Developmental Psychology

Developmental Psychology

section three

 

Babies are such a nice way to start people.

—Don Herold

American Writer, 20th Century

Infancy

As newborns, we were not empty-headed organisms. We had some basic reflexes, among them crying, kicking, and coughing. We slept a lot, and occasionally we smiled, although the meaning of our first smiles was not entirely clear. We ate and we grew. We crawled and then we walked, a journey of a thousand miles beginning with a single step. Sometimes we conformed; sometimes others conformed to us. Our development was a continuous creation of more complex forms. We needed the meeting eyes of love. We juggled the necessity of curbing our will with becoming what we could will freely. This section contains three chapters: “Physical Development in Infancy,” “Cognitive Development in Infancy,” and “Socioemotional Development in Infancy.”

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chapter 4
PHYSICAL DEVELOPMENT IN INFANCY
chapter outline

1 Physical Growth and Development in Infancy

Learning Goal 1  Discuss physical growth and development in infancy.

Patterns of Growth

Height and Weight

The Brain

Sleep

Nutrition

2 Motor Development

Learning Goal 2  Describe infants’ motor development.

The Dynamic Systems View

Reflexes

Gross Motor Skills

Fine Motor Skills

3 Sensory and Perceptual Development

Learning Goal 3  Summarize the course of sensory and perceptual development in infancy.

What Are Sensation and Perception?

The Ecological View

Visual Perception

Other Senses

Intermodal Perception

Nature, Nurture, and Perceptual Development

Perceptual-Motor Coupling

image1 ©Image Source/Getty Images

Latonya is a newborn baby inPage 105 Ghana. During her first days of life, she has been kept apart from her mother and bottle fed. Manufacturers of infant formula provide the hospital where she was born with free or subsidized milk powder. Her mother has been persuaded to bottle feed rather than breast feed her. When her mother bottle feeds Latonya, she overdilutes the milk formula with unclean water. Latonya’s feeding bottles have not been sterilized. Latonya becomes very sick. She dies before her first birthday.

Ramona was born in a Nigerian hospital with a “baby-friendly” program. In this program, babies are not separated from their mothers when they are born, and the mothers are encouraged to breast feed them. The mothers are told of the perils that bottle feeding can bring because of unsafe water and unsterilized bottles. They also are informed about the advantages of breast milk, which include its nutritious and hygienic qualities, its ability to immunize babies against common illnesses, and the role of breast feeding in reducing the mother’s risk of breast and ovarian cancer. Ramona’s mother is breast feeding her. At 1 year of age, Ramona is very healthy.

image2 (Top) An HIV-infected mother breast feeding her baby in Nairobi, Kenya. (Bottom) A Rwandan mother bottle feeding her baby. What are some concerns about breast versus bottle feeding in impoverished African countries?(Top) ©Wendy Stone/Corbis/Getty Images;  (bottom) ©Dave Bartruff/Corbis/Getty Images

For many years, maternity units in hospitals favored bottle feeding and did not give mothers adequate information about the benefits of breast feeding. In recent years, the World Health Organization and UNICEF have tried to reverse the trend toward bottle feeding of infants in many impoverished countries. They instituted “baby-friendly” programs in many countries (Grant, 1993). They also persuaded the International Association of Infant Formula Manufacturers to stop marketing their baby formulas to hospitals in countries where the governments support the baby-friendly initiatives (Grant, 1993). For the hospitals themselves, costs actually were reduced as infant formula, feeding bottles, and separate nurseries became unnecessary. For example, baby-friendly Jose Fabella Memorial Hospital in the Philippines reported saving 8 percent of its annual budget. Still, there are many places in the world where the baby-friendly initiatives have not been implemented.

The advantages of breast feeding in impoverished countries are substantial (UNICEF, 2017). However, these advantages must be balanced against the risk of passing the human immunodeficiency virus (HIV) to babies through breast milk if the mothers have the virusPage 106 (Croffut & others, 2018; Mnyani & others, 2017; Wojcicki, 2017). In some areas of Africa, more than 30 percent of mothers have HIV, but the majority of these mothers don’t know that they are infected (Mepham, Bland, and Newell, 2011). Later in the chapter, in the section on nutrition, we will look more closely at recent research on breast feeding in the United States, outlining the benefits for infants and mothers and discussing several life-threatening diseases that infants can contract as a result of malnutrition.

topical connections looking back

Previously, we followed the physical development that takes place from fertilization through the germinal, embryonic, and fetal periods of prenatal development. We learned that by the time the fetus has reached full gestational age (approximately 40 weeks), it has grown from a fertilized egg, barely visible to the human eye, to a fully formed human weighing approximately 8 pounds and measuring 20 inches in length. Also remarkable is the fact that by the end of the prenatal period the brain has developed approximately 100 billion neurons.

preview

It is very important for infants to get a healthy start. When they do, their first two years of life are likely to be a time of amazing development. In this chapter, we focus on the biological domain and the infant’s physical development, exploring physical growth, motor development, and sensory and perceptual development.

1 Physical Growth and Development  in Infancy

LG1 Discuss physical growth and development in infancy.

Patterns of Growth

Height and Weight

The Brain

Sleep

Nutrition

Infants’ physical development in the first two years of life is extensive. Newborns’ heads are quite large in comparison with the rest of their bodies. They have little strength in their necks and cannot hold their heads up, but they have some basic reflexes. In the span of 12 months, infants become capable of sitting anywhere, standing, stooping, climbing, and usually walking. During the second year, growth decelerates, but rapid increases in such activities as running and climbing take place. Let’s now examine in greater detail the sequence of physical development in infancy.

A baby is the most complicated object made by unskilled labor.

—Anonymous

PATTERNS OF GROWTH

An extraordinary proportion of the total body is occupied by the head during prenatal development and early infancy (see  Figure 1 ). The  cephalocaudal pattern  is the sequence in which the earliest growth always occurs at the top—the head—with physical growth and differentiation of features gradually working their way down from top to bottom (for example, shoulders, middle trunk, and so on). This same pattern occurs in the head area,Page 107because the top parts of the head—the eyes and brain—grow faster than the lower parts, such as the jaw.

image3 FIGURE 1 CHANGES IN PROPORTIONS OF THE HUMAN BODY DURING GROWTH. As individuals develop from infancy through adulthood, one of the most noticeable physical changes is that the head becomes smaller in relation to the rest of the body. The fractions listed refer to head size as a proportion of total body length at different ages.

Motor development generally proceeds according to the cephalocaudal principle. For example, infants see objects before they can control their torso, and they can use their hands long before they can crawl or walk. However, development does not follow a rigid blueprint. One study found that infants reached for toys with their feet prior to reaching with their hands (Galloway & Thelen, 2004). On average, infants first touched the toy with their feet when they were 12 weeks old and with their hands when they were 16 weeks old.

Growth also follows the  proximodistal pattern , the sequence in which growth starts at the center of the body and moves toward the extremities. For example, infants control the muscles of their trunk and arms before they control their hands and fingers, and they use their whole hands before they can control several fingers (Bindler & others, 2017).

HEIGHT AND WEIGHT

The average North American newborn is 20 inches long and weighs 7.6 pounds. Ninety-five percent of full-term newborns are 18 to 22 inches long and weigh between 5 and 10 pounds.

In the first several days of life, most newborns lose 5 to 7 percent of their body weight before they adjust to feeding by sucking, swallowing, and digesting. Then they grow rapidly, gaining an average of 5 to 6 ounces per week during the first month. They have doubled their birth weight by the age of 4 months and have nearly tripled it by their first birthday. Infants grow about 1 inch per month during the first year, approximately doubling their birth length by their first birthday.

Growth slows considerably in the second year of life (London & others, 2017). By 2 years of age, infants weigh approximately 26 to 32 pounds, having gained a quarter to half a pound per month during the second year to reach about one-fifth of their adult weight. At 2 years of age, infants average 32 to 35 inches in height, which is nearly half of their adult height.

An important point about growth is that it often is not smooth and continuous but rather is episodic, occurring in spurts (Adolph, 2018; Adolph & Berger, 2015). In infancy, growth spurts may occur in a single day and alternate with long time frames characterized by little or no growth for days and weeks (Lampl & Johnson, 2011; Lampl & Schoen, 2018). In two analyses, in a single day, infants grew seven-tenths of an inch in length in a single day (Lampl, 1993) and their head circumference increased three-tenths of an inch (Caino & others, 2010).

THE BRAIN

We have described the amazing growth of the brain from conception to birth. By the time it is born, the infant that began as a single cell is estimated to have a brain that contains approximately 100 billion nerve cells, or neurons. Extensive brain development continues after birth, through infancy and later (Sullivan & Wilson, 2018; Vasa & others, 2018). Because the brain is still developing so rapidly in infancy, the infant’s head should be protected from falls or other injuries and the baby should never be shaken. Shaken baby syndrome, which includes brain swelling and hemorrhaging, affects hundreds of babies in the United States each year (Hellgren & others, 2017). One analysis found that fathers were the most frequent perpetrators of shaken baby syndrome, followed by child care providers and boyfriends of the victim’s mother (National Center on Shaken Baby Syndrome, 2012).

Researchers have been successful in using the electroencephalogram (EEG), a measure of the brain’s electrical activity, to learn about the brain’s development in infancy (Bell & others, 2018; Hari & Puce, 2017) (see  Figure 2 ). For example, a recent study found that higher-quality mother-infant interaction early in infancy predicted higher-quality frontal lobe functioning that was assessed with EEG later in infancy (Bernier, Calkins, & Bell, 2016).

image4 FIGURE 2 MEASURING THE ACTIVITY OF AN INFANT’S BRAIN WITH AN ELECTROENCEPHALOGRAM (EEG). By attaching up to 128 electrodes to a baby’s scalp to measure the brain’s activity, researchers have found that newborns produce distinctive brain waves that reveal they can distinguish their mother’s voice from another woman’s, even while they are asleep. Why is it so difficult to measure infants’ brain activity?Courtesy of Vanessa Vogel Farley

Researchers also are increasingly using functional near-infrared spectroscopy (fNIRS), which uses very low levels of near-infrared light to monitor changes in blood oxygen, to study infants’ brain activity (de Oliveira & others, 2018; Emberson & others, 2017a, b; Taga, Watanabe, & Homae, 2018) (see  Figure 3 ). Unlike fMRI, which uses magnetic fields or electrical activity, fNIRS is portable and allows the infants to be assessed as they explore the world around them. And recently Patricia Kuhl and her colleagues (Ferjan Ramirez & others, 2017) at the Institute for Learning and Brain Sciences at the University of Washington have been using magnetoencephalography,Page 108 or MEG, brain-imaging machines to assess infants’ brain activity. MEG maps brain activity by recording magnetic fields produced by electrical currents and is being used to assess such perceptual and cognitive activities as vision, hearing, and language in infants (see  Figure 4 ).

image5 FIGURE 3 FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (fNRIS) Functional near-infrared spectroscopy is increasingly being used to examine the brain activity of infants. fNRIS is non-invasive and can assess infants as they move and explore their environment.©Oli Scarff/Getty Imagesimage6 FIGURE 4 MEASURING THE ACTIVITY OF AN INFANT’S BRAIN WITH MAGNETOENCEPHALOGRAPHY (MEG). This baby’s brain activity is being assessed with a MEG brain-imaging device while the baby is listening to spoken words in a study at the Institute of Learning and Brain Sciences at the University of Washington. The infant sits under the machine and when he or she experiences a word, touch, sight, or emotion, the neurons working together in the infant’s brain generate magnetic fields and MEG pinpoints the location of the fields in the brain.©Dr. Patricia Kuhl, Institute for Learning and Brain Sciences, University of Washington

Among the researchers who are making strides in finding out more about the brain’s development in infancy are:

· Charles Nelson and his colleagues (Berens & Nelson, 2015; Bick & Nelson, 2018; Bick & others, 2017; Finch & others, 2017; McLaughlin, Sheridan, & Nelson, 2017; Nelson, 2007, 2012, 2013a, b; Nelson, Fox, & Zeanah, 2014; Vanderwert & others, 2016; Varcin & others, 2016) who are exploring various aspects of memory development, face recognition and facial emotion, and the role of experience in influencing the course of brain development;

· Martha Ann Bell and her colleagues (Bell, 2015; Bell & Cuevas, 2012, 2014, 2015; Bell & others, 2018; Bell, Ross, & Patton, 2018; Broomell & Bell, 2018; Li & others, 2017; MacNeill & others, 2018; Lusby & others, 2016) who are studying brain-behavior links, emotion regulation, inhibitory control, and the integration of cognition and emotion;

· Mark Johnson and his colleagues (Anzures & others, 2016; Gliga & others, 2017; Hakuno & others, 2018; Johnson, Jones, & Gliga, 2015; Johnson, Senju, & Tomalski, 2015; Milosavlijevic & others, 2017; Saez de Urabain & others, 2017; Senju & others, 2016), who are examining neuroconstructivist links between the brain, cognitive and perceptual processes, and environmental influences as well as studying the development of the prefrontal cortex and its functions, early identification of autism, face processing, and early social experiences; and

· John Richards and his colleagues (Emberson & others, 2071a; Lloyd-Fox & others, 2015; Richards, 2009, 2010, 2013; Richards & others, 2015; Richards, Reynolds, & Courage, 2010; Richards & Xie, 2015; Xie, Mallin, & Richards, 2018; Xie & Richards, 2016, 2017) who are examining sustained attention, perception of TV programs, and eye movements.

developmental connection
Brain Development

How does the brain change from conception to birth? Connect to “Prenatal Development and Birth.”

The Brain’s Development At birth, the newborn’s brain is about 25 percent of its adult weight. By the second birthday, the brain is about 75 percent of its adult weight. However, the brain’s areas do not mature uniformly.

Mapping the Brain Scientists analyze and categorize areas of the brain in numerous ways (Bell & others, 2018; Dean & others, 2018; Ferjan Ramirez & others, 2017). The portion farthest from the spinal cord is known as the forebrain. This region includes the cerebral cortex and several structures beneath it. The cerebral cortex covers the forebrain like a wrinkled cap. The brain has two halves, or hemispheres (see  Figure 5 ). Based on ridges and valleys in the cortex, scientists distinguish four main areas, called lobes, in each hemisphere. Although the lobes usually work together, each has a somewhat different primary function (see  Figure 6 ):

image7 FIGURE 5 THE HUMAN BRAIN’S HEMISPHERES. The two hemispheres of the human brain are clearly seen in this photograph. It is a myth that the left hemisphere is the exclusive location of language and logical thinking and that the right hemisphere is the exclusive location of emotion and creative thinking.©A.Glauberman/Science Sourceimage8 FIGURE 6 THE BRAIN’S FOUR LOBES. Shown here are the locations of the brain’s four lobes: frontal, occipital, temporal, and parietal.

· Frontal lobes are involved in voluntary movement, thinking, personality, and intentionality or purpose.

· Occipital lobes function in vision.

· Temporal lobes have an active role in hearing, language processing, and memory.

· Parietal lobes play important roles in registering spatial location, attention, and motor control.

To some extent, the type of information handled by neuronsPage 109 depends on whether they are in the left or right hemisphere of the cortex (Benjamin & others, 2017; Sidtis & others, 2018). Speech and grammar, for example, depend on activity in the left hemisphere in most people; humor and the use of metaphors depend on activity in the right hemisphere (Holler-Wallscheid & others, 2017). This specialization of function in one hemisphere of the cerebral cortex or the other is called  lateralization . However, most neuroscientists agree that complex functions such as reading or performing music involve both hemispheres. Labeling people as “left-brained” because they are logical thinkers or “right-brained” because they are creative thinkers does not correspond to the way the brain’s hemispheres work. Complex thinking in normal people is the outcome of communication between both hemispheres of the brain (Nora & others, 2017; Raemaekers & others, 2018).

At birth, the hemispheres of the cerebral cortex already have started to specialize: Newborns show greater electrical brain activity in the left hemisphere than the right hemisphere when they are listening to speech sounds (Telkemeyer & others, 2011). How are the areas of the brain different in the newborn and the infant from those in an adult, and why do the differences matter? Important differences have been documented at both the cellular and the structural levels.

Changes in Neurons Within the brain, the type of nerve cells called neurons send electrical and chemical signals, communicating with each other. A neuron is a nerve cell that handles information processing (see  Figure 7 ). Extending from the neuron’s cell body are two types of fibers known as axons and dendrites. Generally, the axon carries signals away from the cell body and dendrites carry signals toward it. A myelin sheath, which is a layer of fat cells, encases many axons (see  Figure 7 ). The myelin sheath insulates axons and helps electrical signals travel faster down the axon (Cercignani & others, 2017; van Tilborg & others, 2018). Myelination also is involved in providing energy to neurons and in communication (Saab & Nave, 2017). At the end of the axon are terminal buttons, which release chemicals called neurotransmitters into synapses, which are tiny gaps between neurons’ fibers. Chemical interactions in synapses connect axons and dendrites, allowing information to pass from neuron to neuron (Ismail, Fatemi, & Johnson, 2017; Zhou & others, 2018). Think of the synapse as a river that blocks a road. A grocery truck arrives at one bank of the river, crosses by ferry, and continues its journey to market. Similarly, a message in the brain is “ferried” across the synapse by a neurotransmitter, which pours out information contained in chemicals when it reaches the other side of the river.

image9 FIGURE 7 THE NEURON. (a) The dendrites of the cell body receive information from other neurons, muscles, or glands through the axon. (b) Axons transmit information away from the cell body. (c) A myelin sheath covers most axons and speeds information transmission. (d) As the axon ends, it branches out into terminal buttons.

Neurons change in two very significant ways during the first years of life. First, myelination, the process of encasing axons with fat cells, begins prenatally and continues after birth, even into adolescence and emerging adulthood (Juraska & Willing, 2017). Second, connectivity among neurons increases, creating new neural pathways (Eggebrecht & others, 2017; Zhou & others, 2018). New dendrites grow, connections among dendrites increase, and synaptic connections between axons and dendrites proliferate. Whereas myelination speeds up neural transmissions, the expansion of dendritic connections facilitates the spreading of neural pathways in infant development.

How complex are these neural connections? In a recent analysis, it was estimated that each of the billions of neurons is connected to as many as 1,000 other neurons, producing neural networks with trillions of connections (de Haan, 2015). As we have discussed previously, most of these billions of neurons essentially have been created, have traveled to their correct locations, and are connected to other neurons by the time of full-term birth. Nonetheless, they undergo further differentiation, and neural connectivity patterns continue to change at least into emerging adulthood (Vasa & others, 2018).

Researchers have discovered an intriguing aspect of synaptic connections: nearly twice as many of these connections are made as will ever be used (Huttenlocher & Dabholkar, 1997). The connections that are used survive and become stronger, while the unused ones are replaced by other pathways or disappear. In the language of neuroscience, these connections will be “pruned” (Gould, 2017). For example, the more babies engage in physical activity or use language, the more those pathways will be strengthened.

developmental connection
Brain Development

Changes in the prefrontal cortex in adolescents and older adults have important implications for their cognitive development. Connect to “Physical and Cognitive Development in Adolescence” and “Physical Development in Late Adulthood.”

The age at which “blooming” and subsequent “pruning” of synapses occurs varies by brain region. For example, the peak of synaptic overproduction in the visual cortex occurs at about the fourth postnatal month, followed by a gradual retraction until the middle to end of the preschool years. In areas of the brain involved in hearing and language, a similar, though somewhat later, course is detected. However, in the prefrontal cortex, the area of the brain where higher-level thinking and self-regulation occur, the peak of overproduction takes place at about 1 year of age; it is not until emerging adulthood that adult density of synapses is attained. Both heredity and environment are thought to influence the timing and course of synaptic overproduction and subsequent retraction.

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Early Experience and the Brain Children who grow up in a deprived environment may have depressed brain activity (Bick & Nelson, 2018; Bick & others, 2017; McLaughlin, Sheridan, & Nelson, 2017; Nelson, Fox, & Zeanah, 2014). As shown in  Figure 8 , a child who grew up in the unresponsive and unstimulating environment of a Romanian orphanage showed considerably depressed brain activity compared with a child who grew up in a normal environment.

image10 FIGURE 8 EARLY DEPRIVATION AND BRAIN ACTIVITY. These two photographs are PET (positron emission tomography) scans, which use radioactive tracers to image and analyze blood flow and metabolic activity in the body’s organs. These scans show the brains of (a) a typically developing child and  (b) an institutionalized Romanian orphan who experienced substantial deprivation since birth. In PET scans, the highest to lowest brain activity is reflected in the colors of red, yellow, green, blue, and black, respectively. As can be seen, red and yellow show up to a much greater degree in the PET scan of the typically developing child than the deprived Romanian orphan.Courtesy of Dr. Harry T. Chugani, Children’s Hospital of Michigan

Are the effects of deprived environments reversible? There is reason to think that for some individuals the answer is “yes” (Dennis & others, 2014). The brain demonstrates both flexibility and resilience. Consider 14-year-old Michael Rehbein. At age 7, he began to experience uncontrollable seizures—as many as 400 a day. Doctors said the only solution was to remove the left hemisphere of his brain where the seizures were occurring. Recovery was slow, but his right hemisphere began to reorganize and take over functions that normally occur in the brain’s left hemisphere, including speech (see  Figure 9 ).

image11 FIGURE 9 PLASTICITY IN THE BRAIN’S HEMISPHERES. (a) Michael Rehbein at 14 years of age. (b) Michael’s right hemisphere (right) has reorganized to take over the language functions normally carried out by corresponding areas in the left hemisphere of an intact brain (left). However, the right hemisphere is not as efficient as the left, and more areas of the brain are recruited to process speech.Courtesy of The Rehbein Family

Neuroscientists believe that what wires the brain—or rewires it, in the case of Michael Rehbein—is repeated experience. Each time a baby tries to touch an attractive object or gazes intently at a face, tiny bursts of electricity shoot through the brain, knitting together neurons into circuits. The results are some of the behavioral milestones we discuss in this chapter.

The Neuroconstructivist View Not long ago, scientists thought that our genes determined how our brains were “wired” and that the cells in the brain responsible for processing information just maturationally unfolded with little or no input from environmental experiences. Whatever brain your heredity had dealt you, you were essentially stuck with. This view, however, turned out to be wrong. Research reveals that the brain has plasticity and its development depends on context (Bick & Nelson, 2018; D’Souza & Karmiloff-Smith, 2018; McLaughlin & Broihier, 2018; Snyder & Smith, 2018).

The infant’s brain depends on experiences to determine how connections are made. Before birth, it appears that genes mainly direct basic wiring patterns. Neurons grow and travel to distant places awaiting further instructions. After birth, the inflowing stream of sights, sounds, smells, touches, language, and eye contact help shape the brain’s neural connections.

In the increasingly popular  neuroconstructivist view , (a) biological processes (genes, for example) and environmental conditions (enriched or impoverished, for example) influence the brain’s development; (b) the brain has plasticity and is context dependent; and (c) the child’s cognitive development is closely linked to development of the brain. These factors constrain or advance the construction of cognitive skills (Goldberg, 2017; Mucke & others, 2018; Schreuders & others, 2018; Westermann, Thomas, & Karmiloff-Smith, 2011). The neuroconstructivist view emphasizes the importance of considering interactions between experience and gene expression in the brain’s development, much as the epigenetic view proposes (Moore, 2017; Smith & others, 2018; Westermann, 2016).

developmental connection
Nature and Nurture

In the epigenetic view, development is an ongoing, bidirectional interchange between heredity and the environment. Connect to “Biological Beginnings.”

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SLEEP

Sleep restores, replenishes, and rebuilds our brains and bodies. What function does sleep have in people’s lives? How do sleep patterns change in infancy?

Why Do We Sleep? A number of theories have been proposed about why we sleep. From an evolutionary perspective, all animals sleep and this sleep likely is necessary for survival. Thus, sleep may have developed because animals needed to protect themselves at night. A second perspective is that sleep replenishes and rebuilds the brain and body, which the day’s waking activities can wear out. In support of this restorative function, many of the body’s cells show increased production and reduced breakdowns of proteins during sleep (Frank, 2017). Further, a current emphasis is that sleep is essential to clearing out waste in neural tissues, such as metabolites and cerebrospinal fluid (Aguirre, 2016). A third perspective is that sleep is critical for brain plasticity (Sterpenich, Ceravolo, & Schwartz, 2017). For example, neuroscientists recently have argued that sleep increases synaptic connections between neurons (Areal, Warby, & Mongrain, 2017). These increased synaptic connections during sleep have been linked to improved consolidation of memories (Gui & others, 2017). Further, a research review concluded that not only can sleep improve memory, but losing a few hours of sleep a night is related to negative effects on attention, reasoning, and decision making (Diekelmann, 2014).

In sum, sleep likely serves a number of functions with no one theory accounting for all of the functions. Let’s now turn our attention to sleep in infancy. In later chapters, we will explore sleep through the remainder of the life span.

Sleep that knits up the ravelled sleave of care . . . Balm of hurt minds, nature’s second course. Chief nourisher in life’s feast.

—William Shakespeare

English Playwright, 17th Century

Infant Sleep When we were infants, sleep consumed more of our time than it does now (Goh & others, 2017). The typical newborn sleeps approximately 18 hours a day, but newborns vary greatly in how much they sleep (Dias & others, 2018; Sadeh, 2008). The range is from about 10 hours to about 21 hours a day.

In a recent study, sleep sessions lasted approximately 3.5 hours during the first few months and increased to about 10.5 hours from 3 to 7 months (Mindell & others, 2016). A previous research review concluded that infants 0 to 2 years of age slept an average of 12.8 hours out of the 24, within a range of 9.7 to 15.9 hours (Galland & others, 2012). Another study revealed that by 6 months of age the majority of infants slept through the night, awakening their parents only once or twice a week (Weinraub & others, 2012).

