered old until they are physically unable to work (Carroll, 2016). Consequently,
women experience more fear, anxiety, and concern about their identity as they age, and may feelpressure to prove themselves as productive and valuable members of society (Bromberger,
Kravitz, & Chang, 2013).
Attitudes about aging, however, do vary by race, culture, and sexual orientation. In some
cultures, aging women gain greater social status. For example, as Asian women age they attaingreater respect and have greater authority in the household (Fung, 2013). Compared to white
women, Black and Latina women possess less stereotypes about aging (Schuler et al., 2008).
Lesbians are also more positive about aging and looking older than heterosexual women (Slevin,2010). The impact of media certainly plays a role in how women view aging by selling antiaging products and supporting cosmetic surgeries to look younger (Gilleard & Higgs, 2000).

Religion and Spirituality
Grzywacz and Keyes (2004) found that in addition to personal health behaviors, such as regularexercise, healthy weight, and not smoking, social behaviors, including involvement in religiousrelated activities, have been shown to be positively related to optimal health. However, it is not
only those who are involved in a specific religion that
benefit, but so too do those identified as being spiritual.
Figure 8.40
According to Greenfield, Vaillant, and Marks (2009)
religiosity refers to engaging with a formal religious
group’s doctrines, values, traditions, and co-members. In
contrast, spirituality refers to an individual’s intrapsychic
sense of connection with something transcendent (thatwhich exists apart from and not limited by the material
universe) and the subsequent feelings of awe, gratitude,
compassion, and forgiveness. Research has demonstrated astrong relationship between spirituality and psychologicalwell-being, irrespective of an individual’s religious
participation (Vaillant, 2008). Additionally, Sawatzky,
Ratner, & Chiu (2005) found that spirituality was related toa higher quality of life for both individuals and societies.
Based on reports from the 2005 National Survey of Midlife
in the United States, Greenfield et al. (2009) found thathigher levels of spirituality were associated with lower
levels of negative affect and higher levels of positive affect,356

Sourcepersonal growth, purpose in life, positive relationships with others, self-acceptance,
environmental mastery, and autonomy. In contrast, formal religious participation was only
associated with higher levels of purpose in life and personal growth among just older adults andlower levels of autonomy. In summary, it appears that formal religious participation andspirituality relate differently to an individual’s overall psychological well-being.
Age: Older individuals identify religion/spirituality as being more important in their lives thanthose younger (Beit-Hallahmi & Argyle, 1998). This age difference has been explained byseveral factors including that religion and spirituality assist older individuals in coping with agerelated losses, provide opportunities for socialization and social support in later life, anddemonstrate a cohort effect in that older individuals were socialized more to be religious andspiritual than those younger (Greenfield et al., 2009).
Gender: In the United States, women report identifying as being more religious and spiritual
than men do (de Vaus & McAllister, 1987). According to the Pew Research Center (2016),
women in the United States are more likely to say religion is very important in their lives thanmen (60% vs. 47%). American women also are more likely than American men to say they pray
daily (64% vs. 47%) and attend religious services at least once a week (40% vs. 32%). Theories
to explain this gender difference include that women may benefit more from the social-relational
aspects of religion/spirituality because social relationships more strongly influence women’s
mental health. Additionally, women have been socialized to internalize the behaviors linked withreligious values, such as cooperation and nurturance, more than males (Greenfield et al., 2009).
Worldwide: To measure the religious beliefs
Figure 8.41
and practices of men and women around theworld, the Pew Research Center (2016)
conducted surveys of the general population in
84 countries between 2008 and 2015. Overall,an estimated 83% of women worldwide
identified with a religion compared with 80% ofmen. This equaled 97 million more women thanmen identifying with a religion. There were nocountries in which men were more religious than
women by 2 percentage points or more. Among
Christians, women reported higher rates ofweekly church attendance and higher rates ofdaily prayer. In contrast, Muslim women andSourceMuslim men showed similar levels of religiousness, except frequency of attendance at worshipservices. Because of religious norms, Muslim men worshiped at a mosque more often thanMuslim women. Similarly, Jewish men attended a synagogue more often than Jewish women. In
Orthodox Judaism, communal worship services cannot take place unless a minyan, or quorum ofat least 10 Jewish men, is present, thus insuring that men will have high rates of attendance.
Only in Israel, where roughly 22% of all Jewish adults self-identify as Orthodox, did a higher
percentage of men than women report engaging in daily prayer.

357

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Chapter 9: Late Adulthood
Late adulthood spans the time when we reach our mid-sixties until death. This is the longest
developmental stage across the lifespan. In this chapter, we will consider the growth in numbers
for those in late adulthood, how that number is expected to change in the future, and theimplications this will bring to both the United States and worldwide. We will also examine
several theories of human aging, the physical, cognitive, and socioemotional changes that occur
with this population, and the vast diversity among those in this developmental stage. Further,ageism and many of the myths associated with those in late adulthood will be explored.

Learning Objectives: Late Adulthood Definition and Demographics
•
•
•
•
•
•
•

Describe the increase in the number of individuals who are currently identified
as late adults
Describe the increase in late adulthood worldwide
Explain gender and ethnic differences in the number of individuals identified
as late adults
Explain the different ways developmental psychologists describe aging
Explain the difference between life span and life expectancy
Define the four age categories for late adulthood
Explain what factors contribute to becoming a centenarian

Late Adulthood in America
Late adulthood, which includes those aged 65 years and above, is the fastest growing age
division of the United States population (Gatz, Smyer, & DiGilio, 2016). Currently, one in seven
Americans is 65 years of age or older. The first of the baby boomers (born from 1946-1964)
turned 65 in 2011, and approximately 10,000 baby boomers turn 65 every day. By the year
2050, almost one in four Americans will be over 65, and will be expected to live longer thanprevious generations. According to the U. S. Census Bureau (2014b) a person who turned 65 in2015 can expect to live another 19 years, which is 5.5 years longer than someone who turned 65
in 1950. This increasingly aged population has been referred to as the “Graying of America”.
This “graying” is already having significant effects on the nation in many areas, including work,
health care, housing, social security, caregiving, and adaptive technologies. Table 9.1 shows the2012, 2020, and 2030 projected percentages of the U.S. population ages 65 and older.

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Table 9.1 Percent of United States Population 65 Years and Older
Percent of United States
Population

2012

2020

2030

65 Years and Older

13.7%

16.8%

20.3%

65-69

4.5%

5.4%

5.6%

70-74

3.2%

4.4%

5.2%

75-79

2.4%

3.0%

4.1%

80-84

1.8%

1.9%

2.9%

85 Years and Older

1.9%

2.0%

2.5%

Compiled from data from An Aging Nation: The older population in the United States.
United States Census Bureau. http://www.census.gov/prod/2014pubs/p25-1140.pdf

The "Graying" of the World
Even though the United States is aging, it is still younger than most other developed countries(Ortman, Velkoff, & Hogan, 2014). Germany, Italy, and Japan all had at least 20% of their
population aged 65 and over in 2012, and Japan had the highest percentage of elderly.
Additionally, between 2012 and 2050, the proportion aged 65 and over is projected to increase in
all developed countries. Japan is projected to continue to have the oldest population in 2030 and
2050. Table 9.2 shows the percentages of citizens aged 65 and older in select developed
countries in 2012 and projected for 2030 and 2050.

Table 9.2 Percentage of Citizens 65 years and Older in Six Developed Countries
Percent of Population 65
and Older

2012

2030

2050

America

13.7%

20.3%

22%

Japan

24%

32.2%

40%

Germany

20%

27.9%

30%

Italy

20%

25.5%

31%

Canada

16.5%

25%

26.5%

Russia

13%

20%

26%

Compiled from data from An Aging Nation: The older population in the United States.
United States Census Bureau. http://www.census.gov/prod/2014pubs/p25-1140.pdf

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According to the National Institute on Aging (NIA,
2015b), there are 524 million people over 65
worldwide. This number is expected to increase from
8% to 16% of the global population by 2050. Between
2010 and 2050, the number of older people in lessdeveloped countries is projected to increase more than
250%, compared with only a 71% increase in developed
countries. Declines in fertility and improvements inlongevity account for the percentage increase for those
65 years and older. In more developed countries,
fertility fell below the replacement rate of two live births
per woman by the 1970s, down from nearly threechildren per woman around 1950. Fertility rates also fell
Sourcein many less developed countries from an average of six
children in 1950 to an average of two or three children
in 2005. In 2006, fertility was at or below the two-child replacement level in 44 less developed
countries (NIA, 2015d).
Figure 9.1 Age is Increasing
Worldwide

In total number, the United States is projected to have a larger older population than the otherdeveloped nations, but a smaller older population compared with China and India, the world’s
two most populous nations (Ortman et al., 2014). By 2050, China’s older population is projected
to grow larger than the total U.S. population today. As the population ages, concerns grow about
who will provide for those requiring long-term care. In 2000, there were about 10 people 85 andolder for every 100 persons between ages 50 and 64. These midlife adults are the most likely
care providers for their aging parents. The number of old requiring support from their children is
expected to more than double by the year 2040 (He, Sengupta, Velkoff, & DeBarros,
2005). These families will certainly need external physical, emotional, and financial support inmeeting this challenge.

Life Expectancy vs LifespanLifespan or Maximum Lifespan is referred to as the greatest age reached by any member of agiven population (or species). For humans, the lifespan is currently between 120 and 125. Life
expectancy is defined as the average number of years that members of a population (or species)
live. According to the World Health Organization (WHO) (2019) global life expectancy for thoseborn in 2019 is 72.0 years, with females reaching 74.2 years and males reaching 69.8 years.
Women live longer than men around the world, and the gap between the sexes has remained thesame since 1990. Overall life expectancy ranges from 61.2 years in the WHO African Region to77.5 years in the WHO European Region. Global life expectancy increased by 5.5 years between
2000 and 2016. Improvements in child survival and access to antiretroviral medication for thetreatment of HIV are considered factors for the increase. However, life expectancy in lowincome countries (62.7 years) is 18.1 years lower than in high-income countries (80.8 years). In
high-income countries, the majority of people who die are old, while in low-income countries
almost one in three deaths are in children under 5 years of age. According to the Central
Intelligence Agency (2019) the United States ranks 45th in the world for life expectancy.

373

World Healthy Life Expectancy: A better way to appreciate the diversity of people in lateadulthood is to go beyond chronological age and examine how well the person is aging. Many inlate adulthood enjoy better health and social well-being than average and would be aging at an
optimal level. In contrast, others experience poor health and dependence to a greater extent thanwould be considered normal. When looking at large populations, the WHO (2019) measures
how many equivalent years of full health on average a newborn baby is expected to have. Thisage takes into account current age-specific mortality, morbidity, and disability risks and isreferred to as The Healthy Life Expectancy. In 2016, the global Healthy Life Expectancy was
63.3 years up from 58.5 years in 2000. The WHO African Region had the lowest Healthy Life
Expectancy at 53.8 years, while the WHO Western Pacific Region had the highest at 68.9 years.
Life Expectancy in America: The overall life expectancy for a baby born in 2017 in the UnitedStates is 78.6 years, decreasing from 78.7 years in 2016 and 78.8 years in 2015 (Arias & Xu,
2019). The decrease from 2016 occurred for males, changing from 76.2 years to 76.1 years,
while it did not change for females (81.1 years). Life expectancy at birth decreased by 0.1 year
for the non-Hispanic white population (78.6 to 78.5). Life expectancy at birth did not change
from 2016 for the non-Hispanic black population (74.9), and the Hispanic population (81.8).
Before this two-year decline, life expectancy had been increasing. Reasons given by the CDC
for this decrease in life expectancy include deaths from drug overdoses, an increase in liverdisease, and a rise in suicide rates (Saiidi, 2019). Figure 9.2 shows the United States life
expectancy from 2006-2017 by ethnicity and sex.
Figure 9.2 2017 U. S. Life Expectancy by Sex and Ethnicity

374

American Healthy Life Expectancy: To
determine the current United States
Healthy Life Expectancy (HLE), factors
were evaluated in 2007-2009 to determine
how long an individual currently at age 65
will continue to experience good health(CDC, 2013). The highest Healthy Life
Expectancy (HLE) was observed in Hawaii
with 16.2 years of additional good health,and the lowest was in Mississippi with only
10.8 years of additional good health.
Overall, the lowest HLE was among
southern states. Females had a greater
HLE than males at age 65 years in every
Sourcestate and DC. HLE was greater for whites
than for blacks in DC and all states from which data were available, except in Nevada and New
Mexico.
Figure 9.3

Although improvements have occurred in overall life expectancy, children born in America
today may be the first generation to have a shorter life span than their parents. Much of thisdecline has been attributed to the increase in sedentary lifestyle and obesity. Since 1980, theobesity rate for children between 2 and 19 years old has tripled, as 20.5% of children were obese
in 2014 compared with 5% in 1980 (American Medical Association, 2016). Obesity in children
is associated with many health problems, including high blood pressure, type 2 diabetes, elevatedblood cholesterol levels, and psychological concerns including low self-esteem, negative body
image and depression. Excess weight is associated with an earlier risk of obesity-relateddiseases and death. In 2007, former Surgeon General Richard Carmona stated, “Because of theincreasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first
generation that will be less healthy and have a shorter life expectancy than their parents” (p. 1).

Gender Differences in Life Expectancy
Biological Explanations: Biological differences in sex chromosomes and different pattern ofgene expression is theorized as one reason why females live longer (Chmielewski, Boryslawski,& Strzelec, 2016). Males are heterogametic (XY), whereas females are homogametic (XX) withrespect to the sex chromosomes. Males can only express their X chromosome genes that comefrom the mother, while females have an advantage by selecting the “better” X chromosome fromtheir mother or father, while inactivating the “worse” X chromosome. This process of selection
for “better” genes is impossible in males and results in the greater genetic and developmental
stability of females.
In terms of developmental biology, women are the “default” sex, which means that the creationof a male individual requires a sequence of events at a molecular level. According to Chmilewski
et al. (2016):

375

These events are initiated by the activity of the SRY gene located on the Y chromosome.
This activity and change in the direction of development results in a greater number ofdisturbances and developmental disorders, because the normal course of development
requires many different factors and mechanisms, each of which must work properly andat a specific stage of the development. (p. 134)
Men are more likely to contract viral and bacterial infections, and their immunity at the cellularlevel decreases significantly faster with age. Although women are slightly more prone toautoimmune and inflammatory diseases, such as rheumatoid arthritis, the gradual deterioration of
the immune system is slower in women (Caruso, Accardi, Virruso, & Candore, 2013; Hirokawa
et al., 2013).
Looking at the influence of hormones, estrogen levels in women appear to have a protective
effect on their heart and circulatory systems (Viña, Borrás, Gambini, Sastre, & Pallardó, 2005).
Estrogens also have antioxidant properties that protect against harmful effects of free radicals,
which damage cell components, cause mutations, and are in part responsible for the aging
process. Testosterone levels are higher in men than in women and are related to more frequentcardiovascular and immune disorders. The level of testosterone is also responsible, in part, formale behavioral patterns, including increased level of aggression and violence (Martin, Poon, &Hagberg, 2011; Borysławski & Chmielewski, 2012). Another factor responsible for risky
behavior is the frontal lobe of the brain. The frontal lobe, which controls judgment andconsideration of an action’s consequences, develops more slowly in boys and young men. This
lack of judgment affects lifestyle choices, and consequently many more boys and men die bysmoking, excessive drinking, accidents, drunk driving, and violence (Shmerling, 2016).
Lifestyle Factors: Certainly not all the reasons
Figure 9.4 Men have more
women live longer than men are biological. As
dangerous jobs
previously mentioned, male behavioral patterns
and lifestyle play a significant role in the shorter
lifespans for males. One significant factor is thatmales work in more dangerous jobs, including
police, fire fighters, and construction, and they
are more exposed to violence. According to theFederal Bureau of Investigation (2014) there were
11,961 homicides in the U.S. in 2014 (last year
for full data) and of those 77% were males.
Males are also more than three times as likely tocommit suicide (CDC, 2016a). Further, males
serve in the military in much larger numbers than
Sourcefemales. According to the Department of Defense(2015), in 2014 83% of all officers in the Services(Navy, Army, Marine Corps and Air Force) were male, while 85% of all enlisted service
members were male.

376

Figure 9.5 Men Benefit from a
Relationship with a Doctor

SourceAdditionally, men are less likely than women to have
health insurance, develop a regular relationship with adoctor, or seek treatment for a medical condition(Scott, 2015). As mentioned in the middle adulthood
chapter, women are more religious than men, which is
associated with healthier behaviors (Greenfield,
Vaillant & Marks, 2009). Lastly, social contact is also
important as loneliness is considered a health hazard.
Nearly 20% of men over 50 have contact with theirfriends less than once a month, compared to only 12%
of women who see friends that infrequently (Scott,2015). Overall, men’s lower life expectancy appears
to be due to both biological and lifestyle factors.

Age Categories in Late Adulthood
There have been many ways to categorize the ages of individuals in late adulthood. In thischapter, we will be dividing the stage into four categories: Young–old (65-74), old-old (75-84),
the oldest-old (85-99), and centenarians (100+) for comparison. These categories are based on
the conceptions of aging including, biological, psychological, social, and chronologicaldifferences. They also reflect the increase in longevity of those living to this latter stage.
Young-old: Generally, this age span includes many
positive aspects and is considered the “golden years”
of adulthood. When compared to those who are older,
the young-old experience relatively good health andsocial engagement (Smith, 2000), knowledge andexpertise (Singer, Verhaeghen, Ghisletta,
Lindenberger, & Baltes, 2003), and adaptive flexibility
in daily living (Riediger, Freund, & Baltes, 2005). The
young-old also show strong performance in attention,
memory, and crystallized intelligence. In fact, those
identified as young-old are more similar to those in
midlife. This group is less likely to require long-termcare, to be dependent or poor, and more likely to be
married, working for pleasure rather than income, andliving independently. Overall, those in this age period
feel a sense of happiness and emotional well-being that
Sourceis better than at any other period of adulthood(Carstensen, Fung, & Charles, 2003; George, 2009;
Robins & Trzesniewski, 2005). It is also an unusual age in that people are considered both in
old age and not in old age (Rubinstein, 2002).
Figure 9.6 Young-old experience
positive well-being

Old-old: Adults in this age period are likely to be living independently, but often experience
physical impairments as chronic diseases increase after age 75. For example, congestive heart
377

failure is 10 times more common in people 75 and older, than in younger adults (National
Library of Medicine, 2019). In fact, half of all cases of heart failure occur in people after age 75(Strait & Lakatta, 2012). In addition, hypertension and cancer rates are also more common after
75, but because they are linked to lifestyle choices, they typically can be can prevented, lessoned,or managed (Barnes, 2011b).
Oldest-old: This age group often includes people who have more serious chronic ailments
among the older adult population. In the U.S., the oldest-old represented 14% of the older adult
population in 2015 (He, Goodkind, & Kowal, 2016). This age group is one of the fastest growing
worldwide and is projected to increase more than 300% over its current levels (NIA, 2015b).
The oldest-old are projected to be nearly 18 million by 2050, or about 4.5% of the U. S.
population, compared with less than 2% of the population today. Females comprise more than
60% of those 85 and older, but they also suffer from more chronic illnesses and disabilities thanolder males (Gatz et al., 2016).
While this age group accounts
for only 2% of the U. S.
population, it accounts for 9% of60
all hospitalizations (Levant,50
Chari & DeFrances, 2015). In a
study of over 64,000 patients age
40
65 and older who visited an
30
emergency department, the20admission rates increased withage. Thirty-five% of admissions
10
after an emergency room visit
0were the young old, almost 43%
65-74
75-84
85+
were the old-old, and nearly half
were the oldest-old (Lee, Oh,
Admissions
Death
Park, Choi, & Wee, 2018). The
Adapted from Source
mortality rate was also higher
with age. The most common
reasons for hospitalization for the oldest-old were congestive heart failure, pneumonia, urinary
tract infections, septicemia, stroke, and hip fractures. In recent years, hospitalizations for manyof these medical problems have been reduced. However, hospitalization for urinary tract
infections and septicemia has increased for those 85 and older Levant et al., 2015).
Figure 9.7 Percentage of Admissions and Death.

Those 85 and older are more likely to require long-term care and to be in nursing homes than theyoungest-old. Almost 50% of the oldest-old require some assistance with daily living activities(APA, 2016). However, most still live in the community rather than a nursing home, as shownin Figure 9.7 (Stepler, 2016b). The oldest-old are less likely to be married and living with aspouse compared with the majority of the young-old (APA, 2016; Stepler, 2016c). As can beseen, in Figure 9.8, gender is also an important factor in the likelihood of being married or livingwith one’s spouse.

378

Figure 9.8 Living Arrangements of Older Adults in 2014
Nursing home of other facility

Unmarried living with family or none family

Unmarried living with own children

Living with spouse

Living alone
120
100
80

30

17

27
46

60
40

46

12

69

49

23
20
0

13
8
2
Women 65-84

13

10
6
8

Women 85+

Men 85+7

4
7
2
Men 65-84

Adapted from Pew Research Center

Centenarians: A segment of the oldest-old are centenarians, that is,
100 and older, and some are also referred to as supercentarians, those
110 and older (Wilcox, Wilcox & Ferrucci, 2008). In 2015 there
were nearly half a million centenarians worldwide, and it is estimatedthat this age group will grow to almost 3.7 million by 2050. The U. S.
has the most centenarians, but Japan and Italy have the most percapita (Stepler, 2016e). Most centenarians tended to be healthier thanmany of their peers as they were growing older, and often there was adelay in the onset of any serious disease or disability until their 90s.
Additionally, 25% reached 100 with no serious chronic illnesses, suchas depression, osteoporosis, heart disease, respiratory illness, ordementia (Ash et al. 2015). Centenarians are more likely toexperience a rapid terminal decline in later life, meaning that for mostof their adulthood, and even older adult years, they are relatively
healthy in comparison to many other older adults (Ash et al., 2015;
Wilcox et al., 2008). According to Guinness World Records (2016),
Jeanne Louise Calment has been documented to be the longest living
person at 122 years and 164 days old (See Figure 9.9).

