Posts Tagged ‘child development’

Every parent will have had the experience of their toddler having a screaming fit in the middle of Target over some bright pink shoes with flashy lights in them. As frustrating as they are, tantrums are a completely normal part of childhood development. There are lots of theories about what is happening for the child at this age, and the one that makes most sense to me is that of Erik Erikson.

Erik Erikson was a psychologist and psychoanalyst mist famous for describing a list of stages that he believed every person passes through in their lives – from infancy to old age. The second stage that he described, occurring at the toddler stage (18 months – three years) is the stage of autonomy – v – shame/doubt.

Erikson believed that a toddler’s task is to develop a sense of autonomy, and if the toddler doesn’t do that, she will be left with shame, and doubt about her ability to function independently.


It can be a difficult stage for us as parents to negotiate as the toddler challenges our authority. On one hand, we want to let our child become more independent: to learn how to put her own shoes on and make decide what kind of sandwich she wants (inevitably jam), but on the other hand we also need to set boundaries and limits. Outside of the house, children need to learn social rules, and of course, be safe.

I think the best way to manage the battle of wills with a toddler is to pick your battles. If a toddler wants to wear a fairy dress over their pajamas, along with a sun hat, sunglasses, scarf and pink slippers, then that really doesn’t matter. It does help to give the child that sense of control over their day and their life.  But if they refuse to sit in the pram and insist on walking, then they must hold mum’s hand. There will be tears and anger, and little ones become overwhelmed by their feelings very easily. But by being firm, while telling the toddler that you understand how they feel when you stop them from climbing up the bookshelves in the shop, the tantrum will pass. And in time, the child will develop a sense of independence and autonomy, and have no doubt in their own ability to be a big kid.

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At around 18-24 months, children begin to enjoy scribbling: they are able to draw a squiggle and tell you that it is a ‘lady’ or a ‘doggie. This is the stage at which children use  symbolism, ie representing things with symbols. Language is also a form of symbolism, as well as art.

This has been described by the developmental psychologist Jean Piaget as part of the ‘preoperational reasoning’ stage of child development, beginnning when children are around 2 years old. Children also start to use pretend play at this stage.

In child psychiatry, we use play as a method of communication and ‘therapy’ with children, as play is used by children in the same way as complex language is in adults. A child will explore events that they have experienced, or worries that they have, through play. For example, a child who has been traumatised may act out that trauma with their toys, or a child who is being bullied may reenact this with toy animals.

This developmental stage is a huge leap for children who previously could only express their frustrations directly, such as by crying when upset. It is exciting for both the children and their parents.

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At work, I use attachment theory to guide my clinical practice, and in my new work as a mother, I have been observing this every day, so I thought it was about time that I wrote about it.

Attachment, in child psychiatry, refers to a quality of the relationship beytween an infant and her mother (I’ll say mother as that is the usual attachment figure, but it could be the father or other primary caregiver). John Bowlby and Mary Ainsworth are the two people most associated with this.

                                                                                                                                                                                                                                         Bowlby studied juvenile delinquents in the early 1950s and believed that delinquency (antisocial/psychopathic traits) was associated with maternal deprivation, or being separated from their mothers at an early age. He also looked to work that had been done in the animal kingdom such as baby animals following adult animals around to ensure survival (imprinting). He concluded that infants have an inbuilt attachment system — activated at times of stress — to ensure that they stay close to their mother for physical survival.  

The idea is that the mother’s response to an infant gives the baby an internal working model of relationships. It’s as if they file away the expectation of what will happen when they are distressed and how their mother will respond. A mother who is warm, empathic and responsive to her baby’s cries teaches that baby trust and security.

Mary Ainsworth worked under Bowlby, mainly at the Tavistock clinic, and developed a laboratory ‘test’ called the strange situation to categorise attachment styles. This involves a room with video cameras, a 12 month old infant, her mother, and a ‘stranger’. The infant is exposed to increasingly stressful situations while being filmed, eg being left alone with the stranger. The child’s reaction to this stress, and behaviour on reunion with their mother, is analysed to put them into one of 3 categories:


The infant gets upset when mum leaves the room, seeks comfort when they are reunited, settles quickly with mum, and goes back to play.