Sleep problems have been estimated to affect 15 to 25 percent of infants. The most common infant sleep-related problem reported by parents is nighttime waking (Dias & others, 2018; Hospital for Sick ChildrenPage 112 & others, 2010). Surveys indicate that 20 to 30 percent of infants have difficulty going to sleep at night and staying asleep until morning (Sadeh, 2008). One study found that nighttime wakings at 1 year of age predicted lower sleep efficiency at 4 years of age (Tikotzky & Shaashua, 2012). Further research found that (1) maternal depression during pregnancy, (2) early introduction of solid foods, (3) infant TV viewing, and (4) child care attendance were related to shorter duration of infant sleep (Nevarez & others, 2010). And a recent study revealed that later bedtime and less sleep across a 24-hour period were linked to infants having more separation distress, greater inhibition, and higher anxiety and depression levels (Mindell & others, 2017).

Research also indicates that parental factors other than maternal depression are linked to infants’ sleep patterns (Field, 2017; Volkovich & others, 2018; Yu & others, 2017). A recent study found that maternal sleep when the infant was 3 months of age predicted the infant’s sleep patterns at 6 months of age and that increased involvement of the father in caregiving responsibilities improved the infant’s sleep (Tikotzky & others, 2015). And other recent research indicated that a higher level of maternal emotional availability at bedtime was associated with a lower level of infant distress at bedtime and longer infant sleep duration (Philbrook & Teti, 2016).

Cultural variations influence infant sleeping patterns (Field, 2017). For example, in the Kipsigis culture in Kenya, infants sleep with their mothers at night and are permitted to nurse on demand (Super & Harkness, 1997). During the day, they are strapped to their mothers’ backs, accompanying them on daily rounds of chores and social activities. As a result, the Kipsigis infants do not sleep through the night until much later than American infants do. During the first eight months of postnatal life, Kipsigis infants rarely sleep longer than three hours at a stretch, even at night. This sleep pattern contrasts with that of American infants, many of whom begin to sleep up to eight hours a night by 8 months of age.

REM Sleep In REM sleep, the eyes flutter beneath closed lids; in non-REM sleep, this type of eye movement does not occur and sleep is more quiet (Bathory & Tomopoulos, 2017).  Figure 10  shows developmental changes in the average number of total hours spent in REM and non-REM sleep. By the time they reach adulthood, individuals spend about one-fifth of their night in REM sleep, and REM sleep usually appears about one hour after non-REM sleep. However, about half of an infant’s sleep is REM sleep, and infants often begin their sleep cycle with REM sleep rather than non-REM sleep. A much greater amount of time is taken up by REM sleep in infancy than at any other point in the life span. By the time infants reach 3 months of age, the percentage of time they spend in REM sleep falls to about 40 percent, and REM sleep no longer begins their sleep cycle.

image12 FIGURE 10 DEVELOPMENTAL CHANGES IN REM AND NON-REM SLEEP

Why do infants spend so much time in REM sleep? Researchers are not certain. The large amount of REM sleep may provide infants with added self-stimulation, since they spend less time awake than do older children. REM sleep also might promote the brain’s development in infancy (Graven, 2006).

When adults are awakened during REM sleep, they frequently report that they have been dreaming, but when they are awakened during non-REM sleep, they are much less likely to report having been dreaming (Cartwright & others, 2006). Since infants spend more time than adults in REM sleep, can we conclude that they dream a lot? We don’t know whether infants dream or not, because they don’t have any way of reporting dreams.

Shared Sleeping Sleeping arrangements for newborns vary from culture to culture (Field, 2017). For example, sharing a bed with a mother is a common practice in many cultures, such as Guatemala and China, whereas in others, such as the United States and Great Britain, newborns usually sleep in a crib, either in the same room as the parents or in a separate room. In some cultures, infants sleep with the mother until they are weaned, after which they sleep with siblings until middle and late childhood (Walker, 2006). Whatever the sleeping arrangements, it is recommended that the infant’s bedding provide firm support and that the crib has side rails (Kreth & others, 2018).

In the United States, shared sleeping remains a controversial issue (Burnham, 2014). Some experts recommend it and others argue against it, although recently the recommendation trend has been to avoid infant-parent bed sharing, especially if the infant is younger than 6 months of age (Byard, 2012a, b; Field, 2017; Mitchell & others, 2017; Weber & others, 2012). In a recent study, infant-parent bed sharing was associated with more night waking for mothers as wellPage 113 as infants, and more marital distress (Teti & others, 2016). The American Academy of Pediatrics Task Force on Infant Positioning and SIDS (AAPTFIPS) (2000) recommends against shared sleeping. Its members argue that in some instances bed sharing might lead to sudden infant death syndrome (SIDS), as could be the case if a sleeping mother rolls over on her baby (Moon & others, 2017). Recent studies have found that bed sharing is linked with a higher incidence of SIDS, especially when parents smoke (Adams, Ward, & Garcia, 2015). Further, a recent large-scale study in six countries (including the United States) found that parents of 6- to 12-month-old infants reported earlier bedtimes, shorter time to fall asleep, fewer sleep interruptions, and more total sleep when the infants slept in a separate room compared with infants sleeping in the same room or same bed with their parents (Mindell, Leichman, & Walters, 2018).

SIDS  Sudden infant death syndrome (SIDS)  is a condition that occurs when infants stop breathing, usually during the night, and die suddenly without any apparent reason. SIDS continues to be a leading cause of infant death in the United States, with more than 2,000 infant deaths annually attributed to SIDS (NICHD, 2018). Risk of SIDS is highest at 2 to 4 months of age.

developmental connection
Sleep

What are some sleep problems that children encounter in early childhood? Connect to “Physical and Cognitive Development in Early Childhood.”

Since 1992, the American Academy of Pediatrics (AAP) has recommended that infants be placed to sleep on their backs (supine position) to reduce the risk of SIDS, and the frequency of prone sleeping (on the stomach) among U.S. infants has dropped dramatically (AAPTFIPS, 2000). Researchers have found that SIDS does indeed decrease when infants sleep on their backs rather than their stomachs or sides (Bombard & others, 2018; Siren, 2017; Sperhake, Jorch, & Bajanowski, 2018). Why? Because sleeping on their backs increases their access to fresh air and reduces their chances of getting overheated.

developmental connection
Sleep

Sleep patterns change in adolescence and are linked to changes in the brain. Connect to “Physical and Cognitive Development in Adolescence.”

In addition to sleeping in a prone position, researchers have found that the following factors are linked to SIDS:

· SIDS occurs more often in infants with abnormal brain stem functioning involving the neurotransmitter serotonin (Rognum & others, 2014; Rubens & Sarnat, 2013).

· Heart arrhythmias are estimated to occur in as many as 15 percent of SIDS cases, and two studies found that gene mutations were linked to the occurrence of these arrhythmias (Brion & others, 2012; Van Norstrand & others, 2012).

· Six percent of infants with sleep apnea, a temporary cessation of breathing in which the airway is completely blocked, usually for 10 seconds or longer, die of SIDS (Ednick & others, 2010).

· Breast feeding is linked to a lower incidence of SIDS (Carlin & Moon, 2017).

· Low birth weight infants are 5 to 10 times more likely to die of SIDS than are their normal-weight counterparts (Horne & others, 2002).

· SIDS is more likely to occur in infants who do not use a pacifier when they go to sleep than in those who do use a pacifier (Carlin & Moon, 2017). A recent research review confirmed that pacifier use is linked to a lower incidence of SIDS (Alm & others, 2016).

· Infants whose siblings have died of SIDS are two to four times as likely to die of it (Lenoir, Mallet, & Calenda, 2000).

· African American and Eskimo infants are four to six times as likely as all others to die of SIDS (Kitsantas & Gaffney, 2010; Moon & others, 2017).

· SIDS is more common in lower socioeconomic groups (Hogan, 2014).

· SIDS is more common in infants who are passively exposed to cigarette smoke (Horne, 2018; Salm Ward & Balfour, 2016).

· SIDS is more common when infants and parents share the same bed (Carlin & Moon, 2017; Moon & others, 2017). A recent Swedish study confirmed that bed sharing was more common in SIDS cases than in other types of infant deaths (Mollborg & others, 2015).

· SIDS is more common if infants sleep in soft bedding (McGarvey & others, 2006).

· SIDS is less common when infants sleep in a bedroom with a fan. One study revealed that sleeping in a bedroom with a fan lowers the risk of SIDS by 70 percent (Coleman-Phox, Odouli, & Li, 2008).

image13 Is this a good sleep position for infants? Why or why not?©Maria Teijeiro/Getty Images

It is generally accepted that the most critical factor in predicting whether an infant will develop SIDS is prone sleeping. As public awareness has grown regarding the importance of not letting infants sleep in a prone position, the number of infant deaths in the United States has decreased, although SIDS still is one of the leading causes of infant deathPage 114 (Bombard & others, 2018). In a recent research review, it was concluded that the two other factors that place infants at the highest risk for SIDS are (1) maternal smoking and (2) bed sharing (Mitchell & Krous, 2015).

One concern raised by critics of the “back to sleep movement” (ensuring that young infants sleep on their back rather than their stomach) is a decline in prone skills. To prevent this decline, many mothers provide their young infants with “tummy time” by periodically placing them on their stomachs when they are awake.

Sleep and Cognitive Development Might infant sleep be linked to children’s cognitive development? A recent research review indicated that there is a positive link between infant sleep and cognitive functioning, including memory, language, and executive function (Tham, Schneider, & Broekman, 2017). A study also revealed that a lower quality of sleep at 1 year of age was linked to lower attention regulation and more behavior problems at 3 to 4 years of age (Sadeh & others, 2015). And in another study, infants with poorer sleep patterns showed more distractibility during an attention task (Geva, Yaron, & Kuint, 2016). The link between infant sleep and children’s cognitive functioning likely occurs because of sleep’s role in brain maturation and memory consolidation, which may improve daytime alertness and learning.

NUTRITION

From birth to 1 year of age, human infants nearly triple their weight and increase their length by 50 percent. What do they need to sustain this growth?

Nutritional Needs and Eating Behavior Individual differences among infants in terms of their nutrient reserves, body composition, growth rates, and activity patterns make defining actual nutrient needs difficult (Borowitz & Borowitz, 2018; Rolfes & Pinna, 2018). However, because parents need guidelines, nutritionists recommend that infants consume approximately 50 calories per day for each pound they weigh—more than twice an adult’s caloric requirement per pound.

A number of developmental changes involving eating characterize the infant’s first year (Leow & others, 2017). As infants’ motor skills improve, they change from using suck-and-swallow movements with breast milk or formula to chew-and-swallow movements with semisolid and then more complex foods. As their fine motor control improves in the first year, they transition from being fed by others toward self-feeding. “By the end of the first year of life, children can sit independently, can chew and swallow a range of textures, are learning to feed themselves, and are making the transition to the family diet and meal patterns” (Black & Hurley, 2007, p. 1). At this point, infants need to have a diet that includes a variety of foods—especially fruits and vegetables.

Caregivers play very important roles in infants’ early development of eating patterns (Baye, Tariku, & Mouquet-Rivier, 2018; Brown, 2017). Caregivers who are not sensitive to developmental changes in infants’ nutritional needs, caregivers who are negligent, and conditions of poverty can contribute to the development of eating problems in infants (Black & Hurley, 2017; Perez-Escamilla & Moran, 2017). One study found that low maternal sensitivity when infants were 15 and 24 months of age was linked to a higher risk of obesity in adolescence (Anderson & others, 2012). And in a recent study, infants who were introduced to vegetables at 4 to 5 months of age showed less fussy eating behavior at 4 years of age than their counterparts who were introduced to vegetables after 6 months (de Barse & others, 2017).

A national study of more than 3,000 randomly selected 4- to 24-month-olds documented that many U.S. parents were feeding their babies too much junk food and not giving them enough fruits and vegetables (Fox & others, 2004). Up to one-third of the babies ate no vegetables and fruit but frequently ate French fries, and almost half of the 7- to 8-month-old babies were fed desserts, sweets, or sweetened drinks. By 15 months, French fries were the most common vegetable the babies ate.

Such poor dietary patterns early in development can result in more infants being overweight (Black & Hurley, 2017; Blake, 2017; Feldman-Winter & others, 2018). In addition to consuming too many French fries, sweetened drinks, and desserts, are there other factors that might explain increased numbers of overweight U.S. infants? A mother’s weight gain during pregnancy and a mother’s own high weight before pregnancy may be factors (Catalano & Shankar, 2017). Also, an important factor likely is whether an infant is breast fed or bottle fed (Uwaezuoke, Eneh, & Ndu, 2017). Breast-fed infants have lower rates of weight gain than bottle-fed infants in childhood and adolescence, and it is estimated that breast feeding reduces the risk of obesity by approximatelyPage 115 20 percent (Uwaezuoke, Eneh, & Ndu, 2017).

Breast versus Bottle Feeding For the first four to six months of life, human milk or an alternative formula is the baby’s source of nutrients and energy. For years, debate has focused on whether breast feeding is better for the infant than bottle feeding. The growing consensus is that breast feeding is better for the baby’s health (Blake, Munoz, & Volpe, 2019; DeBruyne & Pinna, 2017; Thompson & Manore, 2018). Since the 1970s, breast feeding by U.S. mothers has soared (see  Figure 11 ). In 2016, 81 percent of U.S. mothers breast fed their newborns, and 52 percent breast fed their 6-month-olds (Centers for Disease Control and Prevention, 2016). The American Academy of Pediatrics Section on Breastfeeding (2012) reconfirmed its recommendation of exclusive breast feeding in the first six months followed by continued breast feeding as complementary foods are introduced, and further breast feeding for one year or longer as mutually desired by the mother and infant.

image14 FIGURE 11 TRENDS IN BREAST FEEDING IN THE UNITED STATES: 1970–2016

What are some of the benefits of breast feeding? The following conclusions have been supported by research.

Outcomes for the Child

· Gastrointestinal infections. Breast-fed infants have fewer gastrointestinal infections (Bartick & others, 2017, 2018).

· Respiratory tract infections. Breast-fed infants have fewer infections of the lower respiratory tract (Bartick & others, 2018).

· Allergies. A recent research review found no support for breast feeding reducing the risk of allergies in young children (Heinrich, 2017).

· Asthma. Exclusive breast feeding for three months protects against wheezing in babies, but whether it prevents asthma in older children is unclear (Wang & others, 2018). However, a recent Japanese study found that breast feeding was linked to a lower incidence of asthma from 6 to 42 months of age (Yamakawa & others, 2015).

· Ear, throat, and sinus infections. One study found that infants who had been breast fed for 9 months or longer were less likely to have developed ear, throat, and sinus infections in the past year when they were 6 years old than their counterparts who had been breast fed for 3 months or less (Li & others, 2014). Breast-fed infants also are less likely to develop otitis media, a middle ear infection (Pelton & Leibovitz, 2009).

· Overweight and obesity. Consistent evidence indicates that breast-fed infants are less likely to become overweight or obese in childhood, adolescence, and adulthood (Catalano & Shankar, 2017; Uwaezuoke, Eneh, & Ndu, 2018).

· Diabetes. Breast-fed infants are less likely to develop type 1 diabetes in childhood (Lund-Blix & others, 2015) and type 2 diabetes in adulthood (Minniti & others, 2014).

· SIDS. Breast-fed infants have lower rates of SIDS (Bartick & others, 2017b; Wennergren & others, 2015).

· Hospitalization. A recent study of more than 500,000 Scottish children found that those who were breast fed exclusively at 6 to 8 weeks of age were less likely to have ever been hospitalized through early childhood than their formula-fed counterparts (Ajetunmobi & others, 2015). Other recent research has found that breast-fed infants had lower rates of hospitalization for a number of conditions, including gastrointestinal problems and lower respiratory tract infection, and breast-feeding mothers had lower rates of hospitalization for cardiovascular problems and diabetes (Bartick & others, 2018).

image15Human milk or an alternative formula is a baby’s source of nutrients for the first four to six months. The growing consensus is that breast feeding is better for the baby’s health, although controversy still swirls about the benefits of breast feeding in comparison with bottle feeding. Why is breast feeding strongly recommended by pediatricians?©JGI/Getty Images

In large-scale research reviews, no conclusivePage 116 evidence for the benefits of breast feeding was found for children’s cognitive development and cardiovascular health (Agency for Healthcare Research and Quality, 2007; Ip & others, 2009).

Outcomes for the Mother

· Breast cancer. Consistent evidence indicates a lower incidence of breast cancer in women who breast feed their infants (Bartick & others, 2017b; Mayor, 2015).

· Ovarian cancer. Evidence also reveals a reduction in ovarian cancer in women who breast feed their infants (Stuebe & Schwartz, 2010).

· Type 2 diabetes. Some evidence suggests that there is a reduction in type 2 diabetes in women who breast feed their infants (Bartick & others, 2017b).

In large-scale research reviews, no conclusive evidence could be found for maternal benefits of breast feeding involving return to prepregnancy weight, reduced rates of osteoporosis, and decreased risk of postpartum depression (Agency for Healthcare Research and Quality, 2007; Ip & others, 2009). However, one study revealed that women who breast fed their infants had a lower incidence of metabolic syndrome (a disorder characterized by obesity, hypertension, and insulin resistance) in midlife (Ram & others, 2008).

Many health professionals have argued that breast feeding facilitates the development of an attachment bond between the mother and infant (Britton, Britton, & Gronwaldt, 2006; Wittig & Spatz, 2008). However, a research review found that the positive role of breast feeding on the mother-infant relationship is not supported by research (Jansen, de Weerth, & Riksen-Walraven, 2008). The review concluded that recommending breast feeding should not be based on its role in improving the mother-infant relationship but rather on its positive effects on infant and maternal health. Also, researchers have not consistently found links between breast feeding and higher intelligence in children, although in two recent studies, breast feeding was associated with a small increase in children’s intelligence (Bernard & others, 2017; Kanazawa, 2015).

Which women are least likely to breast feed? They include mothers who work full-time outside the home, mothers under age 25, mothers without a high school diploma, African American mothers, and mothers in low-income circumstances (Merewood & others, 2007). In one study of low-income mothers in Georgia, interventions (such as counseling focused on the benefits of breast feeding and the free loan of a breast pump) increased the incidence of breast feeding (Ahluwalia & others, 2000). Increasingly, mothers who return to work during the infant’s first year of life use a breast pump to extract breast milk that can be stored for later feeding of the infant when the mother is not present.

As mentioned earlier, the American Academy of Pediatrics Section on Breastfeeding (2012) strongly endorses exclusive breast feeding for the first 6 months and further recommends breast feeding for another year. Are there circumstances when mothers should not breast feed? Yes, a mother should not breast feed (1) when she is infected with HIV or some other infectious disease that can be transmitted through her milk, (2) if she has active tuberculosis, or (3) if she is taking any drug that may not be safe for the infant (Brown & others, 2017; Schultz, Kostic, & Kharasch, 2018; Williams & others, 2016).

Some women cannot breast feed their infants because of physical difficulties; others feel guilty if they terminate breast feeding early. Mothers may also worry that they are depriving their infants of important emotional and psychological benefits if they bottle feed rather than breast feed. Some researchers have found, however, that there are no psychological differences between breast-fed and bottle-fed infants (Ferguson, Harwood, & Shannon, 1987; Young, 1990).

A further issue in interpreting the benefits of breast feeding was underscored in large-scale research reviews (Agency for Healthcare Research and Quality, 2007; Ip & others, 2009). While highlighting a number of breast feeding benefits for children and mothers, the report issued a caution about breast feeding research: None of the findings imply causality. Breast versus bottle feeding studies are correlational rather than experimental, and women who breast feed are wealthier, older, more educated, and likely more health-conscious than their bottle feeding counterparts, which could explain why breast-fed children are healthier.

developmental connection
Research Methods

How does a correlational study differ from an experimental study? Connect to “Introduction.”

Malnutrition in Infancy Many infants around the world are malnourished (UNICEF, 2018). Early weaning of infants from breast milk to inadequate sources of nutrients, such as unsuitable and unsanitary cow’s milk formula, can cause protein deficiency and malnutrition in infants. However, as we saw in the discussion following the chapter opening story, a concern in developing countries is the increasing number of women who are HIV-positive and the fear that they will transmit this virus to their offspring (Croffut & others, 2018). Breast feeding is more optimal for mothers and infants in developing countries, except for mothers who have or are suspected of having HIV/AIDS.

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connecting development to life

Improving the Nutrition of Infants and Young Children Living in Low-Income Families

Poor nutrition is a special concern in the lives of infants from low-income families. To address this problem in the United States, the WIC (Women, Infants, and Children) program provides federal grants to states for healthy supplemental foods, health care referrals, and nutrition education for women from low-income families beginning in pregnancy, and to infants and young children up to 5 years of age who are at nutritional risk (Chang, Brown, & Nitzke, 2017; Gilmore & others, 2017). WIC serves approximately 7,500,000 participants in the United States.

Positive influences on infants’ and young children’s nutrition and health have been found for participants in WIC (Chen & others, 2018; Gross & others, 2017; Lee & others, 2017; Martinez-Brockman & others, 2018; McCoy & others, 2018). One study revealed that a WIC program that introduced peer counseling services for pregnant women increased breast feeding initiation by 27 percent (Olson & others, 2010a, b). Another study found that entry during the first trimester of pregnancy to the WIC program in Rhode Island reduced rates of maternal cigarette smoking (Brodsky, Viner-Brown, & Handler, 2009). Also, a multiple-year literacy intervention with Spanish-speaking families in the WIC program in Los Angeles increased literacy resources and activities at home, which in turn led to a higher level of school readiness in children (Whaley & others, 2011). And in recent longitudinal studies, when mothers participated prenatally and in early childhood in WIC programs their young children showed short-term cognitive benefits and longer-term reading and math benefits (Jackson, 2015).

image16 Participants in the WIC program. What are some changes the WIC program is trying to implement?Source: USDA Food and Nutrition Service, Supplemental Nutrition Assistance Program USDA Food and Nutrition Service “SNAP Photo Gallery/Jen Mitchell SNAP-Ed Connection http://snap.nal.usda.gov”

Why would the WIC program provide lactation counseling as part of its services?

A large-scale study that examined feeding practices in 28 developing countries found that the practices were far from optimal (Arabi & others, 2012). In this study, only 25 percent of infants 5 months of age and younger were breast fed. Also, feeding guidelines call for introducing complementary foods (solid and semisolid foods) beginning at 6 months. However, in this study, only 50 percent of the caregivers reported feeding their 6- to 8-month-olds complementary foods.

Even if it is not fatal, severe and lengthy malnutrition is detrimental to physical, cognitive, and social development (Donatelle & Ketcham, 2018; UNICEF, 2018; Wardlaw, Smith, & Collene, 2018). One study found that Asian Indian children who had a history of chronic malnutrition performed more poorly on tests of attention and memory than their counterparts who were not malnourished (Kar, Rao, & Chandramouli, 2008). And a longitudinal study revealed that Barbadians who had experienced moderate to severe protein/energy malnutrition during infancy had persisting attention deficits when they were 40 years old (Galler & others, 2012). Researchers also have found that interventions can benefit individuals who have experienced malnutrition in infancy. For example, in one study standard nutritional care combined with a psychosocial intervention (group meetings with mothers and play sessions with infants, as well as six months of home visits) reduced the negative effects of malnutrition on severely malnourished Bangladeshi 6- to 24-month-olds’ cognitive development (Najar & others, 2008).

To read about programs designed to improve infants’ and young children’s nutrition, see  Connecting Development to Life .

Adequate early nutrition is an important aspect of healthy development (Rolfes & Pinna, 2018). In addition to sound nutrition, children need a nurturing, supportive environment (Black & Hurley, 2017; Blake, 2017). One individual who has stood out as an advocate of caring for children and who has been especially passionate about preventing child obesity is pediatrician Faize Mustafa-Infante, who is featured in  Connecting with Careers .

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connecting with careers

Faize Mustafa-Infante

Dr. Mustafa-Infante grew up in Colombia, South America. Her initial profession was as an elementary school teacher in Colombia and then she obtained her medical degree with a specialty in pediatrics. Once she finished her medical training, she moved to San Bernardino, California, working as a health educator with a focus on preventing and treating child obesity in low-income communities. Dr. Mustafa-Infante currently works at Mission Pediatrics in Riverside, California, where she mainly treats infants. She continues her effort to prevent obesity in children and also serves as a volunteer for Ayacucho Mission, a nonprofit organization that provides culturally sensitive medical care for people living in poverty in Ayacucho, Peru. With regard to her cultural background, Dr. Mustafa-Infante describes herself as a Latino doctor with a middle-eastern name that reflects her strong family commitments to both heritages. Dr. Mustafa says that hard work and education have been the keys to her success and personal satisfaction.

For more information about what pediatricians do, see the Careers in Life-Span Development appendix.

Review Connect Reflect

LG1 Discuss physical growth and development in infancy.

Review

· What are cephalocaudal and proximodistal patterns?

· What changes in height and weight take place in infancy?

· What are some key features of the brain and its development in infancy?

· What changes occur in sleep during infancy?

· What are infants’ nutritional needs?

Connect

· What types of brain research technology can be used to study infants that cannot be used to study them before they are born? Which techniques can be used on adults but not infants? How might these limitations affect our understanding of brain development across the life span?

Reflect Your Own Personal Journey of Life

· What sleep and nutrition guidelines would you follow for enhancing the health and safety of your own infant?

2 Motor Development

LG2 Describe infants’ motor development.

The Dynamic Systems View

Reflexes

Gross Motor Skills

Fine Motor Skills

As a newborn, Ramona, whom you read about in the chapter opening story, could suck, fling her arms, and tightly grip a finger placed in her tiny hand. Within just two years, she would be toddling around on her own, opening doors and jars as she explored her little world. Are her accomplishments inevitable? How do infants develop their motor skills, and which skills do they develop at specific ages?

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THE DYNAMIC SYSTEMS VIEW

Developmentalist Arnold Gesell (1934) thought his painstaking observations had revealed how people develop their motor skills. He had discovered that infants and children develop rolling, sitting, standing, and other motor skills in a fixed order and within specific time frames. These observations, said Gesell, show that motor development comes about through the unfolding of a genetic plan, or maturation.