379

Figure 9.9 JeanneLouise Calment
from France

SourceLearning Objectives: Physical Development in Late Adulthood
•
•
•
•
•
•
•
•
•

Describe different theories of aging
Describe the changes in physical appearance in late adulthood
Describe the sensory changes in late adulthood
Describe chronic health conditions during late adulthood
Describe the importance of nutrition and exercise in late adulthood
Describe the physical and functional changes in the brain during lateadulthood
Explain what happens in Parkinson’s disease
Explain how sleep patterns change in late adulthood
Explain how sexuality changes in late adulthood

Theories of Aging
Why do we age? There are many theories that attempt to explain how we age, however,researchers still do not fully understand what factors contribute to the human lifespan (Jin, 2010).
Research on aging is constantly evolving and includes a variety of studies involving genetics,
biochemistry, animal models, and human longitudinal studies (NIA, 2011a). According to Jin(2010), modern biological theories of human aging involve two categories. The first is
Programmed Theories that follow a biological timetable, possibly a continuation of childhood
development. This timetable would depend on “changes in gene expression that affect thesystems responsible for maintenance, repair, and defense responses,” (p. 72). The second
category includes Damage or Error Theories which emphasize environmental factors thatcause cumulative damage in organisms. Examples from each of these categories will be
discussed.
Genetics: One’s genetic make-up certainly plays a
Figure 9.10
role in longevity, but scientists are still attempting
to identify which genes are responsible. Based onanimal models, some genes promote longer life,
while other genes limit longevity. Specifically,
longevity may be due to genes that better equip
someone to survive a disease. For others, some
genes may accelerate the rate of aging, while others
decrease the rate. To help determine which genes
promote longevity and how they operate,
researchers scan the entire genome and compare
Sourcegenetic variants in those who live longer with those
who have an average or shorter lifespan. For
example, a National Institutes of Health study identified genes possibly associated with blood fatlevels and cholesterol, both risk factors for coronary disease and early death (NIA, 2011a).

380

Researchers believe that it is most likely a combination of many genes that affect the rate ofaging.
Evolutionary Theory: Evolutionary psychology emphasizes the importance of natural selection;that is, those genes that allow one to survive and reproduce will be more likely to be transmitted
to offspring. Genes associated with aging, such as Alzheimer Disease, do not appear until after
the individual has passed their main reproductive years. Consequently, natural selection has not
eliminated these damaging disorders from the gene pool. If these detrimental disorders occurredearlier in the development cycle, they may have been eliminated already (Gems, 2014).
Cellular Clock Theory: This theory suggests that
Figure 9.11 Telomeres andbiological aging is due to the fact that normal cells
Cellular Senescencecannot divide indefinitely. This is known as the
Hayflick limit, and is evidenced in cells studied in test
tubes, which divide about 40-60 times before they stop
(Bartlett, 2014). But what is the mechanism behind thiscellular senescence? At the end of each chromosomal
strand is a sequence of DNA that does not code for any
particular protein, but protects the rest of thechromosome, which is called a telomere. With each
replication, the telomere gets shorter. Once it becomes
too short the cell does one of three things. It can stop
replicating by turning itself off, called cellularsenescence. It can stop replicating by dying, called
Adapted from National Institute on Aging
apoptosis. Or, as in the development of cancer, it cancontinue to divide and become abnormal. Senescentcells can also create problems. While they may be turned off, they are not dead, thus they stillinteract with other cells in the body and can lead to an increase risk of disease. When we areyoung, senescent cells may reduce our risk of serious diseases such as cancer, but as we age they
increase our risk of such problems (NIA, 2011a). Understanding why cellular senescencechanges from being beneficial to being detrimental is still under investigation. The answer may
lead to some important clues about the aging process.
DNA Damage: Over time DNA, which contains the genetic code for all organisms, accumulates
damage. This is usually not a concern as our cells are capable of repairing damage throughout
our life. Further, some damage is harmless. However, some damage cannot be repaired andremains in our DNA. Scientists believe that this damage, and the body’s inability to fix itself, isan important part of aging (NIA, 2011a). As DNA damage accumulates with increasing age, it
can cause cells to deteriorate and malfunction (Jin, 2010). Factors that can damage DNA include
ultraviolet radiation, cigarette smoking, and exposure to hydrocarbons, such as auto exhaust andcoal (Dollemore, 2006).
Mitochondrial Damage: Damage to mitochondrial DNA can lead to a decaying of themitochondria, which is a cell organelle that uses oxygen to produce energy from food. The
mitochondria convert oxygen to adenosine triphosphate (ATP) which provides the energy for thecell. When damaged, mitochondria become less efficient and generate less energy for the celland can lead to cellular death (NIA, 2011a).
381

Free Radicals: When the mitochondria uses oxygen to
produce energy, they also produce potentially harmful
byproducts called oxygen free radicals (NIA, 2011a). The
free radicals are missing an electron and create instability
in surrounding molecules by taking electrons from them.
There is a snowball effect (A takes from B and then B takes
from C, etc.) that creates more free radicals which disrupt
the cell and causes it to behave abnormally (See Figure
9.11). Some free radicals are helpful as they can destroy
bacteria and other harmful organisms, but for the most part
they cause damage in our cells and tissue. Free radicals are
identified with disorders seen in those of advanced age,
including cancer, atherosclerosis, cataracts, andneurodegeneration. Some research has supported adding
antioxidants to our diets to counter the effects of free radical
damage because the antioxidants can donate an electron thatcan neutralize damaged molecules. However, the researchon the effectiveness of antioxidants is not conclusive(Harvard School of Public Health, 2016).

Figure 9.12 Free Radicals

SourceFigure 9.13 Former President Obama

Barack Obama 2008
SourceBarack Obama 2012
SourceImmune and Hormonal Stress Theories:
Ever notice how quickly U.S. presidents seemto age? Before and after photos reveal how
stress can play a role in the aging process.
When gerontologists study stress, they are notjust considering major life events, such as
unemployment, death of a loved one, or thebirth of a child. They are also including
metabolic stress, the life sustaining activitiesof the body, such as circulating the blood,
eliminating waste, controlling bodytemperature, and neuronal firing in the brain.
In other words, all the activities that keep the
body alive also create biological stress.

To understand how this stress affects aging, researchers note that both problems with the innate
and adaptive immune system play a key role. The innate immune system is made up of the skin,mucous membranes, cough reflex, stomach acid, and specialized cells that alert the body of animpending threat. With age these cells lose their ability to communicate as effectively, making it
harder for the body to mobilize its defenses. The adaptive immune system includes the tonsils,
spleen, bone marrow, thymus, circulatory system and the lymphatic system that work to produce
and transport T cells. T-cells, or lymphocytes, fight bacteria, viruses, and other foreign threats tothe body. T-cells are in a “naïve” state before they are programmed to fight an invader andbecome “memory cells”. These cells now remember how to fight a certain infection should the382

body ever come across this invader again. Memory cells can remain in your body for many
decades, and why the measles vaccine you received as a child is still protecting you from thisvirus today. As older adults produce fewer new T-cells to be programmed, they are less able tofight off new threats and new vaccines work less effectively. The reason why the shingles
vaccine works well with older adults is because they already have some existing memory cells
against the varicella virus. The shingles vaccine is acting as a booster (NIA, 2011a).
Hormonal Stress Theory, also known as Neuroendocrine Theory of Aging, suggests that as
we age the ability of the hypothalamus to regulate hormones in the body begins to decline
leading to metabolic problems (American Federation of Aging Research (AFAR) 2011). Thisdecline is linked to excess of the stress hormone cortisol. While many of the body’s hormones
decrease with age, cortisol does not (NIH, 2014a). The more stress we experience, the more
cortisol released, and the more hypothalamic damage that occurs. Changes in hormones havebeen linked to several metabolic and hormone related problems that increase with age, such as
diabetes (AFAR, 2011), thyroid problems (NIH, 2013), osteoporosis, and orthostatic hypotension(NIH, 2014a).

Physical Changes of Aging
The Baltimore Longitudinal Study on Aging (BLSA) (NIA, 2011b) began in 1958 and has traced
the aging process in 1,400 people from age 20 to 90. Researchers from the BLSA have foundthat the aging process varies significantly from individual to individual and from one organsystem to another. However, some key generalization can be made including:• Heart muscles thicken with age• Arteries become less flexible• Lung capacity diminishes• Kidneys become less efficient in removing waste from the blood• Bladder loses its ability to store urine• Brain cells also lose some functioning, but new neurons can also be produced.
Many of these changes are determined by genetics, lifestyle, and disease. Other changes in lateadulthood include:
Body Changes: Everyone’s body shape changes naturally as they age. According to the National
Library of Medicine (2014) after age 30 people tend to lose lean tissue, and some of the cells of
the muscles, liver, kidney, and other organs are lost. Tissue loss reduces the amount of water inyour body and bones may lose some of their minerals and become less dense (a condition called
osteopenia in the early stages and osteoporosis in the later stages). The amount of body fat goesup steadily after age 30, and older individuals may have almost one third more fat compared towhen they were younger. Fat tissue builds up toward the center of the body, including around theinternal organs.
Skin, Hair and Nails: With age skin becomes thinner, less elastic, loses fat, and no longer looks
plump and smooth. Veins and bones can be seen easier, and scratches, cuts, and bumps can takelonger to heal. Years exposed to the sun may lead to wrinkles, dryness, age spots, and cancer.
Older people may bruise more easily, and it can take longer for these bruises to heal. Some383

medicines or illnesses may also cause bruising. Gravity can cause skin to sag and wrinkle, andsmoking can wrinkle the skin. Also, seen in older adults are age spots, previously called “liver
spots”. They look like flat, brown spots and are often caused by years in the sun. Skin tags are
small, usually flesh-colored growths of skin that have a raised surface. They become common as
people age, especially for women, but both age spots and skin tags are harmless (NIA, 2015f).
Nearly everyone has hair loss as they age, and the rateof hair growth slows down as many hair follicles stop
producing new hairs (U.S. National Library ofMedicine, 2019). The loss of pigment and subsequentgraying begun in middle adulthood continues in lateadulthood. The body and face also lose hair. Facial hair
may grow coarser. For women this often occurs aroundthe chin and above the upper lip. For men the hair ofthe eyebrows, ears, and nose may grow longer. Nails,
particularly toenails, may become hard and thick.
Lengthwise ridges may develop in the fingernails andtoenails. However, pits, lines, changes in shape or color
should be checked by a healthcare provider as they canbe related to nutritional deficiencies or kidney disease(U.S. National Library of Medicine).
Figure 9.15 Bone Growth Changes

Figure 9.14

Height and Weight: The tendency to become shorter as
one ages occurs among all races and both sexes. Heightloss is related to aging changes in the bones, muscles,
and joints. People typically lose almost one-half inch
every 10 years after age 40, and height loss is evenmore rapid after age 70. A total of 1 to 3 inches inheight is lost with aging. Changes in body weight vary
for men and woman. Men often gain weight until about
age 55, and then begin to lose weight later in life,
possibly related to a drop in the male sex hormone
testosterone. Women usually gain weight until age 65,
and then begin to lose weight. Weight loss later in life
occurs partly because fat replaces lean muscle tissue,
and fat weighs less than muscle. Diet and exercise areimportant factors in weight changes in late adulthood(National Library of Medicine, 2014).

Sarcopenia is the loss of muscle tissue as a natural partof aging. Sarcopenia is most noticeable in men, andphysically inactive people can lose as much as 3% toSource5% of their muscle mass each decade after age 30, buteven when active muscle loss still occurs (Webmd,
2016). Symptoms include a loss of stamina and weakness, which can decrease physical activity
and subsequently further shrink muscles. Sarcopenia typically happens faster around age 75, but384

it may also speed up as early as 65 or as late as 80. Factors involved in sarcopenia include a
reduction in nerve cells responsible for sending signals to the muscles from the brain to begin
moving, a decrease in the ability to turn protein into energy, and not receiving enough calories orprotein to sustain adequate muscle mass. Any loss of muscle is important because it lessens
strength and mobility, and sarcopenia is a factor in frailty and the likelihood of falls and fracturesin older adults. Maintaining strong leg and heart muscles are important forindependence. Weight-lifting, walking, swimming, or engaging in other cardiovascular exercises
can help strengthen the muscles and prevent atrophy.

Sensory Changes in Late Adulthood
Vision: In late adulthood, all the senses show signs of decline, especially among the oldest-old.
In the last chapter, you read about the visual changes that were beginning in middle adulthood,such as presbyopia, dry eyes, and problems seeing in dimmer light. By later adulthood thesechanges are much more common. Three serious eyes diseases are more common in older adults:
Cataracts, macular degeneration, and glaucoma. Only the first can be effectively cured in mostpeople.
Cataracts are a clouding of the lens of the eye. The lens of the eye is made up of mostly waterand protein. The protein is precisely arranged to keep the lens clear, but with age some of theprotein starts to clump. As more of the protein clumps together the clarity of the lens is reduced.
While some adults in middle adulthood may show signs of cloudiness in the lens, the area
affected is usually small enough to not interfere with vision. More people have problems withcataracts after age 60 (NIH, 2014b) and by age 75, 70% of adults will have problems withcataracts (Boyd, 2014). Cataracts also cause a discoloration of the lens, tinting it more yellow
and then brown, which can interfere with the ability to distinguish colors such as black, brown,
dark blue, or dark purple.

Figure 9.16

SourceRisk factors besides age include certain health problems
such as diabetes, high blood pressure, and obesity,
behavioral factors such as smoking, other environmental
factors such as prolonged exposure to ultraviolet sunlight,
previous trauma to the eye, long-term use of steroid
medication, and a family history of cataracts (NEI, 2016a;
Boyd, 2014). Cataracts are treated by removing andreplacing the lens of the eye with a synthetic lens. In
developed countries, such as the United States, cataracts
can be easily treated with surgery. However, indeveloping countries, access to such operations are limited,making cataracts the leading cause of blindness in lateadulthood in the least developed countries (Resnikoff,
Pascolini, Mariotti & Pokharel, 2004). As shown in Figure
9.16, areas of the world with limited medical treatment for
cataracts often results in people living more years with aserious disability. For example, of those living in the385darkest red color on the map, more than 990 out of 100,00 people have a shortened lifespan due
to the disability caused by cataracts.
Older adults are also more likely to develop age-related macular degeneration, which is theloss of clarity in the center field of vision, due to the deterioration of the macula, the center ofthe retina. Macular degeneration does not usually cause total vision loss, but the loss of thecentral field of vision can greatly impair day-to-day functioning. There are two types of maculardegeneration: dry and wet. The dry type is the most common form and occurs when tiny piecesof a fatty protein called drusen form beneath the retina. Eventually the macular becomes thinnerand stops working properly (Boyd, 2016). About 10% of people with macular degeneration havethe wet type, which causes more damage to their central field of vision than the dry form. This
form is caused by an abnormal development of blood vessels beneath the retina. These vessels
may leak fluid or blood causing more rapid loss of vision than the dry form.
The risk factors for macular degeneration include smoking, which doubles your risk (NIH,
2015a); race, as it is more common among Caucasians than African Americans or
Hispanics/Latinos; high cholesterol; and a family history of macular degeneration (Boyd, 2016).
At least 20 different genes have been related to this eye disease, but there is no simple genetic
test to determine your risk, despite claims by some genetic testing companies (NIH, 2015a). At
present, there is no effective treatment for the dry type of macular degeneration. Some researchsuggests that certain patients may benefit from a cocktail of certain antioxidant vitamins andminerals, but the results are mixed at best. They are not a cure for the disease nor will they
restore the vision that has been lost. This “cocktail” can slow the progression of visual loss insome people (Boyd, 2016; NIH, 2015a). For the wet type medications that slow the growth ofabnormal blood vessels, and surgery, such as laser treatment to destroy the abnormal bloodvessels may be used. Only 25% of those with the wet version may see improvement with theseprocedures (Boyd, 2016).
A third vision problem that increases withage is glaucoma, which is the loss of
peripheral vision, frequently due to abuildup of fluid in eye that damages the
optic nerve. As you age the pressure in
the eye may increase causing damage tothe optic nerve. The exterior of the optic
nerve receives input from retinal cells on
the periphery, and as glaucoma
progresses more and more of theperipheral visual field deteriorates toward
the central field of vision. In theadvanced stages of glaucoma, a person
can lose their sight. Fortunately,
glaucoma tends to progresses slowly(NEI, 2016b).

Figure 9.17 Normal Vision vs. Cataracts,
Macular Degeneration and Glaucoma

SourceGlaucoma is the most common cause ofblindness in the U.S. (NEI, 2016b).
African Americans over age 40, and everyone else over age 60 has a higher risk for glaucoma.
386

Those with diabetes, and with a family history of glaucoma also have a higher risk (Owsley etal., 2015). There is no cure for glaucoma, but its rate of progression can be slowed, especiallywith early diagnosis. Routine eye exams to measure eye pressure and examination of the optic
nerve can detect both the risk and presence of glaucoma (NEI, 2016b). Those with elevated eyepressure are given medicated eye drops. Reducing eye pressure lowers the risk of developing
glaucoma or slow its progression in those who already have it.
Hearing: As you read in Chapter 8, our hearing declines both in terms of the frequencies ofsound we can detect, and the intensity of sound needed to hear as we age. These changes
continue in late adulthood. Almost 1 in 4 adults aged 65 to 74 and 1 in 2 aged 75 and older havedisabling hearing loss (NIH, 2016). Table 9.4 lists some common signs of hearing loss.
Presbycusis is a common form of hearing
loss in late adulthood that results in a
gradual loss of hearing. It runs in families
and affects hearing in both ears (NIA,
2015c). Older adults may also noticetinnitus, a ringing, hissing, or roaring
sound in the ears. The exact cause oftinnitus is unknown, although it can be
related to hypertension and allergies. It
may come and go or persist and get worse
over time (NIA, 2015c). The incidence ofboth presbycusis and tinnitus increase withage and males have higher rates of botharound the world (McCormak,
Edmondson-Jones, Somerset, & Hall,2016).

Table 9.3 Common Signs of Hearing Loss
*Have trouble hearing over the telephone*Find it hard to follow conversations when two
or more people are talking*Often ask people to repeat what they are saying*Need to turn up the TV volume so loud that
others complain*Have a problem hearing because of backgroundnoise*Think that others seem to mumble*Cannot understand when women and children
are speaking

Your auditory system has two jobs: To
help you to hear, and to help you maintain
Adapted from NIA, 2015cbalance. Your balance is controlled by thebrain receiving information from theshifting of hair cells in the inner ear about the position and orientation of the body. With age thisfunction of the inner ear declines which can lead to problems with balance when sitting,standing, or moving (Martin, 2014).
Taste and Smell: Our sense of
taste and smell are part of ourchemical sensing system. Oursense of taste, or gustation,
appears to age well. Normal taste
occurs when molecules that are
released by chewing foodstimulate taste buds along the
tongue, the roof of the mouth,
and in the lining of the throat.
These cells send messages to theTable 9.4

Types of Smell Disorders
Presbyosmia
Hyposmia
Anosmia
Dysosmia
Phantosmia

Smell loss due to aging
Loss of only certain odors
Total loss of smell
Change in the perception of odors.
Familiar odors are distorted.
Smell odors that are not present

Adapted from NIH Senior Health: Problems with Smell387

brain, where specific tastes are identified. After age 50 we start to lose some of these sensory
cells. Most people do not notice any changes in taste until ones 60s (NIH: Senior Health, 2016b).
Given that the loss of taste buds is very gradual, even in late adulthood, many people are often
surprised that their loss of taste is most likely the result of a loss of smell.
Our sense of smell, or olfaction, decreases more with age, and problems with the sense of smell
are more common in men than in women. Almost 1 in 4 males in their 60s have a disorder withthe sense of smell, while only 1 in 10 women do (NIH: Senior Health, 2016b). This loss of smell
due to aging is called presbyosmia. Olfactory cells are located in a small area high in the nasal
cavity. These cells are stimulated by two pathways; when we inhale through the nose, or via theconnection between the nose and the throat when we chew and digest food. It is a problem withthis second pathway that explains why some foods such as chocolate or coffee seem tastelesswhen we have a head cold. There are several types of loss of smell. Total loss of smell, or
anosmia, is extremely rare.
Problems with our chemical senses can be linked to other serious medical conditions such as
Parkinson’s, Alzheimer’s, or multiple sclerosis (NIH: Senior Health, 2016a). Any suddenchange should be checked out. Loss of smell can change a person’s diet, with either a loss ofenjoyment of food and eating too little for balanced nutrition or adding sugar and salt to foods
that are becoming blander to the palette.
Touch: Research has found that with age, people may experience reduced or changed sensationsof vibration, cold, heat, pressure, or pain (Martin, 2014). Many of these changes are also alignedwith a number of medical conditions that are more common among the elderly, such as diabetes.
However, there are changes in the touch sensations among healthy older adults. The ability todetect changes in pressure have been shown to decline with age, with it being more pronounced
by the 6th decade and diminishing further with advanced age (Bowden & McNelty, 2013). Yet,
there is considerable variability, with almost 40% showing sensitivity that is comparable toyounger adults (Thornbury & Mistretta, 1981). However, the ability to detect theroughness/smoothness or hardness/softness of an object shows no appreciable change with age(Bowden & McNulty, 2013). Those who show increasing insensitivity to pressure, temperature,or pain are at risk for injury (Martin, 2014).
Pain: According to Molton and Terrill (2014), approximately
60%-75% of people over the age of 65 report at least somechronic pain, and this rate is even higher for those individuals
living in nursing homes. Although the presence of painincreases with age, older adults are less sensitive to pain than
younger adults (Harkins, Price, & Martinelli, 1986). Farrell(2012) looked at research studies that included neuroimaging
techniques involving older people who were healthy and those
who experienced a painful disorder. Results indicated that there
were age-related decreases in brain volume in those structures
involved in pain. Especially noteworthy were changes in theprefrontal cortex, brainstem, and hippocampus. Women are
more likely to identify feeling pain than men (Tsang et al.,2008). Women have fewer opioid receptors in the brain, andwomen also receive less relief from opiate drugs (Garrett, 2015).
388

Figure 9.18
Pain from Arthritis

SourceBecause pain serves an important indicator that there is something wrong, a decreased sensitivity
to pain in older adults is a concern because it can conceal illnesses or injuries requiring medical
attention.
Chronic health problems, including arthritis, cancer, diabetes, joint pain, sciatica, and shingles
are responsible for most of the pain felt by older adults (Molton & Terrill, 2014). Cancer is a
special concern, especially “breakthrough pain” which is a severe pain that comes on quickly
while a patient is already medicated with a long-acting painkiller. It can be very upsetting, andafter one attack many people worry it will happen again. Some older individuals worry aboutdeveloping an addiction to pain medication, but if medicine is taken exactly as prescribed,
addiction should not be a concern (NIH, 2015b). Lastly, side effects from pain medicine
including constipation, dry mouth, and drowsiness may occur that can adversely affect theelder’s life.
Some older individuals put off going to the doctor because they think pain is just part of aging
and nothing can help. Of course, this is not true. Managing pain is crucial to ensure feelings ofwell-being for the older adult. When chronic pain is not managed, the individual will restrict
their movements for fear of feeling pain or injuring themselves further. This lack of activity will
result in more restriction, further decreased participation, and greater disability (Jensen, Moore,
Bockow, Ehde, & Engel, 2011). A decline in physical activity because of pain is also associatedwith weight gain and obesity in adults (Strine, Hootman, Chapman, Okoro, & Balluz, 2005).
Additionally, sleep and mood disorders, such as depression, can also occur (Moton & Terrill,2014). Learning to cope effectively with pain is an important consideration in late adulthood andworking with one’s primary physician or a pain specialist is recommended (NIH, 2015b).
For those 65 and older, 35% have a disability of some type. Figure 9.19 identifies the percentageof those who have a disability based on the type.
Figure 9.19 Percentage of adults 65 and older with a disability in 2017

Source389

Nutrition
A healthy diet is necessary for older adults toincrease mental acuteness, resistance toillness and disease, boost energy levels,
improve immune system strength,
recuperation speed, and have greater
effectiveness in the management of chronic
health problems (Mayer, 2016). The new
MyPlate for Older Adults, a website from
Tufts University, suggests that older adults
should strive for 50% of their diet being
fruits and vegetables; 25% grains, many ofwhich should be whole grains; and 25%
protein-rich foods, such as nuts, beans, fish,lean meat, poultry, and fat-free and low-fat
Source: Bill Branson (photographer)dairy products such as milk, cheeses, and yogurts. Unfortunately, changes in sensory functions,such as smell and taste, along with loss of teeth, can derail an older adult’s ability to eat right.
Older adults are likely to use salt and sugar to flavor foods that no longer taste the way they once
did. Several government websites provide older adults with alternatives to the salt shaker tomake foods more palatable.
Figure 9.20 Couple enjoying lunch

Chronic Conditions
Chronic illnesses are illnesses that are
Table 9.5
ongoing, generally incurable conditions
Percentage of Older Adults with Chronicthat require continuing medical attention
Conditions
and affect daily life. As individuals live
High cholesterol
58.2
longer, diseases that affect older
Hypertension
56.7
individuals will become more prevalent,
Arthritis
48.7
and the burden of chronic illness grows
Cancer
23.1
with age. Less than 50% of adults 50-64
Diabetes
20.5
have a chronic condition, 90% aged 75
Heart disease
17.9
and up do (Cohen, 2011). Almost 80%
Ulcers11.3
have at least one chronic disease, andStroke7.2
77% have at least two (National Council
Asthma6.9
on Aging, 2019). Older women are more
Kidney disease
5.1
likely to have a chronic condition than are
Chronic
bronchitis
5.0
older men (83% vs. 88%) (CDC, 2009).
Emphysema
4.0
Table 9.6 lists the percentage of older
Adaptedfrom
CDC
National
HealthInterview 2014
adults who have certain chronic illnesses
based on the National Health Survey
conducted in 2014. Other studies place the figure of diabetes in older adults at 26% (CDC,2014).