Insecure – avoidant

The infant doesn’t show she’s upset when mum leaves the room, is distant when mum comes back in and doesn’t cling to her.

Insecure – ambivalent

This infant is often anxious even before  mum leaves, and becomes very upset when she goes and doesn’t settle. When they are reunited, the child is angry yet clingy and difficult to console.

What is the significance of this?

Studies have shown that the attachment style at 12 months is predictive of the attachment relationship throughout childhood and into adulthood. Our own attachment style generally predicts the attachment relationship that we will have with our own children. Insecurely attached children/adults have higher rates of mental health disturbance and social and emotional difficulties; a secure attachment is protective.

At the moment, I can’t leave the room without A crying, crawling after me and clinging to my leg. Last week, we went to dinner at a friend’s house. When we first got there, A took a look around and cried while clinging to me. AFter 5 or 10 minutes, she settled and started to explore, though if she became too stressed, she’d crawl back over to me for some reassurance. When A cries, and I respond, I know that I am teaching her that I am a secure base for her. Sadly, in our society, we seem to value children who don’t cry or protest – those with avoidant attachment styles. How many times have you heard “Oh, she’s a good baby – she’ll go to anyone, she hardly cries!” It is normal and desirable for babies to cry, and they should be clingy and wary of strangers. This is the way they have been designed so that they can survive. This is attachment at work.

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Returning to work, for a new mother, is a big and difficult decision. Once a parent has decided to do this, the next step is looking for childcare.

Child care is talked about as if it is one entity, but of course there are many options and huge variations in the quality of it. Options range from hiring a nanny to come into your house, giving a consistent one on one figure in the familiar surroundings of your home, to home day care, and centre based day care. And of course, the outcomes for children will depend not only on the type and quality of day care, but also on the age at which they go into care and the length of time they spend there. A child who has full-time day care from eight weeks is a different situation to one who attends three half days a week from age three. And the variable that is often not considered is the quality of the relationship with their parents.

In the 1980s, there were a couple of studies which said that having more than 20 hours a week of childcare in the first year of life was associated with a more insecure attachment relationship between mother and child, but these results were controversial. Other studies found no such difference, and a study was designed to answer this question: The NICDH (National Institute of Child Health and Human Development) Study of Early ChildCare and Youth Development. This followed up 1364 children randomly chosen from birth from across the USA, and is still going as the children become older. They found that child care factors themselves (hours, age at entry, quality, frequency of changes in child care) did not predict poor attachment. Children were more likely to be insecurely attached when they had ‘dual risk’  i.e. problems in the relationship with their mother/parent as well as child care factors. Also, good quality child care could ‘compensate’ for a poor mother-infant relationship more than in low-quality care.

(Howes & Spieker: (2008). Attachment Relationships in the context of Multiple Caregivers. In Cassidy and Shaver, (eds.),  Handbook of Attachment, 2nd ed (pp 324-325). New York:  The Guilford Press.)

The study is large and there are many more factors to take into account, but it seems to confirm that child care itself – particularly if it is high quality – is not a risk factor for poor attachment relationships, and probably what is more important is the quality of the mother-child relationship.

As with most things in parenting, each family makes the choices that are right for them. A mother who feels isolated when she isn’t working, or a family under financial stress, is potentially much more of a problem than a child being in some form of child care.

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In their first year of life, babies start to play the ‘lets drop toys from the highchair’ game. This is the start of a phase which a psychologist called Jean Piaget called ‘Object Permanence’.

Piaget theorised that young infants believe that their world consists of only what they can see. So, when they can’t see a toy, or a person, they believe that the object no longer exists.  So, a young infant believes that when their mother leaves the room, they have disappeared from her world, and that frightens them.

As babies get older, they start to learn that things exist even when they don’t see them, and this is what Piaget called object permanence. A child at this stage throws a cup away, she realises that it is still nearby, so looks for it as and delights when it reappears. This can also be seen in playing ‘peek a boo’. With time, she will gradually learn that even if her mother is not with her, she still exist and will come back to her (this links into infant attachment). Their separation anxiety will lessen, and the appeal of throwing toys down on the floor will diminish…


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