Later studies, however, demonstrated that the sequence of developmental milestones is not as fixed as Gesell indicated and not due as much to heredity as Gesell argued (Adolph, 2018; Adolph & Robinson, 2015). Beginning in the 1980s, the study of motor development experienced a renaissance as psychologists developed new insights about how motor skills develop (Adolph, 2018; Kretch & Adolph, 2018). One increasingly influential perspective is dynamic systems theory, proposed by Esther Thelen (Thelen & Smith, 1998, 2006).

According to  dynamic systems theory , infants assemble motor skills for perceiving and acting. Notice that perception and action are coupled, according to this theory. To develop motor skills, infants must perceive something in their environment that motivates them to act and use their perceptions to fine-tune their movements. Motor skills assist infants in reaching their goals (Adolph, 2018).

image17Esther Thelen is shown conducting an experiment to discover how infants learn to control their arm movements to reach and grasp for objects. A computer device is used to monitor the infant’s arm movements and to track muscle patterns. Thelen’s research is conducted from a dynamic systems perspective. What is the nature of this perspective?Courtesy of Dr. David Thelen

How is a motor skill developed, according to this theory? When infants are motivated to do something, they might create a new motor behavior. The new behavior is the result of many converging factors: the development of the nervous system, the body’s physical properties and its possibilities for movement, the goal the child is motivated to reach, and availability of environmental support for the skill. For example, babies learn to walk only when maturation of the nervous system allows them to control certain leg muscles, when they want to move, when their legs have grown strong enough to support their weight, and when they have sufficient balance control to support their body on one leg.

Mastering a motor skill requires the infant’s active efforts to coordinate several components of the skill. Infants explore and select possible solutions to the demands of a new task; they assemble adaptive patterns by modifying their current movement patterns (Adolph, 2018). The first step occurs when the infant is motivated by a new challenge—such as the desire to cross a room—and gets into the “ballpark” of the task demands by taking a couple of stumbling steps. Then, the infant “tunes” these movements to make them smoother and more effective. The tuning is achieved through repeated cycles of action and perception of the consequences of that action. According to the dynamic systems view, even universal milestones, such as crawling, reaching, and walking, are learned through this process of adaptation: Infants modulate their movement patterns to fit a new task by exploring and selecting possible configurations (Adolph, 2018; Comalli, Persand, & Adolph, 2017).

To see how dynamic systems theory explains motor behavior, imagine that you offer a new toy to a baby named Gabriel (Thelen & others, 1993). There is no exact program that can tell Gabriel ahead of time how to move his arm and hand and fingers to grasp the toy. Gabriel must adapt to his goal—grasping the toy—and the context. From his sitting position, he must make split-second adjustments to extend his arm, holding his body steady so that his arm and torso don’t plow into the toy. Muscles in his arm and shoulder contract and stretch in a host of combinations, exerting a variety of forces. He improvises a way to reach out with one arm and wrap his fingers around the toy.

Thus, according to dynamic systems theory, motor development is not a passive process in which genes dictate the unfolding of a sequence of skills over time. Rather, the infant actively puts together a skill to achieve a goal within the constraints set by the infant’s body and environment. Nature and nurture, the infant and the environment, are all working together as part of an ever-changing system.

As we examine the course of motor development, we will describe how dynamic systems theory applies to some specific skills. First, though, let’s examine the beginning of motor development: the infant’s reflexes.

image18 How might dynamic systems theory explain the development of learning to walk?©Di Studio/Shutterstock

REFLEXES

The newborn is not completely helpless. Among other things, it has some basic reflexes. For example, when submerged in water, the newborn automatically holds its breath and contracts its throat to keep water out.

Reflexes  are built-in reactions to stimuli; they governPage 120 the newborn’s movements, which are automatic and beyond the newborn’s control. Reflexes are genetically carried survival mechanisms. They allow infants to respond adaptively to their environment before they have had the opportunity to learn. The rooting and sucking reflexes are important examples. Both have survival value for newborn mammals, who must find a mother’s breast to obtain nourishment. The  rooting reflex  occurs when the infant’s cheek is stroked or the side of the mouth is touched. In response, the infant turns its head toward the side that was touched in an apparent effort to find something to suck. The  sucking reflex  occurs when newborns automatically suck an object placed in their mouth. This reflex enables newborns to get nourishment before they have associated a nipple with food and also serves as a self-soothing or self-regulating mechanism.

Another example is the  Moro reflex , which occurs in response to a sudden, intense noise or movement (see  Figure 12 ). When startled, the newborn arches its back, throws back its head, and flings out its arms and legs. Then the newborn rapidly draws in its arms and legs. The Moro reflex is believed to be a way of grabbing for support while falling; it would have had survival value for our primate ancestors.

image19 FIGURE 12 NEWBORN REFLEXES. Young infants have several reflexes, including the Moro reflex (top) and grasping reflex (bottom).(Top) ©Petit Format/Science Source; (bottom) ©Stockbyte/PunchStock

Some reflexes—coughing, sneezing, blinking, shivering, and yawning, for example—persist throughout life. They are as important for the adult as they are for the infant. Other reflexes, though, disappear several months following birth, as the infant’s brain matures and voluntary control over many behaviors develops. The rooting and Moro reflexes, for example, tend to disappear when the infant is 3 to 4 months old.

The movements of some reflexes eventually become incorporated into more complex, voluntary actions. One important example is the  grasping reflex , which occurs when something touches the infant’s palms (see  Figure 12 ). The infant responds by grasping tightly. By the end of the third month, the grasping reflex diminishes and the infant shows a more voluntary grasp. As its motor coordination becomes smoother, the infant will grasp objects, carefully manipulate them, and explore their qualities.

The old view of reflexes is that they were exclusively genetic, built-in mechanisms that governed the infant’s movements. The new perspective on infant reflexes is that they are not automatic or completely beyond the infant’s control. For example, infants can alternate the movement of their legs to make a mobile jiggle or change their sucking rate to listen to a recording (Adolph & Robinson, 2015).

GROSS MOTOR SKILLS

Ask any parents about their baby, and sooner or later you are likely to hear about one or more motor milestones, such as “Cassandra just learned to crawl,” “Jesse is finally sitting alone,” or “Angela took her first step last week.” Parents proudly announce such milestones as their children transform themselves from babies unable to lift their heads to toddlers who grab things off the grocery store shelf, chase a cat, and participate actively in the family’s social life (Thelen, 2000). These milestones are examples of  gross motor skills , which involve large-muscle activities such as moving one’s arms and walking.

The Development of Posture How do gross motor skills develop? As a foundation, these skills require postural control. For example, to track moving objects, you must be able to control the movement of your head in order to stabilize your gaze; before you can walk, you must be able to balance on one leg.

Posture is more than just holding still and straight. Posture is a dynamic process that is linked with sensory information in the skin, joints, and muscles, which tell us where we are in space; in vestibular organs in the inner ear that regulate balance and equilibrium; and in vision and hearing (Soska, Robinson, & Adolph, 2015).

Newborn infants cannot voluntarily control their posture. Within a few weeks, though, they can hold their heads erect, and soon they can lift their heads while prone. By 2 months of age, babies can sit while supported on a lap or an infant seat, but they cannot sit independently until they are 6 or 7 months of age. Standing also develops gradually during the first year of life. By about 8 to 9 months of age, infants usually learn to pull themselves up and hold on to a chair, and they often can stand alone by about 10 to 12 months of age.

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Learning to Walk Locomotion and postural control are closely linked, especially in walking upright (Kretch & Adolph, 2018). To walk upright, the baby must be able both to balance on one leg as the other is swung forward and to shift weight from one leg to the other.

Even young infants can make the alternating leg movements that are needed for walking. The neural pathways that control leg alternation are in place from a very early age, even at birth or before. Indeed, researchers have found that alternating leg movements occur during the fetal period and at birth (Adolph & Robinson, 2015). Both alternating leg movements and forward stepping movements occur early in development and are precursors to walking.

If infants can produce forward stepping movements so early, why does it take them so long to learn to walk? The key skills in learning to walk appear to be stabilizing balance on one leg long enough to swing the other forward and shifting weight without falling. These are difficult biomechanical problems to solve, and it takes infants about a year to do it.

In learning to locomote, infants learn what kinds of places and surfaces are safe for locomotion (Adolph, 2018; Karasik, Tamis-LeMonda, & Adolph, 2016). Karen Adolph (1997) investigated how experienced and inexperienced crawling infants and walking infants go down steep slopes (see  Figure 13 ). Newly crawling infants, who averaged about 8½ months in age, rather indiscriminately went down the steep slopes, often falling in the process (with their mothers next to the slope to catch them). After weeks of practice, the crawling babies became more adept at judging which slopes were too steep to crawl down and which ones they could navigate safely. New walkers also could not judge the safety of the slopes, but experienced walkers accurately matched their skills with the steepness of the slopes. They rarely fell downhill, either refusing to go down the steep slopes or going down backward in a cautious manner. Experienced walkers perceptually assessed the situation—looking, swaying, touching, and thinking before they moved down the slope. With experience, both the crawlers and the walkers learned to avoid the risky slopes where they would fall, integrating perceptual information with the development of a new motor behavior. In this research, we again see the importance of perceptual-motor coupling in the development of motor skills. Thus, practice is very important in the development of new motor skills (Adolph & Berger, 2015).

image20 FIGURE 13 THE ROLE OF EXPERIENCE IN CRAWLING AND WALKING INFANTS’ JUDGMENTS OF WHETHER TO GO DOWN A SLOPE. Karen Adolph (1997) found that locomotor experience rather than age was the primary predictor of adaptive responding on slopes of varying steepness. Newly crawling and walking infants could not judge the safety of the various slopes. With experience, they learned to avoid slopes where they would fall. When expert crawlers began to walk, they again made mistakes and fell, even though they had judged the same slope accurately when crawling. Adolph referred to this as the specificity of learning because it does not transfer across crawling and walking.Courtesy of Dr. Karen Adolph, New York University

Practice is especially important in learning to walk (Adolph, 2018; Adolph & Robinson, 2015). “Thousands of daily walking steps, each step slightly different from the last because of variations in the terrain and the continually varying biomechanical constraints on the body, may help infants to identify the relevant” combination of strength and balance required to improve their walking skills (Adolph, Vereijken, & Shrout, 2003, p. 495). In one study, Adolph and her colleagues (2012) observed 12- to 19-month-olds during free play. Locomotor experience was extensive, with the infants averaging 2,368 steps and 17 falls per hour.

A recent study explored how infants plan and guide their locomotion in the challenging context of navigating a series of bridges varying in width (Kretch & Adolph, 2018). Infants’ visual exploration (direction of their gaze) was assessed using a head-mounted eye-tracking device, and their locomotor actions were captured using video. The 14-month-olds engaged in visual exploration from a distance as an initial assessmentPage 122 before they crossed almost every bridge. The visual information led to modifications in their gait when approaching narrow bridges, and they used haptic (touch) information at the edge of the bridges. As they gained more walking experience, their exploratory behaviors became more efficient and they became more adept at deciding which bridges were safe to walk across.

Might the development of walking be linked to advances in other aspects of development? Walking allows the infant to gain contact with objects that were previously out of reach and to initiate interaction with parents and other adults, thereby promoting language development (Adolph & Robinson, 2015; He, Walle, & Campos, 2015). Thus, just as with advances in postural skills, walking skills can produce a cascade of changes in the infant’s development (Marrus & others, 2018).

The First Year: Motor Development Milestones and Variations  Figure 14  summarizes the range of ages at which infants accomplish various gross motor skills during the first year, culminating in the ability to walk easily. After studying  Figure 14 , you should be able to order the milestones and describe the typical ages at which babies reach these milestones.

image21 FIGURE 14 MILESTONES IN GROSS MOTOR DEVELOPMENT. The horizontal red bars indicate the range of ages at which most infants reach various milestones in gross motor development.(Photo credit left to right) ©Barbara Penoyar/Getty Images; ©StephaneHachey/Getty Images; ©Image Source/Alamy; ©Victoria Blackie/Getty Images; ©Digital Vision; ©Fotosearch/Getty Images;  ©Corbis/PictureQuest; ©amaviael/123RF

A recent study found a number of factors that are linked to motor development in the first year of life (Flensborg-Madsen & Mortensen, 2017). Twelve developmental milestones were assessed, including grasping, rolling, sitting, and crawling; standing and walking; and overall mean of milestones. A larger size at birth (such as birth weight, birth length, and head circumference) was the aspect of pregnancy and delivery that showed the strongest link to reaching motor milestones earlier. Mother’s smoking in the last trimester of prenatal development was associated with reaching the motor milestones later. Also, increase in size (weight increase, length increase, and head increase) in the first year were related to reaching the motor milestones earlier. Breast feeding also was linked to reaching the milestones earlier.

However, the timing of these milestones, especially the later ones, may vary by as muchPage 123 as two to four months, and experiences can modify the onset of these accomplishments (Adolph, 2018). For example, since 1992, when pediatricians began recommending that parents place their babies on their backs to sleep, fewer babies crawled, and those who crawled did so later (Davis & others, 1998). Also, some infants do not follow the standard sequence of motor accomplishments. For example, many American infants never crawl on their belly or on their hands and knees. They may discover an idiosyncratic form of locomotion before walking, such as rolling or scooting, or they might never locomote until they are upright (Adolph & Robinson, 2015). In the African Mali tribe, most infants do not crawl (Bril, 1999). And in Jamaica, approximately one-fourth of babies skip crawling (Hopkins, 1991).

A baby is an angel whose wings decrease as his legs increase.

—French Proverb

According to Karen Adolph and Sarah Berger (2005), “the old-fashioned view that growth and motor development reflect merely the age-related output of maturation is, at best, incomplete. Rather, infants acquire new skills with the help of their caregivers in a real-world environment of objects, surfaces, and planes.”

Development in the Second Year The motor accomplishments of the first year bring increasing independence, allowing infants to explore their environment more extensively and to initiate interaction with others more readily. In the second year of life, toddlers become more motorically skilled and mobile. Motor activity during the second year is vital to the child’s competent development, and few restrictions, except for safety, should be placed on their adventures.

By 13 to 18 months, toddlers can pull a toy attached to a string and use their hands and legs to climb a number of steps. By 18 to 24 months, toddlers can walk quickly or run stiffly for a short distance, balance on their feet in a squatting position while playing with objects on the floor, walk backward without losing their balance, stand and kick a ball without falling, stand and throw a ball, and jump in place.

Can parents give their babies a head start on becoming physically fit and physically talented through structured exercise classes? Most infancy experts recommend against structured exercise classes for babies. But there are other ways to guide infants’ motor development.

Mothers in developing countries tend to stimulate their infants’ motor skills more than mothers in more developed countries (Hopkins, 1991; Karasik & others, 2015). In many African, Indian, and Caribbean cultures, mothers massage and stretch their infants during daily baths (Adolph, Karasik, & Tamis-LeMonda, 2010). Mothers in the Gusii culture of Kenya also encourage vigorous movement in their babies.

image22(Top) In the Algonquin culture in Quebec, Canada, babies are strapped to a cradle board for much of their infancy. (Bottom) In Jamaica, mothers massage and stretch their infants’ arms and legs. To what extent do cultural variations in the activity infants engage in influence the time at which they reach motor milestones?(Top) ©Michael Greenlar/The Image Works; (bottom) ©Pippa Hetherington/Earthstock/Newscom

Do these cultural variations make a difference in the infant’s motor development? When caregivers provide babies with physical guidance by physically handling them in special ways (such as stroking, massaging, or stretching) or by giving them opportunities for exercise, the infants often reach motor milestones earlier than infants whose caregivers have not provided these activities (Adolph, 2018; Adolph, Karasik, & Tamis-LeMonda, 2010; Karasik & others, 2015). For example, Jamaican mothers expect their infants to sit and walk alone two to three months earlier than English mothers do (Hopkins & Westra, 1990). And in sub-Saharan Africa, traditional practices in many villages involve mothers and siblings engaging babies in exercises, such as frequent exercise for trunk and pelvic muscles (Super & Harkness, 1997).

Many forms of restricted movement—such as Chinese sandbags, orphanage restrictions, and failure of caregivers to encourage movement in Budapest—have been found to produce substantial delays in motor development (Adolph, Karasik, & Tamis-LeMonda, 2010). In some rural Chinese provinces, for example, babies are placed in a bag of fine sand, which acts as a diaper and is changed once a day. The baby is left alone, face up, and is visited only when being fed by the mother (Xie & Young, 1999).

Some studies of swaddling (wrapping an infant tightly in a blanket) show slight delays in motor development, but other studies show no delays. Cultures that do swaddle infants usually do so early in the infant’s development when the infant is not yet mobile; when the infant becomes more mobile, swaddling decreases.

FINE MOTOR SKILLS

Whereas gross motor skills involve large muscle activity,  fine motor skills  involve finely tuned movements. Grasping a toy, using a spoon, buttoning a shirt, or any activity that requires finger dexterity demonstrates fine motor skills. Infants have hardly any control over fine motor skills at birth, but newborns do have many components of whatPage 124 will become finely coordinated arm, hand, and finger movements (McCormack, Hoerl, & Butterfill, 2012).

The onset of reaching and grasping marks a significant achievement in infants’ ability to interact with their surroundings (Rachwani & others, 2015). During the first two years of life, infants refine how they reach and grasp (Dosso, Herrera, & Boudreau, 2017; Needham, 2009). Initially, infants reach by moving their shoulders and elbows crudely, swinging their arms toward an object. Later, when infants reach for an object they move their wrists, rotate their hands, and coordinate their thumb and forefinger. Infants do not have to see their own hands in order to reach for an object (Clifton & others, 1993). Cues from muscles, tendons, and joints, not sight of the limb, guide reaching by 4-month-old infants. Recent research studies found that short-term training involving practice of reaching movements increased both preterm and full-term infants’ reaching for and touching objects (Cunha & others, 2016; Guimaraes & Tudelia, 2015).

image23A young girl uses a pincer grip to pick up puzzle pieces.©Newstockimages/SuperStock

Infants refine their ability to grasp objects by developing two types of grasps. Initially, infants grip with the whole hand, which is called the palmar grasp. Later, toward the end of the first year, infants also grasp small objects with their thumb and forefinger, which is called the pincer grip. Their grasping system is very flexible. They vary their grip on an object depending on its size, shape, and texture, as well as the size of their own hands relative to the object’s size. Infants grip small objects with their thumb and forefinger (and sometimes their middle finger too), but they grip large objects with all of the fingers of one hand or both hands.

Perceptual-motor coupling is necessary for the infant to coordinate grasping (Barrett, Traupman, & Needham, 2008). At different stages of development, infants use different perceptual systems to coordinate grasping. Four-month-old infants rely greatly on touch to determine how they will grip an object; 8-month-olds are more likely to use vision as a guide (Newell & others, 1989). This developmental change is efficient because vision lets infants preshape their hands as they reach for an object.

Experience plays a role in reaching and grasping. In a recent study, 3-month-olds who were not yet engaging in reaching behavior were provided with reaching experiences. These experiences were linked to increased object exploration and attention focusing skills at 15 months of age (Libertus, Joh, & Needham, 2016). In another study, 3-month-old infants participated in play sessions wearing “sticky mittens”—“mittens with palms that stuck to the edges of toys and allowed the infants to pick up the toys” (Needham, Barrett, & Peterman, 2002, p. 279) (see  Figure 15 ). Infants who participated in sessions with the mittens grasped and manipulated objects earlier in their development than a control group of infants who did not receive the “mitten” experience. The infants who had worn the sticky mittens looked at the objects longer, swatted at them more during visual contact, and were more likely to mouth the objects. In a later study, 5-month-old infants whose parents trained them to use the sticky mittens for 10 minutes a day over a two-week period showed advances in their reaching behavior at the end of the two weeks (Libertus & Needham, 2010). Also, in a recent study, 3-month-old infants participated in active motor training using sticky mittens that allowed them to pick up toys, and these infants engaged in more sophisticated object exploration at 5.5 months of age (Wiesen, Watkins, & Needham, 2016).

image24 FIGURE 15 INFANTS’ USE OF “STICKY MITTENS” TO EXPLORE OBJECTS. Amy Needham and her colleagues (2002) found that “sticky mittens” enhanced young infants’ object exploration skills.Courtesy of Dr. Amy Needham

Just as infants need to exercise their gross motor skills, they also need to exercise their fine motor skills (Needham, 2009). Especially when they can manage a pincer grip, infants delight in picking up small objects. Many develop the pincer grip and begin to crawl at about the same time, and infants at this time pick up virtually everything in sight, especially on the floor, and put the objects in their mouth. Thus, parents need to be vigilant in regularly monitoring what objects are within the infant’s reach (Keen, 2005).

Rachel Keen (2011; Keen, Lee, & Adolph, 2014) emphasizes that tool use is an excellent context for studying problem solving in infants because tool use provides information about how infants plan to reach a goal. Researchers in this area have studied infants’ intentional actions, which range from picking up a spoon in different orientations to retrieving rakes from inside tubes. One study explored motor origins of tool use by assessing developmental changes in banging movements in 6- to 15-month-olds (Kahrs, Jung, & Lockman, 2013). In this study, younger infants were inefficient and variable when banging an object but by one year of age infants showed consistent straight up-and-down hand movements that resulted in precise aiming and consistent levels of force.

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Review Connect Reflect

LG2 Describe infants’ motor development.

Review

· What is the dynamic systems view?

· What are some reflexes that infants have?

· How do gross motor skills develop in infancy?

· How do fine motor skills develop in infancy?

Connect

· What are the differences between the grasping reflex present at birth and the fine motor grasping skills an infant develops between 4 and 12 months of age?

Reflect Your Own Personal Journey of Life

· Think of a motor skill that you perform. How would dynamic systems theory explain your motor skill performance?

3 Sensory and Perceptual Development

LG3 Summarize the course of sensory and perceptual development in infancy.

What Are Sensation and Perception?

The Ecological View

Visual Perception

Other Senses

Intermodal Perception

Nature, Nurture, and Perceptual Development

Perceptual-Motor  Coupling

How do sensations and perceptions develop? Can a newborn see? If so, what can it perceive? What about the other senses—hearing, smell, taste, and touch? What are they like in the newborn, and how do they develop? Can an infant put together information from two modalities, such as sight and sound? These are among the intriguing questions that we will explore in this section.

WHAT ARE SENSATION AND PERCEPTION?

How does a newborn know that her mother’s skin is soft rather than rough? How does a 5-year-old know what color his hair is? Infants and children “know” these things as a result of information that comes through the senses. Without vision, hearing, touch, taste, and smell, we would be isolated from the world; we would live in dark silence, a tasteless, colorless, feelingless void.

Sensation  occurs when information interacts with sensory receptors—the eyes, ears, tongue, nostrils, and skin. The sensation of hearing occurs when waves of pulsating air are collected by the outer ear and transmitted through the bones of the inner ear to the auditory nerve. The sensation of vision occurs as rays of light contact the eyes, become focused on the retina, and are transmitted by the optic nerve to the visual centers of the brain.

The experiences of the first three years of life are almost entirely lost to us, and when we attempt to enter into a small child’s world, we come as foreigners who have forgotten the landscape and no longer speak the native tongue.

—Selma Fraiberg

Developmentalist and Child Advocate, 20th Century

Perception  is the interpretation of what is sensed. The air waves that contact the ears might be interpreted as noise or as musical sounds, for example. The physical energy transmitted to the retina of the eye might be interpreted as a particular color, pattern, or shape, depending on how it is perceived.

THE ECOLOGICAL VIEW

For the past several decades, much of the research on perceptual development in infancy has been guided by the ecological view of Eleanor and James J. Gibson (E. J. Gibson, 1969, 1989, 2001; J. J. Gibson, 1966, 1979). They argue that we do not have to take bits and pieces of data from sensations and build up representations of the world in our minds. Instead, our perceptual system can select from the rich information that the environment itself provides.

According to the Gibsons’  ecological view , we directly perceive informationPage 126 that exists in the world around us. This view is called ecological “because it connects perceptual capabilities to information available in the world of the perceiver” (Kellman & Arterberry, 2006, p. 112). Thus, perception brings us into contact with the environment so we can interact with and adapt to it (Kretch & Adolph, 2017). Perception is designed for action. Perception gives people information such as when to duck, when to turn their bodies as they move through a narrow passageway, and when to put their hands up to catch something.

In the Gibsons’ view, objects have  affordances , which are opportunities for interaction offered by objects that fit within our capabilities to perform activities. A pot may afford you something to cook with, and it may afford a toddler something to bang. Adults typically know when a chair is appropriate for sitting, when a surface is safe for walking, or when an object is within reach. An infant who runs down a steep slope or crawls across a narrow beam is determining the affordances of the slope or beam. We directly and accurately perceive these affordances by sensing information from the environment—the light or sound reflecting from the surfaces of the world—and from our own bodies through muscle receptors, joint receptors, and skin receptors, for example (Adolph & Kretch, 2015).

image25 How would you use the Gibsons’ ecological theory of perception and the concept of affordance to explain the role that perception is playing in this baby’s activity?©Ryan KC Wong/Getty Images

An important developmental question is: What affordances can infants or children detect and use? In one study, for example, when babies who could walk were faced with a squishy waterbed, they stopped and explored it, then chose to crawl rather than walk across it (Gibson & others, 1987). They combined perception and action to adapt to the demands of the task.

Similarly, as we described earlier in the section on motor development, infants who were just learning to crawl or just learning to walk were less cautious when confronted with a steep slope than experienced crawlers or walkers were (Adolph, 1997). The more experienced crawlers and walkers perceived that a slope affords the possibility for not only faster locomotion but also for falling. Again, infants coupled perception and action to make a decision about what to do in their environment. Through perceptual development, children become more efficient at discovering and using affordances (Kretch & Adolph, 2017).

Studying infants’ perceptions has not been an easy task. For instance, if newborns have limited communication abilities and are unable to verbalize what they are seeing, hearing, smelling, and so on, how can we study their perception?  Connecting Through Research  describes some of the ingenious ways researchers study infants’ perceptions.

VISUAL PERCEPTION

What do newborns see? How does visual perception develop in infancy?