390

Cancer and Major Cardiovascular Disease: As discussed in chapter 8, cancer andcardiovascular disease are the overall leading causes of death, and they are especially highreasons for death in middle and late adults. Table 9.7 identifies the percentages of deaths due tocancer and cardiovascular disease for selected age groups in 2016; the most recent year for data
(Heron, 2018).
Cancer: Advancing
age is a significant
risk factor for cancer,
with persons over 65
2016 CAUSES OF DEATH
45-64
65+
85+
accounting for 60%
of newly diagnosed
cancer and 70% of all
CANCER
29.2
21.1
12.1
cancer deaths (Berger
et al., 2006).
HEART DISEASE
20.9
25.3
25.3
Additionally, morethan 70% of the
Sourcemortality associatedwith many cancers,
including prostate, bladder, colon, uterus, pancreas, stomach, rectum and lung occur in patients
65 and older. Other conditions that affect the elderly can occur with cancer, including anemia,
coronary artery diseases, congestive heart failure, chronic obstructive pulmonary diseases, renal
insufficiency, cerebrovascular diseases, neurovascular complications of diabetes mellitus, andarthritis that restricts mobility (Balducci & Extermann, 2000). Comorbidity will complicate
treatment.
Table 9.6 Death Percentages for Cancer and Heart Disease for
Selected Age Groups

Balducci and Extermann (2000) examined several concerns of cancer treatment in the elderly.
With aging, there is a decline in multiple organ systems that can adversely affect the ability of
medications to treat the cancer. Chemotherapy has been found to compromise the cognitive
function of those being treated for cancer, and it may further exacerbate dementia and elderly
cognitive declines. Frail individuals, defined as having limited life expectancy and near-toexhausted functional reserves, are also not considered candidates for more toxic forms of
chemotherapy. With cancer, the prevalence and risk of malnutrition are higher, and diminishedvisual and hearing function makes elderly cancer patients more susceptible to environmental
injury. Screening for depression is also recommended because depression is associated withweight loss, failure to thrive, and may reduce the motivation to receive treatment. Consequently,
depression has been associated with decreased survival rates in the elderly. Due to the projected
increase in the total number of older patients with cancer, it is recommended that physicians andcaretakers have expertise in both oncology and geriatrics (Berger et al., 2006).
Heart Disease: There are changes to the heart that happen with age, and some may increase aperson’s risk of heart disease. These include stiffening blood vessels and valves, which may
result in leaks or problems pumping blood out of the heart (NIA, 2012). As previously stated,heart disease is the leading cause of death for those in late adulthood (CDC, 2016b). There aredifferent types of heart disease, and as already discussed in chapter 8, the most common isatherosclerosis, the buildup of fatty deposits or plaques in the walls of arteries. As plaque builds
up, blood is unable to flow normally and bring oxygen throughout the body, including to the391heart. Depending on where the buildup is, atherosclerosis can cause a heart attack, leg pain, or astroke. However, Atherosclerosis is not part of normal aging. Many of the problems older
people have with their heart and blood vessels are caused by disease and not by aging. For
example, an older heart can normally pump blood as strong as a younger heart, while less ability
to pump blood is caused by disease. Therefore, leading a heart-healthy lifestyle is most importantto keeping one’s heart strong in late adulthood.
Arthritis: Arthritis and other rheumatic conditions are the most common cause of disability
among US adults and have been the most common cause of disability among US adults for the
past 15 years (NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases,2014). According to the NIH, approximately 62% of adults with arthritis are 65 years old and up.
Almost 1 in 2 older adults with arthritis have some degree of mobility limitations, such as
climbing stairs, walking, and grasping objects. The pain and other limitations of arthritis canalso increase the risk of depression and other forms of mental distress. Osteoarthritis is the mostcommon type of arthritis. “When the cartilage, the slick, cushioning surface on the ends of bones
wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints canlose strength and pain may become chronic” (Arthritis Foundation, 2017, para 3). Common risk
factors for osteoarthritis include genetics, obesity, age, previous injury, and other medical
conditions.
Figure 9.21
Osteoporosis

SourceOsteoporosis and Kyphosis: Osteoporosis is a disease that thins andweakens bones to the point that they become fragile and break easily.
After age 50, 1 in 2 women and 1 in 4 men will experience anosteoporosis related fracture in their lifetime, often leading to hip, spine,
and wrist fractures (Dailey & Cravedi, 2006). Broken hips are a very
serious problem as we age. They greatly increase the risk of death,especially during the year after they break (NIH Senior Health, 2015). In
the U.S., more than 53 million adults either already have osteoporosis orat a high risk due to low bone mass (NIH Senior Health, 2015). As bones
weaken in the spine, adults gradually lose height and their posture
becomes hunched over, which is called Kyphosis. Over time a bent spine
can make it hard to walk or even sit up. Adults can prevent the loss ofbone mass by eating a healthy diet with enough calcium and vitamin D,
regularly exercising, limiting alcohol, and not smoking (National
Osteoporosis Foundation, 2016).

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease in which the
airways become damaged making it difficult to breathe. COPD includes problems such as
emphysema and chronic bronchitis (NIH Senior Health, 2013). COPD kills more than 120,000
people every year, making it one of the leading causes of death. COPD was once considered a“man’s disease”. However, since 2000, 58% of those with COPD are women and they comprise
8% of all women (American Lung Association, 2019). Research has indicated that women may
be more susceptible to the effects of cigarette smoke due to having smaller lungs and estrogenworsening the effects.

392

Figure 9.22 compares healthy to
Figure 9.22
damaged lungs due to COPD. As
COPD develops slowly, people may
not notice the early signs, and may
attribute the shortness of breath toage or lack of physical exercise. Most
people are not diagnosed until
midlife or late adulthood. There is no
cure as the damage cannot bereversed. Treatments aim at slowing
further damage. Cigarette smoking is
the leading cause of COPD, but othertypes of tobacco smoking, such as apipe or cigar, can cause COPD,
especially if the smoke is inhaled.
Heavy or long-term exposure tosecond hand smoke can also lead to
COPD (NIH Senior Health, 2013).
SourceCOPD can also occur in people whohave long term exposure to other environmental irritants, such as chemical fumes, and dust fromthe environment and workplace.
About 1 in every 1,600 to 5,000 people have a risk for COPD because of a recessive genetic
condition known as alpha-1 antitrypsin (AAT) deficiency (NIH, 2011). AAT is a protein madein the liver that protects organs, especially the lungs, from the effects of other harmful proteins.
In those with the genetic defect, the AAT protein created is the wrong shape and cannot leave theliver. This can lead to a heightened risk for lung disease, and even liver disease, as the excess of
the AAT protein can lead to cirrhosis, which is a disease in which the liver becomes scarred anddoes not function properly. While some people with ATT deficiency are not affected and live anormal life, COPD is more likely to occur in such individuals if their lungs are exposed toenvironmental irritants.
Shingles: According to the National Institute on Aging (2015e), shingles is a disease that
affects your nerves. Shingles is caused by the same virus as chicken pox, the varicella-zoster
virus (VZV). After you recover from chickenpox, the virus continues to live in some of yournerve cells. It is usually inactive, and most adults live with VZV in their body and never get
shingles. However, the virus will become active in one in three adults. Instead of causing
chickenpox again, it produces shingles. A risk factor for shingles includes advanced age as
people have a harder time fighting off infections as they get older. About half of all shingles
cases are in adults age 60 or older, and the chance of getting shingles becomes much greater by
age 70. Other factors that weaken an individual’s ability to fight infections, such as cancer, HIV
infections, or other medical conditions, can put one at a greater risk for developing shingles.
Shingles results in pain, burning, tingling, or itching in the affected area, as well as a rash andblisters. Typically, shingles develops only on one side of the body or face and in a small arearather than all over. Most cases of shingles last 3 to 5 weeks. After the shingles rash goes away,393

some people may be left with ongoing pain, called
post-herpetic neuralgia (PHN) in the area where therash had been (NIA, 2015e). The older one is when
getting shingles, the greater the chance of developing
PHN. Some people with PHN find it hard to go about
their daily activities, like dressing, cooking, andeating. They can also suffer from depression, anxiety
and sleeplessness. Medicines can help with pain andusually PHN will disappear. Unfortunately, theblisters from shingles may become infected or leave ascar. Blisters near or in the eye can cause lasting eyedamage or blindness. A brief paralysis of the face,hearing loss, and very rarely, swelling of the brain
Source(encephalitis) can also occur. There is a shingles
vaccine that is recommended for those aged 50 andolder. Shingles is not contagious, but one can catch chickenpox from someone with shingles.
Figure 9.23 Shingles Rash

Beliefs about Health: Despite the fact that the majority of older adults have at least one chronic
illness, most rate their overall health positively (Graham, 2019). Based on results of the CDC’s
2017 National Health Interview Survey, 82% of those aged 65-74 and 73% of those 75 and older
rated their health as excellent, very good or good. Because older adults focus more on emotional
well-being, positive social relationships, remaining active, and overall life satisfaction, poor
physical functioning is not considered as important. Older adults often look to those who areworse off than themselves, including those having died or are in a nursing home, andconsequently feel more positive about themselves. This perspective is in contrast to thoseyounger who believe that there should not be anything wrong with them, and consequently
experience negative feelings when they have an illness. Older adults expect there will be somedeterioration in their health and are able to adapt to it. Similarly, most older adults identify
positive mental health in conjunction with their physical health.

Brain Functioning
Research has demonstrated that the brain loses 5% to 10% of its weight between 20 and 90 yearsof age (Fjell & Walhovd, 2010). This decrease in brain volume appears to be due to theshrinkage of neurons, lower number of synapses, and shorter length of axons. According to
Garrett (2015), the normal decline in cognitive ability throughout the lifespan has been
associated with brain changes, including reduced activity of genes involved in memory storage,
synaptic pruning, plasticity, and glutamate and GABA (neurotransmitters) receptors. There isalso a loss in white matter connections between brain areas. Without myelin, neurons
demonstrate slower conduction and impede each other’s actions. A loss of synapses occurs inspecific brain areas, including the hippocampus (involved in memory) and the basal forebrain
region. Older individuals also activate larger regions of their attentional and executive networks,
located in the parietal and prefrontal cortex, when they perform complex tasks. This increased
activation correlates with a reduced performance on both executive tasks and tests of working
memory when compared to those younger (Kolb & Whishaw, 2011).

394

Continued Neurogenesis: Researchers at the University of Chicago found that new neurons
continued to form into old age. Tobin et al. (2019) examined post-mortem brain tissue ofindividuals between the ages of 79 and 99 (average age 90.6) and found evidence ofneurogenesis in the hippocampus. Approximately 2000 neural progenitor cells and 150, 000
developing neurons were found per brain, although the number of developing neurons was lower
in people with cognitive impairments or Alzheimer’s disease. Tobin et al. hypothesized that thelower levels of neurogenesis in the hippocampus were associated with symptoms of cognitive
decline and reduced synaptic plasticity.
The brain in late adulthood also exhibits considerable plasticity, and through practice andtraining, the brain can be modified to compensate for any age-related changes (Erber &Szuchman, 2015). Park and Reuter-Lorenz (2009) proposed the Scaffolding Theory of Aging
and Cognition which states that the brain adapts to neural atrophy (dying of brain cells) bybuilding alternative connections, referred to as scaffolding. This scaffolding allows older brains
to retain high levels of performance. Brain compensation is especially noted in the additional
neural effort demonstrated by those individuals who are aging well. For example, older adults
who performed just as well as younger adults on a memory task used both prefrontal areas, while
only the right prefrontal cortex was used in younger participants (Cabeza, Anderson, Locantore,& McIntosh, 2002). Consequently, this decrease in brain lateralization appears to assist older
adults with their cognitive skills.
Healthy Brain Functioning: Cheng (2016) found thatphysical activity and stimulating cognitive activity resulted insignificant reductions in the risk of neurocognitive disorders inlongitudinal studies. Physical activity, especially aerobic
exercise, is associated with less age-related gray and whitematter loss, as well and diminished neurotoxins in the brain.
Overall, physical activity preserves the integrity of neurons
and brain volume. Cognitive training improves the efficiencyof the prefrontal cortex and executive functions, such as
working memory, and strengthens the plasticity of neuralcircuits. Both activities support cognitive reserve, or “thestructural and dynamic capacities of the brain that buffer
against atrophies and lesions” (p. 85). Although it is optimal
to begin physical and cognitive activities earlier in life, it is not
too late to start these programs in late adulthood to improve
one’s cognitive health.

Figure 9.24 Exercise isImportant to Brain
Functioning

Can we improve brain functioning? Many training programs
have been created to improve brain functioning. ACTIVE
Source(Advanced Cognitive Training for Independent and Vital
Elderly), a study conducted between 1999 and 2001 in which
2,802 individuals age 65 to 94, suggests that the answer is "yes". These racially diverse
participants received 10 group training sessions and 4 follow up sessions to work on tasks ofmemory, reasoning, and speed of processing. These mental workouts improved cognitive
functioning even 5 years later. Many of the participants believed that this improvement could be395

seen in everyday tasks as well (Tennstedt et al., 2006). However, programs for the elderly on
memory, reading, and processing speed training demonstrate that there is improvement on thespecific tasks trained, but there is no generalization to other abilities (Jarrett, 2015). Further,
these programs have not been shown to delay or slow the progression of Alzheimer’s disease.
Although these programs are not harmful, “physical exercise, learning new skills, and socializing
remain the most effective ways to train your brain” (p. 207). These activities appear to build areserve to minimize the effects of primary aging of the brain.
Parkinson’s disease is characterized by motor tremors, loss of balance, poor coordination,
rigidity, and difficulty moving (Garrett, 2015). Parkinson’s affects approximately 1% of thoseover the age of 60, and it appears more frequently in family members in a little less than 10%of cases. Twenty-eight chromosomal areas have been implicated in Parkinson’s disease, but
environmental factors have also been identified and include brain injury. Being knocked
unconscious once increases the risk by 32% and being knocked out several times increases therisk by 174% (Garrett, 2015). Other environmental influences include toxins, industrial
chemicals, carbon monoxide, herbicides and pesticides (Olanow & Tatton, 1999). The
symptoms are due to the deterioration of the substantia nigra, an area in the midbrain whose
neurons send dopamine-releasing axons to the basal ganglia which affects motor activity.
Treatment typically includes the medication levodopa (L-dopa), which crosses the blood-brain
barrier and is converted into dopamine in the brain. Deep brain stimulation, which involves
inserting an electrode into the brain that provides electrical stimulation, has resulted in
improved motor functioning (Garrett, 2015).

Sleep
Similar to other adults, older adults need between 7 to 9 hours of sleep per night, but they tend to
go to sleep earlier and get up earlier than those younger. This pattern is called advanced sleep
phase syndrome and is based on changes in circadian rhythms (National Sleep Foundation,2009). There are sleep problems in older adults, and insomnia is the most common problem inthose 60 and older (NIA, 2016). People with insomnia have trouble falling asleep and staying
asleep. There are many reasons why older people may have insomnia, including certain
medications, being in pain, having a medical or psychiatric condition, and even worrying before
bedtime about not being able to sleep. Using over the counter sleep aids or medication may only
work when used for a short time. Consequently, sleep problems should be discussed with ahealth care professional.
Also, common in older adults are sleep disorders, including sleep apnea, restless legs syndrome,
periodic limb movement disorder, and rapid eye movement sleep behavior disorder (NIA, 2016).
Sleep apnea refers to repeated short pauses in breathing, while an individual sleeps, that canlead to reduced oxygen in the blood. Snoring is a common symptom of sleep apnea and it often
worsens with age. Untreated sleep apnea can lead to impaired daytime functioning, high bloodpressure, headaches, stroke, and memory loss. Restless legs syndrome feels like there istingling, crawling, or pins and needles in one or both legs, and this feeling is worse at night.
Periodic limb movement disorder causes people to jerk and kick their legs every 20 to 40
seconds during sleep. Rapid eye movement sleep behavior disorder occurs when one’s
muscles can move during REM sleep and sleep is disrupted.
396

According to the National Sleep Foundation (2009), there are many medical conditions that
affect sleep and include gastroesophageal reflux disease, diabetes mellitus, renal failure,
respiratory diseases such as asthma, and immune disorders. Diseases such as Parkinson's disease
and multiple sclerosis also commonly cause problems sleeping. Lastly, Alzheimer’s disease caninterfere with sleeping patterns. Individuals may wake up many times during the night, wander
when up, and yell which can alter the amount of time they sleep. Both minor and major sleep
problems in older adults can lead to increased risk of accidents, falls, chronic fatigue, decreased
quality of life, cognitive decline, reduced immune function, and depression (Buman, 2013).
Figure 9.25 Exercise
Improves Sleep

SourceBecause of sleep problems experienced by those in lateadulthood, research has looked into whether exercise can
improve their quality of sleep. Results show that 150
minutes per week of exercise can improve sleep quality(Buman, 2013). This amount of exercise is also
recommended to improve other health areas including
lowering the risk for heart disease, diabetes, and somecancers. Aerobic activity, weight training, and balance
programs are all recommended. For those who live inassisted living facilities even light exercise, such as
stretching and short walks, can improve sleep. High intensity
activity is not necessary to see improvements. Overall, theeffects of exercise on sleep may actually be even larger for
older adults since their sleep quality may not be ideal tostart.

Sexuality
According to Kane (2008), older men and women are often
viewed as genderless and asexual. There is a stereotype thatelderly individuals no longer engage in sexual activity andwhen they do, they are perceived to have committed somekind of offense. These ageist myths can become
internalized, and older people have a more difficult time
accepting their sexuality (Gosney, 2011). Additionally,some older women indicate that they no longer worry about
sexual concerns anymore once they are past the childbearing years.

Figure 9.26

In reality, many older couples find greater satisfaction in
their sex life than they did when they were younger. They
Sourcehave fewer distractions, more time and privacy, no worries
about getting pregnant, and greater intimacy with a lifelong partner (NIA, 2013). Results fromthe National Social Life Health, and Aging Project indicated that 72% of men and 45.5% of
women aged 52 to 72 reported being sexually active (Karraker, DeLamater, & Schwarz, 2011).
Additionally, the National Survey of Sexual Health data indicated that 20%-30% of individuals
remain sexually active well into their 80s (Schick et al., 2010). However, there are issues that
occur in older adults that can adversely affect their enjoyment of healthy sexual relationships.
397

Causes of Sexual Problems: According to the National Institute on Aging (2013), chronic
illnesses including arthritis (joint pain), diabetes (erectile dysfunction), heart disease (difficulty
achieving orgasm for both sexes), stroke (paralysis), and dementia (inappropriate sexual
behavior) can all adversely affect sexual functioning. Hormonal changes, physical disabilities,
surgeries, and medicines can also affect a senior’s ability to participate in and enjoy sex. How
one feels about sex can also affect performance. For example, a woman who is unhappy about
her appearance as she ages may think her partner will no longer find her attractive. A focus on
youthful physical beauty for women may get in the way of her enjoyment of sex. Likewise, mostmen have a problem with erectile dysfunction (ED) once in a while, and some may fear that ED
will become a more common problem as they age. If there is a decline in sexual activity for aheterosexual couple, it is typically due to a decline in the male’s physical health (Erber &Szuchman, 2015).
Overall, the best way to experience a healthy sex life in later life is to keep sexually active while
aging. However, the lack of an available partner can affect heterosexual women’s participation
in a sexual relationship. Beginning at age 40 there are more women than men in the population,and the ratio becomes 2 to 1 at age 85 (Karraker et al., 2011). Because older men tend to pairwith younger women when they become widowed or divorced, this also decreases the pool ofavailable men for older women (Erber & Szuchman, 2015). In fact, a change in marital status
does not result in a decline in the sexual behavior of men aged 57 to 85 years-old, but it does
result in a decline for similar aged women (Karraker et al., 2011).
Concluding Thoughts: Key players in improving the quality of life among older adults willbe those adults themselves. By exercising, reducing stress, stopping smoking, limiting use ofalcohol, and consuming more fruits and vegetables, older adults can expect to live longer
and more active lives (He et al., 2005). Stress reduction, both in late adulthood and earlier inlife, is also crucial. The reduction of societal stressors can promote active life expectancy. In
the last 40 years, smoking rates have decreased, but obesity has increased, and physicalactivity has only modestly increased.