Visual Acuity and Human Faces Psychologist William James (1890/1950) called the newborn’s perceptual world a “blooming, buzzing confusion.” More than a century later, we can safely say that he was wrong (Bremner & others, 2017; Damon & others, 2018; Singarajah & others, 2017; Weatherhead & White, 2017). Even the newborn perceives a world with some order. That world, however, is far different from the one perceived by the toddler or the adult.

Just how well can infants see? At birth, the nerves and muscles and lens of the eye are still developing. As a result, newborns cannot see small things that are far away. The newborn’s vision is estimated to be 20/240 on the well-known Snellen chart used for eye examinations, which means that a newborn can see at 20 feet what an adult with normal vision can see at 240 feet (Aslin & Lathrop, 2008). In other words, an object 20 feet away is only as clear to the newborn as it would be if it were 240 feet away from an adult with normal vision (20/20). By 6 months of age, though, on average vision is 20/40 (Aslin & Lathrop, 2008).

Faces are possibly the most important visual stimuli in children’s social environment, and it is important that they extract key information from others’ faces (Singarajah & others, 2017; Sugden & Moulson, 2017). Infants show an interest in human faces soon after birth (Johnson & Hannon, 2015). Research shows that within hours after infants are born, they prefer to look at faces rather than other objects and to look at attractive faces more than at unattractive ones (Lee & others, 2013).

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connecting through research

How Can Newborns’ Perception Be Studied?

The creature has poor motor coordination and can move itself only with great difficulty. Although it cries when uncomfortable, it uses few other vocalizations. In fact, it sleeps most of the time, about 16 to 17 hours a day. You are curious about this creature and want to know more about what it can do. You think to yourself, “I wonder if it can see. How could I find out?”

You obviously have a communication problem with the creature. You must devise a way that will allow the creature to “tell” you that it can see. While examining the creature one day, you make an interesting discovery. When you move an object horizontally in front of the creature, its eyes follow the object’s movement.

The creature’s eye movement suggests that it has at least some vision. In case you haven’t already guessed, the creature you have been reading about is the human infant, and the role you played is that of a researcher interested in devising techniques to learn about the infant’s visual perception. After years of work, scientists have developed research methods and tools sophisticated enough to examine the subtle abilities of infants and to interpret their complex actions (Bendersky & Sullivan, 2007).

Following are six research techniques that are used to study sensory and perceptual development: (1) visual preference method, (2) habituation/dishabituation, (3) high-amplitude sucking, (4) orienting response, (5) eye tracking, and (6) equipment.

Visual Preference Method

Robert Fantz (1963) was a pioneer in this effort. Fantz made an important discovery that advanced the ability of researchers to investigate infants’ visual perception: Infants look at different things for different lengths of time. Fantz placed an infant in a “looking chamber,” which had two visual displays on the ceiling above the infant’s head. An experimenter viewed the infant’s eyes by looking through a peephole. If the infant was fixating on one of the displays, the experimenter could see the display’s reflection in the infant’s eyes. This allowed the experimenter to determine how long the infant looked at each display. Fantz (1963) found that infants only 2 days old looked longer at patterned stimuli, such as faces and concentric circles, than at red, white, or yellow discs. Infants 2 to 3 weeks old also preferred to look at patterns—a face, a piece of printed matter, or a bull’s-eye—longer than at red, yellow, or white discs (see  Figure 16 ). Fantz’s research method—studying whether infants can distinguish one stimulus from another by measuring the length of time they attend to different stimuli—is referred to as the  visual preference method.

image26 FIGURE 16 FANTZ’S EXPERIMENT ON INFANTS’ VISUAL PERCEPTION. (a) Infants 2 to 3 weeks old preferred to look at some stimuli more than others. In Fantz’s experiment, infants preferred to look at patterns rather than at color or brightness. For example, they looked longer at a face, a piece of printed matter, or a bull’s-eye than at red, yellow, or white discs. (b) Fantz used a “looking chamber” to study infants’ perception of stimuli.©David Linton, Courtesy of the Linton Family

Habituation and Dishabituation

Another way that researchers have studied infant perception is to present a stimulus (such as a sight or a sound) a number of times. If the infant decreases its response to the stimulus after several presentations, it indicates that the infant is no longer interested in looking at the stimulus. If the researcher now presents a new stimulus, the infant’s response will recover—indicating the infant can discriminate between the old and new stimulus (Messinger & others, 2017).

Habituation  is the name given to decreased responsiveness to a stimulus after repeated presentations of the stimulus.  Dishabituation  is the recovery of a habituated response after a change in stimulation. Newborn infants can habituate to repeated sights, sounds, smells, or touches (Rovee-Collier, 2004). Among the measures researchersPage 128 use in habituation studies are sucking behavior (sucking stops when the young infant attends to a novel object), heart and respiration rates, and the length of time the infant looks at an object.  Figure 17  shows the results of one study of habituation and dishabituation with newborns (Slater, Morison, & Somers, 1988).

image27 FIGURE 17 HABITUATION AND DISHABITUATION. In the first part of one study, (a) 7-hour-old newborns were shown a stimulus. As indicated, the newborns looked at it an average of 41 seconds when it was first presented to them (Slater, Morison, & Somers, 1988). Over seven more presentations of the stimulus, they looked at it less and less. In the second part of the study, (b) infants were presented with both the familiar stimulus to which they had just become habituated and a new stimulus (which was rotated 90 degrees). The newborns looked at the new stimulus three times as long as the familiar stimulus.

High-Amplitude Sucking

To assess an infant’s attention to sound, researchers often use a method called high-amplitude sucking. In this method, infants are given a nonnutritive nipple to suck, and the nipple is connected to a sound-generating system. The researcher computes a baseline high-amplitude sucking rate in a one-minute silent period. Following the baseline, presentation of a sound is made contingent on the rate of high-amplitude sucking. Initially babies suck frequently so the sound occurs often. Gradually they lose interest in hearing the same sound, so they begin to suck less often. Then the researcher changes the sound that is being presented. If the babies renew their vigorous sucking, the inference is that they have noticed the sound change and are sucking more because they want to hear the interesting new sound (Menn & Stoel-Gammon, 2009).

The Orienting Response and Eye-Tracking

A technique that can be used to determine whether an infant can see or hear is the orienting response, which involves turning one’s head toward a sight or sound. However, the most important recent advance in measuring infant perception is the development of sophisticated eye-tracking equipment (Boardman & Fletcher-Watson, 2017; Kretch & Adolph, 2017; van Renswoude & others, 2018). Eye-tracking consists of measuring eye movements that follow (track) a moving object and can be used to evaluate an infant’s early visual ability, or a startle response can determine an infant’s reaction to a noise (Bendersky & Sullivan, 2007).  Figure 18  shows an infant wearing an eye-tracking headgear in a recent study on visually guided motor behavior and social interaction. Most studies of infant development use remote optics eye trackers that have a camera that is not attached to the infant’s head.

image28 FIGURE 18 AN INFANT WEARING EYE-TRACKING HEADGEAR. Photo from Karen Adolph’s laboratory at New York University.Courtesy of Dr. Karen Adolph, New York University

One of the main reasons that infant perceptionPage 129 researchers are so enthusiastic about the availability of sophisticated eye-tracking equipment is that looking time is among the most important measures of infant perceptual and cognitive development (Aslin, 2012). The new eye-tracking equipment allows for far greater precision in assessing various aspects of infant looking and gaze than is possible with human observation (Boardman & Fletcher-Watson, 2017; Law & others, 2018). Among the areas of infant perception in which eye-tracking equipment is being used are attention (Jia & others, 2017; Meng, Uto, & Hashiya, 2017), memory (Kingo & Krojgaard, 2015), and face processing (Chhaya & others, 2018). Further, eye-tracking equipment is improving our understanding of atypically developing infants, such as those who have autism or who were born preterm (Falck-Ytter & others, 2018; Finke, Wilkinson, & Hickerson, 2017; Liberati & others, 2017).

One eye-tracking study shed light on the effectiveness of TV programs and DVDs that claim to educate infants (Kirkorian, Anderson, & Keen, 2012). In this study, 1-year-olds, 4-year-olds, and adults watched Sesame Street and the eye-tracking equipment recorded precisely what they looked at on the screen. The 1-year-olds were far less likely to consistently look at the same part of the screen as their older counterparts, suggesting that the 1-year-olds showed little understanding of the Sesame Street video but instead were more likely to be attracted by what was salient than by what was relevant.

Equipment

Technology can facilitate the use of most methods for investigating the infant’s perceptual abilities. Video-recording equipment allows researchers to investigate elusive behaviors. High-speed computers make it possible to perform complex data analysis in minutes. Other equipment records respiration, heart rate, body movement, visual fixation, and sucking behavior, which provide clues to what the infant is perceiving. For example, some researchers use equipment that detects whether a change in infants’ respiration follows a change in the pitch of a sound. If so, it suggests that the infants heard the pitch change.

Scientists have had to be very creative when assessing the development of infants, discovering ways to “interview” them even though they cannot yet talk. Other segments of the population, such as adults who have suffered from a stroke, have difficulty communicating verbally. What kinds of methods or equipment do you think researchers might use to evaluate their perceptual abilities?

Figure 19 shows a computer estimation of what a picture of a face looks like to an infant at different ages from a distance of about 6 inches. Infants spend more time looking at their mother’s face than a stranger’s face as early as 12 hours after being born (Bushnell, 2003). By 3 months of age, infants (1) match voices to faces, (2) distinguish between male and female faces, and (3) discriminate between faces of their own ethnic group and those of other ethnic groups (Gaither, Pauker, & Johnson, 2012; Kelly & others, 2005, 2007; Lee & others, 2013; Liu & others, 2011, 2015).

image29 FIGURE 19 VISUAL ACUITY DURING THE FIRST MONTHS OF LIFE. The four photographs represent a computer estimation of what a picture of a face looks like to a 1-month-old, 2-month-old, 3-month-old, and 1-year-old (which approximates the visual acuity of an adult).©Kevin Peterson/Getty Images; Simulation by Vischek

Experience plays an important role in face processing in infancy and later in development. One aspect of this experience involves the concept of perceptual narrowing, in which infants are more likely to distinguish between faces to which they have been exposed than faces that they have never seen before (Kobayashi & others, 2018; Minar & Lewkowicz, 2018; Tham, Bremner, & Hayes, 2017).

Color Vision The infant’s color vision also improves (Yang & others, 2015). By 8 weeks, and possibly as early as 4 weeks, infants can discriminate between some colors (Kelly, Borchert, & Teller, 1997). By 4 months of age, they have color preferencesPage 130 that mirror adults’ in some cases, preferring saturated colors such as royal blue over pale blue, for example (Bornstein, 1975). In part, the changes in vision described here reflect biological origins and maturation (Skelton & others, 2017). Experience, however, is also necessary for color vision to develop normally (Sugita, 2004).

Perceptual Constancy Some perceptual accomplishments are especially intriguing because they indicate that the infant’s perception goes beyond the information provided by the senses (Bremner & others, 2017). This is the case in perceptual constancy, in which sensory stimulation is changing but perception of the physical world remains constant. If infants did not develop perceptual constancy, each time they saw an object at a different distance or in a different orientation, they would perceive it as a different object. Thus, the development of perceptual constancy allows infants to perceive their world as stable. Two types of perceptual constancy are size constancy and shape constancy.

Size constancy  is the recognition that an object remains the same even though the retinal image of the object changes as you move toward or away from the object. The farther away from us an object is, the smaller its image is on our eyes. Thus, the size of an object on the retina is not sufficient to tell us its actual size. For example, you perceive a bicycle standing right in front of you as smaller than the car parked across the street, even though the bicycle casts a larger image on your eyes than the car does. When you move away from the bicycle, you do not perceive it to be shrinking even though its image on your retinas shrinks; you perceive its size as constant.

But what about babies? Do they have size constancy? Researchers have found that babies as young as 3 months of age show size constancy (Bower, 1966; Day & McKenzie, 1973). However, at 3 months of age, this ability is not full-blown. It continues to develop until 10 or 11 years of age (Kellman & Banks, 1998).

Shape constancy  is the recognition that an object remains the same shape even though its orientation to us changes. Look around the room you are in right now. You likely see objects of varying shapes, such as tables and chairs. If you get up and walk around the room, you will see these objects from different sides and angles. Even though your retinal image of the objects changes as you walk and look, you will still perceive the objects as having the same shape.

Do babies have shape constancy? As with size constancy, researchers have found that babies as young as 3 months of age have shape constancy (Bower, 1966; Day & McKenzie, 1973). Three-month-old infants, however, do not have shape constancy for irregularly shaped objects such as tilted planes (Cook & Birch, 1984).

Perception of Occluded Objects Look around where you are now. You likely see that some objects are partly occluded by other objects that are in front of them—possibly a desk behind a chair, some books behind a computer, or a car parked behind a tree. Do infants perceive an object as complete when it is occluded by an object in front of it?

In the first two months of postnatal development, infants don’t perceive occluded objects as complete; instead, they perceive only what is visible (Johnson & Hannon, 2015). Beginning at about 2 months of age, infants develop the ability to perceive that occluded objects are whole (Slater, Field, & Hernandez-Reif, 2007). How does perceptual completion develop? In Scott Johnson’s research (2010, 2011, 2013), learning, experience, and self-directed exploration via eye movements play key roles in the development of perceptual completion in young infants.

Many objects that are occluded appear and disappear behind closer objects, as when you are walking down the street and see cars appear and disappear behind buildings as they move or you move. Infants develop the ability to track briefly occluded moving objects at about 3 to 5 months of age (Bertenthal, 2008). One study explored the ability of 5- to 9-month-old infants to track moving objects that disappeared gradually behind an occluded partition, disappeared abruptly, or imploded (shrank quickly in size) (Bertenthal, Longo, & Kenny, 2007) (see  Figure 20 ). In this study, the infants were more likely to accurately predict the reappearance of the moving object when it disappeared gradually than when it vanished abruptly or imploded.

image30 FIGURE 20 INFANTS’ PREDICTIVE TRACKING OF A BRIEFLY OCCLUDED MOVING BALL. The top picture shows the visual scene that infants experienced. At the beginning of each event, a multicolored ball bounced up and down with an accompanying bouncing sound, and then rolled across the floor until it disappeared behind the partition. The other three pictures show the three stimulus events that the 5- to 9-month-old infants experienced: (a) Gradual occlusion—the ball gradually disappears behind the right side of the occluding partition located in the center of the display. (b) Abrupt occlusion—the ball abruptly disappears when it reaches the location of the white circle and then abruptly reappears two seconds later at the location of the second white circle on the other side of the occluding partition. (c) Implosion—the rolling ball quickly decreases in size as it approaches the occluding partition and rapidly increases in size as it reappears on the other side of the occluding partition.

Depth Perception Might infants even perceive depth? To investigate this question, Eleanor Gibson and Richard Walk (1960) constructed a miniature cliff with a drop-off covered by glass in their laboratory. They placed infants on the edge of this visual cliff and had their mothers coax them to crawl onto the glass (see  Figure 21 ). Most infants would not crawl out on the glass, choosing instead to remain on the shallow side, an indication that they could perceive depth.

image31 FIGURE 21 EXAMINING INFANTS’ DEPTH PERCEPTION ON THE VISUAL CLIFF. Eleanor Gibson and Richard Walk (1960) found that most infants would not crawl out on the glass, which, according to Gibson and Walk, indicated that they had depth perception. However, some critics point out that the visual cliff is a better indication of the infant’s social referencing and fear of heights than of the infant’s perception of depth.©Mark Richard/PhotoEditPage 131

OTHER SENSES

Other sensory systems besides vision also develop during infancy. We will explore development in hearing, touch and pain, smell, and taste.

Hearing During the last two months of pregnancy, as the fetus nestles in its mother’s womb, it can hear sounds such as the mother’s voice, music, and so on (Kisilevsky & others, 2009). Two psychologists wanted to find out if a fetus who heard Dr. Seuss’ classic story The Cat in the Hat while still in the mother’s womb would prefer hearing the story after birth (DeCasper & Spence, 1986). During the last months of pregnancy, 16 women read The Cat in the Hat to their fetuses. Then shortly after the babies were born, they listened to recordings of their mothers reading either The Cat in the Hat or a story with a different rhyme and pace, The King, the Mice and the Cheese (which was not read to them during prenatal development). The infants sucked on a nipple in a different way when they listened to the recordings of the two stories, suggesting that the infants recognized the pattern and tone of The Cat in the Hat (see  Figure 22 ). This study illustrates not only that a fetus can hear but also that it has a remarkable ability to learn and remember even before birth. An fMRI study confirmed capacity of the fetus to hear at 33 to 34 weeks into the prenatal period by assessing fetal brain response to auditory stimuli (Jardri & others, 2012).

image32 FIGURE 22 HEARING IN THE WOMB. (a) Pregnant mothers read The Cat in the Hat to their fetuses during the last few months of pregnancy. (b) When they were born, the babies preferred listening to a recording of their mothers reading The Cat in the Hat, as evidenced by their sucking on a nipple that produced this recording, rather than another story, The King, the Mice and the Cheese.(a) ©McGraw Hill Companies/Jill Braaten, Photographer;  (b) Courtesy of Dr. Melanie J. Spence

The fetus can also recognize the mother’s voice, as one study demonstrated (Kisilevsky & others, 2003). Sixty term fetuses (mean gestational age, 38.4 weeks) were exposed to a tape recording either of their mother or of a female stranger reading a passage. The sounds of the tape were delivered through a loudspeaker held just above the mother’s abdomen. Fetal heart rate increased in response to the mother’s voice but decreased in response to the stranger’s voice.

What kind of changes in hearing take place during infancy? They involve perception of a sound’s loudness, pitch, and localization:

· Loudness. Immediately after birth, infants cannot hear soft sounds quite as well as adults can; a stimulus must be louder to be heard by a newborn than by an adult (Trehub & others, 1991). For example, an adult can hear a whisper from about 4 to 5 feet away, but a newborn requires that sounds be closer to a normal conversational level to be heard at that distance. By three months of age, infants’ perception of sounds improves, although some aspects of loudness perception do not reach adult levels until 5 to 10 years of age (Trainor & He, 2013).

· Pitch. Infants are also less sensitive to the pitch of a sound than adults are. Pitch is the perception of the frequency of a sound. A soprano voice sounds high-pitched, a bass voice low-pitched. Infants are less sensitive to low-pitched sounds and are more likely to hear high-pitched sounds (Aslin, Jusczyk, & Pisoni, 1998). One study revealed that by 7 months of age, infants can process simultaneous pitches when they hear voices but they are more likely to encode the higher-pitched voice (Marie & Trainor, 2013). By 2 years of age, infants have considerably improved their ability to distinguish sounds of different pitch.

· Localization. Even newborns can determine the general location from which a sound is coming, but by 6 months of age, they are more proficient at localizing sounds or detecting their origins. Their ability to localize sounds continues to improve during the second year (Burnham & Mattock, 2010).

Although infants can process variations in sound loudness, pitch, and localization, these aspects of hearing continue to improve during the childhood years (Trainor & He, 2013).

Touch and Pain Do newborns respond to touch? Can they feel pain?

Newborns do respond to touch. A touch to the cheek produces a turning of the head; a touch to the lips produces sucking movements.

Regular gentle tactile stimulation prenatally may have positive developmental outcomes. For example, a recent study found that 3-month-olds who had regular gentle tactile stimulation as fetuses were more likely to have an easy temperament than their counterparts who had irregular gentle or no tactile stimulation as fetuses (Wang, Hua, & Xu, 2015).

Newborns can also feel painPage 132 (Bellieni & others, 2016). If you have a son and consider whether he should be circumcised, the issue of an infant’s pain perception probably will become important to you. Circumcision is usually performed on infant boys about the third day after birth. Will your son experience pain if he is circumcised when he is 3 days old? An investigation by Megan Gunnar and her colleagues (1987) found that newborn infant males cried intensely during circumcision. Circumcised infants also display amazing resiliency. Within several minutes after the surgery, they can nurse and interact in a normal manner with their mothers. And, if allowed to, the newly circumcised newborn drifts into a deep sleep, which seems to serve as a coping mechanism.

developmental connection
Sensation and Perception

Kangaroo care and massage therapy are associated with many positive outcomes in preterm and low birth weight infants. Connect to “Prenatal Development and Birth.”

For many years, doctors performed operations on newborns without anesthesia. This practice was accepted because of the dangers of anesthesia and because of the supposition that newborns do not feel pain. As researchers demonstrated that newborns can feel pain, the practice of operating on newborns without anesthesia has been challenged. Anesthesia now is used in some circumcisions (Morris & others, 2012).

Recent neuroimaging studies indicate that newborn infants likely experience some aspects of pain similarly to adults (Ranger & Grunau, 2015). Magnetic resonance imaging (MRI) studies of adults have found that there is a complex brain activity network that underlies pain, which is called the “pain matrix.” The pain matrix brain regions consist of areas located in the thalamus, somatosensory cortex, and amygdala (Denk, McMahon, & Tracey, 2014). In a recent study, researchers discovered that 18 of the 20 regions in the adult pain matrix also are present in the newborn’s pain matrix (Goksan & others, 2015). However, a major brain region in the adult’s pain matrix that was not present in the infant’s was the amygdala, which involves emotional responses. Also in this study, the MRI information revealed that the pain threshold in newborns occurs at a lower level of stimulation than for adults, confirming newborns’ heightened pain sensitivity that has been found in earlier behavioral studies. And in a recent study, kangaroo care was effective in reducing neonatal pain, especially indicated by the significantly lower level of crying when the care was instituted after the newborn’s blood had been drawn by a heel stick (Seo, Lee, & Ahn, 2016).

Smell Newborns can differentiate odors (Doty & Shah, 2008). The expressions on their faces seem to indicate that they like the way vanilla and strawberries smell but do not like the way rotten eggs and fish smell (Steiner, 1979). In one investigation, 6-day-old infants who were breast fed showed a clear preference for smelling their mother’s breast pad rather than a clean breast pad (MacFarlane, 1975) (see  Figure 23 ). However, when they were 2 days old they did not show this preference, indicating that they require several days of experience to recognize this odor.

image33 FIGURE 23 NEWBORNS’ PREFERENCE FOR THE SMELL OF THEIR MOTHER’S BREAST PAD. In the experiment by MacFarlane (1975), 6-day-old infants preferred to smell their mother’s breast pad rather than a clean one that had never been used, but 2-day-old infants did not show this preference, indicating that odor preference requires several days of experience to develop.©Jean Guichard

Taste Sensitivity to taste is present even before birth (Doty & Shah, 2008). Human newborns learn tastes prenatally through the amniotic fluid and in breast milk after birth (Beauchamp & Mennella, 2009). In one study, even at only 2 hours of age, babies made different facial expressions when they tasted sweet, sour, and bitter solutions (Rosenstein & Oster, 1988). At about 4 months of age, infants begin to prefer salty tastes, which as newborns they had found to be aversive (Doty & Shah, 2008).

INTERMODAL PERCEPTION

Imagine yourself playing basketball or tennis. You are experiencing many visual inputs: the ball coming and going, other players moving around, and so on. However, you are experiencing many auditory inputs as well: the sound of the ball bouncing or being hit, the grunts and groans of other players, and so on. There is good correspondence between much of the visual and auditory information: When you see the ball bounce, you hear a bouncing sound; when a player stretches to hit a ball, you hear a groan. When you look at and listen to what is going on, you do not experience just the sounds or just the sights—you put all these things together. You experience a unitary episode. This is  intermodal perception , which involves integrating information from two or more sensory modalities, such as vision and hearing (Bremner & Spence, 2017; Hannon, Schachner, & Nave-Blodgett, 2017; Nomikou, Koke, & Rohlfing, 2017). Most perception is intermodal (Bahrick, 2010).

Early, exploratory forms of intermodal perception exist even in newborns (Bahrick & Hollich, 2008; Bremner, 2017; Guellai & others, 2016). For example, newborns turn their eyes and their head toward the sound of a voice or rattle when the soundPage 133 is maintained for several seconds (Clifton & others, 1981), but the newborn can localize a sound and look at an object only in a crude way (Bechtold, Bushnell, & Salapatek, 1979). These early forms of intermodal perception become sharpened with experience in the first year of life (Bremner & Spence, 2017; Kirkham & others, 2012). In one study, infants as young as 3 months old looked longer at their parents when they also heard their voices (Spelke & Owsley, 1979). Thus, even young infants can coordinate visual-auditory information involving people.

image34 What is intermodal perception? Which two senses is this infant using to integrate information about the blocks?©Kaori Ando/Getty Images

Can young infants put vision and sound together as precisely as adults do? In the first six months, infants have difficulty connecting sensory input from different modes, but in the second half of the first year they show an increased ability to make this connection mentally (Hannon, Schachner, & Nave-Blodgett, 2017).

NATURE, NURTURE, AND PERCEPTUAL DEVELOPMENT

Now that we have discussed many aspects of perceptual development, let’s explore one of developmental psychology’s key issues in relation to perceptual development: the nature-nurture issue. There has been a longstanding interest in how strongly infants’ perception is influenced by nature or nurture (Bremner, 2017; Chen & others, 2017; Johnson & Hannon, 2015). In the field of perceptual development, nature proponents are referred to as nativistsand those who emphasize learning and experience are called empiricists.

In the nativist view, the ability to perceive the world in a competent, organized way is inborn or innate. A completely nativist view of perceptual development no longer is accepted in developmental psychology.

The Gibsons argued that a key question in infant perception is what information is available in the environment and how infants learn to generate, differentiate, and discriminate the information—certainly not a nativist view. The Gibsons’ ecological view also is quite different from Piaget’s constructivist view. According to Piaget, much of perceptual development in infancy must await the development of a sequence of cognitive stages for infants to construct more complex perceptual tasks. Thus, in Piaget’s view the ability to perceive size and shape constancy, a three-dimensional world, intermodal perception, and so on, develops later in infancy than the Gibsons envision.

The longitudinal research of Daphne Maurer and her colleagues (Chen & others, 2017; Lewis & Maurer, 2005, 2009; Maurer, 2016; Maurer & Lewis, 2013; Maurer & others, 1999) has focused on infants born with cataracts—a thickening of the lens of the eye that causes vision to become cloudy, opaque, and distorted and thus severely restricts infants’ ability to experience their visual world. Studying infants whose cataracts were removed at different points in development, they discovered that those whose cataracts were removed and new lenses placed in their eyes in the first several months after birth showed a normal pattern of visual development. However, the longer the delay in removing the cataracts, the more their visual development was impaired. In their research, Maurer and her colleagues (2007) have found that experiencing patterned visual input early in infancy is important for holistic and detailed face processing after infancy. Maurer’s research program illustrates how deprivation and experience influence visual development, revealing an early sensitive period when visual input is necessary for normal visual development (Chen & others, 2017; Maurer & Lewis, 2013).

Today, it is clear that just as an extreme nativist position on perceptual development is unwarranted, an extreme empiricist position also is unwarranted. Much of very early perception develops from innate (nature) foundations, and the basic foundation of many perceptual abilities can be detected in newborns (Bornstein, Arterberry, & Mash, 2015). However, as infants develop, environmental experiences (nurture) refine or calibrate many perceptual functions, and they may be the driving force behind some functions (Amso & Johnson, 2010). The accumulation of experience with and knowledge about their perceptual world contributes to infants’ ability to process coherent perceptions of people and things (Bremner & others, 2016; Johnson & Hannon, 2015). Thus, a full portrait of perceptual development includes the influence of nature, nurture, and a developing sensitivity to information (Bremner & others, 2016; Chen & others, 2017; Maurer, 2016).

image35 What roles do nature and nurture play in the infant’s perceptual development?©Boris Ryaposov/ShutterstockPage 134

PERCEPTUAL-MOTOR COUPLING

As we come to the end of this chapter, we return to the important theme of perceptual-motor coupling. The distinction between perceiving and doing has been a time-honored tradition in psychology. However, a number of experts on perceptual and motor development question whether this distinction makes sense (Adolph, 2018; Thelen & Smith, 2006). The main thrust of research in Esther Thelen’s dynamic systems approach is to explore how people assemble motor behaviors for perceiving and acting. The main theme of the ecological approach of Eleanor and James J. Gibson is to discover how perception guides action. Action can guide perception, and perception can guide action. Only by moving one’s eyes, head, hands, and arms and by moving from one location to another can an individual fully experience his or her environment and learn how to adapt to it. Perception and action are coupled (Kretch & Adolph, 2018).

image36 How are perception and action coupled in children’s development?©Kevin Liu/Getty Images

Babies, for example, continually coordinate their movements with perceptual information to learn how to maintain balance, reach for objects in space, and move across various surfaces and terrains (Bremner & others, 2017). They are motivated to move by what they perceive. Consider the sight of an attractive toy across the room. In this situation, infants must perceive the current state of their bodies and learn how to use their limbs to reach the toy. Although their movements at first are awkward and uncoordinated, babies soon learn to select patterns that are appropriate for reaching their goals.

Equally important is the other part of the perception-action coupling. That is, action educates perception (Adolph, 2018). For example, watching an object while exploring it manually helps infants to determine its texture, size, and hardness. Locomoting in the environment teaches babies about how objects and people look from different perspectives, or whether various surfaces will support their weight.

The infant is by no means as helpless as it looks and is quite capable of some very complex and important actions.

—Herb Pick

Developmental Psychologist, University of Minnesota

How do infants develop new perceptual-motor couplings? Recall from our discussion earlier in this chapter that in the traditional view of Gesell, infants’ perceptual-motor development is prescribed by a genetic plan to follow a fixed and sequential progression of stages in development. The genetic determination view has been replaced by the dynamic systems view that infants learn new perceptual-motor couplings by assembling skills for perceiving and acting. New perceptual-motor coupling is not passively accomplished; rather, the infant actively develops a skill to achieve a goal within the constraints set by the infant’s body and the environment (Kretch & Adolph, 2018).

Children perceive in order to move and move in order to perceive. Perceptual and motor development do not occur in isolation from each other but instead are coupled.

Review Connect Reflect

LG3 Summarize the course of sensory and perceptual development in infancy.

Review

· What are sensation and perception?

· What is the ecological view of perception?

· How does visual perception develop in infancy?

· How do hearing, touch and pain, smell, and taste develop in infancy?

· What is intermodal perception?

· What roles do nature and nurture play in perceptual development?

· How is perceptual-motor development coupled?

Connect

· Perceptual-motor coupling was discussed in the previous section as well as in this section. Describe how this concept could be linked to the concept of nature versus nurture.

Reflect Your Own Personal Journey of Life

· How much sensory stimulation would you provide your own baby? A little? A lot? Could you overstimulate your baby? Explain.

Page 135

topical connections looking forward

In the next chapter, you will read about the remarkable cognitive changes that characterize infant development and how soon infants are able to competently process information about their world. Advances in infants’ cognitive development—together with the development of the brain and perceptual-motor advances discussed in this chapter—allow infants to adapt more effectively to their environment. Later in this text, we will further explore physical development when we examine how children progress through early childhood (ages 3 to 5). Young children’s physical development continues to change and to become more coordinated in early childhood, although gains in height and weight are not as dramatic in early childhood as in infancy.

reach your learning goals
Physical Development in Infancy
1 Physical Growth and Development in Infancy

LG1 Discuss physical growth and development  in infancy.

Patterns of Growth

Height and Weight

The Brain

Sleep

Nutrition

· The cephalocaudal pattern is the sequence in which growth proceeds from top to bottom. The proximodistal pattern is the sequence in which growth starts at the center of the body and moves toward the extremities.

· The average North American newborn is 20 inches long and weighs 7.6 pounds. Infants grow about 1 inch per month in the first year and nearly triple their weight by their first birthday. The rate of growth slows in the second year.

· One of the most dramatic changes in the brain in the first two years of life is dendritic spreading, which increases the connections between neurons. Myelination, which speeds the conduction of nerve impulses, continues through infancy and even into adolescence.

· The cerebral cortex has two hemispheres (left and right). Lateralization refers to specialization of function in one hemisphere or the other. Early experiences play an important role in brain development.

· Neural connections are formed early in an infant’s life. Before birth, genes mainly direct neurons to different locations. After birth, the inflowing stream of sights, sounds, smells, touches, language, and eye contact helps to shape the brain’s neural connections, as does stimulation from caregivers and others. The neuroconstructivist view, in which brain development is influenced by a person’s environment and experiences, is an increasingly popular perspective.

· Newborns usually sleep about 18 hours a day. By 6 months of age, many American infants approach adult-like sleeping patterns. REM sleep—during which dreaming occurs—is present more in early infancy than in childhood and adulthood.

· Sleeping arrangements for infants vary across cultures. In America, infants are more likely to sleep alone than in many other cultures. Some experts believe shared sleeping can lead to sudden infant death syndrome (SIDS), a condition that occurs when a sleeping infant suddenly stops breathing and dies without an apparent cause. However, it is generally accepted that the most critical factor in predicting whether an infant will develop SIDS is prone sleeping.

· Infants need to consume about 50 calories per day for each pound they weigh. The growing consensus is that in most instances breast feeding is superior to bottle feeding for both the infant and the mother, although the correlational nature of studies must be considered.

· Severe infant malnutrition is still prevalent in manyPage 136 parts of the world. A special concern in impoverished countries is early weaning from breast milk and the misuse and hygiene problems associated with bottle feeding in these countries. The Women, Infants, and Children (WIC) program has produced positive benefits in low-income families in the United States.

2 Motor Development

LG2 Describe infants’ motor development.

The Dynamic Systems View

Reflexes

Gross Motor Skills

Fine Motor Skills

· Thelen’s dynamic systems theory seeks to explain how motor behaviors are assembled for perceiving and acting. Perception and action are coupled. According to this theory, motor skills are the result of many converging factors, such as the development of the nervous system, the body’s physical properties and its movement possibilities, the goal the child is motivated to reach, and environmental support for the skill. In the dynamic systems view, motor development is far more complex than the result of a genetic blueprint.

· Reflexes—automatic movements—govern the newborn’s behavior. They include the sucking, rooting, and Moro reflexes. The rooting and Moro reflexes disappear after three to four months. Permanent reflexes include coughing and blinking. For infants, sucking is an especially important reflex because it provides a means of obtaining nutrition.

· Gross motor skills involve large-muscle activities. Key skills developed during infancy include control of posture and walking. Although infants usually learn to walk by their first birthday, the neural pathways that allow walking begin forming earlier. The age at which infants reach milestones in the development of gross motor skills may vary by as much as two to four months, especially for milestones in late infancy.

· Fine motor skills involve finely tuned movements. The onset of reaching and grasping marks a significant accomplishment, and this skill becomes more refined during the first two years of life.

3 Sensory and Perceptual Development

LG3 Summarize the course of sensory and perceptual development in infancy.

What Are Sensation and Perception?

The Ecological View

Visual Perception

Other Senses

Intermodal Perception

Nature, Nurture, and Perceptual Development

Perceptual-Motor Coupling

· Sensation occurs when information interacts with sensory receptors. Perception is the interpretation of sensation.

· Created by the Gibsons, the ecological view states that we directly perceive information that exists in the world around us. Perception brings people in contact with the environment to interact with and adapt to it. Affordances provide opportunities for interaction offered by objects that fit within our capabilities to perform activities.

· Researchers have developed a number of methods to assess the infant’s perception, including the visual preference method (which Fantz used to determine young infants’ preference for looking at patterned over nonpatterned displays), habituation and dishabituation, and tracking.

· The infant’s visual acuity increases dramatically in the first year of life. Infants’ color vision improves as they develop. Young infants systematically scan human faces. As early as 3 months of age, infants show size and shape constancy. At approximately 2 months of age, infants develop the ability to perceive that occluded objects are complete. In Gibson and Walk’s classic study, infants as young as 6 months of age indicated they could perceive depth.

· The fetus can hear during the last two months of pregnancy. Immediately after birth, newborns can hear, but their sensory threshold is higher than that of adults. Developmental changes in the perception of loudness, pitch, and localization of sound occur during infancy. Newborns can respond to touch and feel pain. Newborns can differentiate odors, and sensitivity to taste may be present before birth.

· Early, exploratory forms of intermodal perception—the ability to relate and integrate information from two or more sensory modalities—are present in newborns and become sharper over the first year of life.

· In describing the sources of perceptualPage 137 development, nature advocates are referred to as nativists and nurture proponents are called empiricists. The Gibsons’ ecological view that has guided much of perceptual development research leans toward a nativist approach but still allows for developmental changes in distinctive features. Piaget’s constructivist view leans toward an empiricist approach, emphasizing that many perceptual accomplishments must await the development of cognitive stages in infancy. A strong empiricist approach is unwarranted. A full account of perceptual development includes the roles of nature, nurture, and the developing sensitivity to information.

· Perception and action are often not isolated but rather are coupled. Individuals perceive in order to move and move in order to perceive.

key terms

affordances

cephalocaudal pattern

dishabituation

dynamic systems theory

ecological view

fine motor skills

grasping reflex

gross motor skills

habituation

intermodal perception

lateralization

Moro reflex

neuroconstructivist view

perception

proximodistal pattern

reflexes

rooting reflex

sensation

shape constancy

size constancy

sucking reflex

sudden infant death syndrome (SIDS)

visual preference method

key people

Karen Adolph

Martha Ann Bell

Robert Fantz

Eleanor Gibson

James J. Gibson

William James

Mark Johnson

Scott Johnson

Rachel Keen

Patricia Kuhl

Daphne Maurer

Charles Nelson

John Richards

Esther Thelen

Richard Walk

chapter 5
COGNITIVE DEVELOPMENT IN INFANCY
chapter outline

1 Piaget’s Theory of Infant Development

Learning Goal 1  Summarize and evaluate Piaget’s theory of infant development.

Cognitive Processes

The Sensorimotor Stage

Evaluating Piaget’s Sensorimotor Stage

2 Learning, Attention, Remembering, and Conceptualizing

Learning Goal 2  Describe how infants learn, focus attention, remember, and conceptualize.

Conditioning

Attention

Memory

Imitation

Concept Formation and Categorization

3 Language Development

Learning Goal 3  Describe the nature of language and how it develops in infancy.

Defining Language

Language’s Rule Systems

How Language Develops

Biological and Environmental Influences

An Interactionist View

image37 ©DreamPictures/Getty Images

 
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Magellan CANS Assessment

Magellan CANS Assessment

Vignette Assumption

When completing the vignettes, there is a vignette assumption. That is, when reading assume that a full assessment has been done and no mention means ‘no evidence’. This is the standard quality assurance if it is not documented it does not exist assumption. What that means, then if there is no mention of a need, the rating should be a ‘0’. If there is no mention of a strength, then the rating should be a ‘3’. So, no mention of a suicidality would result in a rating of ‘0’ on Suicide Risk. No mention of any talents or interests would result in a rating of ‘3’ on Talents/Interests.

Another way to think about it is that you start the assessment with all 0 ratings on the Needs and all 3 ratings on the Child/Youth Strength and then you look for evidence to adjust your scores accordingly using the action levels.   Caregiver ratings use the Need action levels for the vignettes.

Please rate mother as caregiver)

 

Lawrence is a 15-year-old boy who last week was found guilty of vandalism and assault.  He was convicted of breaking into his school with two friends and vandalizing the hallway walls.   He was caught in the act by school security and turned over to the police.  He resisted arrest and physically assaulted the security guard whose arm was injured in the event.  This incident makes Lawrence at risk of being placed in juvenile detention.  He will be sentenced in six weeks.  This is Lawrence’s second conviction. He is currently on probation because eight months ago he was convicted of a weapons charge when he was caught carrying a knife at school.

 

Lawrence attends 9th grade at a local high school and states that he hates school.  He is currently failing most of his classes.  He is excelling in art class and likes to sketch.  He says that he can get lost in his art work and it makes him feels calmer.  He talks about becoming a tattoo artist but does not have a plan on how to become one.    Lawrence is frequently in trouble at school and was suspended two weeks ago because of a verbal argument with a teacher in which Lawrence insulted her with profanity and threatened to hit her.  The argument started when Lawrence was asked to read a passage aloud in his English class.   Lawrence has been diagnosed with several learning disabilities and he received special education services that include behavioral supports.  The school officials state that they don’t have any other options for Lawrence and he will need a different school placement that can address his needs.

 

Lawrence lives with his mother and older sister in an apartment.   Lawrence’s mother works two jobs and is often not home.  Lawrence’s sister has a 14-month old daughter and he helps out with his niece when his sister is at work.   His mother reports that Lawrence is kind to the baby and he has a good relationship with his mother and his sister.   However, he does frequently miss his curfew as he likes to hang out with his friends as long as possible.   She worries that as he gets older she won’t be able to manage his behaviors and feels overwhelmed by that.   They have a large extended family with whom they are very close and who are supportive even though they do not live nearby.

 

Lawrence makes friends easily.  He has a group of friends with whom he hangs out. They often play basketball at the nearby park; however, they sometimes get into trouble, as they play basketball when the park is closed.  Lawrence says he and his friends like the thrill of possibly getting in trouble for using the park after hours and he believes that there are no real consequences.   His mother blames the influence of these youth for most of Lawrence’s trouble with the police.  She states that they are a bad group and she believes some might even be gang members.   Lawrence denies gang involvement but says that he knows some guys who are part of a gang.   Lawrence admits to drinking with his friends but says everyone does it and he never ‘passes out’ like other friends do.  He has also admitted to drinking before going to school and had been the day he was suspended for verbally assaulting his teacher.

 

In the past six weeks, mother reports that Lawrence has become increasingly irritable, withdrawn and angers very quickly. He has become very sensitive to criticism and reacts with verbal aggression to even minor perceived slights.   She noted that he is sleeping later and is harder to get out of bed to go to school.  This has resulted in several tardy and a number of missed days.   Prior to being suspended, he had been going to school about 4 out of 5 days.

Behavioral/Emotional Needs Domain

Put rating (number) next to each.

 

0. No evidence of need

1. History or Suspicion
2. Action Needed, Need interferes with Functioning
3. Immediate Action Needed, Need is dangerous or disabling

Top of Form

         
1. Psychosis        
2. Impulsivity/Hyperactivity        
3. Depression        
4. Anxiety        
5. Oppositional        
6. Conduct        
7. Anger Control        
8. Substance Use        
9. Adjustment to Trauma        

Caregiver Needs & Resources

0. No evidence of need
1. History or Suspicion
2. Action Needed, Need interferes with Functioning
3. Immediate Action Needed, Need is dangerous or disabling

Top of Form

         
1. Supervision        
2. Involvement with Care        
3. Knowledge        
4. Safety        
5. Residential Stability        
6. Organization        
7. Social Resources        
8. Mental Health/Substance Use        
9. Medical/Physical/Developmental        

Cultural Factors Domain

0. No evidence of need
1. History or Suspicion
2. Action Needed, Need interferes with Functioning
3. Immediate Action Needed, Need is dangerous or disabling

Top of Form

         
1. Language        
2. Traditions and Rituals        
3. Cultural Stress        

Life Functioning Domain

0. No evidence of need
1. History or Suspicion
2. Action Needed, Need interferes with Functioning
3. Immediate Action Needed, Need is dangerous or disabling

Top of Form

         
1. Family Functioning        
2. Living Situation        
3. School Achievement        
4. School Attendance        
5. School Behavior        
6. Social Functioning        
7. Developmental/Intellectual        
8. Decision-Making        
9. Medical/Physical        
10. Sexual Development        
11. Sleep        

Risk Behaviors Domain

0. No evidence of need
1. History or Suspicion
2. Action Needed, Need interferes with Functioning
3. Immediate Action Needed, Need is dangerous or disabling

Top of Form

         
1. Suicide Risk        
2. Non-Suicidal Self-Injurious Behavior        
3. Other Self-Harm        
4. Danger to Others        
5. Sexually Problematic Behavior        
6. Delinquent Behavior        
7. Runaway        

Strengths Domain

0. Centerpiece Strength
1. Useful Strength
2. Identified Strength
3. No Evidence

Top of Form

         
1. Family Strengths        
2. Interpersonal        
3. Educational Settings        
4. Talents and Interests        
5. Spiritual/Religious        
6. Cultural Identity        
7. Community Life        
8. Natural Supports        
9. Optimism        
10. Resilience        
11. Resourcefulness        

Bottom of Form

Bottom of Form

Bottom of Form

Bottom of Form

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Psychology Responses homework help

Psychology Responses homework help

Response 1:

Resiliency

Respond to at least two colleagues in one or more of the following ways:

        

·      Add to your colleague’s suggestion for applying resiliency to Talia’s case by suggesting an adaptation of the strategy.

·      Critique your colleague’s suggested application of resiliency to social work practice, stating whether you might use the strategy in your own practice, and why

·      Be sure to support your responses with specific references to the resources. If you are using additional articles, be sure to provide full APA-formatted citations for your references.
 

Colleague 1: B

Nineteen year old Talia Johnson was the victim of a rape at a fraternity party (Plummer, Makris and Brocksen, 2014).  This week’s video depiction highlights Talia’s struggle with navigating her way back into the life she knew prior to the sexual assault (Laureate Education, 2013).  The social worker has a glimpse into her daily life, particularly as she struggles with her parent’s understandable discomfort with their daughter remaining on campus (Laureate Education, 2013).  Talia views her current situation as stagnant and not easily changeable.  During these situations, the professional charged with helping the client achieve the best positive outcomes when pairing their innate resiliency with a Strengths Based Perspective (Zastrow and Kirst- Ashman, 2016).  Zastrow and Kirst-Ashman recognize the importance of emphasizing one’s resiliency, particularly when faced with undeniable adversity (Zastrow and Kirst-Ashman, 2016).

 

While this may be proven as an effective approach, convincing a client who is experiencing consistent feelings of helplessness and hopelessness, is certainly not an easy feat.  Therefore, the focus of this approach should remain small, manageable tasks seen through to completion (Zastrow and Kirst-Ashman, 2016).  In Talia’s case, perhaps suggesting she schedules agreed upon times to speak with her mother would alleviate the stress she feels by receiving the numerous phone calls (Laureate Education, 2013).  The premise behind this suggestion is that when Talia starts seeing small daily success, she may start “buying in” to the fact that she, too, can come back from the trauma that has placed her where she is.  Thus, her acceptance of her own resiliency, while her innate strengths are continually highlighted by the social worker, will only add to her achievement of positive outcomes (Zastrow and Kirst – Ashman, 2016).

 

By applying this concept of resiliency to Talia’s case, it is clear how this would be an effective approach within my own future social work practice.  Every client with whom a social worker comes in contact, has some innate level of resiliency.  Finding the opportunities to point out resiliency, even in its simplest form, becomes the responsibility of the professional charged with guiding the client toward the desired outcomes.   For example, when a client drives a car for the first time after being involved in a car accident, this can be identified as  form of resiliency and the first step in achieving their goals.  The ultimate goal would be for the client to recognize this resiliency within himself, but until this time the social worker can serve as the client’s “strength identifier.”

 

Laureate Education (Producer). (2013). Johnson family: Episode 5 [Video file]. Retrieved from https://class.waldenu.edu

 

Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader

 

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.)Boston, MA:  Cengage Learning.

 

 

 

Colleague 2: J

Talia is a 19-year-old college student who was sexually assaulted at a frat party. After seeking help from campus resources and the services of a counselor, she has begun to experience high levels of anxiety and stress (Plummer, Makris, and Brocksen, 2014). While Talia has begun to resent her counselor for the coping mechanisms she has given Talia, Talia has nonetheless continued to do the things suggested for her, such as journaling, going to group meetings, and talking about her feelings (Laureate Education, 2013). As an observer, these behaviors exhibited by Talia all suggest that she is a resilient individual who refuses to let the things that have befallen her ruin her life permanently.

 

As a social worker, it can be a very difficult task to convince a client that they are resilient, especially when they feel like their life is falling apart. As mentioned by Zastrow and Kirst-Ashman (2016,) giving the individual small, manageable tasks to achieve can boost their confidence and encourage them to take on larger, more difficult tasks. The social worker in Talia’s case already has proof that she is resilient by Talia’s compliance and adherence to journaling and going to group meetings (Laureate Education, 2013).

 

In my own practice, using the concept of resiliency will only serve to increase my client’s self-esteem and self-worth. By giving clients small goals that they can achieve, I can build up their confidence and determination. I think it will also be important to still call clients resilient when they fail at a goal- by still coming to sessions and admitting failure, they are only improving themselves. This would also give them the chance to evaluate the goal or their performance and see what went wrong, what can be done to fix it, and when can it be tried again. Resiliency means to be able to keep going through adversity; it also means to be able to adapt and change with the situations at hand. By instilling this in clients, they can begin the healing process.

 

Laureate Education (Producer). (2013). Johnson family: Episode 5 [Video file]. Retrieved from https://class.waldenu.edu.

 

Plummer, S.-B., Makris, S., & Brocksen, S. M. (2013). The Johnson Family. In Sessions: Case Histories. Laureate Education, Inc.

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.)Boston, MA:  Cengage Learning.

 

 

 

 

 

Response 2:

 

Discussion: Micro vs. Macro Practice

 

·      Respond to at least two colleagues by identifying three reasons that macro practice should not be dominated by micro practice if social work policy is to effectively deal with the problems of oppressed and marginalized groups.

·      Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
Colleague 1: D

Micro practice is to work with individuals.  Macro practice is to work at the organizational level.  Micro practice has come to dominate the social work profession because if we were to break down the macro and mezzo levels, we are left with individuals.  “Social workers have long recognized that micro and macro practice are complementary, but they have generally emphasized the micro, individual treatment aspect of the profession” (Popple & Leighninger, 2015, p. 7).  It has been discussed plenty that social workers find themselves working with individuals a majority of the time.  The root of the individual’s issues is based on things that are bigger than the individual (Popple & Leighninger, 2015, p. 7).

 

Popple, P. R., & Leighninger, L. (2015). The policy-based profession: An introduction to social welfare policy analysis for social workers. (6th ed.). Upper Saddle River, NJ: Pearson Education.

 

Colleague 2: R

The dichotomy between micro and macro social worker practice varies in the approaches used. Micro social worker practices are based on the ideas on how to better equip the individual to deal with societal needs and expectations. If there is an individual in need of services, the micro approach will link that individual to services to assist their individual underlying needs. The macro social worker approach attempts to have the community meet people at their levels of need. The idea behind the macro level approach to is discuss social worker and the needs of group of individual to larger organizations and agencies such as schools or child welfare agencies. In essence, and as mentioned in this week’s reading, the ideas of micro and macro practices are to compliment from one another. Understanding the needs of one might be just be the needs of the general population of that area, (Popple & Leighninger, 2015). Therefore becoming familiar and effective with using techniques on the micro level, might uncover solutions to bigger societal problems in communities.

 

 

Popple, P.R., & Leighninger, L. 2015. The police-based profession: Introduction to social welfare policy analysis for social workers. 6th ed. Upper Saddle River, NJ: Pearson Educations

 
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Nursing Paper Example on Agraphia: Understanding a Neurological Disorder

Nursing Paper Example on Agraphia: Understanding a Neurological Disorder

Agraphia, a neurological disorder characterized by impaired writing abilities, presents unique challenges to affected individuals. This condition, often arising from various underlying causes, significantly impacts communication and daily functioning. Understanding the etiology, signs, and symptoms of agraphia is crucial for accurate diagnosis and effective treatment. From strokes to traumatic brain injuries and neurodegenerative diseases, the causes of agraphia vary, highlighting the complexity of this condition. The pathophysiology involves disruptions in the brain’s language processing regions, leading to difficulties in forming letters, words, and coherent sentences. Diagnosing agraphia follows criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ensuring standardized assessment and intervention approaches. Treatment regimens typically involve a multidisciplinary approach, focusing on improving writing skills and addressing underlying conditions. Patient education plays a vital role in empowering individuals to cope with challenges and maximize their quality of life despite the impact of agraphia. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

Nursing Paper Example on Agraphia: Understanding a Neurological Disorder

Causes of Agraphia

Agraphia stems from various underlying causes, each contributing to the impairment of writing abilities. One common cause is stroke, where disruption of blood flow to the brain leads to damage in areas responsible for language processing and production. Specifically, damage to regions such as Broca’s area in the left hemisphere can result in agraphia. Traumatic brain injury is another significant cause, often affecting neural pathways involved in writing due to physical trauma or shearing forces. Neurodegenerative diseases, such as Alzheimer’s, gradually deteriorate cognitive functions, including writing skills, as the disease progresses.