Learning Objectives: Cognitive Development in Late Adulthood
•
•
•
•
•
•
•
•

Describe how memory changes for those in late adulthood
Describe the theories for why memory changes occur
Describe how cognitive losses in late adulthood are exaggerated
Explain the pragmatics and mechanics of intelligence
Define what is a neurocognitive disorder
Explain Alzheimer’s disease and other neurocognitive disorders
Describe work and retirement in late adulthood
Desribe how those in late adulthood spend their leisure time398

How Does Aging Affect Information Processing?
There are numerous stereotypes regarding older adults as being forgetful and confused, but what
does the research on memory and cognition in late adulthood reveal? Memory comes in many
types, such as working, episodic, semantic, implicit, and prospective. There are also many
processes involved in memory, thus it should not be a surprise that there are declines in some
types of memory and memory processes, while other areas of memory are maintained or evenshow some improvement with age. In this section, we will focus on changes in memory,
attention, problem solving, intelligence, and wisdom, including the exaggeration of losses
stereotyped in the elderly.

MemoryFigure 9.27
Changes in Working Memory: As discussed in chapter
4, working memory is the more active, effortful part of ourmemory system. Working memory is composed of threemajor systems: The phonological loop that maintains
information about auditory stimuli, the visuospatialsketchpad, that maintains information about visual
stimuli, and the central executive, that oversees working
memory, allocating resources where needed andmonitoring whether cognitive strategies are being effective(Schwartz, 2011). Schwartz reports that it is the central
executive that is most negatively impacted by age. In tasks
that require allocation of attention between different
stimuli, older adults fair worse than do younger adults. In a Source
study by Göthe, Oberauer, and Kliegl (2007) older andyounger adults were asked to learn two tasks simultaneously. Young adults eventually managed
to learn and perform each task without any loss in speed and efficiency, although it did takeconsiderable practice. None of the older adults were able to achieve this. Yet, older adults could
perform at young adult levels if they had been asked to learn each task individually. Having
older adults learn and perform both tasks together was too taxing for the central executive. In
contrast, working memory tasks that do not require much input from the central executive, suchas the digit span test, which uses predominantly the phonological loop, we find that older adults
perform on par with young adults (Dixon & Cohen, 2003).
Changes in Long-term Memory: As you should recall, long-term memory is divided intosemantic (knowledge of facts), episodic (events), and implicit (procedural skills, classicalconditioning and priming) memories. Semantic and episodic memory are part of the explicit
memory system, which requires conscious effort to create and retrieve. Several studies
consistently reveal that episodic memory shows greater age-related declines than semantic
memory (Schwartz, 2011; Spaniol, Madden, & Voss, 2006). It has been suggested that episodic
memories may be harder to encode and retrieve because they contain at least two different typesof memory, the event and when and where the event took place. In contrast, semantic memories
are not tied to any particular time line. Thus, only the knowledge needs to be encoded or
retrieved (Schwartz, 2011). Spaniol et al. (2006) found that retrieval of semantic information399

was considerably faster for both younger and older adults than the retrieval of episodic
information, with there being little difference between the two age groups for semantic memory
retrieval. They note that older adults’ poorer performance on episodic memory appeared to berelated to slower processing of the information and the difficulty of the task. They found that as
the task became increasingly difficult, the gap between each age groups’ performance increased
for episodic memory more so than for semantic memory.
Studies which test general knowledge (semantic memory), such as politics and history (Dixon,
Rust, Feltmate, & See, 2007), or vocabulary/lexical memory (Dahlgren, 1998) often find thatolder adults outperform younger adults. However, older adults do find that they experience more
“blocks” at retrieving information that they know. In other words, they experience more tip-ofthe-tongue (TOT) events than do younger adults (Schwartz, 2011).
Implicit memory requires little conscious effort and often involves skills or more habitualpatterns of behavior. This type of memory shows few declines with age. Many studies assessing
implicit memory measure the effects of priming. Priming refers to changes in behavior as aresult of frequent or recent experiences. If you were shown pictures of food and asked to rate
their appearance and then later were asked to complete words such as s_ _ p, you may be more
likely to write soup than soap, or ship. The images of food “primed” your memory for words
connected to food. Does this type of memory and learning change with age? The answer istypically “no” for most older adults (Schacter, Church, & Osowiecki, 1994).
Prospective memory refers to remembering
Figure 9.28 Aids for Prospective Memory
things we need to do in the future, such as
remembering a doctor’s appointment next
week, or to take medication before bedtime.
It has been described as “the flip-side of
episodic memory” (Schwartz, 2011, p. 119).
Episodic memories are the recall of events in
our past, while the focus of prospective
memories is of events in our future. In
general, humans are fairly good at prospective
memory if they have little else to do in themeantime. However, when there arecompeting tasks that are also demanding ourattention, this type of memory rapidly
declines. The explanation given for this is
Sourcethat this form of memory draws on the central
executive of working memory, and when thiscomponent of working memory is absorbed in other tasks, our ability to remember to dosomething else in the future is more likely to slip out of memory (Schwartz, 2011). However,prospective memories are often divided into time-based prospective memories, such as having
to remember to do something at a future time, or event-based prospective memories, such as
having to remember to do something when a certain event occurs. When age-related declines arefound, they are more likely to be time-based, than event-based, and in laboratory settings rather
than in the real-world, where older adults can show comparable or slightly better prospective400

memory performance (Henry, MacLeod, Phillips & Crawford, 2004; Luo & Craik, 2008). Thisshould not be surprising given the tendency of older adults to be more selective in where theyplace their physical, mental, and social energy. Having to remember a doctor’s appointment is ofgreater concern than remembering to hit the space-bar on a computer every time the word “tiger”
is displayed.
Recall versus Recognition: Memory performance often depends on whether older adults are
asked to simply recognize previously learned material or recall material on their own. Generally,
for all humans, recognition tasks are easier because they require less cognitive energy. Olderadults show roughly equivalent memory to young adults when assessed with a recognition task
(Rhodes, Castel, & Jacoby, 2008). With recall measures, older adults show memory deficits incomparison to younger adults. While the effect is initially not that large, starting at age 40 adults
begin to show declines in recall memory compared to younger adults (Schwartz, 2011).

Figure 9.29

SourceThe Age Advantage: Fewer age differences are observed whenmemory cues are available, such as for recognition memorytasks, or when individuals can draw upon acquired knowledge
or experience. For example, older adults often perform as well
if not better than young adults on tests of word knowledge or
vocabulary. With age often comes expertise, and research has
pointed to areas where aging experts perform quite well. For
example, older typists were found to compensate for agerelated declines in speed by looking farther ahead at printed
text (Salthouse, 1984). Compared to younger players, older
chess experts focus on a smaller set of possible moves, leading
to greater cognitive efficiency (Charness, 1981). Accrued
knowledge of everyday tasks, such as grocery prices, can help
older adults to make better decisions than young adults(Tentori, Osheron, Hasher, & May, 2001).

Attention and Problem Solving
Changes in Attention in Late Adulthood: Changes in sensory functioning and speed ofprocessing information in late adulthood often translates into changes in attention (Jefferies etal., 2015). Research has shown that older adults are less able to selectively focus on information
while ignoring distractors (Jefferies et al., 2015; Wascher, Schneider, Hoffman, Beste, & Sänger,2012), although Jefferies and her colleagues found that when given double time, older adults
could perform at young adult levels. Other studies have also found that older adults have greaterdifficulty shifting their attention between objects or locations (Tales, Muir, Bayer, & Snowden,
2002). Consider the implication of these attentional changes for older adults.
How do changes or maintenance of cognitive ability affect older adults’ everyday lives?
Researchers have studied cognition in the context of several different everyday activities. One
example is driving. Although older adults often have more years of driving experience, cognitive
declines related to reaction time or attentional processes may pose limitations under certain
circumstances (Park & Gutchess, 2000). In contrast, research on interpersonal problem solving
401

suggested that older adults use more effective strategies than younger adults to navigate throughsocial and emotional problems (Blanchard-Fields, 2007). In the context of work, researchers
rarely find that older individuals perform poorer on the job (Park & Gutchess, 2000). Similar to
everyday problem solving, older workers may develop more efficient strategies and rely on
expertise to compensate for cognitive decline.
Problem Solving: Problem solving tasks that require processing non-meaningful information
quickly (a kind of task that might be part of a laboratory experiment on mental processes)
declines with age. However, many real-life challenges facing older adults do not rely on speed ofprocessing or making choices on one’s own. Older adults resolve everyday problems by relying
on input from others, such as family and friends. They are also less likely than younger adults todelay making decisions on important matters, such as medical care (Strough, Hicks, Swenson,
Cheng & Barnes, 2003; Meegan & Berg, 2002).
What might explain these deficits as we age? The processing speed theory, proposed by
Salthouse (1996, 2004), suggests that as the nervous system slows with advanced age our ability
to process information declines. This slowing of processing speed may explain age differences
on many different cognitive tasks. For instance, as we age, working memory becomes lessefficient (Craik & Bialystok, 2006). Older adults also need longer time to complete mental tasks
or make decisions. Yet, when given sufficient time older adults perform as competently as doyoung adults (Salthouse, 1996). Thus, when speed is not imperative to the task healthy older
adults do not show cognitive declines.
In contrast, inhibition theory argues that older adults have difficulty with inhibitory functioning,or the ability to focus on certain information while suppressing attention to less pertinent
information tasks (Hasher & Zacks, 1988). Evidence comes from directed forgetting research. In
directed forgetting people are asked to forget or ignore some information, but not otherinformation. For example, you might be asked to memorize a list of words but are then told thatthe researcher made a mistake and gave you the wrong list and asks you to “forget” this list. You
are then given a second list to memorize. While most people do well at forgetting the first list,
older adults are more likely to recall more words from the “forget-to-recall” list than are younger
adults (Andrés, Van der Linden, & Parmentier, 2004).
Cognitive losses exaggerated: While there areinformation processing losses in late adulthood,overall loss has been exaggerated (Garrett, 2015).
One explanation is that the type of tasks that people
are tested on tend to be meaningless. For example,
older individuals are not motivated to remember arandom list of words in a study, but they are
motivated for more meaningful material related totheir life, and consequently perform better on thosetests. Another reason is that the research is often
cross-sectional. When age comparisons occur
longitudinally, however, the amount of loss
diminishes (Schaie, 1994). A third reason is that the402

Figure 9.30

Sourceloss may be due to a lack of opportunity in using various skills. When older adults practiced
skills, they performed as well as they had previously. Although diminished performance speed is
especially noteworthy in the elderly, Schaie (1994) found that statistically removing the effectsof speed diminished the individual’s performance declines significantly. In fact, Salthouse andBabcock (1991) demonstrated that processing speed accounted for all but 1% of age-relateddifferences in working memory when testing individuals from 18 to 82. Finally, it is wellestablished that our hearing and vision decline as we age. Longitudinal research has proposedthat deficits in sensory functioning explain age differences in a variety of cognitive abilities(Baltes & Lindenberger, 1997). Not surprisingly, more years of education, and subsequently
higher income, are associated with higher cognitive level and slower cognitive decline (Zahodne,
Stern, & Manly, 2015).

Intelligence and Wisdom
When looking at scores on traditional intelligence tests, tasks measuring verbal skills show
minimal or no age-related declines, while scores on performance tests, which measure solving
problems quickly, decline with age (Botwinick, 1984). This profile mirrors crystalized and fluid
intelligence. As you recall from last chapter, crystallized intelligence encompasses abilities thatdraw upon experience and knowledge. Measures of crystallized intelligence include vocabulary
tests, solving number problems, and understanding texts. Fluid intelligence refers to information
processing abilities, such as logical reasoning, remembering lists, spatial ability, and reaction
time. Baltes (1993) introduced two additional types of intelligence to reflect cognitive changes inaging. Pragmatics of intelligence are cultural exposure to facts and procedures that are
maintained as one ages and are similar to crystalized intelligence. Mechanics of intelligenceare dependent on brain functioning and decline with age, similar to fluid intelligence. Baltes
indicated that pragmatics of intelligence show little decline and typically increase with age.
Additionally, pragmatics of intelligence may compensate for the declines that occur withmechanics of intelligence. In summary, global cognitive declines are not typical as one ages, andindividuals compensate for some cognitive declines, especially processing speed.
Wisdom is the ability to use the accumulated knowledge about practical matters that allows forsound judgment and decision making. A wise person is insightful and has knowledge that can beused to overcome obstacles in living. Does aging bring wisdom? While living longer brings
experience, it does not always bring wisdom. Paul Baltes and his colleagues (Baltes &Kunzmann, 2004; Baltes & Staudinger, 2000) suggest that wisdom is rare. In addition, theemergence of wisdom can be seen in late adolescence and young adulthood, with there being few
gains in wisdom over the course of adulthood (Staudinger & Gluck, 2011). This would suggestthat factors other than age are stronger determinants of wisdom. Occupations and experiencesthat emphasize others rather than self, along with personality characteristics, such as openness toexperience and generativity, are more likely to provide the building blocks of wisdom (Baltes &Kunzmann, 2004). Age combined with a certain types of experience and/or personality brings
wisdom.

403

Neurocognitive Disorders
Historically, the term dementia was used to refer to an individual experiencing difficulties withmemory, language, abstract thinking, reasoning, decision making, and problem-solving (Erber& Szuchman (2015). However, in the latest edition of the Diagnostic and Statistical Manual of
Mental Disorders Fifth Edition (DSM-5) (American Psychiatric Association, 2013) the termdementia has been replaced by neurocognitive disorder. A major neurocognitive disorder isdiagnosed as a significant cognitive decline from a previous level of performance in one ormore cognitive domains and interferes with independent functioning, while a minor
neurocognitive disorder is diagnosed as a modest cognitive decline from a previous level of
performance in one of more cognitive domains and does not interfere with independentfunctioning. There are several different neurocognitive disorders that are typicallydemonstrated in late adulthood and determining the exact type can be difficult because thesymptoms may overlap with each other. Diagnosis often includes a medical history, physicalexam, laboratory tests, and changes noted in behavior. Alzheimer’s disease, vascular
neurocognitive disorder and neurocognitive disorder with Lewy bodies will be discussed
below.
Alzheimer’s Disease: Probably the most well-known and most common neurocognitive
disorder for older individuals is Alzheimer’s disease. In 2016 an estimated 5.4 million
Americans were diagnosed with Alzheimer’s disease (Alzheimer’s Association, 2016), which
was approximately one in nine aged 65 and over. By 2050 the number of people age 65 andolder with Alzheimer's disease is projected to be 13.8 million if there are no medical
breakthroughs to prevent or cure the disease. Alzheimer’s disease is the 6th leading cause ofdeath in the United States, but the 5th leading cause for those 65 and older. Among the top 10
causes of death in America, Alzheimer's disease is the only one that cannot be prevented,
cured, or even slowed. Current estimates indicate that Alzheimer disease affects
approximately 50% of those identified with a neurocognitive disorder (Cohen & Eisdorfer,2011).
Alzheimer’s disease has a gradual onset with subtle personality changes and memory loss thatdiffers from normal age-related memory problems occurring first. Confusion, difficulty withchange, and deterioration in language, problem-solving skills, and personality become evident
Figure 9.31

Source404

next. In the later stages, the individual loses physical coordination and is unable to complete
everyday tasks, including self-care and personal hygiene (Erber & Szuchman, 2015). Lastly,
individuals lose the ability to respond to their environment, to carry on a conversation, andeventually to control movement (Alzheimer’s Association, 2016). On average people with
Alzheimer’s survive eight years, but some may live up to 20 years. The disease course often
depends on the individual’s age and whether they have other health conditions.
The greatest risk factor for Alzheimer’s disease is age, but there are genetic and environmental
factors that can also contribute. Some forms of Alzheimer’s are hereditary, and with the early
onset type, several rare genes have been identified that directly cause Alzheimer's. People who
inherit these genes tend to develop symptoms in their 30s, 40s and 50s. Five percent of those
identified with Alzheimer’s disease are younger than age 65. When Alzheimer's disease iscaused by deterministic genes, it is called familial Alzheimer's disease (Alzheimer’s Association,2016). Traumatic brain injury is also a risk factor, as well as obesity, hypertension, highcholesterol, and diabetes (Carlson, 2011).
Βeta Amyloid and Tau: According to Erber and Szuchman (2015) the problems that occur
with Alzheimer’s disease are due to the “death of neurons, the breakdown of connections
between them, and the extensive formation of plaques and tau, which interfere with neuron
functioning and neuron survival” (p. 50). Plaques are abnormal formations of protein pieces
called beta-amyloid. Beta-amyloid comes from a larger protein found in the fatty membranesurrounding nerve cells. Because beta-amyloid is sticky, it builds up into plaques (Alzheimer’s
Association, 2016). These plaques appear to block cell communication and may also trigger
an inflammatory response in the immune system, which leads to further neuronal death.
Tau is an important protein that helps maintain the brain’s transport system. When tau
malfunctions, it changes into twisted strands called tangles that disrupt the transport system.
Consequently, nutrients and other supplies cannot move through the cells and they eventuallydie. The death of neurons lead to the brain shrinking and affecting all aspects of brain
Figure 9.32 Plaques and Tangles

Figure 9.33

SourceSource405

functioning. For example, the hippocampus is involved in learning and memory, and the brain
cells in this region are often the first to be damaged. This is why memory loss is often one of
the earliest symptoms of Alzheimer's disease. Figures 9.32 and 9.33 illustrate the difference
between an Alzheimer’s brain and a healthy brain.
Washington University School of Medicine (2019) reported that researchers associated with the
School of Medicine discovered that failing immune cells, known as microglia, appear be the link
between amyloid and tau, which are the two damaging proteins of Alzheimer's disease. Amyloid
plaques, which appear first, do not cause Alzheimer’s, but the presence of amyloid leads to theformation of tau tangles, which are responsible for the memory loss and cognitive deficits seen in
those with Alzheimer’s disease. It appears that weakening microglia cause the amyloid plaques
to injure nearby neurons, thus creating a toxic environment that increases the formation andspread of tau tangles. These findings could lead to a new approach for developing therapies for
Alzheimer's.
Sleep Deprivation and Alzheimer’s: Studies suggest that sleep plays a role in clearing bothbeta-amyloid and tau out of the brain. Shokri-Kojori et al. (2018) scanned participants’ brains
after getting a full night’s rest and after 31 hours without sleep. Beta-amyloid increased about
5% in the participants’ brains after losing a night of sleep. These changes occurred in brain
regions that included the thalamus and hippocampus, which are associated with the early stagesof Alzheimer’s disease. Shokri-Kojori et al. also found that participants with the largest increases
in beta-amyloid reported the worst mood after sleep deprivation. These findings support otherstudies that have found that the hippocampus and thalamus are involved in mood disorders.
Additionally, Holth et al. (2019) found that healthy adults who remained awake all day andnight, had tau levels that were elevated by about 50 percent. Once tau begins to accumulate inbrain tissue, the protein can spread from one brain area to the next along neural connections.
Holth et al. also found that older people who had more tau tangles in their brains by PET
scanning had less slow-wave, deep sleep. Holth et al. concluded that good sleep habits and/or
treatments designed to encourage plenty of high-quality sleep might play an important role inslowing Alzheimer’s disease. In contrast, poor sleep might worsen the condition and serve as an
early warning sign of Alzheimer’s disease.
Figure 9.34

SourceHealthy Lifestyle Combats Alzheimer’s: Dhana andcolleagues with the Rush University Medical Center in
Chicago examined how healthy lifestyle mitigates therisk of Alzheimer’s disease (Natanson, 2019). The
researchers followed a diverse group of 2765
participants for 9 years and focused on five low-risk
lifestyle factors: healthy diet, at least 150
minutes/week of moderate to vigorous physicalactivity, not smoking, light to moderate alcohol intake,and engaging in cognitively stimulating activities.
Results indicated that those who adopted four or five
low-risk lifestyle factors had a 60% lower risk of
Alzheimer’s disease when compared with participants
who did not follow any or only one of the low-risk406

factors. The authors concluded that incorporating these lifestyle changes can have a positiveeffect on one’s brain functioning and lower the risk for Alzheimer’s disease.
Vascular Neurocognitive Disorder is the second most common neurocognitive disorderaffecting 0.2% in the 65-70 years age group and 16% of individuals 80 years and older(American Psychiatric Association, 2013). Vascular neurocognitive disorder is associated witha blockage of cerebral blood vessels that affects one part of the brain rather than a general lossof brain cells seen with Alzheimer’s disease. Personality is not as affected in vascular
neurocognitive disorder, and more males are diagnosed than females (Erber and Szuchman,2015). It also comes on more abruptly than Alzheimer’s disease and has a shorter course
before death. Risk factors include smoking, diabetes, heart disease, hypertension, or a historyof strokes.
Neurocognitive Disorder with Lewy bodies: According to the National Institute on Aging(2015a), Lewy bodies are microscopic protein deposits found in neurons seen postmortem. They
affect chemicals in the brain that can lead to difficulties in thinking, movement, behavior andmood. Neurocognitive Disorder with Lewy bodies is the third most common form and affects
more than 1 million Americans. It typically begins at age 50 or older and appears to affectslightly more men than women. The disease lasts approximately 5 to 7 years from the time ofdiagnosis to death but can range from 2 to 20 years depending on the individual’s age, health,and severity of symptoms. Lewy bodies can occur in both the cortex and brain stem which
results in cognitive as well as motor symptoms (Erber & Szuchman, 2015). The movement
symptoms are similar to those with Parkinson’s disease and include tremors and muscle rigidity.
However, the motor disturbances occur at the same time as the cognitive symptoms, unlike with
Parkinson’s disease when the cognitive symptoms occur well after the motor symptoms.
Individuals diagnosed with Neurocognitive Disorder with Lewy bodies also experience sleep
disturbances, recurrent visual hallucinations, and are at risk for falling.