In addition to these primary causes, other factors can contribute to the development of agraphia. Brain tumors may exert pressure on brain structures responsible for language processing, leading to impairments in writing abilities. Infections affecting the brain, such as encephalitis or meningitis, can also result in agraphia through inflammation and damage to neural tissue. Furthermore, psychiatric disorders like schizophrenia or bipolar disorder may manifest with symptoms of agraphia, highlighting the complex interplay between mental health and cognitive functions.

In some cases, the exact cause of agraphia remains unknown, posing challenges in diagnosis and treatment. These idiopathic cases underscore the need for comprehensive evaluation and ongoing research to elucidate underlying mechanisms.

Overall, the causes of agraphia encompass a wide range of neurological, neurodegenerative, traumatic, and sometimes idiopathic factors. Understanding the specific cause is crucial for tailoring treatment approaches and addressing underlying conditions to improve writing skills and overall functional abilities in individuals affected by agraphia. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

Signs and Symptoms

Agraphia manifests through distinct signs and symptoms that affect an individual’s ability to write coherently. One prominent sign is impaired handwriting, characterized by illegible or disjointed writing that may be difficult to decipher. Individuals with agraphia often struggle to form letters and words correctly, resulting in irregular or distorted scripts.

Nursing Paper Example on Agraphia: Understanding a Neurological Disorder

Spelling difficulties are another common symptom of agraphia, wherein individuals may have trouble spelling words correctly or consistently. This difficulty extends beyond mere typographical errors and may involve fundamental challenges in recalling and representing letter sequences accurately.

In addition to handwriting and spelling impairments, individuals with agraphia may experience difficulty composing coherent sentences. This symptom manifests as disjointed or fragmented written expression, with sentences lacking proper syntax and organization. Consequently, written communication may be challenging to comprehend and may lack clarity and cohesion.

Moreover, agraphia can impact both written and oral language abilities, affecting overall communication skills. Individuals may struggle to express themselves effectively through writing or verbal communication, leading to frustration and communication breakdowns.

Furthermore, the severity of symptoms can vary widely among individuals with agraphia, ranging from mild to profound impairment. Some individuals may experience relatively mild difficulties with occasional spelling errors or handwriting inconsistencies, while others may struggle significantly with fundamental aspects of writing and language production.

Overall, recognizing these signs and symptoms is essential for timely diagnosis and intervention. Healthcare professionals rely on thorough assessments of writing skills, including handwriting samples and spelling tests, to evaluate the presence and severity of agraphia. By identifying and addressing these symptoms, individuals with agraphia can receive appropriate support and interventions to improve their writing abilities and enhance overall communication skills. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

Etiology of Agraphia

The etiology of agraphia encompasses various underlying factors that contribute to the impairment of writing abilities. One primary cause is stroke, which occurs when disruption of blood flow to the brain leads to damage in regions crucial for language processing and production. Ischemic strokes, resulting from blockages in blood vessels supplying the brain, and hemorrhagic strokes, caused by bleeding into the brain tissue, can both precipitate agraphia.

Traumatic brain injury (TBI) represents another significant etiological factor, often resulting from physical trauma or shearing forces affecting the brain. TBI can disrupt neural pathways involved in writing, leading to agraphia. The severity and location of the injury influence the extent of impairment and recovery potential.

Neurodegenerative diseases, such as Alzheimer’s disease, progressively deteriorate cognitive functions, including writing skills, as the disease advances. These conditions involve the accumulation of abnormal proteins and neuronal loss, particularly in brain regions crucial for language processing.

Additionally, brain tumors can contribute to the development of agraphia by exerting pressure on or infiltrating brain structures responsible for language production. The location and size of the tumor determine the specific impairments observed.

Infections affecting the brain, such as encephalitis or meningitis, can lead to agraphia through inflammation and damage to neural tissue. Psychiatric disorders, including schizophrenia and bipolar disorder, may also manifest with symptoms of agraphia, highlighting the intricate interplay between mental health and cognitive functions.

In some cases, the etiology of agraphia remains idiopathic, with no identifiable cause despite thorough evaluation. These cases underscore the complexity of the disorder and the need for ongoing research to elucidate underlying mechanisms and inform treatment approaches. Understanding the specific etiological factors contributing to agraphia is crucial for tailoring interventions and addressing underlying conditions to improve writing skills and overall functional abilities in affected individuals. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

Pathophysiology

The pathophysiology of agraphia involves disruptions in the brain’s intricate network of language-processing regions, leading to difficulties in writing and related language functions. Damage to specific brain areas crucial for language production and coordination, such as Broca’s area in the left hemisphere, plays a central role in the development of agraphia.

In cases of stroke-induced agraphia, ischemic or hemorrhagic events disrupt blood flow to the brain, resulting in localized damage to language centers. Ischemic strokes, caused by arterial blockages, deprive brain regions of oxygen and nutrients, leading to neuronal dysfunction and cell death. Hemorrhagic strokes, characterized by bleeding into brain tissue, exert pressure on surrounding structures, disrupting neural connectivity and function.

Traumatic brain injury (TBI) disrupts neural pathways involved in writing due to physical trauma or shearing forces affecting the brain. TBI can result in diffuse axonal injury, neuronal loss, and glial scarring, impairing communication between brain regions responsible for language processing and production.

Neurodegenerative diseases, such as Alzheimer’s, involve the progressive accumulation of abnormal proteins and neuronal loss, particularly in brain regions crucial for language processing. These pathological changes disrupt synaptic transmission and neural communication, impairing writing skills as the disease advances.

Furthermore, alterations in neurotransmitter systems, including acetylcholine and dopamine, may contribute to the pathophysiology of agraphia. Imbalances in these neurotransmitters disrupt neuronal signaling and synaptic plasticity, affecting cognitive functions such as language processing and writing abilities.

Overall, the pathophysiology of agraphia involves complex interactions between structural brain damage, neural connectivity disruptions, and neurotransmitter imbalances. Understanding these underlying mechanisms is crucial for developing targeted treatment approaches and addressing the specific needs of individuals with agraphia. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

DSM-5 Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides criteria for diagnosing agraphia as a neurocognitive disorder. To receive a diagnosis of agraphia, individuals must exhibit significant impairment in writing abilities that cannot be attributed to intellectual disabilities or other neurological conditions. The impairment must cause clinically significant distress or functional impairment in daily life activities.

According to DSM-5 criteria, the diagnosis of agraphia requires the presence of specific symptoms, including impaired handwriting, spelling difficulties, and difficulty composing coherent sentences. These symptoms must persist despite efforts to improve writing skills, such as remedial education or cognitive rehabilitation.

Additionally, the DSM-5 emphasizes the importance of ruling out other potential causes of writing impairments, such as intellectual disabilities, language disorders, or motor coordination deficits. A comprehensive evaluation, including standardized assessments of writing skills, neurological examinations, and medical history review, is essential to differentiate agraphia from other conditions.

Furthermore, the diagnosis of agraphia considers the severity and impact of symptoms on daily functioning. Clinicians assess the extent to which impaired writing abilities interfere with communication, academic or occupational performance, and social interactions.

Overall, the DSM-5 diagnosis of agraphia requires careful consideration of specific criteria and comprehensive evaluation to differentiate it from other neurocognitive disorders. By adhering to standardized diagnostic criteria, healthcare professionals can accurately identify agraphia and develop tailored treatment plans to address the unique needs of individuals affected by this condition. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

Treatment Regimens and Patient Education

Treatment regimens for agraphia typically involve a multidisciplinary approach tailored to individual needs. Speech therapists play a crucial role in implementing structured writing exercises and strategies to improve handwriting, spelling, and sentence construction. These interventions may include practicing letter formation, word recognition, and sentence composition through repetitive exercises and task-specific training. Additionally, speech therapists employ techniques such as modeling, cueing, and feedback to facilitate learning and reinforce correct writing behaviors.

Nursing Paper Example on Agraphia: Understanding a Neurological Disorder

Occupational therapists may also be involved in the treatment of agraphia, focusing on fine motor skills and coordination to enhance writing proficiency. Occupational therapy interventions may include activities to improve grip strength, hand-eye coordination, and motor planning necessary for handwriting. Furthermore, adaptive equipment and assistive devices, such as specialized writing utensils or keyboard adaptations, may be recommended to accommodate individual needs and enhance writing performance.

Cognitive rehabilitation techniques, including memory training and attentional exercises, may complement speech and occupational therapy interventions to address underlying cognitive deficits contributing to agraphia. These interventions aim to improve cognitive functions such as attention, working memory, and executive functioning, which are essential for effective writing and language processing.

In addition to formal therapy sessions, individuals with agraphia benefit from practicing writing skills in daily life activities and real-world contexts. Encouraging individuals to engage in writing tasks relevant to their personal interests and daily routines promotes skill generalization and functional independence.

Patient education plays a vital role in empowering individuals with agraphia to understand their condition and actively participate in treatment. Educating individuals and their families about the nature of agraphia, its underlying causes, and available treatment options fosters understanding and collaboration in the rehabilitation process. Providing strategies and resources to support writing skills, such as visual aids, mnemonic devices, and assistive technologies, enables individuals to overcome challenges associated with agraphia and maximize their functional abilities.

Moreover, educating individuals about compensatory strategies, such as breaking down writing tasks into smaller components or using alternative communication methods, empowers them to navigate daily life with confidence and adapt to their unique needs. By equipping individuals with knowledge and resources, patient education facilitates active participation in treatment and enhances the overall quality of life for individuals with agraphia. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

Conclusion

Agraphia poses significant challenges to individuals affected by this neurological disorder, impacting their ability to write coherently and communicate effectively. Understanding the multifaceted etiology, signs, and symptoms of agraphia is essential for accurate diagnosis and tailored treatment interventions. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for diagnosing agraphia, guiding healthcare professionals in evaluating and managing this condition effectively. Treatment regimens for agraphia involve a multidisciplinary approach, incorporating speech therapy, occupational therapy, and cognitive rehabilitation to address underlying impairments and improve writing skills. Additionally, patient education plays a crucial role in empowering individuals with agraphia to understand their condition, learn compensatory strategies, and actively participate in treatment. By combining clinical expertise with patient-centered care and support, healthcare professionals can help individuals with agraphia navigate challenges and maximize their quality of life despite the impact of this disorder. (Nursing Paper Example on Agraphia: Understanding a Neurological Disorder)

References

https://www.ncbi.nlm.nih.gov/books/NBK560722/

 
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Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder

Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder

Agnosia, a neurological condition shrouded in mystery, presents a perplexing phenomenon where individuals struggle to recognize and interpret sensory stimuli despite intact sensory organs. This enigmatic disorder challenges the conventional understanding of sensory perception, highlighting the intricacies of the human brain’s processing capabilities. While rare, Agnosia’s impact on affected individuals is profound, disrupting fundamental aspects of daily life such as recognizing familiar faces, objects, or sounds. Understanding the complexities of Agnosia is essential for healthcare professionals tasked with diagnosis and management, as well as for individuals and their caregivers navigating the challenges it presents. This paper endeavors to delve into the depths of Agnosia, exploring its causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, patient education, and offering insights into this intricate neurological condition. Through unraveling the mysteries of Agnosia, we aim to shed light on its complexities and pave the way for improved understanding and management strategies. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder

Causes of Agnosia

Agnosia arises from various neurological disruptions that interfere with the brain’s ability to process sensory information accurately. One primary cause is brain injury, often resulting from traumatic incidents such as car accidents, falls, or sports-related injuries. In these cases, the impact can lead to damage in specific brain regions responsible for sensory perception, triggering Agnosia.

Another contributing factor is cerebrovascular accidents, commonly known as strokes, which disrupt blood flow to the brain, leading to tissue damage. Depending on the affected area, strokes can impair sensory processing regions, causing Agnosia.

Furthermore, brain tumors can exert pressure on brain structures, causing compression or damage that disrupts sensory pathways, resulting in Agnosia. Neurodegenerative diseases such as Alzheimer’s disease, which progressively damages brain cells, can also contribute to Agnosia by affecting regions crucial for sensory processing.

Additionally, infectious diseases like encephalitis or meningitis can lead to inflammation of the brain, causing damage to sensory processing areas and subsequent Agnosia. Genetic factors may also play a role, as certain hereditary conditions predispose individuals to neurological abnormalities that can manifest as Agnosia.

Moreover, toxins or chemicals, whether ingested or environmental, can damage the brain and disrupt sensory processing, contributing to Agnosia. Drug abuse, particularly substances that affect neurotransmitter function, can also lead to neurological impairments and Agnosia.

Agnosia can stem from various causes, including brain injury, stroke, tumors, neurodegenerative diseases, infectious diseases, genetic factors, toxins, and drug abuse. Understanding these diverse etiological factors is crucial for diagnosing and managing Agnosia effectively, as each case may require specific approaches to treatment and intervention. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

Signs and Symptoms

Agnosia presents a spectrum of signs and symptoms that vary depending on the type and severity of the condition. Visual Agnosia, for instance, may manifest as difficulty recognizing familiar objects, faces, or places despite intact vision. Individuals may struggle to identify common items such as keys, utensils, or household items, leading to challenges in daily activities.

Auditory Agnosia, on the other hand, affects the interpretation of sounds and speech. Affected individuals may have difficulty understanding spoken language, distinguishing between voices, or recognizing familiar tunes or melodies. This can lead to communication difficulties and social isolation.

Tactile Agnosia involves impaired recognition of textures, temperatures, or shapes through touch. Individuals may struggle to identify objects by touch alone, such as distinguishing between fabrics or perceiving the shape of items placed in their hands.

Furthermore, there are specific subtypes of Agnosia, such as Prosopagnosia, characterized by the inability to recognize faces, even those of close friends or family members. This can lead to social awkwardness and challenges in interpersonal relationships.

In some cases, individuals with Agnosia may exhibit anosognosia, a lack of awareness or recognition of their sensory deficits. They may deny or minimize their difficulties, leading to frustration and misunderstandings with others.

Overall, the signs and symptoms of Agnosia can significantly impact daily functioning, interpersonal relationships, and overall quality of life. Understanding these manifestations is crucial for accurate diagnosis and tailored interventions to help affected individuals cope with their sensory perception deficits effectively. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

Etiology of Agnosia

The etiology of Agnosia is multifaceted, involving a complex interplay of neurological factors that disrupt sensory processing pathways in the brain. One primary contributor to Agnosia is brain injury, which can result from traumatic incidents such as falls, sports-related injuries, or motor vehicle accidents. These injuries can lead to structural damage or lesions in specific brain regions responsible for sensory perception, causing Agnosia.

Cerebrovascular accidents, commonly known as strokes, represent another significant etiological factor in Agnosia. Strokes disrupt blood flow to the brain, leading to tissue damage in critical sensory processing areas, thereby impairing sensory recognition and interpretation.

Moreover, brain tumors can exert pressure on brain structures, causing compression or damage that disrupts sensory pathways, leading to Agnosia. Neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, or dementia, can also contribute to Agnosia by progressively damaging brain cells and affecting regions crucial for sensory processing.

Infectious diseases, including encephalitis or meningitis, can lead to inflammation of the brain, causing damage to sensory processing areas and subsequent Agnosia. Additionally, genetic factors may play a role in predisposing individuals to neurological abnormalities that manifest as Agnosia.

Furthermore, exposure to toxins or chemicals, whether ingested or environmental, can damage the brain and disrupt sensory processing, contributing to Agnosia. Drug abuse, particularly substances that affect neurotransmitter function, can also lead to neurological impairments and Agnosia.

Understanding the diverse etiological factors underlying Agnosia is crucial for accurate diagnosis and targeted interventions to address the underlying causes and mitigate its impact on affected individuals’ sensory perception and daily functioning. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

Pathophysiology of Agnosia

Agnosia stems from disruptions in the neural pathways responsible for processing sensory information in the brain. These disruptions can arise from various etiological factors, including brain injury, stroke, tumors, neurodegenerative diseases, and genetic predispositions.

The pathophysiology of Agnosia involves abnormalities in specific brain regions involved in sensory perception, including the primary sensory cortices and associated higher-order processing areas. Structural damage or lesions in these regions impede the transmission and interpretation of sensory signals, leading to impaired recognition and interpretation of sensory stimuli.

In cases of visual Agnosia, for example, lesions in the occipital and temporal lobes, particularly the ventral visual pathway, disrupt the processing of visual information essential for object recognition. Similarly, lesions affecting the auditory cortex or associated pathways can result in auditory Agnosia, impairing the interpretation of sounds and speech.

Tactile Agnosia may arise from lesions in somatosensory processing areas, such as the parietal lobe, hindering the recognition of textures, shapes, or temperatures through touch. The pathophysiology of Agnosia varies depending on the type and location of brain damage, with specific regions implicated in each subtype.

Furthermore, neurodegenerative diseases like Alzheimer’s disease or Parkinson’s disease contribute to Agnosia through progressive damage to brain cells and disruption of neural pathways involved in sensory processing. Genetic factors may also influence the pathophysiology of Agnosia, predisposing individuals to structural or functional abnormalities in sensory processing regions.

Overall, the pathophysiology of Agnosia involves complex disruptions in neural pathways and brain regions responsible for sensory perception, highlighting the intricate nature of this neurological disorder and the diverse mechanisms underlying its manifestation. Understanding these pathophysiological mechanisms is essential for guiding diagnostic and therapeutic approaches to manage Agnosia effectively. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

DSM-5 Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies Agnosia under the broader category of Neurocognitive Disorders. Diagnosis of Agnosia involves a comprehensive assessment to evaluate sensory perception deficits and their impact on daily functioning.

Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder

Clinical interviews play a crucial role in gathering information about the onset, duration, and progression of sensory recognition difficulties. Healthcare professionals also conduct neurological examinations to assess sensory modalities and identify any associated neurological deficits.

Neuropsychological testing is an essential component of the diagnostic process, involving specialized assessments to evaluate sensory recognition abilities across different modalities. These tests may include tasks to assess visual object recognition, auditory discrimination, tactile perception, and other sensory processing abilities.

The DSM-5 criteria for Agnosia emphasize the presence of significant impairment in recognizing or identifying familiar objects, faces, sounds, or other sensory stimuli despite intact sensory organs. The deficits must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Additionally, the diagnosis of Agnosia requires ruling out other potential etiologies for sensory recognition difficulties, such as sensory deficits due to primary sensory organ dysfunction or cognitive impairments unrelated to sensory processing.

Overall, the DSM-5 diagnosis of Agnosia involves a comprehensive evaluation of sensory perception deficits and their impact on daily functioning, guided by specific criteria outlined in the diagnostic manual. Accurate diagnosis is essential for implementing targeted interventions and support strategies to help individuals with Agnosia cope with their sensory recognition difficulties effectively. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

Treatment Regimens and Patient Education for Agnosia

Effective management of Agnosia involves a multidisciplinary approach encompassing various treatment regimens and patient education strategies to address the complex nature of sensory recognition deficits.

Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder

Treatment Regimens:

  1. Sensory Rehabilitation Techniques: Occupational therapists and rehabilitation specialists employ sensory retraining techniques to improve sensory perception and recognition abilities. These may include repetitive exposure to sensory stimuli, sensory discrimination exercises, and multisensory integration activities to enhance sensory processing skills.
  2. Assistive Devices: Utilizing assistive devices such as magnifiers, auditory aids, or tactile cueing devices can facilitate sensory recognition and compensate for deficits. These devices aim to enhance sensory input and improve functional independence in daily activities.
  3. Cognitive-Behavioral Therapies: Psychologists or cognitive therapists may employ cognitive-behavioral techniques to address emotional and psychological challenges associated with Agnosia. Therapy sessions focus on coping strategies, stress management, and cognitive restructuring to alleviate distress and enhance coping skills.
  4. Environmental Modifications: Modifying the environment to reduce sensory overload and enhance accessibility can improve functional abilities for individuals with Agnosia. This may involve simplifying surroundings, organizing objects, and providing clear cues to facilitate recognition and navigation.
  5. Medication: In some cases, medication may be prescribed to manage underlying conditions contributing to Agnosia, such as neurodegenerative diseases or neurological disorders. Pharmacological interventions aim to alleviate symptoms and slow disease progression, although their efficacy in treating Agnosia specifically may vary.

Patient Education:

  1. Understanding Agnosia: Providing comprehensive education about Agnosia helps individuals and their caregivers understand the nature of the condition, its causes, and implications. Education sessions include information about sensory recognition deficits, associated challenges, and available treatment options.
  2. Compensatory Strategies: Educating individuals about compensatory strategies and adaptive techniques to cope with sensory recognition difficulties is essential. This includes teaching techniques to enhance sensory perception, improve daily functioning, and maintain independence.
  3. Support Networks: Encouraging individuals to engage with support networks, such as support groups or online communities, can provide emotional support, practical advice, and share experiences with others facing similar challenges.
  4. Advocacy and Resources: Providing information about advocacy resources, disability services, and community support organizations helps individuals access necessary resources and navigate healthcare and social systems effectively.
  5. Regular Follow-Up: Emphasizing the importance of regular follow-up appointments with healthcare providers ensures ongoing monitoring of Agnosia symptoms, adjustment of treatment regimens as needed, and support for individuals and their caregivers throughout their journey with the condition.

By implementing comprehensive treatment regimens and patient education strategies, healthcare professionals can support individuals with Agnosia in managing their sensory recognition deficits, improving functional abilities, and enhancing overall quality of life. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

Conclusion

Agnosia presents a complex neurological challenge characterized by impaired sensory recognition despite intact sensory organs. Through exploring its causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education, we gain valuable insights into this enigmatic disorder. The causes of Agnosia encompass diverse neurological factors such as brain injury, stroke, tumors, and neurodegenerative diseases. Its signs and symptoms manifest across various sensory modalities, affecting daily functioning and interpersonal relationships. Understanding the etiology and pathophysiology of Agnosia guides accurate diagnosis and targeted interventions. The DSM-5 criteria assist in identifying sensory recognition deficits, while treatment regimens encompass sensory rehabilitation, assistive devices, cognitive-behavioral therapies, and environmental modifications. Patient education plays a pivotal role in empowering individuals and their caregivers to cope with Agnosia effectively, fostering adaptive strategies, accessing support networks, and advocating for resources. By addressing Agnosia comprehensively, healthcare professionals can improve outcomes and enhance the quality of life for individuals navigating this challenging neurological condition. (Nursing Paper Example on Understanding Agnosia: An Overview of a Neurological Disorder)

References

https://www.ncbi.nlm.nih.gov/books/NBK493156/

 
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Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care

Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care

Encephalitis, a neurological disorder characterized by inflammation of the brain, affects millions worldwide, making it a significant public health concern. This essay aims to provide a comprehensive overview of encephalitis, focusing on its causes, symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education. Understanding encephalitis is vital due to its diverse etiologies and complex clinical presentations, which necessitate prompt diagnosis and appropriate management. By exploring the intricacies of this disorder, we can enhance our knowledge of its underlying mechanisms and improve therapeutic approaches. With a deeper understanding of encephalitis, healthcare professionals can better support patients in navigating their diagnosis, treatment, and recovery journey. Thus, this essay serves as a valuable resource for healthcare providers and individuals seeking to comprehend and address the challenges posed by encephalitis. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care

Causes

Encephalitis has various causes, spanning infectious and non-infectious origins. Viral infections are predominant culprits, with herpes simplex virus (HSV) and varicella-zoster virus (VZV) being common offenders. These viruses can directly invade the brain, triggering an inflammatory response and leading to encephalitis. Additionally, other viral agents such as enteroviruses, arboviruses (e.g., West Nile virus), and influenza viruses can also induce encephalitis.

Bacterial infections like Lyme disease, caused by Borrelia burgdorferi, can result in neuroborreliosis, leading to encephalitis in some cases. Moreover, certain parasitic infections, such as toxoplasmosis and malaria, can cause encephalitis through indirect mechanisms.

Non-infectious triggers, including autoimmune reactions, can also contribute to encephalitis. Autoimmune encephalitis occurs when the body’s immune system mistakenly attacks healthy brain tissue, leading to inflammation and neurological dysfunction. Conditions like anti-NMDA receptor encephalitis and autoimmune limbic encephalitis exemplify this mechanism.

Environmental factors such as exposure to toxins or chemicals may also precipitate encephalitis. For instance, exposure to heavy metals like lead or mercury can trigger neuroinflammation, potentially leading to encephalitis.

Furthermore, immunocompromised individuals, such as those with HIV/AIDS or undergoing immunosuppressive therapy, are at higher risk of developing encephalitis due to their weakened immune defenses.

Understanding the diverse array of causes underlying encephalitis is crucial for accurate diagnosis and targeted treatment. Differentiating between infectious and non-infectious etiologies guides clinicians in selecting appropriate therapeutic interventions and optimizing patient outcomes. Thus, a comprehensive understanding of encephalitis causes is essential for effective management and improved prognosis.

Signs and Symptoms

Encephalitis manifests through a spectrum of signs and symptoms, often varying in severity and presentation. The hallmark features typically include fever, headache, and altered mental status, which may range from mild confusion to profound disorientation or coma. These cognitive changes often accompany behavioral alterations, including irritability, agitation, or personality changes.

Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care

Neurological manifestations of encephalitis can encompass a wide array of symptoms, such as seizures, focal neurological deficits, and impaired consciousness. Seizures may manifest as generalized convulsions or focal motor seizures, further complicating the clinical picture.

In some cases, patients may exhibit psychiatric symptoms, including psychosis, hallucinations, or delusions, reflecting the profound impact of encephalitis on brain function. Additionally, movement disorders such as tremors, ataxia, or dyskinesias may arise due to disruption of neural circuits within the basal ganglia or cerebellum.

Furthermore, encephalitis can lead to autonomic dysfunction, presenting as fluctuations in blood pressure, heart rate, or temperature regulation. These autonomic disturbances contribute to the overall clinical complexity of encephalitis and may pose challenges in management.

Children with encephalitis may exhibit distinct symptoms, including irritability, lethargy, poor feeding, or developmental regression. Early recognition of these pediatric-specific signs is critical for prompt diagnosis and intervention.

It is essential to recognize the broad spectrum of signs and symptoms associated with encephalitis, as timely identification facilitates early initiation of appropriate treatment and improves clinical outcomes. Vigilance for subtle neurological changes, particularly in high-risk populations, is paramount for early intervention and preventing potential complications. Thus, a comprehensive understanding of encephalitis symptoms is essential for timely diagnosis and effective management. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

Etiology

Encephalitis encompasses a diverse etiology, reflecting the multifaceted nature of this neurological disorder. Viral infections stand as predominant etiological factors, with herpes simplex virus (HSV) and varicella-zoster virus (VZV) accounting for a significant proportion of cases. These viruses gain access to the central nervous system (CNS) via neuronal pathways, causing direct neuronal injury and triggering an inflammatory response within the brain.

Other viral agents, including enteroviruses, arboviruses (e.g., West Nile virus), and influenza viruses, can also precipitate encephalitis through various mechanisms. These viruses may disseminate hematogenously or via peripheral nerves, leading to CNS invasion and subsequent neuroinflammation.

Bacterial infections represent another important etiological category, with pathogens such as Borrelia burgdorferi (causing Lyme disease) and Mycobacterium tuberculosis capable of inducing encephalitis. These bacteria may infiltrate the CNS through hematogenous spread or direct extension from adjacent structures, inciting an inflammatory cascade within the brain parenchyma.

Parasitic infections, though less common, can also contribute to encephalitis pathogenesis. Toxoplasma gondii and Plasmodium species (causing malaria) are notable examples, with encephalitis arising secondary to parasitic invasion of the CNS and subsequent inflammatory response.

Non-infectious etiologies, particularly autoimmune reactions, are increasingly recognized as significant contributors to encephalitis. Autoimmune encephalitis encompasses a spectrum of disorders characterized by immune-mediated attacks on neuronal antigens, leading to neuroinflammation and neurological dysfunction.

Furthermore, environmental factors such as exposure to toxins or chemicals may precipitate encephalitis by eliciting neuroinflammatory responses within the brain. Understanding the diverse etiological factors underlying encephalitis is crucial for accurate diagnosis and targeted therapeutic interventions, ultimately improving patient outcomes and guiding preventive strategies. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care

Pathophysiology

The pathophysiology of encephalitis involves a complex interplay of inflammatory cascades, immune responses, and neuronal dysfunction, culminating in neurological impairment. Viral encephalitis typically begins with viral invasion of the central nervous system (CNS), facilitated by hematogenous dissemination or neuronal spread from peripheral sites of infection. Upon entering the CNS, viruses target neurons, glial cells, and endothelial cells, initiating a robust immune response characterized by cytokine release and activation of resident immune cells.

This inflammatory milieu triggers endothelial cell activation and disruption of the blood-brain barrier (BBB), allowing infiltration of immune cells into the brain parenchyma. Activated microglia and infiltrating macrophages release pro-inflammatory mediators, exacerbating neuroinflammation and promoting neuronal injury.

In addition to direct viral-induced damage, immune-mediated mechanisms contribute to neuronal dysfunction in encephalitis. Autoimmune encephalitis, for instance, results from antibodies targeting neuronal antigens, leading to synaptic dysfunction, neuronal excitotoxicity, and impaired neurotransmission.

The ensuing neuronal injury and inflammation disrupt neural circuits and neurotransmitter pathways, manifesting clinically as altered mental status, seizures, and focal neurological deficits. Moreover, disruption of the BBB facilitates the entry of neurotoxic substances and exacerbates neuroinflammation, further exacerbating neuronal injury.

The pathophysiological processes underlying encephalitis are dynamic and multifactorial, involving a delicate balance between viral replication, immune responses, and neuronal damage. Understanding these mechanisms is crucial for developing targeted therapeutic strategies aimed at mitigating neuroinflammation, preserving neuronal function, and optimizing patient outcomes. Further research into the pathophysiology of encephalitis is warranted to unravel its complexities and identify novel therapeutic targets for intervention. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

DSM-5 Diagnosis

Diagnosing encephalitis entails a comprehensive evaluation based on clinical presentation, laboratory findings, and neuroimaging studies, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM-5 provides criteria for diagnosing neurocognitive disorders, including those resulting from infectious or inflammatory etiologies such as encephalitis.

The DSM-5 criteria emphasize the presence of significant cognitive decline from a previous level of functioning, which may manifest as impaired memory, executive function, attention, or language skills. Additionally, individuals with encephalitis may exhibit disturbances in consciousness, orientation, perception, or behavior, reflecting the multifaceted nature of the disorder.

Laboratory investigations play a crucial role in confirming the diagnosis of encephalitis. Cerebrospinal fluid (CSF) analysis reveals lymphocytic pleocytosis, elevated protein levels, and sometimes the presence of specific pathogens or antibodies indicative of viral or autoimmune etiologies. Serological tests for viral antibodies and polymerase chain reaction (PCR) assays can identify viral pathogens circulating in the CNS.

Neuroimaging studies, particularly magnetic resonance imaging (MRI) of the brain, may demonstrate characteristic findings such as focal or diffuse signal abnormalities in the affected brain regions. These imaging findings complement clinical and laboratory assessments, aiding in confirming the diagnosis of encephalitis and guiding treatment decisions.

The DSM-5 diagnosis of encephalitis underscores the importance of a multidisciplinary approach involving neurologists, infectious disease specialists, and psychiatrists. By integrating clinical, laboratory, and imaging data, healthcare professionals can accurately diagnose encephalitis and initiate timely interventions to optimize patient outcomes. Moreover, adherence to DSM-5 criteria ensures consistency and precision in diagnosing encephalitis across diverse clinical settings, facilitating effective management and support for affected individuals. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

Treatment Regimens and Patient Education

Treatment of encephalitis necessitates a multifaceted approach aimed at addressing the underlying cause, managing symptoms, and preventing complications. Antiviral therapy is the mainstay of treatment for viral encephalitis, targeting specific viral pathogens such as herpes simplex virus (HSV) or varicella-zoster virus (VZV). Intravenous administration of antiviral medications like acyclovir or ganciclovir is initiated promptly upon suspicion of viral encephalitis to mitigate viral replication and reduce neuronal damage.

In cases of bacterial encephalitis, antibiotic therapy targeting the causative pathogen is imperative. Prompt initiation of antibiotics like ceftriaxone or penicillin G is crucial to combat bacterial invasion of the central nervous system (CNS) and prevent systemic complications.

In autoimmune encephalitis, immunomodulatory therapy aims to suppress the aberrant immune response directed against neuronal antigens. Treatment may involve corticosteroids, intravenous immunoglobulin (IVIG), or immunosuppressive agents like rituximab or cyclophosphamide to attenuate neuroinflammation and preserve neuronal function.

Supportive care plays a pivotal role in managing complications and promoting recovery in patients with encephalitis. This includes close monitoring of vital signs, maintenance of adequate hydration, seizure management, and addressing nutritional needs. In severe cases with neurological sequelae, rehabilitation therapy may be necessary to optimize functional outcomes and enhance quality of life.

Patient education is integral to the management of encephalitis, empowering individuals and their caregivers to navigate the challenges associated with the condition. Patients should be educated about the importance of adhering to prescribed medications, attending follow-up appointments, and recognizing warning signs of disease progression or relapse. Furthermore, patients and caregivers should receive guidance on strategies to optimize brain health, including adequate rest, nutrition, and cognitive stimulation.

Moreover, raising awareness about encephalitis within the community is crucial to promoting early recognition and timely intervention. Educational initiatives aimed at healthcare providers, schools, and the general public can facilitate prompt referral to specialized care centers and improve outcomes for individuals affected by encephalitis.

The treatment of encephalitis involves a comprehensive approach encompassing specific antiviral or antibiotic therapy, immunomodulatory interventions, and supportive care measures. Patient education is paramount in empowering individuals and caregivers to actively participate in disease management and promote optimal outcomes. By addressing both the medical and educational aspects of encephalitis, healthcare providers can enhance the quality of care and support for affected individuals and their families. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

Conclusion

Encephalitis is a complex neurological disorder with diverse causes, symptoms, and treatment regimens. This essay has provided a comprehensive overview, emphasizing the importance of understanding its multifaceted etiology, including viral, bacterial, autoimmune, and environmental factors. The discussion of signs and symptoms underscored the varied clinical presentations, highlighting the need for early recognition and intervention. Additionally, the exploration of pathophysiology elucidated the intricate interplay of inflammatory processes and neuronal dysfunction underlying encephalitis. The DSM-5 diagnosis section outlined the criteria for accurate identification, guiding clinicians in diagnostic evaluation and treatment planning. Furthermore, the treatment regimens and patient education section emphasized the multidisciplinary approach to management, incorporating antiviral, antibiotic, and immunomodulatory therapies alongside supportive care measures. By addressing both the medical and educational aspects, healthcare providers can optimize outcomes for individuals affected by encephalitis, underscoring the importance of timely intervention and comprehensive support. (Nursing Paper Example on Understanding Encephalitis: Causes, Symptoms, Treatment, and Patient Care)

References

https://www.ncbi.nlm.nih.gov/books/NBK470162/

 
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Psych 635 Shaping And Chaining, Reinforcement Schedules And One-Trial Learning Week 3

HEALTH AND SPORTS PSYCHOLOGY REVIEW

Running head: HEALTH AND SPORTS PSYCHOLOGY REVIEW

1

HEALTH AND SPORTS PSYCHOLOGY REVIEW

2

Health and Sports Psychology Review

Psych 635

February 9, 2015 Health and Sports Psychology Review

The foundation of sports psychology centers on helping players maximize their performance and strengthen motor learning skills, by learning techniques to overcome mental blocks. The first publication of sports psychology focused on how spectators influence athletes competing in competitive bicycling (Brown & Mahoney, 1984). Health and sports psychology focuses on the influences of athletics and the psychological and physiological impact it has on humans. A sports psychologist assists athletes through the application of shaping and chaining, reinforcement schedules, and one-trial learning techniques in teaching new technical skills.

Shaping and Chaining

As a sports psychologist, one must comprehend the concepts of shaping and chaining when teaching and implementing unfamiliar technical skills to athletes. Before a behavior arises, an athlete cannot associate his or her skills and performance to a behavior, therefore shaping is only useful when linking behaviors that can help athletes perform adequately and comprehensively. “The basic operant conditioning method of behavioral change is shaping, or differential reinforcement of successive approximations to the desired form or rate of behavior” (Schunk, 2012). The process of shaping identifies behaviors not yet present, and assists athletes retrieve a specific behavior, mindset, and skill expansion. The process of shaping in sports psychology consists of the identification of the current abilities of an athlete, identification of a behavior, identification of possible reinforcement within an athlete’s environment, dividing the goal into smaller goals, and ultimately, guide the athlete to his or her desired behavior through the use of reinforcements (Schunk, 2012). For instance, when an athlete complains of weak leg muscles, he or she can begin with leg muscle development that fosters strength, stamina, and confidence. Once an athlete works toward a desired behavior, he or she will need to continue to reinforce the behavior until the desired results are achieved. A good example of this is hurdles.

Hurdles is a type of sports activity that requires athletes to run and leap over a bar at pre-determined intervals thus building leg muscles, strength and increasing versatility. An athlete accomplishing a hurdles race builds confidence and physical strength. By receiving corrective feedback, an athlete can achieve his or her desired goal. A sports psychological can assist an athlete by monitoring speed, versatility, and strength and encouraging an athlete to do more, go faster, and untimely achieve their goal.

According to B.F. Skinner, “Chaining is the process of producing or altering some of the variables that serve as stimuli for future responses” (Schunk, 2012, p. 99). Chaining identifies when an athlete desired skill acquisition without reinforcement of successful elements of monitor behavior an athlete cannot improve or achieve higher performance (Greene, 2012). “The operant principle of chaining has been widely researched and implemented with motor skill acquisition and improvement, therefore, in order to ensure proper motor learning, reinforcement of specific behaviors must occur” (Greene, 2012, p.1). Every step offers a signal of action for the next step; a chain is a sequence of cues and behaviors, therefore when one’s behavior in a chain of reactive step generates another signal for the next course of action. Chaining is very useful for sports psychologists when assisting athletes enhance performance and achieve their goals. For example, when an athlete is struggling while training for an event, or merely has a desire to improve his or her performance, a sports psychologist can develop a plan for the athlete to follow on a daily, weekly, and monthly basis. When an athlete follows these guidelines, he or she is creating a chain. Many times athletes develop psychological hindrances that prevent them from performing at an optimal level, therefore a sport psychologist can analyze those factors and examine methods of motivation, enhancing, or eliminating self-esteem issues and offer encouragement throughout stages of progress. Shaping and chaining is a useful tool for sport psychologists in assisting athletes by focusing on the psychological and physiological factors athletes need to succeed.

Reinforcement Schedules

Primarily known for his theory of operant conditioning, B.F. Skinner believed behaviors were dependent on the after-effect of a response called operant behavior. In operant conditioning, scheduling reinforcements are crucial components of learning. There are two types of reinforcement schedules: continuous and partial reinforcement. The schedule of frequency for behavioral reinforcement has a significant impact on the intensity and timeline of the desired response. Continuous reinforcement is more effective during the initial stages of learning to develop a solid connection of the behavior and response. This occurs through the presentation of reinforcement every time an undesired or desired behavior appears. Partial reinforcement is the response of reinforcement only part of the time rather than continuously. Reinforcement schedules can help athletes learn new technical skills through reward or punishment. These schedules help ensure an athlete’s dedication and focus toward his or her goals. When an individual suffers from a psychological or physiological issue, positive reinforcement is pure joy such as an enjoyable evening with friends or a day without working out, therefore the experience is pleasurable and desirable. The negative reinforcement and punishment stage is when the joy is taken away or controlled (consequence). For example, an extra workout, or additional laps around the track or denial of participating in an upcoming event. Although it is important for sports psychologists to provide a positive and encouraging environment for their clients, it is also important to use negative reinforcement to motivate athletes to improve perform.

One-Trial Learning Techniques

The one-trial learning technique involves learning by a single paired response and stimulus, not repetitive responses. If a child places his or her hand on a hot stove and burns it, the child will most likely not do so again fearing the pain from the first experience. Sports psychologists can use one-trial learning techniques to teach athletes the type of mistakes not to make more than once, therefore avoiding time and health consuming hindrances. Many times injuries can happen to athletes causing financial, physiological, and psychological setbacks. When an athlete heals, he or she learns from that one-time error, to avoid such a task or move. Many times athletes over-exert themselves and the one-trial learning technique teaches them to realize and respect their limitations. For example, when long-distance runners decide to push themselves to beat their current time or a competitor’s, they may be doing more good than harm, therefore if they pull a ligament or become sore or unable to run on schedule, they will have learned from this learning technique.

Conclusion

According to Division 47 of the American Psychological Association (2013),

Sports psychology, includes a range of topics that include motivation to continue and achieve, psychological considerations in sport injury and rehabilitation, counseling techniques with athletes, assessing talent, exercise adherence and well-being, self-perceptions related to achieving, expertise in sport, youth sport and performance enhancement and self-regulation techniques (para.1).

Health and sports psychology focuses on an extensive spectrum of clinical, scientific, and adapted subject matter regarding exercise and sports. This field of science focuses on the psychological vision of applying motivation and performance improvement and the comprehension of improving mental and physical health. Among these applied techniques are shaping and chaining, reinforcement schedules, and one-trail learning techniques to assist athletes achieving optimal psychological and physiological health.

References

American Psychological Association. (2013). Purpose and goals. Retrieved from http://www.apa.org/divisions/div47/APA%20Div%2047%20(2)/about_purposeandgoals. html

Browne, M. A., & Mahoney, M. J. (1984). Sport psychology. Annual Review of Psychology,

35(1), 605.

Greene, L. M. (2012). Mastery chaining and modeling to improve dart throwing skill acquisition. (Order No. 3549416, Hofstra University). ProQuest Dissertations and Theses, 85. Retrieved from http://search.proquest.com/docview/1283383949?accountid=458. (1283383949).

Schunk, D. H. (2012). Learning theories: An educational perspective (6th ed.). Boston, MA: Pearson Education.

 
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Initial Assessment homework help

Initial Assessment homework help

Prior to beginning work on this discussion, please read Chapters 2, 6, and 7 in DSM-5 Made Easy: The Clinician’s Guide to Diagnosis.  Additionally, please watch the video Beer Is Cheaper than Therapy: Fort Hood’s PTSD Problem .  (https://fod.infobase.com/OnDemandEmbed.aspx?Token=49272&aid=18596&Plt=FOD&loid=0&w=640&h=480&ref)

For this discussion, the patient for whom you wrote your transcript in the Week One Initial Call discussion has come to your office for a 15-minute initial assessment. As part of the intake process, you have asked the patient to fill out a biographical form that contains the same information included in the case study. Based on this information, propose three questions you would ask the patient to determine a diagnosis and treatment plan.

Provide a transcript of this brief initial session including your three questions and the answers you would expect the prospective patient to give. Beneath the transcript, provide a rationale for each of the three questions you proposed. Include the case study title you chose for your Week One Initial Call discussion post.

Examine your colleague’s transcript, and write an evaluation of the prospective patient’s apparent symptoms and presenting problem(s) within the context of a theoretical orientation. Theoretical orientations are based on the personality theories you learned about in PSY615, and are referred to as “approaches” in Abnormal and Clinical Psychology: An Introductory Textbook.

Remember that symptoms may not be explicitly mentioned by the patient, but they may be inferred by the patient’s presenting problem(s). Summarize views of these symptoms from at least two historical perspectives. For instance, how have these symptoms have been conceptualized and understood, historically? Finally, suggest diagnostic manuals and handbooks besides the DSM-5 that might be used to assess this patient.

Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The Guilford Press.Retrieved from https://redshelf.com

 

“CHAPTER 6 Trauma- and Stressor-Related Disorders

 