Work, Retirement, and LeisureWork: According to the United States
Census Bureau, in 1994, approximately
12% of those employed were 65 andover, and by 2016, the percentage had
increased to 18% of those employed(McEntarfer, 2019). Looking moreclosely at the age ranges, more than
40% of Americans in their 60s are stillworking, while 14% of people in their
70s and just 4% of those 80 and older
are currently employed (Livingston,2019). Even though they make up asmaller number of workers overall,
those 65- to 74-year-old and 75-andolder age groups are projected to havethe fastest rates of growth in the next

Figure 9.35 2014-2024 Percentage Labor Growthby Age Group

Source407

decade. See Figure 9.35 for the projected annual growth rate in labor force by age in percentages,
2014-2024.
Livingston (2019) reported that, similar to other age groups, those with higher levels of
education are more likely to be employed. Approximately 37% of adults who are 60 and older
and have a bachelor’s degree or more are working. In contrast, 31% with some college
experience and 21% of those with a high school diploma or less are still working at age 60 andbeyond. Additionally, men 60 and older are more likely to be working than women (33% vs.
24%). Not only are older persons working more, but they are also earning more than previously,
and their growth in earnings is greater compared to workers of other ages (McEntarfer, 2019).
Older adults are proving just as capable as younger adults at the workplace. In fact, jobs that
require social skills, accumulated knowledge, and relevant experiences favor older adults (Erber& Szuchman, 2015). Older adults also demonstrate lower rates of absenteeism and greater
investment in their work.
Transitioning into Retirement: For most Americans, retirement is a process and not a one-time
event (Quinn & Cahill, 2016). Sixty percent of workers transition straight to bridge jobs, which
are often part-time, and occur between a career and full retirement. About 15% of workers get
another job after being fully retired. This may be due to not having adequate finances after
retirement or not enjoying their retirement. Some of these jobs may be in encore careers, orwork in a different field from the one in which they retired. Approximately 10% of workers
begin phasing into retirement by reducing their hours. However, not all employers will allow
this due to pension regulations.
Retirement age changes: Looking at retirement data, the average age of retirement declined
from more than 70 in 1910 to age 63 in the early 1980s. However, this trend has reversed andthe current average age is now 65. Additionally, 18.5% of those over the age of 65 continue towork (US Department of Health and Human Services, 2012) compared with only 12% in 1990
(U. S. Government Accountability Office, 2011). With individuals living longer, once retired theaverage amount of time a retired worker collects social security is approximately 17-18 years(James, Matz-Costa, & Smyer, 2016).
When to retire: Laws often influence when someone decides to retire. In 1986 the Age
Discrimination in Employment Act (ADEA) was amended, and mandatory retirement waseliminated for most workers (Erber & Szuchman, 2015). Pilots, air traffic controllers, federal
law enforcement, national park rangers, and fire fighters continue to have enforced retirement
ages. Consequently, for most workers they can continue to work if they choose and are able.
Social security benefits also play a role. For those born before 1938, they can receive full social
security benefits at age 65. For those born between 1943 and 1954, they must wait until age 66
for full benefits, and for those born after 1959 they must wait until age 67 (Social Security
Administration, 2016). Extra months are added to those born in years between. For example, ifborn in 1957, the person must wait until 66 years and 6 months. The longer one waits to receive
social security, the more money will be paid out. Those retiring at age 62, will only receive 75%of their monthly benefits. Medicare health insurance is another entitlement that is not available
until one is aged 65.

408

Delayed Retirement: Older adults primarily choose to delay
retirement due to economic reasons (Erber & Szchman,2015). Financially, continuing to work provides not only
added income, but also does not dip into retirement savings
which may not be sufficient. Historically, there have been
three parts to retirement income; that is, social security, apension plan, and individual savings (Quinn & Cahill, 2016).
With the 2008 recession, pension plans lost value for mostworkers. Consequently, many older workers have had towork later in life to compensate for absent or minimal
pension plans and personal savings. Social security wasnever intended to replace full income, and the benefits
provided may not cover all the expenses, so elders continue towork. Unfortunately, many older individuals are unable tosecure later employment, and those especially vulnerable
include persons with disabilities, single women, the oldestold, and individuals with intermittent work histories.

Figure 9.36

SourceSome older adults delay retirement for psychological reasons, such as health benefits and social
contacts. Recent research indicates that delaying retirement has been associated with helping
one live longer. When looking at both healthy and unhealthy retirees, a one-year delay in retiring
was associated with a decreased risk of death from all causes (Wu, Odden, Fisher, & Stawski,2016). When individuals are forced to retire due to health concerns or downsizing, they are more
likely to have negative physical and psychological consequences (Erber & Szuchman, 2015).
Retirement Stages: Atchley (1994) identified several phases that individuals ago through when
they retire:
•
•
•
•
•
•

Remote pre-retirement phase includes fantasizing about what one wants to do inretirement
Immediate pre-retirement phase when concrete plans are established
Actual retirement
Honeymoon phase when retirees travel and participate in activities they could not dowhile working
Disenchantment phase when retirees experience an emotional let-downReorientation phase when the retirees attempt to adjust to retirement by making lesshectic plans and getting into a regular routine

Not everyone goes through every stage, but this model demonstrates that retirement is a process.
Post-retirement: Those who look most forward to retirement and have plans are those who
anticipate adequate income (Erber & Szuchman, 2015). This is especially true for males who
have worked consistently and have a pension and/or adequate savings. Once retired, staying
active and socially engaged is important. Volunteering, caregiving and informal helping cankeep seniors engaged. Kaskie, Imhof, Cavanaugh and Culp (2008) found that 70% of retirees
who are not involved in productive activities spent most of their time watching TV, which iscorrelated with negative affect. In contrast, being productive improves well-being.
409

Figure 9.37

Elder Education: Attending college is not just for the young
as discussed in the previous chapter. There are many reasons
why someone in late adulthood chooses to attend college.
PNC Financial Services surveyed retirees aged 70 and overand found that 58% indicated that they had retired before they
had planned (Holland, 2014). Many of these individuals choseto pursue additional training to improve skills to return to workin a second career. Others may be looking to take their careerin a new direction. For some older students who no longer are
focus on financial reasons, returning to school is intended toenable them to pursue work that is personally fulfilling.
Attending college in late adulthood is also a great way forseniors to stay young and keep their minds sharp.

Even if an elder chooses not to attend college for a degree,
there are many continuing education programs on topics ofSourceinterest available. In 1975, a nonprofit educational travelorganization called Elderhostel began in New Hampshire withfive programs for several hundred retired participants (DiGiacomo, 2015). This program
combined college classroom time with travel tours and experiential learning experiences. In
2010 the organization changed its name to Road Scholar, and it now serves 100,000 people per
year in the U.S. and in 150 countries. Academic courses, as well as practical skills such as
computer classes, foreign languages, budgeting, and holistic medicines, are among the courses
offered. Older adults who have higher levels of education are more likely to take continuing
education. However, offering more educational experiences to a diverse group of older adults,
including those who are institutionalized in nursing homes, can bring enhance the quality of life.
Leisure: During the past 10 years, leisure time for Americans 60
Figure 9.38
and older has remained at about 7 hours a day. However, theamount of time spent on TVs, computers, tablets or otherelectronic devices has risen almost 30 minutes per day over the
past decade (Livingston, 2019). Those 60 and older now spend
more than half of their daily leisure time (4 hours and 16 minutes)
in front of screens. Screen time has increased for those in their 60s,
70s, 80s and beyond, and across genders and education levels. This
rise in screen time coincides with significant growth in the use ofdigital technology by older Americans. In 2000, 14% of those aged
65 and older used the Internet, and now 73% are users and 53%
own smartphones. Alternatively, the time spent on otherrecreational activities, such as reading or socializing, has gone
Sourcedown slightly. People with less education spend more of theirleisure time on screens and less time reading compared with thosewith more education. Less educated adults also spend less time exercising: 12 minutes a day for
those with a high school diploma or less, compared with 26 minutes for college graduates.

410

Learning Objectives: Psychosocial Development in Late Adulthood
•
•
•
•
•
•
•
•
•
•
•
•

Explain the stereotypes of those in late adulthood and how it impacts their lives
Summarize Erikson’s eighth psychosocial task of integrity vs despair
Explain how self-concept and self-esteem affect those in late adulthood
Identify sources of despair and regret
Describe paths to integrity, including the activity, socioemotional selectivity, andconvoy theories
Describe the continuation of generativity in late adulthood
Describe the relationships those in late adulthood have with their children andother family members
Describe singlehood, marriage, widowhood, divorce, and remarriage in lateadulthood
Describe the different types of residential living in late adulthood
Describe friendships in late life
Explain concerns experienced by those in late adulthood, such as abuse andmental health issues
Explain how those in late adulthood use strategies to compensate for losses

AgeismStereotypes of people in late adulthood lead many to assume that aging
automatically brings poor physical health and mental decline. These
stereotypes are reflected in everyday conversations, the media, and evenin greeting cards (Overstreet, 2006). Age is not revered in the UnitedStates, and so laughing about getting older in birthday cards is one way
to get relief. The negative attitudes people have about those in lateadulthood are examples of ageism, or prejudice based on age. The term
ageism was first used in 1969, and according to Nelson (2016), ageism
remains one of the most institutionalized forms of prejudice today.

Figure 9.39

Nelson (2016) reviewed the research on ageism and concluded thatwhen older individuals believed their culture’s negative stereotypes
Sourceabout those who are old, their memory and cognitive skills declined. In
contrast, older individuals in cultures, such as China, that held morepositive views on aging did not demonstrate cognitive deficits. It appears that when one agrees
with the stereotype, it becomes a self-fulfilling prophecy, or the belief in one’s ability results inactions that make it come true.
Being the target of stereotypes can adversely affect individuals’ performance on tasks because
they worry they will confirm the cultural stereotypes. This is known as stereotype threat, and it
was originally used to explain race and gender differences in academic achievement (Gatz et al.,2016). Stereotype threat research has demonstrated that older adults who internalize the aging
411

stereotypes will exhibit worse memory performance, worse physical performance, and reduced
self-efficacy (Levy, 2009).
In terms of physically taking care of themselves, those who believe in negative stereotypes areless likely to engage in preventative health behaviors, less likely to recover from illnesses, andmore likely to feel stress and anxiety, which can adversely affect immune functioning andcardiovascular health (Nelson, 2016). Additionally, individuals who attribute their healthproblems to their age, had a higher death rate. Similarly, doctors who believe that illnesses are
just natural consequence of aging are less likely to have older adults participate in clinical trials
or receive life-sustaining treatment. In contrast, those older adults who possess positive andoptimistic views of aging are less likely to have physical or mental health problems and are more
likely to live longer. Removing societal stereotypes about aging and helping older adults reject
those notions of aging is another way to promote health and life expectancy among the elderly.
Minority status: Older minority adults accounted for approximately 21% of the U. S. populationin 2012 but are expected to reach 39% of the population in 2050 (U. S. Census Bureau, 2012).
Unfortunately, racism is a further concern for minority elderly already suffering from ageism.
Older adults who are African American, Mexican American, and Asian American experience
psychological problems that are often associated with discrimination by the White majority(Youdin, 2016). Ethnic minorities are also more likely to become sick, but less likely to receive
medical intervention. Older, minority women can face ageism, racism, and sexism, often referred
to as triple jeopardy (Hinze, Lin, & Andersson, 2012), which can adversely affect their life inlate adulthood.
Poverty rates: According to Quinn and Cahill (2016), the poverty rate for older adults varies
based on gender, marital status, race, and age. Women aged 65 or older were 70% more likely to
be poor than men, and older women aged 80 and above have higher levels of poverty than thoseyounger. Married couples are less likely to be poor than nonmarried men and women, andpoverty is more prevalent among older racial minorities. In 2012 the poverty rates for White
older men (5.6%) and White older women (9.6%) were lower than for Black older men (14%),
Black older women (21%), Hispanic older men (19%), and Hispanic older women (22%).

Living Arrangements
Do those in late adulthood primarily live alone? No. In 2017, of those 65 years of age andolder, approximately 72% of men and 48% of women lived with their spouse or partner(Administration on Aging, 2017). Between 1900 and 1990 the number of older adults living
alone increased, most likely due to improvements in health and longevity during this time (seeFigure 9.40). Since 1990 the number of older adults living alone has declined, because of older
women more likely to be living with their spouse or children (Stepler, 2016c). Women continue
to make up the majority of older adults living alone in the U.S., although that number has
dropped from those living alone in 1990 (Stepler, 2016a). Older women are more likely to beunmarried, living with children, with other relatives or non-relatives. Older men are more likely
to be living alone than they were in 1990, although older men are more likely to reside with theirspouse. The rise in divorce among those in late adulthood, along with the drop-in remarriage
rate, has resulted in slightly more older men living alone today than in the past (Stepler, 2016c).

412

Figure 9.40 Living Arrangements for those 65 andolder in 2017

Older adults who live alone
report feeling more financiallystrapped than do those livingwith others (Stepler, 2016d).
According to a Pew ResearchCenter Survey, only 33% of
those living alone reported they
were living comfortably, while
nearly 49% of those living withothers said they were living
comfortably. Similarly, 12% of
those living alone, but only 5%of those living with others,reported that they lacked moneyfor basic needs (Stepler, 2016d).

Do those in late adulthood
primarily live with family
members? No, but according to
the Pew Research Center, there
has been an increase in thenumber of families living in
multigenerational housing; thatis three generations living
Sourcetogether than in previous
generations (Cohn & Passel,
2018). In 2016, a record 64 million Americans, or 20% of the population, lived in a house withat least two adult generations. However, ethnic differences are noted in the percentage ofmultigenerational households with Hispanic (27%), Black (26%), and Asian (29%) families
living together in greater numbers than White families (16%). Consequently, the majority ofolder adults wish to live independently for as long as they are able.
Do those in late adulthood move after retirement? No. According to Erber and Szuchman(2015), the majority of those in late adulthood remain in the same location, and often in the same
house, where they lived before retiring. Although some younger late adults (65-74 years) may
relocate to warmer climates, once they are older (75-84 years) they often return to their home
states to be closer to adult children (Stoller & Longino, 2001). Despite the previous trends,
however, the recent housing crisis has kept those in late adulthood in their current suburban
locations because they are unable to sell their homes (Erber & Szuchman, 2015).
Do those in late adulthood primarily live in institutions? No. Only a small portion (3.2%) ofadults older than 65 lived in an institution in 2015 (United States Department of Health andHuman Services, 2015). However, as individuals increase in age the percentage of those living
in institutions, such as a nursing home, also increases. Specifically: 1% of those 65-74, 3% of
those 75-84, and 10% of those 85 years and older lived in an institution in 2015. Due to theincreasing number of baby boomers reaching late adulthood, the number of people who will
depend on long-term care is expected to rise from 12 million in 2010 to 27 million in 2050
413

(United States Senate Commission on Long-Term Care, 2013). To meet this higher demand forservices, a focus on the least restrictive care alternatives has resulted in a shift toward home andcommunity-based care instead of placement in a nursing home (Gatz et al., 2016).

Erikson: Integrity vs. Despair
How do people cope with old age? According to Erikson, the last psychosocial stage is Integrity
vs. Despair. This stage includes, “a retrospective accounting of one’s life to date; how muchone embraces life as having been well lived, as opposed to regretting missed opportunities,”(Erikson, 1982, p. 112). Those in late adulthood need to achieve both the acceptance of theirlife and the inevitability of their death (Barker, 2016). This stage includes finding meaning in
one’s life and accepting one’s accomplishments, but also acknowledging what in life has notgone as hoped. It is also feeling a sense of contentment and accepting others’ deficiencies,
including those of their parents. This acceptance will lead to integrity, but if elders are unable toachieve this acceptance, they may experience despair. Bitterness and resentments inrelationships and life events can lead one to despair at the end of life. According to Erikson(1982), successful completion of this stage leads to wisdom in late life.
Erikson’s theory was the first to propose a lifespan approach to development, and it has
encouraged the belief that older adults still have developmental needs. Prior to Erikson’s theory,
older adulthood was seen as a time of social and leisure restrictions and a focus primarily on
physical needs (Barker, 2016). The current focus on aging well by keeping healthy and active,
helps to promote integrity. There are many avenues for those in late adulthood to remain vital
members of society, and they will be explored next.
Staying Active: Many older adults want to remain
active and work toward replacing opportunities lost withnew ones. Those who prefer to keep themselves busy
demonstrate the Activity Theory, which states that
greater satisfaction with one’s life occurs with those
who remain active (Lemon, Bengston, & Peterson,1972). Not surprisingly, more positive views on aging
and greater health are noted with those who keep active
than those who isolate themselves and disengage withothers. Community, faith-based, and volunteer
organizations can all provide those in late adulthoodwith opportunities to remain active and maintain social
networks. Erikson’s concept of generativity applies tomany older adults, just as it did in midlife.

Figure 9.41

SourceGenerativity in Late Adulthood
Research suggests that generativity is not just a concern for midlife adults, but for many elders,concerns about future generations continue into late adulthood. As previously discussed, someolder adults are continuing to work beyond age 65. Additionally, they are volunteering in theircommunity, and raising their grandchildren in greater numbers.
414

Volunteering: Many older adults spend time volunteering. Hooyman and Kiyak (2011) foundthat religious organizations are the primary settings for encouraging and providing opportunities
to volunteer. Hospitals and environmental groups also provide volunteer opportunities for older
adults. While volunteering peaks in middle adulthood, it continues to remain high among adults
in their 60s, with about 40% engaging in volunteerism (Hooyman & Kiyak, 2011). While thenumber of older adults volunteering their time does decline with age, the number of hours older
adults volunteer does not show much decline until they are in their late 70s (Hendricks & Cutler,
2004). African-American older adults volunteer at higher levels than other ethnic groups(Taylor, Chatters, & Leving, 2004). Taylor and colleagues attribute this to the higher
involvement in religious organizations by older African-Americans.
Volunteering aids older adults as muchas it does the community at large.
Older adults who volunteer experience
more social contact, which has been
linked to higher rates of life
satisfaction, and lower rates ofdepression and anxiety (Pilkington,
Windsor, & Crisp, 2012).
Longitudinal research also finds astrong link between health in later
adulthood and volunteering (Kahana,
Bhatta, Lovegreen, Kahana, &Midlarsky, 2013). Lee and colleagues
found that even among the oldest-old,
Sourcethe death rate of those who volunteer ishalf that of non-volunteers (Lee,Steinman, & Tan, 2011). However, older adults who volunteer may already be healthier, which
is why they can volunteer compared to their less heathy age mates.
Figure 9.42

New opportunities exist for older adults to serve as virtual volunteers by dialoguing online withothers from around the world and sharing their support, interests, and expertise. These volunteer
opportunities range from helping teens with their writing to communicating with ‘neighbors’ invillages of developing countries. Virtual volunteering is available to those who cannot engage inface-to-face interactions, and it opens-up a new world of possibilities and ways to connect,
maintain identity, and be productive.
Grandparents Raising Grandchildren: According to the 2014 American Community Survey(U.S. Census, 2014a), over 5.5 million children under the age of 18 were living in families
headed by a grandparent. This was more than a half a million increase from 2010. While mostgrandparents raising grandchildren are between the ages of 55 and 64, approximately 25% ofgrandparents raising their grandchildren are 65 and older (Office on Women’s Health, 2010a).
For many grandparents, parenting a second time can be harder. Older adults have far less415

Figure 9.43

Sourceenergy, and often the reason why they are now acting
as parents to their grandchildren is because traumatic
events. A survey by AARP (Goyer, 2010) found that
grandparents were raising their grandchildren because
the parents had problems with drugs and alcohol, hada mental illness, were incarcerated, had divorced, hada chronic illness, were homeless, had neglected orabused the child, were deployed in the military, or
had died. While most grandparents state they gain
great joy from raising their grandchildren, they also
face greater financial, health, education, and housing
challenges that often derail their retirement plans thando grandparents who do not have primary
responsibility for raising their grandchildren.

Social Networks in Late Adulthood
A person’s social network consists of the people with whom one is directly involved, such as
family, friends, and acquaintances (Fischer, 1982). As individuals age, changes occur in thesesocial networks, and The Convoy Model of Social Relations and Socioemotional Selectivity
Theory address these changes (Wrzus, Hanel, Wagner, & Neyer, 2013). Both theories indicatethat less close relationships will decrease as one ages, while close relationships will persist.
However, the two theories differ in explaining why this occurs.
The Convoy Model of Social Relations suggests that the social connections that people
accumulate differ in levels of closeness and are held together by exchanges in social support(Antonucci, 2001; Kahn & Antonucci, 1980). According to the Convoy Model, relationships
with a spouse and family members, people in the innermost circle of the convoy, should remain
stable throughout the lifespan. In contrast, coworkers, neighbors, and acquaintances, people in
the periphery of the convoy, should be less stable. These peripheral relationships may end due tochanges in jobs, social roles, location, or other life events. These relationships are more
vulnerable to changing situations than family relationships. Therefore, the frequency, type, andreciprocity of the social exchanges with peripheral relationships decrease with age.
The Socioemotional Selectivity Theory focuses on changes in motivation for actively seekingsocial contact with others (Carstensen, 1993; Carstensen, Isaacowitz & Charles, 1999). This
theory proposes that with increasing age, our motivational goals change based on how much time
one has left to live. Rather than focusing on acquiring information from many diverse social
relationships, as noted with adolescents and young adults, older adults focus on the emotional
aspects of relationships. To optimize the experience of positive affect, older adults actively
restrict their social life to prioritize time spent with emotionally close significant others. In linewith this theory, older marriages are found to be characterized by enhanced positive and reduced
negative interactions and older partners show more affectionate behavior during conflictdiscussions than do middle-aged partners (Carstensen, Gottman, & Levenson, 1995). Researchshowing that older adults have smaller networks compared to young adults, and tend to avoid
negative interactions, also supports this theory.
416

Relationship with Adult Children: Many older
Figure 9.44
adults provide financial assistance and/or housing
to adult children. There is more support goingfrom the older parent to the younger adult children
than in the other direction (Fingerman & Birditt,2011). In addition to providing for their own
children, many elders are raising their
grandchildren. Consistent with socioemotional
selectivity theory, older adults seek, and are helped
by, their adult children providing emotional
Sourcesupport (Lang & Schütze, 2002). Lang and
Schütze, as part of the Berlin Aging Study(BASE), surveyed adult children (mean age 54) and their aging parents (mean age 84). They
found that the older parents of adult children who provided emotional support, such as showing
tenderness toward their parent, cheering the parent up when he or she was sad, tended to report
greater life satisfaction. In contrast, older adults whose children provided informational support,such as providing advice to the parent, reported less life satisfaction. Lang and Schütze foundthat older adults wanted their relationship with their children to be more emotionally meaningful.
Daughters and adult children who were younger, tended to provide such support more than sonsand adult children who were older. Lang and Schütze also found that adult children who weremore autonomous rather than emotionally dependent on their parents, had more emotionally
meaningful relationships with their parents, from both the parents’ and adult children’s point ofview.
Friendships: Friendships are not formed in order to enhance status or careers, and may be based
purely on a sense of connection or the enjoyment of being together. Most elderly people have atleast one close friend. These friends may provide emotional as well as physical support. Being
able to talk with friends and rely on others is very important during this stage of life. Bookwala,
Marshall, and Manning (2014) found that the availability of a friend played a significant role inprotecting the health from the impact of widowhood. Specifically, those who became widowed
and had a friend as a confidante, reported significantly lower somatic depressive symptoms,
better self-rated health, and fewer sick days in bed than those who reported not having a friend asa confidante. In contrast, having a family member as a confidante did not provide healthprotection for those recently widowed.
Loneliness or Solitude: Loneliness is the discrepancy between the social contact a person has
and the contacts a person wants (Brehm, Miller, Perlman, & Campbell, 2002). It can result fromsocial or emotional isolation. Women tend to experience loneliness due to social isolation; menfrom emotional isolation. Loneliness can be accompanied by a lack of self-worth, impatience,
desperation, and depression. Being alone does not always result in loneliness. For some, it means
solitude. Solitude involves gaining self-awareness, taking care of the self, being comfortable
alone, and pursuing one’s interests (Brehm et al., 2002). In contrast, loneliness is perceived
social isolation.
For those in late adulthood, loneliness can be especially detrimental. Novotney (2019) reviewed
the research on loneliness and social isolation and found that loneliness was linked to a 40%417

increase in a risk for dementia and a 30% increase in the risk of stroke or coronary heart disease.
This was hypothesized to be due to a rise in stress hormones, depression, and anxiety, as well as
the individual lacking encouragement from others to engage in healthy behaviors. In contrast,
older adults who take part in social clubs and church groups have a lower risk of death.
Opportunities to reside in mixed age housing and continuing to feel like a productive member ofsociety have also been found to decrease feelings of social isolation, and thus loneliness.

Late Adult Lifestyles
Figure 9.45 Marital Status: Age 65+ in 2017

Marriage: As can beseen in Figure 9.45,
the most common
living arrangementfor older adults in2015 was marriage(AOA, 2017).
Although this wasmore common for
older men.

Widowhood: Losing
one’s spouse is oneof the most difficulttransitions in life.
The Social
SourceReadjustment Rating
Scale, commonly
known as the Holmes-Rahe Stress Inventory, rates the death of a spouse as the most significant
stressor (Holmes & Rahe, 1967). The loss of a spouse after many years of marriage may make anolder adult feel adrift in life. They must remake their identity after years of seeing themselves asa husband or wife. Approximately, 1 in 3 women aged 65 and older are widowed, comparedwith about 1 in 10 men.
Loneliness is the biggest challenge for those who have lost their spouse (Kowalski & Bondmass,
2008). However, several factors can influence how well someone adjusts to this event. Olderadults who are more extroverted (McCrae & Costa, 1988) and have higher self-efficacy, (Carr,
2004b) often fare better. Positive support from adult children is also associated with fewer
symptoms of depression and better adjustment in the months following widowhood (Ha, 2010).
The context of the death is also an important factor in how people may react to the death of a
spouse. The stress of caring for an ill spouse can result in a mixed blessing when the ill partner
dies (Erber & Szchman, 2015). The death of a spouse who died after a lengthy illness may comeas a relief for the surviving spouse, who may have had the pressure of providing care forsomeone who was increasingly less able to care for themselves. At the same time, this sense ofrelief may be intermingled with guilt for feeling relief at the passing of their spouse. The
emotional issues of grief are complex and will be discussed in more detail in chapter 10.
418

Widowhood also poses health risks. The widowhood mortality effect refers to the higher riskof death after the death of a spouse (Sullivan & Fenelon, 2014). Subramanian, Elwert, andChristakis (2008) found that widowhood increases the risk of dying from almost all causes.
However, research suggests that the predictability of the spouse’s death plays an important rolein the relationship between widowhood and mortality. Elwert and Christakis (2008) found thatthe rate of mortality for windows and widowers was lower if they had time to prepare for thedeath of their spouse, such as in the case of a terminal illness like Parkinson’s or Alzheimer’s.
Another factor that influences the risk of mortality is gender. Men show a higher risk ofmortality following the death of their spouse if they have higher health problems (Bennett,
Hughes, & Smith, 2005). In addition, widowers have a higher risk of suicide than do widows(Ruckenhauser, Yazdani, & Ravaglia, 2007).
Divorce: As noted in Chapter 8, older adults are divorcing at
Figure 9.46
higher rates than in prior generations. However, adults age
65 and over are still less likely to divorce than middle-aged
and young adults (Wu & Schimmele, 2007). Divorce posesa number of challenges for older adults, especially women,
who are more likely to experience financial difficulties andare more likely to remain single than are older men(McDonald & Robb, 2004). However, in both America (Lin,2008) and England (Glaser, Stuchbury, Tomassini, &Askham, 2008) studies have found that the adult children of
divorced parents offer more support and care to their
Sourcemothers than their fathers. While divorced, older men may
be better off financially and are more likely to find anotherpartner, they may receive less support from their adult children.
Dating: Due to changing social norms and shifting cohort demographics, it has become morecommon for single older adults to be involved in dating and romantic relationships (Alterovitz &Mendelsohn, 2011). An analysis of widows and widowers ages 65 and older found that 18
months after the death of a spouse, 37% of men and 15% of women were interested in dating(Carr, 2004a). Unfortunately, opportunities to develop close relationships often diminish in later
life as social networks decrease because of retirement, relocation, and the death of friends andloved ones (de Vries, 1996). Consequently, older adults, much like those younger, are increasing
their social networks using technologies, including e-mail, chat rooms, and online dating sites(Fox, 2004; Wright & Query, 2004; Papernow, 2018).
Interestingly, older men and women parallel online dating information as those younger.
Alterovitz and Mendelsohn (2011) analyzed 600 internet personal ads from different age groups,
and across the life span, men sought physical attractiveness and offered status related
information more than women. With advanced age, men desired women increasingly younger
than themselves, whereas women desired older men until ages 75 and over, when they sought
men younger than themselves. Research has previously shown that older women in romantic
relationships are not interested in becoming a caregiver or becoming widowed for a second time
(Carr, 2004a). Additionally, older men are more eager to repartner than are older women(Davidson, 2001; Erber & Szuchman, 2015). Concerns expressed by older women included not419

wanting to lose their autonomy, care for a potentially ill partner, or merge their finances withsomeone (Watson & Stelle, 2011).
Older dating adults also need to know about threats to sexual health, including being at risk forsexually transmitted diseases, including chlamydia, genital herpes, and HIV. Nearly 25% of
people living with HIV/AIDS in the United States are 50 or older (Office on Women’s Health,
2010b). Githens and Abramsohn (2010) found that only 25% of adults 50 and over who were
single or had a new sexual partner used a condom the last time they had sex. Robin (2010) statedthat 40% of those 50 and over have never been tested for HIV. These results indicated that
educating all individuals, not just adolescents, on healthy sexual behavior is important.
Remarriage and Cohabitation: Older adults who remarry often find that their remarriages are
more stable than those of younger adults. Kemp and Kemp (2002) suggest that greater emotional
maturity may lead to more realistic expectations regarding marital relationships, leading togreater stability in remarriages in later life. Older adults are also more likely to be seeking
companionship in their romantic relationships. Carr (2004a) found that older adults who haveconsiderable emotional support from their friends were less likely to seek romantic relationships.
In addition, older adults who have divorced often desire the companionship of intimate
relationships without marriage. As a result, cohabitation is increasing among older adults, andlike remarriage, cohabitation in later adulthood is often associated with more positive
consequences than it is in younger age groups (King & Scott, 2005). No longer being interested
in raising children, and perhaps wishing to protect family wealth, older adults may see
cohabitation as a good alternative to marriage. In 2014, 2% of adults age 65 and up were
cohabitating (Stepler, 2016b).
Living Apart Together: In addition to cohabiting there has been an increase in living apart
together (LAT), which is “a monogamous intimate partnership between unmarried individuals
who live in separate homes but identify themselves as a committed couple” (Benson & Coleman,
2016, p. 797). This trend has been found in several nations and is motivated by:••••

A strong desire to be independent in day-to-day decisions
Maintaining their own home
Keeping boundaries around established relationships
Maintaining financial stability

Besides the desire to be autonomous, there is also a need for companionship, sexual intimacy,
and emotional support. According to Bensen and Coleman, there are differences in LAT amongolder and younger adults. Those who are younger often enter into LAT out of circumstances,such as the job market, and they frequently view this arrangement as a transitional stage. In
contrast, 80% older adults reported that they did not wish to cohabitate or marry. For some it
was a conscious choice to live more independently. For instance, older women desired the LAT
lifestyle as a way of avoiding the traditional gender roles that are often inherent in relationships
where the couple lives together. However, some older adults become LATs because they fearsocial disapproval from others if they were to live together.

420

Gay and Lesbian Elders
Approximately 3 million older adults in the United States identify as lesbian or gay (Hillman &Hinrichsen, 2014). By 2025 that number is expected to rise to more than 7 million (National
Gay and Lesbian Task Force, 2006). Despite the increase in numbers, older lesbian and gay
adults are one of the least researched demographic groups, and the research there is portrays apopulation faced with discrimination. According to the Centers for Disease Control andPrevention (2011), compared to heterosexuals, lesbian and gay adults experience both physicaland mental health differences. More than 40% of lesbian and gay adults ages 50 and over sufferfrom at least one chronic illness or disability and compared to heterosexuals they are more likely
to smoke and binge drink (Hillman & Hinrichsen, 2014). Additionally, gay older adults have an
increased risk of prostate cancer (Blank, 2005) and infection from HIV and other sexuallytransmitted illnesses (Centers for Disease Control and Prevention, 2008). When compared toheterosexuals, lesbian and gay elders have less support from others as they are twice as likely tolive alone and four times less likely to have adult children (Hillman & Hinrichsen, 2014).
Lesbian and gay older adults who belong to ethnic and cultural minorities, conservative
religions, and rural communities may face additional stressors. Ageism, heterocentrism, sexism,
and racism can combine cumulatively and impact the older adult beyond the negative impact ofeach individual form of discrimination (Hillman & Hinrichsen, 2014). David and Knight (2008)
found that older gay black men reported higher rates of racism than younger gay black men andhigher levels of perceived ageism than older gay white men.
LGBT Elder Care: Approximately 7 million LGBT people over age 50 will reside in the UnitedStates by 2030, and 4.7 million of them will need elder care. Decisions regarding elder care isoften left for families, and because many LGBT people are estranged from their families, they
are left in a vulnerable position when seeking living arrangements (Alleccia & Bailey, 2019). A
history of discriminatory policies, such as housing restricted to married individuals involving one
man and one woman, and stigma associated with LGBT people make them especially vulnerable
to negative housing experiences when looking for elder care.
Although lesbian and gay older adults face many
challenges, more than 80% indicate that they
engage in some form of wellness or spiritual
activity (Fredrickson-Goldsen et al., 2011). They
also gather social support from friends and“family members by choice” rather than legal or
biological relatives (Hillman & Hinrichsen, 2014).
This broader social network provides extra
support to gay and lesbian elders.
An important consideration when reviewing thedevelopment of gay and lesbian older adults is thecohort in which they grew up (Hillman &Hinrichsen, 2014). The oldest lesbian and gay
adults came of age in the 1950s when there were421

Figure 9.47

Sourceno laws to protect them from victimization. The baby boomers, who grew up in the 1960s and1970s, began to see states repeal laws that criminalized homosexual behavior. Future lesbian
and gay elders will have different experiences due to the legal right for same-sex marriage andgreater societal acceptance. Consequently, just like all those in late adulthood, understanding thatgay and lesbian elders are a heterogeneous population is important when understanding theiroverall development.

Elder Abuse
Current research indicates that at least 1 in 10, or approximately 4.3 million, older Americans areaffected by at least one form of elder abuse per year (Roberto, 2016). Those between 60 and 69
years of age are more susceptible than those older. This may be because younger older adults
more often live with adult children or a spouse, two groups with the most likely abusers.
Cognitive impairment, including confusion and communication deficits, is the greatest risk factor
for elder abuse, while a decline in overall health resulting in greater dependency on others is
another. Having a disability also places an elder at a higher risk for abuse (Youdin, 2016).
Definitions of elder abuse typically recognize five types of abuse as shown in Table 9.8
Consequences of elder abuse are significant and include injuries, new or exacerbated healthconditions, hospitalizations, premature institutionalization, and early death (Roberto, 2016).
Psychological and emotional abuse is considered the most common form, even though it isunderreported and may go unrecognized by the elder. Continual emotional mistreatment is very
damaging as it becomes internalized and results in late-life emotional problems and impairment.
Financial abuse and exploitation is increasing and costs seniors nearly 3 billion dollars per year
(Lichtenberg, 2016). Financial abuse is the second most common form after emotional abuse
and affects approximately 5% of elders. Abuse and neglect occurring in a nursing home isestimated to be 25%-30% (Youdin, 2016). Abuse of nursing home residents is more often foundin facilities that are run down and understaffed
Table 9.7 Types of Elder AbuseType
Physical Abuse
Sexual Abuse
Psychological and Emotional
Abuse
Financial Abuse and Exploitation
Neglect and Abandonment

Description
Physical force resulting in injury, pain, or impairment
Nonconsensual sexual contact
Infliction of distress through verbal or nonverbal acts such as
yelling, threatening, or isolating
Improper use of an elder’s finances, property, or assets
Intentional or unintentional refusal or failure to fulfill
caregiving duties to an elder

Adapted from Roberto (2016)

Older women are more likely to be victims than men, and one reason is due to women living
longer. Additionally, a family history of violence makes older women more vulnerable,
especially for physical and sexual abuse (Acierno et al., 2010). However, Kosberg (2014) foundthat men were less likely to report abuse. Recent research indicated no differences among ethnic
groups in abuse prevalence, however, cultural norms regarding what constitutes abuse differ
based on ethnicity. For example, Dakin and Pearlmutter found that working class White women422

did not consider verbal abuse as elder abuse, and higher socioeconomic status African Americanand White women did not consider financial abuse as a form of elder abuse (as cited in Roberto,
2016, p. 304).
Perpetrators of elder abuse are typically family members and include spouses/partners and older
children (Roberto, 2016). Children who are abusive tend to be dependent on their parents forfinancial, housing, and emotional support. Substance use, mental illness, and chronic
unemployment increase dependency on parents, which can then increase the possibility of elder
abuse. Prosecuting a family member who has financially abused a parent is very difficult. The
victim may be reluctant to press charges and the court dockets are often very full resulting inlong waits before a case is heard. According to Tanne, family members abandoning older family
members with severe disabilities in emergency rooms is a growing problem as an estimated
100,000 are dumped each year (as cited in Berk, 2007). Paid caregivers and professionals trusted
to make decisions on behalf of an elder, such as guardians and lawyers, also perpetuate abuse.
When elders feel they have social support and are engaged with others, they are less likely tosuffer abuse.

Substance Abuse and the Elderly
Alcohol and drug problems, particularly prescription drug abuse, have become a serious healthconcern among older adults. Although people 65 years of age and older make up only 13% of
the population, they account for almost 30% of all medications prescribed in the United States.
According to the National Council on Alcoholism and Drug Dependence (NCADD) (2015), thefollowing statistics illustrate the significance of substance abuse for those in late adulthood:
•
•

•
•
•
•

There are 2.5 million older adults with an alcohol or drug problem.
Six to eleven percent of elderly hospital admissions, 14 percent of elderly emergency room
admissions, and 20 percent of elderly psychiatric hospital admissions are a result of alcoholor drug problems.
Widowers over the age of 75 have the highest rate of alcoholism in the U.S.
Nearly 50 percent of nursing home residents have alcohol related problems.
Older adults are hospitalized as often for alcoholic related problems as for heart attacks.
Nearly 17 million prescriptions for tranquilizers are prescribed for older adults each year.
Benzodiazepines, a type of tranquilizing drug, are the most commonly misused and abusedprescription medications.

Risk factors for psychoactive substance abuse in older adults include social isolation, which canlead to depression (Youdin, 2016). This can be caused by the death of a spouse/partner, family
members and/or friends, retirement, moving, and reduced activity levels. Additionally, medical
conditions, chronic pain, anxiety, and stress can all lead to the abuse of substances.
Diagnosis Difficulties: Using criteria from the Diagnostic and Statistical Manual of Disorder-5th
Edition (American Psychiatric Association, 2013), diagnosing older adults with a substance use
disorder can be difficult (Youdin, 2016). For example, compared to adolescents and younger
adults, older adults are not looking to get high, but rather become dependent by accident.
Additionally, stereotypes of older adults, which include memory deficits, confusion, depression,agitation, motor problems, and hostility, can result in a diagnosis of cognitive impairment instead423

of a substance use disorder. Further, a diagnosis of a substance use disorder involves impairment
in work, school, or home obligations, and because older adults are not typically working, inschool or caring for children, these impairments would not be exhibited. Stigma and shameabout use, as well as the belief that one’s use is a private matter, may keep older adults fromseeking assistance. Lastly, physicians may be biased against asking those in late adulthood ifthey have a problem with drugs or alcohol (NCADD, 2015).
Abused Substances: Drugs of choice for older
adults include alcohol, benzodiazepines, opioidprescription medications and marijuana. The
abuse of prescription medications is expected toincrease significantly. Siriwardena, Qureshi,
Gibson, Collier, and Lathamn (2006) found thatfamily physicians prescribe benzodiazepines andopioids to older adults to deal with psychosocialand pain problems rather than prescribe
alternatives to medication such as therapy. Thosein late adulthood are also more sensitive to theeffects of alcohol than those younger because of
Sourcean age-related decrease in the ratio between leanbody mass and fat (Erber & Szuchman, 2015).
Additionally, “liver enzymes that metabolize alcohol become less efficient with age and central
nervous system sensitivity to drugs increase with age” (p.134). Those in late adulthood are also
more likely to be taking other medications, and this can result in unpredictable interactions withthe psychoactive substances (Youdin, 2016).
Figure 9.48

Cannabis Use: Blazer and Wu (2009) found that adults aged 50-64 were more likely to use
cannabis than older adults. These “baby boomers” with the highest cannabis use included men,those unmarried/unpartnered, and those with depression. In contrast to the negative effects ofcannabis, which include panic reactions, anxiety, perceptual distortions and exacerbation ofmood and psychotic disorders, cannabis can provide benefit to the older adult with medical
conditions (Youdin, 2016). For example, cannabis can be used in the treatment for multiple
sclerosis, Parkinson’s disease, chronic pain, and the fatigue and nausea from the effects ofchemotherapy (Williamson & Evans, 2000).
Future Substance Abuse Concerns: There will be an increase in the number of seniors abusing
substances in the future because the baby boomer generation has a history of having been
exposed to, and having experienced, psychoactive substance use over their adult life. This is asignificant difference from the current and previous generations of older adults (National
Institutes of Health, 2014c). Efforts will be needed to adequately address these future substanceabuse issues for the elderly due to both the health risks for them and the expected burden on thehealth care system.

Successful Aging
Although definitions of successful aging are value-laden, Rowe and Kahn (1997) defined threecriteria of successful aging that are useful for research and behavioral interventions.
424

They include:• Relative avoidance of disease, disability, and risk factors, like high blood pressure,smoking, or obesity• Maintenance of high physical and cognitive functioning• Active engagement in social and productive activities
For example, research has demonstrated that age-related declines in cognitive functioning acrossthe adult life span may be slowed through physical exercise and lifestyle interventions (Kramer& Erickson, 2007).
Another way that older adults can respond to the challenges of aging is through compensation.
Specifically, selective optimization with compensation is used when the elder makes
adjustments, as needed, in order to continue living as independently and actively as possible(Baltes & Dickson, 2001). When older adults lose functioning, referred to as loss-based
selection, they may first use new resources/technologies or continually practice tasks to maintaintheir skills. However, when tasks become too difficult, they may compensate by choosing otherways to achieve their goals. For example, a person who can no longer drive needs to findalternative transportation, or a person who is compensating for having less energy, learns how toreorganize the daily routine to avoid over-exertion.
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437

Chapter 10: Death and Dying
We have now reached the end of the lifespan. While it is true that death occurs more commonlyat the later stages of age, death can occur at any point in the life cycle. Death is a deeply
personal experience evoking many different reactions, emotions, and perceptions. Children andyoung adults in their prime of life may perceive death differently from adults dealing withchronic illness or the increasing frequency of the death of family and friends. If asked, mostpeople envision their death as quick and peaceful. However, except for a handful of illnesses inwhich death does often quickly follow diagnosis, or in the case of accidents or trauma, mostdeaths come after a lengthy period of chronic illness or frailty (Institute of Medicine (IOM),
2015). While modern medicine and better living conditions have led to a rise in life expectancy
around the world, death will still be the inevitable final chapter of our lives.

Learning Objectives: Death and Dying
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Define death
Describe what characterizes physical and social deathCompare the leading causes of death in the world with those in the UnitedStates
Review the current statistics on suicide and fatal drug overdoses
Define deaths of despair
Explain where people die
Describe how attitudes about death and death anxiety change as people age
Explain the philosophy and practice of palliative care
Describe the roles of hospice and family caregivers
Explain the different types of advanced directives
Describe cultural differences in end of life decisions
Explain the different types of euthanasia and their controversies
Describe funeral rituals in different religions
Describe the new practice of green burials
Differentiate among grief, bereavement, and mourning
List and describe the stages of loss based on Kübler-Ross’s model and describe
the criticisms of the model
Explain the dual-process model of grief
Identify the impact of losing a child and parent
Identify the four tasks of mourning
Explain the importance of support groups for those in grief

438

Death Defined
One way to understand death and dying is to look more closely at what defines physical deathand social death. According to the Uniform Determination of Death Act (UDDA) (Uniform Law
Commissioners, 1980), death is defined clinically as the following:
An individual who has sustained either (1) irreversible cessation of circulatory andrespiratory functions, or (2) irreversible cessation of all functions of the entire brain,including the brain stem, is dead. A determination of death must be made in accordancewith accepted medical standards.
The UDDA was approved for the United States in 1980 by a committee of national
commissioners, the American Medical Association, the American Bar Association, and thePresident’s Commission on Medical Ethics. This act has since been adopted by most states andprovides a comprehensive and medically factual basis for determining death in all situations.
Death Process: For those individuals who are terminal, and death is expected, a series ofphysical changes occur. Bell (2010) identifies some of the major changes that occur in the
weeks, days, and hours leading up to death:•Weeks Before Passing• Minimal appetite; prefer easily digested foods• Increase in the need for sleep• Increased weakness• Incontinence of bladder and/or bowel• Restlessness or disorientation• Increased need for assistance with care•Days Before Passing• Decreased level of consciousness• Pauses in breathing• Decreased blood pressure• Decreased urine volume and urine color darkens• Murmuring to people others cannot see• Reaching in air or picking at covers• Need for assistance with all care•Days to Hours Before Passing• Decreased level of consciousness or comatose-like state• Inability to swallow• Pauses in breathing become longer• Shallow breaths• Weak or absent pulse• Knees, feet, and/or hands becoming cool or cold
• Knees, feet, and/or hand discoloring to purplish hue• Noisy breathing due to relaxed throat muscles, often called a “death rattle”• Skin coloring becoming pale, waxen (pp. 5, 176-177)
439

Social death begins much earlier than physical death (Pattison,
Figure 10.1
1977). Social death occurs when others begin to dehumanize andHIV/AIDS Awarenesswithdraw from someone who is terminally ill or has been
diagnosed with a terminal illness (Glaser & Strauss, 1966).
Dehumanization includes ignoring them, talking about them if they
were not present, making decisions without consulting them first,
and forcing unwanted procedures. Sweeting and Gilhooly (1997)
further identified older people in general, and people with a loss of
personhood, as having the characteristics necessary to be treated associally dead. More recently, the concept has been used todescribe the exclusion of people with HIV/AIDS, younger people
living with terminal illness, and the preference to die at home
(Brannelly, 2011). Those diagnosed with conditions such as AIDSor cancer may find that friends, family members, and even health
Sourcecare professionals begin to say less and visit less frequently.
Meaningful discussions may be replaced with comments about theweather or other topics of light conversation. Doctors may spend less time with patients after
their prognosis becomes poor.
Why do others begin to withdraw? Friends and family members may feel that they do not knowwhat to say or that they can offer no solutions to relieve suffering. They withdraw to protect
themselves against feeling inadequate or from having to face the reality of death. Healthprofessionals, trained to heal, may also feel inadequate and uncomfortable facing decline anddeath. People in nursing homes may live as socially dead for years with no one visiting or
calling. Social support is important for quality of life, and those who experience social death aredeprived from the benefits that come from loving interaction with others (Bell, 2010).
Why would younger or healthier people dehumanize those who are incapacitated, older, or
unwell? One explanation is that dehumanization is the result of the healthier person placing aprotective distance between themselves and the incapacitated, older, or unwell person(Brannelly, 2011). This keeps the well person from thinking of themselves as becoming ill or inneed of assistance. Another explanation is the repeated experience of loss that paid caregivers
experience when working with terminally ill and older people requires a distance which protects
against continual grief and sadness, and possibly even burnout.

Most Common Causes of Death
The World: The most recent statistics analyzed by the World Health Organization were in 2016
(WHO, 2018) and non-communicable deaths; that is, those not passed from person-to-person,
were responsible for the majority of deaths (see Figure 10.2). The three most common
noncommunicable diseases were heart disease, stroke, and COPD. Tobacco use is attributed as
one of the top killers and is often the hidden cause behind many of the diseases that result indeath, such as heart disease and chronic lung diseases.

440

Figure 10. 2

These statistics hide the differences in the causes of death among high versus low income
nations. In high-income countries, defined as having a per capita annual income of $12,476 or
more, 70% of deaths are among people aged 70 and older. Only 1% of deaths occur in children
under 15 years of age. People predominantly die of chronic diseases, such as cardiovasculardisease, cancers, dementia, or diabetes. Lower respiratory infections remain the only leading
infectious cause of death in such nations. In contrast, in low-income countries, defined ashaving a per capital annual income of $1025 or less, almost 40% of deaths are among children
under age 15, and only 20% of deaths are among people aged 70 years and older. People
predominantly die of infectious diseases such as lower respiratory infections, HIV/AIDS,
diarrheal diseases, malaria and tuberculosis. These account for almost one third of all deaths inthese countries. Complications of childbirth due to prematurity, birth asphyxia, and birth trauma
are among the leading causes of death for newborns and infants in the poorest of nations (WHO,2018).
The United States: In 1900, the most common causes of death were infectious diseases, whichbrought death quickly. Today, the most common causes of death are chronic diseases in which aslow and steady decline in health ultimately results in death. In 2016, heart disease, cancer, andaccidents were the leading causes of death (see Figure 10.3, The Advisory Board, 2018)

441

Figure 10.3

Source

The causes of death vary by age (see Figure 10.4 and 10.5, Heron, 2018). Prior to age 1, SIDS,
congenital problems, and other birth complications are the largest contributors to infantmortality. Accidents, known as unintentional injury, become the leading cause of deaththroughout childhood and into middle adulthood. In later middle adulthood and late adulthoodheart disease, cancer and other medical conditions become the leading killers.

Figure 10.4 Causes of Death for Ages 1-24

Source442

Figure 10.5 Causes of Death for Ages 25-85+

SourceChapters 8 and 9 discussed the chronic conditions that are associated with dying at later stages inlife. However, suicides and drug overdoses are currently claiming lives throughout the lifespan,and consequently will be discussed next.

SuicideAccording to the latest research from the CDC (Hedegaard, Curtin, & Warner, 2018), the suicide
rate increased 33% from 1999 through 2017. In the United States, suicide is the 10th leading
cause of death overall, but it ranks as the 2nd leading cause of death for those 10-34 and the 4thleading cause for those aged 35-54 (Weir, 2019). Overall, approximately 45, 0000 people died bysuicide in 2016 (CDC, 2018). Suicide rates have risen for all racial and ethnic groups andincreased in every state, except for Nevada which was already high. Further, the suicide rate forthe most rural counties (20.0 per 100,000) is higher than the most urban counties (11.1 per
100,000) (Hedegaard et al., 2018).

443

Suicide and Gender: Suicide
rates increased for both males
and females, especially after
2006. For males, the rateincreased 26% from 17.8 per
100,000 males in 1999 to 22.4
per 100,000 in 2017. For
females, the rate increased 53%
from 4.0 per 100,000 females in1999 to 6.1 per 100,000 in 2017(see Figure 10.6).

Figure 10.6 Suicide Rate from 1999-2017

By ages, suicide rates forfemales in 2017 were higher for
every age group, except those
aged 75 and older. The highest
female rates were for those aged
Source45–64. In contrast, men aged 75
and older had the highest rates,
although the rate for older males had decreased from 1999 (see Figures 10.7 and 10.8).
Males have consistently demonstrated higher rates of suicide as they typically experience higher
rates of substance use disorders, do not seek out mental health treatment, and use more lethalmeans. However, females are now closing the suicide gap with males, as females are now
responding to the stress in their lives through self-harm, substance abuse, and risk taking
behaviors (Healy, 2019). Females who identify pain, depression, and anxiety are especially atrisk in middle age.
Figure 10.7 Male Suicide Rate by Age, 1999 and 2017444

SourceFigure 10.8 Female Suicide Rate by Age, 1999 and 2017

SourceDeaths of Despair: While the suicide rate has increased in America, during the same period it
has gone down in other countries, including Canada, Japan, China, Russia, United Kingdom,
Germany, and most of Western Europe. Globally, suicide rates have fallen when the living
conditions have improved (Weir, 2019). Not surprisingly, the opposite is true, and thus adecrease in economic and social well-being, referred to as deaths of despair, has been linked tosuicides in America. The loss of farming and manufacturing jobs are believed to havecontributed to these deaths of despair, especially in rural communities where there is less accessto mental health treatment. According to the CDC (2018), other factors that contributed tosuicide among those with and without mental health conditions included relationship problems,
substance use disorders, financial or legal problems, and health concerns (see Figure 10.9).
Figure 10.9 Reasons Given for Suicide445

Prevention: Globally, limiting access tolethal means has contributed to a decrease Figure 10.10 CDC’s 12 Warning Signs of
Suicidein suicide rates (Weir, 2019). For• Feeling like a burden
example, switching from less-toxic gas• Being isolated
for heating decreased carbon monoxide• Increased anxiety
deaths, making it more difficult to access• Feeling trapped or in unbearable pain
toxic pesticides decreased poisoning• Increased substance use
deaths, installing bridge barriers• Looking for a way to access lethal means
decreased jumping, and limiting access to• Increased anger or rage
firearms lowered deaths by guns. Equally• Extreme mood swings
as important are prevention programs and• Expressing hopelessness
improving access to mental health• Sleeping too little or too muchtreatment, especially in the workplace.
• Talking or posting about wanting to die
Many occupations have seen increases in• Making plans for suicide
suicide rates, and consequently specificprograms are being designed to address
Sourcethe stressors associated with these jobs.
Knowing the warning signs of suicideand encouraging someone to get treatment are things that everyone can do to address the increasein the suicide rate (see Figure 10.10).

Fatal Drug Overdoses
Another factor linked to the
Figure 10.11 U.S. Drug Overdose Death Rates: 1999–
deaths of despair has been
2017
fatal drug overdoses. In 2017,
deaths from fatal drug
overdoses in the United Statesequaled 70,237 (Hedegaard,
Miniño, & Warner, 2018).
The rate of drug overdose
deaths has been steadily
increasing since 1999, and in2017 the rate (21.7/100,000)
was 9.6% higher than the rate
in 2016 (19.8/100,000) (seeFigure 10.11). Unlike suicide
rates, deaths from overdoses
occur equally among thoseliving in urban and rural
areas. The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs
such as fentanyl, fentanyl analogs, and tramadol) increased by 45% between 2016 and 2017,from 6.2 to 9.0 per 100,000 (see Figure 10.12). Fetanyl is an especially powerful opioid that caneasily lead to a fatal overdose. Because it is synthetic, it is cheap to make and easier to conceal
than heroin.

446

Figure 10.12

Where do People Die?
Gathering statistics on the location of death is not a simple matter. Those with terminal illnesses
may be going through the process of dying at home or in a nursing home, only to be transported
to a hospital in the final hours of their life. According to the Stanford Medical School (2019),
most Americans (80%) would prefer to die at home, however:•••

60% of Americans die in acute care hospitals
20% in nursing homes
20% at home.

While dying at home is not favored in certain cultures, and some patients may prefer to die in a
hospital, the results indicate that less people are dying at home than want to.
Internationally, 54% of deaths in over 45 nations occurred in hospitals, with the most frequent
occurring in Japan (78%) and the least frequent occurring in China (20%), according to a study
by Broad et al. (2013). They also found that for older adults, 18% of deaths occurred in someform of residential care, such as nursing homes, and that for each decade after age 65, the rate ofdying in a such settings increased 10%. In addition, the number of women dying in residential
care was considerably higher than for males.

447

Developmental Perceptions of Death and Death Anxiety
The concept of death changes as we develop from early childhood to late adulthood. Cognitive
development, societal beliefs, familial responsibilities, and personal experiences all shape anindividual’s view of death (Batts, 2004; Erber & Szuchman, 2015; National Cancer Institute,2013).
Infancy: Certainly, infants do not comprehend death, however, they do react to the separation
caused by death. Infants separated from their mothers may become sluggish and quiet, no longer
smile or coo, sleep less, and develop physical symptoms such as weight loss.
Early Childhood: As you recall from Piaget’s preoperational stage of cognitive development,
young children experience difficulty distinguishing reality from fantasy. It is therefore notsurprising that young children lack an understanding of death. They do not see death aspermanent, assume it is temporary or reversible, think the person is sleeping, and believe they
can wish the person back to life. Additionally, they feel they may have caused the death throughtheir actions, such as misbehavior, words, and feelings.
Middle Childhood: Although children in middle childhood begin tounderstand the finality of death, up until the age of 9 they may still
participate in magical thinking and believe that through theirthoughts they can bring someone back to life. They also may thinkthat they could have prevented the death in some way, andconsequently feel guilty and responsible for the death.
Late Childhood: At this stage, children understand the finality ofdeath and know that everyone will die, including themselves.
However, they may also think people die because of some wrong
doing on the part of the deceased. They may develop fears of theirparents dying and continue to feel guilty if a loved one dies.

Figure 10.13

SourceAdolescence: Adolescents understand death as well as adults. With
formal operational thinking, adolescents can now think abstractly about death, philosophize
about it, and ponder their own lack of existence. Some adolescents become fascinated withdeath and reflect on their own funeral by fantasizing on how others will feel and react. Despite apreoccupation with thoughts of death, the personal fable of adolescence causes them to feel
immune to the death. Consequently, they often engage in risky behaviors, such as substance use,
unsafe sexual behavior, and reckless driving thinking they are invincible.
Early Adulthood: In adulthood, there are differences in the level of fear and anxiety concerning
death experienced by those in different age groups. For those in early adulthood, their overalllower rate of death is a significant factor in their lower rates of death anxiety. Individuals inearly adulthood typically expect a long life ahead of them, and consequently do not think about,
nor worry about death.

448Middle Adulthood: Those in middle adulthood report more fear of death than those in either
early and late adulthood. The caretaking responsibilities for those in middle adulthood is asignificant factor in their fears. As mentioned previously, middle adults often provide assistancefor both their children and parents, and they feel anxiety about leaving them to care forthemselves.
Late Adulthood: Contrary to the belief that because they are so close to death, they must fear
death, those in late adulthood have lower fears of death than other adults. Why would thisoccur? First, older adults have fewer caregiving responsibilities and are not worried about
leaving family members on their own. They also have had more time to complete activities they
had planned in their lives, and they realize that the future will not provide as many opportunities
for them. Additionally, they have less anxiety because they have already experienced the deathof loved ones and have become accustomed to the likelihood of death. It is not death itself thatconcerns those in late adulthood; rather, it is having control over how they die.

Curative, Palliative, and Hospice Care
When individuals become ill, they need to make choices about the treatment they wish toreceive. One’s age, type of illness, and personal beliefs about dying affect the type of treatment
chosen (Bell, 2010).
Curative care is designed to overcome and cure disease and illness (Fox, 1997). Its aim is topromote complete recovery, not just to reduce symptoms or pain. An example of curative carewould be chemotherapy. While curing illness and disease is an important goal of medicine, it is
not its only goal. As a result, some have criticized the curative model as ignoring the other goalsof medicine, including preventing illness, restoring functional capacity, relieving suffering, andcaring for those who cannot be cured.
Palliative care focuses on providing comfort and relief from physical and emotional pain topatients throughout their illness, even while being treated (NIH, 2007). In the past, palliative
care was confined to offering comfort for the dying. Now it is offered whenever patients sufferfrom chronic illnesses, such as cancer or heart disease (IOM, 2015). Palliative care is also part of
hospice programs.
Hospice emerged in the United Kingdom in the mid-20th century as a result of the work of Cicely
Saunders. This approach became popularized in the U.S. by the work of Elizabeth Kübler-Ross(IOM, 2015), and by 2012 there were 5,500 hospice programs in the U.S. (National Hospice andPalliative Care Organization (NHPCO), 2013).
Hospice care whether at home, in a hospital, nursing home, or hospice facility involves a team ofprofessionals and volunteers who provide terminally ill patients with medical, psychological,
and spiritual support, along with support for their families (Shannon, 2006). The aim of hospiceis to help the dying be as free from pain as possible, and to comfort both the patients and theirfamilies during a difficult time.

449

In order to enter hospice, a patient must be diagnosed
as terminally ill with an anticipated death within 6months (IOM, 2015). The patient is allowed to go
through the dying process without invasive
treatments. Hospice workers try to inform the familyof what to expect and reassure them that much ofwhat they see is a normal part of the dying process.
According to the National Hospice and Palliative
Care Organization (2019) there are four types of
hospice care in America:••••

Figure 10.14

SourceRoutine hospice care, where the patient has chosen to receive hospice care at home, is themost common form of hospice.
Continuous home care is predominantly nursing care, with caregiver and hospice aides
supplementing this care, to manage pain and acute symptom crises for 8 to 24 hours in
the home.
Inpatient respite care is provided by a hospital, hospice, or long-term care facility toprovide temporary relief for family caregivers.
General inpatient care is provided by a hospital, hospice, or long-term care facility when
pain and acute symptom management can on be handled in other settings.

In 2017, an estimated 1.5 million people resideing in American received hospice care (NHPCO,
2019). The majority of patients on hospice were patients suffering from dementia, heart disease,or cancer, and typically did not enter hospice until the last few weeks prior to death. Almost one
out of three patients were on hospice for less than a week.
According to Shannon (2006), the basic elements of hospice include:• Care of the patient and family as a single unit
• Pain and symptom management for the patient• Having access to day and night care
• Coordination of all medical services• Social work, counseling, and pastoral services• Bereavement counseling for the family up to one year after the patient’s death
Although hospice care has become more widespread, these new programs are subjected to more
rigorous insurance guidelines that dictate the types and amounts of medications used, length ofstay, and types of patients who are eligible to receive hospice care (Weitz, 2007). Thus, morepatients are being served, but providers have less control over the services they provide, andlengths of stay are more limited. In addition, a recent report by the Office of the Inspector
General at U.S. Department of Health and Human Services (2018) highlighted some of thevulnerabilities of the hospice system in the U.S. Among the concerns raised were that hospices
did not always provide the care that was needed and sometimes the quality of that care was poor,
even at Medicare certified facilities.
Not all racial and ethnic groups feel the same way about hospice care. African-American
families may believe that medical treatment should be pursued on behalf of an ill relative as long450

as possible and that only God can decide when a person dies. Chinese-American families may
feel very uncomfortable discussing issues of death or being near the deceased family member's
body. The view that hospice care should always be used is not held by everyone, and health careproviders need to be sensitive to the wishes and beliefs of those they serve (Coolen, 2012).

Family Caregivers
Figure 10.15

According to the Institute of Medicine (2015), it is estimated that66 million Americans, or 29% of the adult population, arecaregivers for someone who is dying or chronically ill. Two-thirdsof these caregivers are women. This care takes its toll physically,
emotionally, and financially. Family caregivers may face thephysical challenges of lifting, dressing, feeding, bathing, andtransporting a dying or ill family member. They may worry about
whether they are performing all tasks safely and properly, as theyreceive little training or guidance. Such caregiving tasks may alsointerfere with their ability to take care of themselves and meetother family and workplace obligations. Financially, families may
face high out of pocket expenses (IOM, 2015).

As can be seen in Table 10.1, most family caregivers are providing
care by themselves with little professional intervention, areemployed, and have provided care for more than 3 years. The
annual loss of productivity in the U.S. was $25 billion in 2013 as a result of work absenteeism
due to providing this care. As the prevalence of chronic disease rises, the need for family
caregivers is growing. Unfortunately, the number of potential family caregivers is declining as
the large baby boomer generation enters into late adulthood (Redfoot, Feinberg, & Houser,
2013).
SourceTable 10.1 Characteristics of Family Caregivers in the United States
Characteristic

Percentages

No home visits by health care professionals

69%

Caregivers are also employed72%

Duration of employed workers who have been caregiving for 3+ years

55%

Caregivers for the elderly

67%

Adapted from IOM, 2015451

Advanced Directives
Advanced care planning refers to all documentsthat pertain to end-of-life care. These include
advance directives and medical orders. Advancedirectives include documents that mention a healthcare agent and living wills. These are initiated by
the patient. Living wills are written or video
statements that outline the health care initiates the
person wishes under certain circumstances.
Durable power of attorney for health care names
the person who should make health care decisions
in the event that the patient is incapacitated. In
contrast, medical orders are crafted by a medical
professional on behalf of a seriously ill patient.
Unlike advanced directives, as these are doctor’s
Sourceorders, they must be followed by other medical
personnel. Medical orders include Physician
Orders for Life-sustaining Treatment (POLST), do-not-resuscitate, do-not-incubate, or do-nothospitalize. In some instances, medical orders may be limited to the facility in which they were
written. Several states have endorsed POLST so that they are applicable across heath caresettings (IOM, 2015).
Figure 10.16 Living Wills help
identify treatments acceptable to thepatient or those refused.

Despite the fact that many Americans worry about the financial burden of end-of-life care, “morethan one-quarter of all adults, including those aged 75 and older, have given little or no thought
to their end-of-life wishes, and even fewer have captured those wishes in writing or throughconversation” (IOM, 2015, p. 18).

Cultural Differences in End-of-Life Decisions
Cultural factors strongly influence how doctors, other health care providers, and family members
communicate bad news to patients, the expectations regarding who makes the health caredecisions, and attitudes about end-of-life care (Ganz, 2019; Searight & Gafford, 2005a). In
Western medicine, doctors take the approach that patients should be told the truth about theirhealth. Blank (2011) reports that 75% of the world’s population do not conduct medicine by thesame standards. Thus, outside Western nations, and even among certain racial and ethnic groups
within the those nations, doctors and family members may conceal the full nature of a terminal
illness, as revealing such information is viewed as potentially harmful to the patient, or at thevery least is seen as disrespectful and impolite. Chattopadhyay and Simon (2008) reported thatin India doctors routinely abide by the family’s wishes and withhold information from thepatient, while in Germany doctors are legally required to inform the patient. In addition, many
doctors in Japan and in numerous African nations used terms such as “mass,” “growth,” and“unclean tissue” rather than referring to cancer when discussing the illness to patients and theirfamilies (Holland, Geary, Marchini, &Tross, 1987). Family members also actively protect
terminally ill patients from knowing about their illness in many Hispanic, Chinese, and Pakistanicultures (Kaufert & Putsch, 1997; Herndon & Joyce, 2004).
452

In western medicine, we view the patient as
Figure 10.17
autonomous in health care decisions(Chattopadhyay & Simon, 2008; Searight &Gafford, 2005a). However, in other nations thefamily or community plays the main role, ordecisions are made primarily by medical
professionals, or the doctors in concert with thefamily make the decisions for the patient. For
instance, in comparison to European Americans
and African Americans, Koreans and MexicanAmericans are more likely to view family
Sourcemembers as the decision makers rather than justthe patient (Berger, 1998; Searight & Gafford,
2005a). In many Asian cultures, illness is viewed as a “family event”, not just something that
impacts the individual patient (Blank, 2011; Candib, 2002; Chattopadhyay & Simon, 2008).
Thus, there is an expectation that the family has a say in the health care decisions. As many
cultures attribute high regard and respect for doctors, patients and families may defer some of theend-of-life decision making to the medical professionals (Searight & Gafford, 2005b).
The notion of advanced directives hold little or no relevance in many cultures outside of western
society (Blank, 2011). For instance, in India advanced directives are virtually non-existent,
while in Germany they are regarded as a major part of health care (Chattopadhyay & Simon,
2008). Moreover, end-of-life decisions involve how much medical aid should be used. In the
United States, Canada, and most European countries artificial feeding is more commonly used
once a patient has stopped eating, while in many other nations lack of eating is seen as a sign,rather than a cause, of dying and do not consider using a feeding tube (Blank, 2011).
According to a Pew Research Center Survey (Lipka,
2014), while death may not be a comfortable topic toponder, 37% of their survey respondents had given agreat deal of thought about their end-of-life wishes,with 35% having put these in writing. Yet, over 25%
had given no thought to this issue. Lipka (2014) also
found that there were clear racial and ethnic
differences in end-of-life wishes (see Figure 10.18).
Whites are more likely than Blacks and Hispanics toprefer to have treatment stopped if they have aterminal illness. While the majority of Blacks (61%)
and Hispanics (55%) prefer that everything be done
to keep them alive. Searight and Gafford (2005a)
suggest that the low rate of completion of advanced
directives among non-whites may reflect a distrust of
the U.S. health care system as a result of the healthcare disparities non-whites have experienced. Among
Hispanics, patients may also be reluctant to select asingle family member to be responsible for end-oflife decisions out of a concern of isolating the person
453

Figure 10.18

named and of offending other family members, as this is commonly seen as a “family
responsibility” (Morrison, Zayas, Mulvihill, Baskin, & Meier, 1998).

Euthanasia
Euthanasia is defined as intentionally ending one’s life when suffering from a terminal illness orsevere disability (Youdin, 2016). Euthanasia is further separated into active euthanasia, whichis intentionally causing death, usually through a lethal dose of medication, and passive
euthanasia occurs when life-sustaining support is withdrawn. This can occur through theremoval of a respirator, feeding tube, or heart-lung machine.
Physician-assisted dying is a form ofactive euthanasia whereby a physician
prescribes the means by which a person
can die. The United States federal
government does not legislate physicianassisted dying as laws are handled at thestate level (ProCon.org, 2018). Nine states
and the District of Columbia (D.C.)
currently allow physician-assisted dying.
The person seeking physician-assisted
dying must be: (1) at least 18 years of age,(2) have six or less months until expected
death, and (3) obtain two oral (or least 15
days apart) and one written request from aphysician (ProCon.org, 2016). Table 10.2
lists the 9 states and D.C. that allow
physician-assisted dying and the date theact was passed.

Table 10.2 Nine States and D.C. Allow Legal
Physician-Assisted Dying
State
Date Passed
OregonPassed November 8, 1994, but
enacted October 27, 1997
Washington
November 4, 2008
Montana
December 31, 2009
Vermont
May 20, 2013
California
September 11, 2015
D.C.
October 5, 2016
Colorado
November 8, 2016
Hawaii
April 5, 2018
New Jersey
March 25, 2019
Maine
June 12, 2019
SourceSince 1997 in Oregon, 2,216 people had lethal prescriptions written and 1459 patients (65.8%)
died from the medication as of January 2019 (Death with Dignity, 2019) (see Figure 10.19).
Figure 10. 19

Source454

Canada and several European countries, including Switzerland, Belgium, Luxembourg, and theNetherlands also allow physician-assisted dying. As of 2014, Belgium is the only country thatallows the right to die to those under the age of 18. Stricter conditions were put in place forchildren, including parental consent, the child must be suffering from a serious and incurable
disease, the child must understand what euthanasia means, and the child’s death must be
expected in the near future (Narayan, 2016).
Figure 10.20 Hippocratic
Oath and Euthanasia

The practice of physician-assisted dying is certainly
controversial with religious, legal, ethical, and medical experts
weighing in with opinions. The main areas where there isdisagreement between those who support physician-assisted
dying and those who do not include: (1) whether a person has
the legal right to die, (2) whether active euthanasia would
become a “slippery slope” and start a trend to legalize deaths forindividuals who may be disabled or unable to give consent, (3)how to interpret the Hippocratic Oath and what it exactly meansfor physicians to do no harm, (4) whether the government
should be involved in end-of-life decisions, and (5) specificreligious restrictions against deliberately ending a life
(ProCon.org, 2016). Not surprisingly, there are strong opinions
on both sides of this topic. According to a 2013 Pew ResearchCenter survey, 47% of Americans approve and 49% disapproveof laws that would allow a physician to prescribe lethal doses ofdrugs that a terminally ill patient could use to commit suicide(Pew Research Center, 2013). Attitudes on physician-assisted
dying were roughly the same in 2005, when 46% approved and
45% disapproved.

SourceReligious Practices after Death
Funeral rites are expressions of loss that reflect personal and cultural beliefs about the meaningof death and the afterlife. Ceremonies provide survivors a sense of closure after a loss. Theserites and ceremonies send the message that the death is real and allow friends and loved ones toexpress their love and duty to those who die. Under circumstances in which a person has been
lost and presumed dead or when family members were unable to attend a funeral, there cancontinue to be a lack of closure that makes it difficult to grieve and to learn to live with loss.
Although many people are still in shock when they attend funerals, the ceremony still provides amarker of the beginning of a new period of one's life as a survivor. The following are some of
the religious practices regarding death, however, individual religious interpretations andpractices may occur (Dresser & Wasserman, 2010; Schechter, 2009).
Hindu: The Hindu belief in reincarnation accelerates the funeral ritual, and deceased Hindus arecremated as soon as possible. After being washed, the body is anointed, dressed, and then placedon a stand decorated with flowers ready for cremation. Once the body has been cremated, theashes are collected and, if possible, dispersed in one of India’s holy rivers.
455

Judaism: Among the Orthodox, the deceased is first washed and then wrapped in a simple white
shroud. Males are also wrapped in their prayer shawls. Once shrouded the body is placed into aplain wooden coffin. The burial must occur as soon as possible after death, and a simple service
consisting of prayers and a eulogy is given. After burial the family members typically gather in
one home, often that of the deceased, and receive visitors. This is referred to as “sitting shiva”.
Muslim: In Islam the deceased are buried as soon as possible, and it is a requirement that thecommunity be involved in the ritual. The individual is first washed and then wrapped in a plain
white shroud called a kafan. Next, funeral prayers are said followed by the burial. The shrouded
dead are placed directly in the earth without a casket and deep enough not to be disturbed. They
are also positioned in the earth, on their right side, facing Mecca, Saudi Arabia.
Roman Catholic: Before death an ill
Catholic individual is anointed by a priest,
commonly referred to as the Anointing of the
Sick. The priest recites a prayer and applies
consecrated oil to the forehead and hands ofthe ill person. The individual also takes a
final communion consisting of consecrated
bread and wine. The funeral rites consist of
three parts. First is the wake that usuallyoccurs in a funeral parlor. The body ispresent, and prayers and eulogies are offeredby family and friends. The funeral mass isnext which includes an opening prayer, bible
readings, liturgy, communion, and aconcluding rite. The funeral then moves tothe cemetery where a blessing of the grave,
scripture reading, and prayers conclude thefuneral ritual.

Figure 10.21

SourceGreen Burial
In 2017, the median cost of an adult funeral withviewing and burial was $8,775. The median cost forviewing and cremation was $6,260 (National
Funeral Directors Association (NFDA), 2019). The
same NFDA survey found that nearly half of all
respondents had attended a funeral in a nontraditional setting, such as an outdoor setting thatwas meaningful to the deceased, and over half of the
respondents said they would be interested in
exploring green funeral options (NFDA, 2017).
According to the Green Burial Council (GBC)(2019) Americans bury over 64 thousand tons ofsteel, 17 thousand tons of copper and bronze, 1.6
456

Figure 10.22 Green Burial Site UK

Sourcemillion tons of concrete, 20 million feet of wood, and over 4 million gallons of embalming fluid
every year. As a result, there has been a growing interest in green or natural burials. Green
burials attempt to reduce the impact on the environment at every stage of the funeral. This can
include using recycled paper, biodegradable caskets, cotton shroud in the place of any casket,
formaldehyde free, or no embalming, and trying to maintain the natural environment around theburial site (GBC, 2019). According to the NFDA (2017), many cemeteries have reported that
consumers are requesting green burial options, and since many of the add-ons of a traditional
burial, such as a concrete vault, embalming, and casket are not required, the cost can besubstantially less.

Grief, Bereavement, and Mourning
The terms grief, bereavement, and mourning are often used interchangeably, however, they havedifferent meanings. Grief is the normal process of reacting to a loss. Grief can be in response toa physical loss, such as a death, or a social loss including a relationship or job. Bereavement is
the period after a loss during which grief and mourning occurs. The time spent in bereavement
for the loss of a loved one depends on the circumstances of the loss and the level of attachment
to the person who died. Mourning is the process by which people adapt to a loss. Mourning isgreatly influenced by cultural beliefs, practices, and rituals (Casarett, Kutner, & Abrahm,2001).
Grief Reactions: Typical grief reactions involve mental, physical, social and/or emotional
responses. These reactions can include feelings of numbness, anger, guilt, anxiety, sadness anddespair. The individual can experience difficulty concentrating, sleep and eating problems, lossof interest in pleasurable activities, physical problems, and even illness. Research has
demonstrated that the immune systems of individuals grieving is suppressed and their healthy
cells behave more sluggishly, resulting in greater susceptibility to illnesses (Parkes & Prigerson,2010). However, the intensity and duration of typical grief symptoms do not match those usuallyseen in severe grief reactions, and symptoms typically diminish within 6-10 weeks (Youdin,
2016).
Complicated Grief: After the loss of a loved one,however, some individuals experience
complicated grief, which includes atypical grief
reactions (Newson, Boelen, Hek, Hofman, &Tiemeier, 2011). Symptoms of complicated grief
include: Feelings of disbelief, a preoccupation
with the dead loved one, distressful memories,
feeling unable to move on with one’s life, and a
yearning for the deceased. Additionally, these
symptoms may last six months or longer andmirror those seen in major depressive disorder(Youdin, 2016).

Figure 10.23

SourceAccording to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American
Psychiatric Association, 2013), distinguishing between major depressive disorder andcomplicated grief requires clinical judgment. The psychologist needs to evaluate the client’s457

individual history and determine whether the symptoms are focused entirely on the loss of the
loved one and represent the individual’s cultural norms for grieving, which would be acceptable.
Those who seek assistance for complicated grief usually have experienced traumatic forms of
bereavement, such as unexpected, multiple and violent deaths, or those due to murders or
suicides (Parkes & Prigerson, 2010).
Disenfranchised Grief: Grief that is not socially recognized is referred to as disenfranchised
grief (Doka, 1989). Examples of disenfranchised grief include death due to AIDS, the suicide ofa loved one, perinatal deaths, abortions, the death of a pet, lover, or ex-spouse, and psychologicallosses, such as a partner developing Alzheimer’s disease. Due to the type of loss, there is noformal mourning practices or recognition by others that would comfort the grieving individual.
Consequently, individuals experiencing disenfranchised grief may suffer intensified symptoms
due to the lack of social support (Parkes & Prigerson, 2010).
Anticipatory Grief: Grief that occurs when a death is expected, and survivors have time toprepare to some extent before the loss is referred to as anticipatory grief. This expectation canmake adjustment after a loss somewhat easier (Kübler-Ross & Kessler, 2005). A death after along-term, painful illness may bring family members a sense of relief that the suffering is over,and the exhausting process of caring for someone who is ill is also completed.

Models of Grief
There are several theoretical models of grief, however, none is all encompassing (Youdin, 2016).
These models are merely guidelines for what an individual may experience while grieving.
However, if individuals do not fit a model, it does not mean there is something “wrong” with theway they experience grief. It is important to remember that there is no one way to grieve, andpeople move through a variety of stages of grief in various ways.
Five Stages of Grief: Kübler-Ross (1969, 1975) describes five stages of loss experienced bysomeone who faces the news of their impending death. These "stages" are not really stages that aperson goes through in order or only once; nor are they stages that occur with the same
intensity. Indeed, the process of death is influenced by a person's life experiences, the timing of
their death in relation to life events, the predictability of their death based on health or illness,
their belief system, and their assessment of the quality of their own life. Nevertheless, thesestages help us to understand and recognize some of what a dying person experiences
psychologically, and by understanding, we are more equipped to support that person as they die.
•Denial is often the first reaction to overwhelming, unimaginable news. Denial, or
disbelief or shock, protects us by allowing such news to enter slowly and to give us time
to come to grips with what is taking place. The person who receives positive test results
for life-threatening conditions may question the results, seek second opinions, or may
simply feel a sense of disbelief psychologically even though they know that the results
are true.

•

Anger also provides us with protection in that being angry energizes us to fight against
something and gives structure to a situation that may be thrusting us into the unknown. It
is much easier to be angry than to be sad, in pain, or depressed. It helps us to temporarily458

believe that we have a sense of control over our future and to feel that we have at least
expressed our rage about how unfair life can be. Anger can be focused on a person, a
health care provider, at God, or at the world in general. It can be expressed over issues
that have nothing to do with our death; consequently, being in this stage of loss is notalways obvious.
•

Bargaining involves trying to think of what could be done to turn the situation
around. Living better, devoting self to a cause, being a better friend, parent, or spouse, are
all agreements one might willingly commit to if doing so would lengthen life. Asking tojust live long enough to witness a family event or finish a task are examples ofbargaining.

•

Depression or sadness is appropriate for such an event. Feeling the full weight of loss,
crying, and losing interest in the outside world is an important part of the process ofdying. This depression makes others feel very uncomfortable and family members may
try to console their loved one. Sometimes hospice care may include the use ofantidepressants to reduce depression during this stage.

•

Acceptance involves learning how to carry on and to incorporate this aspect of the life
span into daily existence. Reaching acceptance does not in any way imply that people
who are dying are happy about it or content with it. It means that they are facing it andcontinuing to make arrangements and to say what they wish to say to others. Someterminally ill people find that they live life more fully than ever before after they come tothis stage.

According to Kübler-Ross (1969), behind these five stages focused on the identified emotions,
there is a sense of hope. Kübler-Ross noted that in all the 200 plus patients she and her students
interviewed, a little bit of hope that they might not die was always in the back of their minds.
Criticisms of Kübler-Ross’s Five Stages of Grief: Some researchers have been skeptical of thevalidity of there being stages to grief among the dying (Friedman & James, 2008). As KüblerRoss notes in her own work, it is difficult to empirically test the experiences of the dying. “Howdo you do research on dying,…? When you cannot verify your data and cannot set up
experiments?” (Kübler-Ross, 1969, p. 19). She and four students from the Chicago Theology
Seminary in 1965 decided to listen to the experiences of dying patients, but her ideas about deathand dying are based on the interviewers’ collective “feelings” about what the dying wereexperiencing and needed (Kübler-Ross, 1969). While she goes on to say in support of her
approach that she and her students read nothing about the prior literature on death and dying, so
as to have no preconceived ideas, a later work revealed that her own experiences of grief fromchildhood undoubtedly colored her perceptions of the grieving process (Kübler-Ross & Kessler,
2005). Kübler-Ross is adamant in her theory that the one stage that all those who are dying go
through is anger. It is clear from her 2005 book that anger played a central role in “her” grief
and did so for many years (Friedman & James, 2008).
There have been challenges to the notion that denial and acceptance are beneficial to the grieving
process (Telford, Kralik, & Koch, 2006). Denial can become a barrier between the patient andhealth care specialists and reduce the ability to educate and treat the patient. Similarly,459

acceptance of a terminal diagnosis may also lead patients to give up and forgo treatments toalleviate their symptoms. In fact, some research suggests that optimism about one’s prognosis
may help in one’s adjustment and increase longevity (Taylor, Kemeny, Reed, Bower &Gruenewald, 2000).
A third criticism is not so much of Kübler-Ross’s work, but how others have assumed that thesestages apply to anyone who is grieving. Her research focused only on those who were terminallyill. This does not mean that others who are grieving the loss of someone would necessarily
experience grief in the same way. Friedman and James (2008) and Telford et al. (2006)
expressed concern that mental health professionals, along with the general public, may assume
that grief follows a set pattern, which may create more harm than good.
Lastly, the Yale Bereavement Study, completed between January 2000 and January 2003, did not
find support for Kübler-Ross’s five stage theory of grief (Maciejewski, Zhang, Block, &Prigerson, 2007). Results indicated that acceptance was the most commonly reported reaction
from the start, and yearning was the most common negative feature for the first two years. The
other variables, such as disbelief, depression, and anger, were typically absent or minimal.
Although there is criticism of the Five Stages of Grief Model, Kübler-Ross made people moreaware of the needs and concerns of the dying, especially those who were terminally ill. As shenotes,…when a patient is severely ill, he is often treated like a person with no right to an
opinion. It is often someone else who makes the decision if and when and where apatient should be hospitalized. It would take so little to remember that the sick person
has feelings, has wishes and opinions, and has – most important of all – the right to beheard. (1969, p. 7-8).
Dual-Process Model of Grieving: The dual-process model takes into consideration that
bereaved individuals move back and forth between grieving and preparing for life without their
loved one (Stroebe & Schut, 2001; Stroebe, Schut, & Stroebe, 2005). This model focuses on aloss orientation, which emphasizes the feelings of loss and yearning for the deceased and a
restoration orientation, which centers on the grieving individual reestablishing roles andactivities they had prior to the death of their loved one. When oriented toward loss grieving
individuals look back, and when oriented toward restoration they look forward. As one cannot
look both back and forward at the same time, a bereaved person must shift back and forth
between the two. Both orientations facilitate normal grieving and interact until bereavement hascompleted.

Grief: Loss of Children and Parents
Loss of a Child: According to Parkes and Prigerson (2010), the loss of a child at any age isconsidered “the most distressing and long-lasting of all griefs” (p. 142). Bereaved parents suffer
an increased risk to both physical and mental health and exhibit an increased mortality rate.
Additionally, they earn higher scores on inventories of grief compared to other types of
bereavement. Of those recently diagnosed with depression, a high percentage had experienced
the death of child within the preceding six months, and 8 percent of women whose child had died460

attempted or committed suicide. Archer (1999) found that the intensity of grief increased withthe child’s age until the age of 17, when it declined. Archer explained that women have a greater
chance of having another child when younger, and thus with added age comes greater grief as
fertility declines. Certainly, the older the child the more the mother has bonded with the childand will experience greater grief.
Even when children are adults, parents may experience intense grief, especially when the death issudden. Adult children dying in traffic accidents was associated with parents experiencing more
intense grief and depression, greater symptoms on a health check list, and more guilt than thoseparents whose adult children died from cancer (Parkes & Prigerson, 2010). Additionally, thedeaths of unmarried adult children still residing at home and those who experienced alcohol andrelationship problems were especially difficult for parents. Overall, in societies in whichchildhood deaths are statistically infrequent, parents are often unprepared for the loss of theirdaughter or son and suffer high levels of grief.
Loss of Parents in Adulthood: In contrast to the loss of a child,the loss of parents in adult life is much more common and resultsin less suffering. In their literature review, Moss and Moss
(1995) found that the loss of a parent in adult life is “rarely
pathological.” Those adult children who appear to have the mostdifficulty dealing with the loss of a parent are adult men who
remain unmarried and continue to live with their mothers. In
contrast, those who are in satisfying marriages are less likely torequire grief assistance (Parkes & Prigerson, 2010). To
determine the effects of gender on parental death, Marks, Jun
and Song (2007) analyzed longitudinal data from the National
Survey of Families and Households that assessed multiple
Sourcedimensions of psychological well-being in adulthood including
depression, happiness, self-esteem, mastery, psychologicalwellness, alcohol abuse, and physical health. Findings indicated that a father’s death led to morenegative effects for sons than daughters, and a mother’s death lead to more negative effects fordaughters.
Figure 10.24 Siblings
Comfort One Another

Loss of Parents in Childhood: Parental deaths inchildhood have been associated with adjustment
problems that may last into adulthood. Ellis, Dowrick
and Lloyd-Williams (2013) identified several negative
outcomes associated with childhood grief including
increased chance of substance abuse, greater
susceptibility to depression, higher chance of criminal
behavior, school underachievement, and lower
employment rates. Typically, professional help is not
required in helping children and teens who are dealing
with the death of a loved one.

Figure 10.25

Source461

However, Worden (2002) identified ten “red flags” displayed by grieving children that may
indicate the need for professional assistance:
•
•
•
•
•
•
•
•
•
•

Persistent difficulty in talking about the dead person
Persistent or destructive aggressive behavior
Persisting anxiety, clinging, or fears
Somatic complaints (stomachaches, headaches)
Sleeping difficulties
Eating disturbanceMarked social withdrawal
School difficulties or serious academic reversal
Persistent self-blame or guilt
Self-destructive behavior

As parents may also be dealing with funeral arrangements and other end of life matters, they may
not always have the time to address questions and concerns that children may have. When
explaining death to children it is important to use real words, such as died and death (Dresser &Wasserman, 2010). Children do not understand the meanings of such phrases as “passed away”,“left us”, or “lost”, and they can become confused as to what happened. Saying a loved one diedof a disease called cancer, is preferable to saying he was “very sick”. The child may become
worried when others become sick that they too will die. Consequently, it is important thatchildren have someone who will listen to, and accurately address their concerns.

Mourning
As a society, are we given the tools and time to adequately mourn? Not all researchers agree that
we do. The "death-denying, grief-dismissing world" is the modern world (Kübler-Ross &Kessler, 2005, p. 205). We often grieve privately, quickly, and medicate our suffering with
substances or activities. Employers grant 3 to 5 days for bereavement, if the loss is that of animmediate family member, and such leaves are sometimes limited to no more than one per
year. Yet grief takes much longer and the bereaved are seldom ready to perform well on the job
after just a few days. Obviously, life does have to continue, but we need to acknowledge andmake more caring accommodations for those who are in grief.
Four Tasks of Mourning: Worden (2008) identified four tasks that facilitate the mourning
process. Worden believes that all four tasks must be completed, but they may be completed inany order and for varying amounts of time. These tasks include:• Acceptance that the loss has occurred• Working through the pain of grief• Adjusting to life without the deceased• Starting a new life while still maintaining a connection with the deceased462

Support Groups: Support groups are helpful forgrieving individuals of all ages, including those
who are sick, terminal, caregiving, or mourning
the loss of a loved one. Support groups reduce
isolation, connect individuals with others who
have similar experiences, and offer thosegrieving a place to share their pain and learn new
ways of coping (Lynn & Harrold, 2011). Support
groups are available through religiousorganizations, hospitals, hospice, nursing homes,
mental health facilities, and schools for children.

Figure 10.26

SourceViewing death as an integral part of the lifespanwill benefit those who are ill, those who are bereaved, and all of us as friends, caregivers,
partners, family members and humans in a global society.

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