“Trauma- and Stressor-Related Disorders Quick Guide to Trauma- and Stressor-Related Disorders Various types of stress and trauma are responsible for the disorders we’ll consider in this chapter. By now, you know the drill: The link indicates where a more detailed discussion begins. Primary Trauma- and Stressor-Related Disorders Reactive attachment disorder. There is evidence of pathogenic care in a child who habitually doesn’t seek comfort from parents or surrogates. Disinhibited social engagement disorder. There is evidence of pathogenic care in a child who fails to show normal reticence in the company of strangers. Posttraumatic stress disorder. These adolescents or adults repeatedly relive a severely traumatic event, such as combat or a natural disaster. Posttraumatic stress disorder in preschool children. Children repeatedly relive a severely traumatic event, such as car accidents, natural disasters, or war. Acute stress disorder. This condition is much like posttraumatic stress disorder, except that it begins during or immediately after the stressful event and lasts a month or less. Adjustment disorder. Following a stressor, an individual develops symptoms that disappear once the cause of stress has subsided. Other specified, or unspecified, trauma- and stressor-related disorder. Patients whose stress or trauma appears related to other presentations may be classified in one of these categories. Other Problems Related to Trauma or Stress Problems related to abuse or neglect. An astonishing number of Z-codes (V-codes in ICD-9) cover the categories of difficulties that arise from neglect or from physical or sexual abuse of children or adults. Separation anxiety disorder. The patient becomes anxious when separated from parent, other attachment figure, or home. INTRODUCTION Another new chapter for the DSMs incorporates certain diagnoses formerly listed as anxiety, developmental, or adjustment disorders. The unifying factor here is that something traumatic or stressful in the patient’s history appears to be at least partly responsible for the symptoms that develop. It is part of a trend toward grouping together patients of any age who have the right mix of symptoms, rather than separating patients by developmental stage. Many diagnoses include statements about what is not causative, but here is the only full DSM-5 section that presumes any etiology at all, let alone one rooted in the psychology of a pathological developmental process. In the instances of reactive attachment and disinhibited social engagement disorders, there must be evidence of pathogenic care; for posttraumatic stress disorder (PTSD) and its cousins, a horrific event; for adjustment disorder a stressful—well, stressor. The respective criteria sets permit us to check off the fulfilled criteria and go on our way, perhaps thinking that we’ve solved the puzzle. While we rejoice that we’ve successfully determined a cause–effect relationship, nagging at the back of our minds must be a sense that there is more to the story. Otherwise, why do some people become symptomatic while others, exposed to the (as nearly as we can tell) exact same stimulus, go untrammeled on their way? Furthermore, studies have demonstrated that, sooner or later, significant stressors will visit the majority of us. Shouldn’t we conclude that the stimulus in question is necessary, but not sufficient, for the outcome observed? At least this DSM-5 chapter has herded most of these etiology-specific diagnoses into one corral, where we can keep a watchful eye on them. F43.10 [309.81] Posttraumatic Stress Disorder Many people who survive severely traumatic events will develop PTSD. Survivors of combat are the most frequent victims, but it is also encountered in those who have experienced other disasters, both natural and contrived. These include rape, floods, abductions, and airplane crashes, as well as the threats that may be posed by a kidnapping or hostage situation. Children can have PTSD as a result of inappropriate sexual experience, whether or not actual injury has occurred. PTSD can be diagnosed even in those who have only learned about severe trauma (or its threat) suffered by someone to whom they are close—children, spouses, other close relatives. One or two in every 1,000 patients who have undergone general anesthesia have afterwards reported awareness of pain, anxiety, helplessness, and the fear of impending death during the procedure; up to half of them may subsequently develop PTSD symptoms. Implicitly excluded from the definition are stressful experiences of ordinary life, such as bereavement, divorce, and serious illness. Awakening from anesthesia while your surgery is still in progress, however, would qualify as a traumatic event, as would learning about a spouse’s sudden, accidental death or a child’s life-threatening illness. Watching TV images of a calamity would not be a sufficient stressor (except if the viewing was related to the person’s job). After some delay (symptoms usually don’t develop immediately after the trauma), the person in some way relives the traumatic event and tries to avoid thinking about it. There are also symptoms of physiological hyperarousal, such as an exaggerated startle response. Patients with PTSD also express negative feelings such as guilt or personal responsibility (“I should have prevented it”). Aside from the traumatic event itself, other factors may play a role in the development of PTSD. Individual factors include the person’s innate character structure and genetic inheritance. Relatively low intelligence and low educational attainment are positively associated with PTSD. Environmental influences include relatively low socioeconomic status and membership in a minority racial or ethnic group. In general, the more horrific or more enduring the trauma, the greater will be the likelihood of developing PTSD. The risk runs to one-quarter of the survivors of heavy combat and two-thirds of former prisoners of war. Those who have experienced natural disasters such as fires or floods are generally less likely to develop symptoms. (Overall lifetime prevalence of PTSD is estimated at about 9%, though European researchers usually report lower overall rates.) Older adults are less likely to develop symptoms than are younger ones, and women tend to have somewhat higher rates than do men. About half the patients recover within a few months; others can experience years of incapacity. In children, the general outline is pretty much the same as the five general points given in the list of typical symptoms, though the emphasis on symptom numbers differs, as discussed below. Mood, anxiety, and substance use disorders are frequently comorbid. A new specifier reflects findings that in perhaps 12–14% of patients, dissociation is important in the development and maintenance of PTSD symptoms. Essential Features of Posttraumatic Stress Disorder Something truly awful has happened. One patient has been gravely injured or perhaps sexually abused; another has been closely involved in the death or injury of someone else; a third has only learned that someone close experienced an accident or other violence, whereas emergency workers (police, firefighters) may be traumatized through repeated exposure. As a result, for many weeks or months these patients: • Repeatedly relive their event, perhaps in nightmares or upsetting dreams, perhaps in intrusive mental images or dissociative flashbacks. Some people respond to reminders of the event with physiological sensations (racing heart, shortness of breath) or emotional distress. • Take steps to avoid the horror: refusing to watch films or television or to read accounts of the event, or pushing thoughts or memories out of consciousness. • Turn downbeat in their thinking: with persistently negative moods, they express gloomy thoughts (“I’m useless,” “The world’s a mess,” “I can’t believe anyone.”) They lose interest in important activities and feel detached from other people. Some experience amnesia for aspects of the trauma; others become numb, feeling unable to love or experience joy. • Experience symptoms of hyperarousal: irritability, excessive vigilance, trouble concentrating, insomnia, or an intensified startle response. The Fine Print The D’s: • Duration (1+ months) • Distress or disability (work/educational, social, or personal impairment) • Differential diagnosis (substance use and physical disorders [especially traumatic brain injury], mood and anxiety disorders, normal reactions to stressful events) Coding Notes Specify if: With delayed expression. Symptoms sufficient for diagnosis didn’t accumulate until at least six months after the event. With dissociative symptoms: Depersonalization. This indicates feelings of detachment, as though dreaming, from the patient’s own mind or body. Derealization. To the patient, the surroundings seem distant, distorted, dreamlike, or unreal. Barney Gorse “They’re gooks! The place is staffed with gooks!” Someone sitting behind Barney Gorse had dropped a book onto the tile floor, and that had set him off. Now he had backed into a corner in the waiting room of the mental health clinic. His pupils were widely dilated, and perspiration stood out on his forehead. He was panting heavily. He pointed a shaky finger at the Asian student who stood petrified on the other side of the room. “Get this goddamn gook out of here!” He made a fist and lumbered off in the direction of the student. “Hang on, Barney. It’s OK.” Barney’s new therapist took him firmly by the elbow and led him to a private office. They sat there in silence for a few minutes, while Barney’s breathing gradually returned to normal and the clinician reviewed his chart. Barney Gorse was 39 now, but he had been barely 20 when his draft number came up and he joined the Ninth Infantry Division in Vietnam. At that time President Nixon was “winding down the war,” which made it seem all the more painful when Barney’s squad was hit by mortar fire from North Vietnamese regulars. He had never talked about it, even during “anger displacement” group therapy with other veterans. Whenever he was asked to tell his story, he would fly into a rage. But something truly devastating must have happened to Barney that day. The reports mentioned a wound in the upper thigh; he had been the only member of his squad to survive the attack. He had been awarded a Purple Heart and a full pension. Barney hadn’t been able to remember several hours of the attack at all. And he had always been careful to avoid films and television programs about war. He said he’d had enough of it to last everybody’s lifetime; in fact, he had gone to some lengths to avoid thinking about it. He celebrated his discharge from the Army by getting drunk, which was how he remained for 6 years. When he finally sobered up, he turned to drugs. Even they hadn’t been enough to obliterate the nightmares that still haunted him; he awakened screaming several times a week. Sudden noises would startle him into a panic attack. Now, thanks to disulfiram and a chaplain in the county jail where he had been held as a persistent public nuisance, Barney had been clean and sober for 6 months. On the condition that he would seek treatment for his substance use, he had been released. The specialists in substance misuse treatment had quickly recognized that he had other problems, and that had led him here. Last week when they met, the therapist had reminded him again that he needed to dig into his feelings about the past. Barney had responded that he didn’t have any feelings; they’d dried up on him. For that matter, the future didn’t look so good, either: “Got no job, no wife, no kids. I just wasn’t meant to have a life.” He got up and put his hand on the doorknob to leave. “It’s no use. I just can’t talk about it.” Evaluation of Barney Gorse Let’s summarize and restate the criteria that must be fulfilled to diagnose PTSD. 1. There must be severe trauma (criterion A). Barney’s occurred in the context of combat, but a variety of civilian stressors can also culminate in death, serious injury, or sexual abuse. Two features must be present for the stressor to be considered sufficiently traumatic: (a) It must involve the fact or threat of death, severe wounds or injuries, or sexual violation; and (b) it must be personally experienced by the patient in some way—through direct observation (not viewed on TV), through personal involvement, or through information obtained after the fact that it involved a relative or close friend. A first responder (police officer, ambulance attendant) could also qualify through repeated exposure to consequences of the horrific event (think workers at Ground Zero shortly after 9/11). Divorce and death of a spouse from cancer, though undeniably stressful, are relatively commonplace and expected; they don’t qualify. 2. Through some intrusive mechanism, the patient relives the stress. Barney had flashbacks (B3), during which he imagined himself actually back in Vietnam. He also experienced rather intense responses to an external cue (seeing a staff member who, to him, resembled a Viet Cong soldier). Less dramatic forms of recollection include recurrent ordinary memories, dreams, and any other reminder of the event that results in distress or physiological symptoms. 3. The patient attempts (wittingly or not) to achieve emotional distance from the stressful event by avoiding reminders of the trauma. The reminders can be either internal (feelings, thoughts) or external (people, places, activities). Barney refused to watch movies and TV programs or to talk about Vietnam (C). 4. The patient experiences expressions (two or more) of negative mood and thoughts related to the trauma. Barney’s included amnesia for much of his time in combat (D1), a persistently negative frame of mind (“I wasn’t meant to have a life”—D4), and the lack of positive mood states (his feelings had “dried up” on him, D7). 5. Finally, for PTSD, patients must have at least two symptoms of heightened arousal and reactivity associated with the traumatic event. Barney suffered from insomnia (E6) and a severe startle response (E4); others may experience general irritability, poor concentration, or excessive vigilance. As with all symptoms, the clinician would have to determine that these symptoms of arousal had not been apparent before Barney’s Vietnam trauma. Barney’s symptoms had persisted far longer than the required minimum of 1 month (F); were obviously stressful and impaired his functioning in a number of areas (G); and could not be attributed to the direct effects of substance use—now that he’d been clean and sober for half a year (H). The experience of severe trauma in combat and the typical symptoms would render any other explanation for Barney’s symptoms unlikely. A patient with intermittent explosive disorder might become aggressive and lose control, but wouldn’t have the history of trauma. Still, clinicians must always be alert to the possibility of another medical condition (H) that might produce anxiety symptoms and could be diagnosed instead of or in addition to PTSD. For example, head injuries would be relatively common among veterans of combat or other violent trauma; we’d have to mention and code any accompanying brain injury. Situational adjustment disorder shouldn’t be confused with PTSD: The severity of the trauma would be far less, and the effects would be transient and less dramatic. In PTSD, comorbidity is the rule rather than the exception. Barney had used drugs and alcohol; his clinician would have gathered additional information about use of other substances and mentioned them in his diagnostic summary. Of combat veterans who have PTSD, half or more also have a problem with a substance use disorder, and use of multiple substances is common. Anxiety disorders (phobic disorders, generalized anxiety disorder) and mood disorders (major depressive disorder and dysthymia) are likewise common in this population. Dissociative amnesia may also occur. Any coexisting personality disorder would be explored, but it is hard to make a definitive diagnosis when a patient is acutely ill from PTSD. Malingering is also a diagnosis to consider whenever there appears to be a possibility of material gain (insurance, disability, legal problems) resulting from an accident or physical attack. Although the vignette is imprecise on this point, Barney’s symptoms probably began by the time he was discharged from the military, so he would not rate the specifier with delayed onset. The vignette doesn’t provide encouragement to add with prominent dissociation. I’d give him a GAF score of 35. Pending further information on substance use, Barney’s diagnosis would read as follows: F43.10 [309.81] Posttraumatic stress disorder F10.20 [303.90] Alcohol use disorder, moderate, in early remission Z60.2 [V60.3] Lives alone Z56.9 [V62.29] Unemployed There is still considerable controversy over the specifier with delayed expression. Many experts deny that symptoms of PTSD can begin many months or years after the trauma. Nonetheless, it is there to use, should you ever find it appropriate. Posttraumatic Stress Disorder in Preschool Children There can be no doubt that preschool children are sometimes exposed to traumatic events. Mostly, these are car accidents, natural disasters, and war—in short, all the benefits contemporary life has to offer. The question is, do very young children respond with typical PTSD symptoms? The best evidence would seem to indicate that they do, but with a likelihood much lower (0–12%) than for older children. Table 6.1 compares the DSM-5 criteria for PTSD in young children, PTSD in adults, and acute stress disorder (to be discussed next). The revamped criteria for PTSD in young children are, as we would hope, more sensitive to symptoms in this age group. Based on interviews with parents, they yield rates in children who have survived severe burns of 25% and 10% at 1 month and 6 months, respectively. TABLE 6.1. Comparison of PTSD in Preschool Children, PTSD in Adults, and Acute Stress Disorder Child PTSD Adult PTSD Acute Stress Disorder Trauma Direct experience Direct experience Direct experience Witness (not just TV) Witness Witness Learn of Learn of Repeat exposure (not just TV) Learn of Repeat exposure (not just TV) Intrusion symptoms (1/5)a Intrusion symptoms (1/5) All symptoms (9/14) • Memories • Memories • Memories • Dreams • Dreams • Dreams • Dissociative reactions • Dissociative reactions • Dissociative reactions • Psychological distress• Physiological reactions • Psychological distress• Physiological reactions • Psychological distress or physiological reactions Avoid/Neg. emotions (1/6) Avoidance (1/2) • Avoids memories • Avoids memories • Avoids memories • Avoids external reminders • Avoids external reminders • Avoids external reminders Negative emotions (2/7) • Altered sense of reality of self or surroundings • Amnesia • Amnesia • Negative beliefs • Distortion → self-blame • Negative emotional state • Negative emotional state • Decreased interest • Decreased interest • Social withdrawal • Detached from others • Decreased positive emotions • No positive emotions • No positive emotions Physiological (2/5) Physiological (2/6) • Irritable, angry • Irritable, angry • Irritable, angry • Reckless, self-destructive • Hypervigilance • Hypervigilance • Hypervigilance • Startle • Startle • Startle • Poor concentration • Poor concentration • Poor concentration • Sleep disturbance • Sleep disturbance • Sleep disturbance Duration >1 month >1 month 3 days–1 month Purchasers of this ebook can download a copy of this table from www.guilford.com/morrison2-forms. aFractions indicate the number of symptoms required of the number possible in the following list. F43 [308.3] Acute Stress Disorder Based on the observation that some people develop symptoms immediately after a traumatic stress, acute stress disorder (ASD) was devised several decades ago. Even then, this wasn’t exactly new information; something similar was noted as far back as 1865, just after the U.S. Civil War. For many years it was termed “shell shock.” Like PTSD, ASD can also be found among civilians. Overall rates of ASD, depending on the nature of the trauma and personal characteristics of the individual, center on 20%. Though the number and distribution of symptoms is different, the criteria embody the same elements required for PTSD: • Exposure to an event that threatens body integrity • Reexperiencing the event • Avoidance of stimuli associated with the event • Negative changes in mood and thought • Increased arousal and reactivity • Distress or impairment The symptoms usually begin as soon as the patient is exposed to the event (or learns about it), but they must be experienced farther out than 3 days after the stressful event to fulfill the criterion for duration. This gets us to a period of time beyond the stressful event itself and its immediate aftermath. Should symptoms last longer than 1 month, they are no longer acute and no longer constitute ASD. Then many patients will be rolled over into a diagnosis of PTSD. This is the fate of as many as 80% of patients with ASD. However, patients with PTSD don’t usually enter through the ASD doorway; most are identified farther along the road than one month. Essential Features of Acute Stress Disorder Something truly awful has happened—grave injury or sexual abuse, or perhaps the traumatic death or injury of someone else. (It could have come about through learning another has experienced violence or injury, or through repeated exposure for an emergency worker.) As a result, for up to a month the patient experiences many symptoms such as intrusive memories or bad dreams; dissociative experiences such as flashbacks or feeling unreal; the inability to experience joy or other love; amnesia for parts of the event; attempts to avoid reminders of the event (refusing to watch films or television or to read accounts of the event); pushing thoughts or memories out of consciousness. The patient may also experience symptoms of hyperarousal: irritability, hypervigilance, trouble concentrating, insomnia, or an intense startle response. The Fine Print The D’s: • Duration (3 days to 1 month) • Distress or disability (work/educational, social, or personal impairment) • Differential diagnosis (substance use and physical disorders (especially traumatic brain injury), panic disorder, mood disorders, dissociative disorders, PTSD) Marie Trudeau Marie Trudeau and her husband, André, sat in the intake interviewer’s office. Marie was the patient, but she spent most of the time rubbing the knuckles of one hand and gazing vacantly into the room. André did most of the talking. “I just can’t believe the change in her,” he said. “A week ago, she was completely normal. Never had anything like this in her life. Heck, she’s never had anything wrong with her. Then, all of a sudden, boom! She’s a mess.” At André’s exclamation, Marie jerked around to face him and rose half out of her chair. For a few seconds she stood there, frozen except for her gaze, which darted from one side of the room to the other. “Aw, geez, I’m sorry, honey. I forgot.” He put his arm around her. Grasping her shoulders firmly but gently, he eased her back into the chair. He held her there until she began to relax her grip on his arm. A week earlier, Marie had just finished her gardening and was sitting in the back yard with a lemonade, reading a book. When she heard airplane engines, she looked up and saw two small planes flying high overhead, directly above her. “My God,” she thought, “they’re going to collide!” As she watched in horror, they did collide. She could see perfectly. The sun was low, highlighting the two planes brilliantly against the deep blue of the late afternoon sky. Something seemed to have been torn off one of them—the news media later reported that the right wing of one plane had ripped right through the cockpit of the other. Thinking to call 911, Marie picked up her portable phone, but she didn’t dial. She could only watch as two tiny objects suddenly appeared beside the stricken airplanes and tumbled toward her in a leisurely arc. “They weren’t objects, they were people.” It was the first time she had spoken during the interview. Marie’s chin trembled, and a lock of hair fell across her eye. She didn’t try to brush it back. As she continued to watch, one of the bodies hurtled into her yard 15 feet from where she was sitting. It buried itself 6 inches deep in the soft earth behind her rose bushes. What happened next, Marie seemed to have blanked out completely. The other body landed in the street a block away. Half an hour later, when the police knocked on her door, they found her in the kitchen peeling carrots for supper and crying into the sink. When André arrived home an hour after that, she seemed dazed. All she would say was “I’m not here.” In the 6 days since, Marie hadn’t improved much. Although she might start a conversation, something would appear to distract her, and she would usually trail off in midsentence. She couldn’t focus much better on her work at home. Amy, their 9-year-old daughter, seemed to be taking care of her. Sleep had slipped to a restless struggle, and three nights running Marie had awakened from a dream, trying to cry out but managing only a terrified squeak. She kept the blinds in the kitchen closed, so she wouldn’t even have to look into the back yard. “It’s like someone I saw in a World War II movie,” André concluded. “You’d think she’d been shell-shocked.” Evaluation of Marie Trudeau Anxiety and depressive symptoms are nearly universal following a severe stress. Usually these are relatively short-lived, however, and do not include the full spectrum of symptoms required for ASD. This diagnosis should only be considered when major symptoms last 3 days or more after personal exposure to a horrific event. Such an event was the plane crash Marie witnessed (criterion A2). She was dazed (B6) and emotionally unresponsive (B5), and could not recall what had happened during part of the accident (B7). When she could sleep at all (B10), she had nightmares (B2); she also avoided looking into the back yard (B9), startled easily (B14), and even in the interviewer’s office appeared hypervigilant (B12). From her inability to finish conversations, we infer poor concentration (B13), as she was distracted by intrusive recollections of the event (B1). As far as we are aware, she had had none of these symptoms (DSM-5 requires 9 of the 14 symptoms listed in criterion B) prior to witnessing the accident. Since then, just a week earlier (C), she had been unable to carry on with her work at home (D). Would any other diagnosis be possible? According to André, Marie’s previous health had been good, reducing the likelihood of another medical condition (E). We aren’t told whether she used alcohol or drugs, though the fact that she was drinking lemonade at the time of the crash could suggest that she did not. (OK, I’m definitely out on a limb here; her clinician needs to rule out a substance use disorder.) Brief psychotic disorder would be ruled out by the lack of delusions, hallucinations, or disorganized behavior or speech. Patients with ASD are likely to have severe depressive symptoms (“survivor’s guilt”), to the point that a concomitant diagnosis of major depressive disorder may sometimes be justified; Marie deserves further investigation along those lines. Until then, with a GAF score of 61, her diagnosis would be straightforward: F43.0 [308.3] Acute stress disorder Adjustment Disorder Patients with adjustment disorder (AD) may be responding to one stress or to many; the stressor may happen once or repeatedly. If the stressor goes on and on, it can even become chronic, as when a child lives with parents who fight continually. In clinical situations, the stressor has usually affected only one person, but it can affect many (think flood, fire, and famine). However, almost any relatively commonplace event could be a stressor for someone. Those most often cited for adults are getting married or divorced, moving, and financial problems; for adolescents, they are problems at school. Whatever the nature of the stressor, patients feels overwhelmed by the demands of something in the environment. As a result, they develop emotional symptoms such as low mood, crying spells, complaints of feeling nervous or panicky, and other depressive or anxiety symptoms—which must not, however, meet criteria for any defined mood or anxiety disorder. Some patients have mainly behavioral symptoms—especially ones we might think of as conduct symptoms, such as driving dangerously, fighting, or defaulting on responsibilities. The course is usually relatively brief; DSM-5 criteria specify that the symptoms must not persist longer than 6 months after the end of the stressor or its consequences. (Some studies report that a large minority of patients continue to have symptoms longer than the 6-month limit.) Of course, if the stressor is one that will be ongoing, such as a chronic illness, it may take a very long time for the patient to adjust. Although AD has been reported in 10% or more of adult primary care patients, and in huge percentages of mental health patients, one recent study found a prevalence of only 3%; many of these patients were being inappropriately treated with psychotropic medications, and in only two cases had the AD diagnosis been made. The discrepancies probably rest on the rather poorly developed criteria and on the (mistaken) view of AD as a residual diagnosis. AD is found in all cultures and age groups, including children. It may be more firmly anchored in adults than in adolescents, whose early symptoms often evolve into other, more definitive mental disorders. The reliability and validity of AD tend to be quite low. In a recent study, in under two-thirds of patients receiving the clinical diagnosis of AD could it be subsequently confirmed with ICD-10 criteria. Personality disorders or cognitive disorders may make a person more vulnerable to stress, and hence to AD. Patients in whom AD is diagnosed often misuse substances as well. Essential Features of Adjustment Disorder A stressor causes someone to develop depression, anxiety, or behavioral symptoms—but the response exceeds what you’d expect for most people in similar circumstances. After the stressor has ended, the symptoms might drag on, but not longer than 6 more months. The Fine Print The D’s: • Duration (starts within 3 months of stressor’s onset, stops within 6 months of stressor’s end) • Distress or disability (work/educational, social, or personal impairment) • Differential diagnosis (just about everything you can name: substance use and physical disorders, mood and anxiety disorders, trauma-related disorders, somatic symptom disorder, psychotic disorders, conduct and other behavior disorders, milder reactions to life’s stresses, normal bereavement) Coding Notes Specify: F43.21 [309.0] With depressed mood. The patient is mainly tearful, sad. F43.22 [309.24] With anxiety. The patient is mainly nervous, tense, or fearful of separation. F43.23 [309.28] With mixed anxiety and depressed mood. Symptoms combine the preceding. F43.24 [309.3] With disturbance of conduct. The patient behaves inappropriately or unadvisedly, perhaps violating societal rules, norms, or the rights of others. F43.25 [309.4] With mixed disturbance of emotions and conduct. The clinical picture combines emotional and conduct symptoms. F43.20 [309.9] Unspecified. Use for other maladaptive stress-related reactions, such as physical complaints, social withdrawal, work or academic inhibition. Specify if: Acute. The condition has lasted less than 6 months. Persistent (or chronic). 6+ months duration of symptoms, though still not lasting more than 6 months after the stressor has ended. Clarissa Wetherby “I know it’s temporary, and I know I’m overreacting. I sure don’t want to, but I just feel upset!” Clarissa Wetherby was speaking of her husband’s new work schedule. Arthur Wetherby was foreman on a road-paving crew whose current job was to widen and resurface a portion of the interstate highway just a few miles from the couple’s house. Because the section the crew was working on involved an interchange with another major highway, the work had to be done at night. For the past 2 months, Arthur had slept days and gone to work at 8:00 P.M. Clarissa worked the day shift as cashier in a restaurant. Except on weekends, when he tried to revert to a normal sleep schedule so he could be with her, they hardly ever saw one another. “I feel like I’ve been abandoned,” she said. The Wetherbys had been married only 3 years, and they had no children. Each partner had been married once before; each was 35. Neither drank or used drugs. Clarissa’s only previous encounter with the mental health system had occurred 7 years earlier, when her first husband had left her for another man. “I respected his right not to continue living a lie,” she said, “but I felt terribly alone and humiliated.” Clarissa’s symptoms now were much as they had been then. Most of the time when she was at work, she felt “about normal” and maintained good interest in what she was doing. But when alone at home in the evenings, she would be overwhelmed by waves of sadness. These left her virtually immobilized, unable even to turn on the television for company. She often cried to herself and felt guilty for giving in to her emotions. “It’s not as if someone had died, after all.” Although she had some difficulty getting to sleep at night, she slept soundly in the morning. Her weight was constant, her appetite was good, and she had no suicidal ideas or death wishes. She did not report any problems with her concentration. She denied ever having mania symptoms. The previous time she’d sought help, she had remained depressed and upset until a few weeks after the divorce was final. Then she seemed suddenly able to put it behind her and begin dating once again. “I know I’ll feel better, once Arthur gets off that schedule,” she said. “I guess it just makes me feel worthless, playing second fiddle to an overpass.” Evaluation of Clarissa Wetherby As she herself recognized, Clarissa’s reaction to the stress of her husband’s work schedule might be considered extreme by some observers. That is one of the important points of this diagnosis: The patient’s misery seems disproportionate to the apparent degree of the stress that has caused it (criterion B1). Her history provides a clue as to the source of her reaction: She was reminded of that awful time when her previous husband abandoned her—for good, and under circumstances that she considered humiliating. It is important, however, always to consider carefully whether a patient’s reaction occurs as a nonpathological response to a genuine danger, which was not the case with Clarissa. The time course of Clarissa’s symptoms was right for AD: They developed shortly after she learned about Arthur’s new work schedule (A). Although we have no way of knowing how long this episode might last, her previous episode ended after a few months, when the aftermath of her divorce had subsided (E). Of course, bereavement didn’t enter into her differential diagnosis (D). Note that AD is not intended as a residual diagnosis, though it is often used that way. Nonetheless, it does come at the end of a long differential diagnosis that comprises every other condition listed in DSM-5 (C). For Clarissa, the symptoms of mood disorder were the most prominent. She had never been manic, so could not qualify for a bipolar disorder. She had low mood, but only when alone in the evenings (not most of the day). She maintained interest in her work (rather than experiencing loss of interest in nearly all activities). Without at least one of these symptoms, there could not be a diagnosis of major depressive disorder, regardless of her guilt feelings, low energy, and trouble getting to sleep at night. Of course, her symptoms had lasted far less than 2 years, ruling out dysthymia. Although she remained fully functional at work, she was seriously distressed, fulfilling the severity requirement. The question of PTSD (and acute stress disorder) often arises in the differential diagnosis of AD. Each of those diagnoses requires that the stressor threaten serious harm and that the patient react with a variety of responses; Clarissa did not fulfill these conditions. She similarly did not have symptoms that would suggest generalized anxiety disorder, another diagnosis prominent in the differential for AD. A personality disorder may worsen (and hence become more apparent) with stress, but there is no hint that Clarissa had any lifelong character pathology. I’d assign her a GAF score of 61. F43.21 [309.0] Adjustment disorder, with depressed mood, acute Although some data support the utility of AD, which has been used clinically for decades, I recommend reserving it as a diagnosis of “almost last resort.” There are several reasons for this warning. For one thing, we probably too often use it when we simply have no better idea of what is going on. For another, the DSM-5 criteria do not tell us how we are to differentiate ordinary events from those that are stressful enough to cause depression, anxiety, or aberrant behavior. I suspect that an event is singled out solely on the basis that it causes and emotional or behavioral problem, and that seems to me a tad circular. F94.1 [313.89] Reactive Attachment Disorder F94.2 [313.89] Disinhibited Social Engagement Disorder In two apparently rare but extremely serious disorders, children who have been mistreated (by accident or design) respond by becoming either extremely withdrawn or pathologically outgoing. For neither disorder do we have a lot of information, placing these two among the least well understood of mental disorders that affect children (or adults, for that matter). Each disorder is conceived as a reaction to an environment in which the child experiences caregiving that is inconstant (frequent change of parent or surrogate) or pathological (abuse, neglect). One of two patterns then develops. In reactive attachment disorder (RAD), even young infants withdraw from social contacts, appearing shy or distant. Inhibited children will resist separation by tantrums or desperate clinging. In severe cases, infants may exhibit failure-to-thrive syndrome, with head circumference, length, and weight hovering around the 3rd percentile on standard growth charts. By contrast, a child’s response in disinhibited social engagement disorder (DSED) borders on the promiscuous. Small children eschew normal wariness and boldly approach strangers; instead of clinging, they may instead appear indifferent to the departure of a parent. In both subtypes, the abnormal responses are more obvious when the main caregiver is absent. Factors that indicate increased risk for either RAD or DSED include being reared in an orphanage or other institution; protracted hospitalizations; multiple and frequent changes in caregivers; severe poverty; abuse (the gamut of physical, emotional, and sexual); and a family riven by death, divorce, or discord. Complications associated with these disorders include stunted physical growth, low self-esteem, delinquency, anger management issues, eating disorders, malnutrition, depression or anxiety, and later substance misuse. In either disorder, a constant, nourishing relationship with a sensitive caregiver is required to reestablish adequate physical and emotional growth. Without such a remedy, the conditions tend to persist into adolescence. There has been almost no follow-up into adult life; despite a dearth of reliable information, you will (of course) find websites. DSM-IV listed these two conditions as subcategories of one disorder. Because of differences in symptoms, course, treatment response, and other correlates, DSM-5 now treats them as separate diagnoses—despite their supposed common etiology. However, some children will appear withdrawn when very young, then become disinhibited later, whereas others have symptoms of both conditions simultaneously. The upshot is that some observers find the dichotomy a bit forced. Essential Features of Reactive Attachment Disorder Adverse child care (abuse, neglect, caregiving insufficient or changed too frequently) has apparently caused a child to withdraw emotionally; the child neither seeks nor responds to soothing from an adult. Such children will habitually show little emotional or social response; far from having positive affect, they may experience periods of unprovoked irritability or sadness. The Fine Print The presumption of causality stems from the temporal relationship of the traumatic child care to the disturbed behavior. The D’s: • Demographics (begins before age 5; child has developmental age of at least 9 months) • Differential diagnosis (autism spectrum disorder, intellectual disability, depressive disorders) Coding Notes Specify if: Persistent. Symptoms are present longer than 1 year. Severe. All symptoms are present at a high level of intensity. Essential Features of Disinhibited Social Engagement Disorder Adverse child care (abuse, neglect, caregiving insufficient or changed too frequently) has apparently caused a child to become unreserved in interactions with strange adults. Such children, rather than showing typical first-acquaintance shyness, will little hesitate to leave with a strange adult; they don’t “check in” with familiar caregivers, and readily become excessively familiar. In so doing, they may cross normal cultural and social boundaries. The Fine Print The presumption of causality stems from the temporal relationship of the traumatic child care to the disturbed behavior. The D’s: • Demographics (child has developmental age of at least 9 months) • Differential diagnosis (autism spectrum disorder, intellectual disability, ADHD) Coding Notes Specify if: Persistent. Symptoms are present longer than 1 year. Severe. All symptoms are present at a high level of intensity. F43.8 [309.89] Other Specified Trauma- or Stressor-Related Disorder This diagnosis will serve to categorize those patients for whom there is an evident stressor or trauma, but who for a specific, stated reason don’t fulfill criteria for any of the standard diagnoses already mentioned above. DSM-5 gives several examples, including two forms of adjustment-like disorders (one form with delayed onset and another with prolonged duration relative to adjustment disorder). Others are as follows: Persistent complex bereavement disorder. For at least a year, a patient experiences intense grief for someone close who has died. There may be yearning and preoccupation of thoughts for the person, or continuing ruminations over the circumstance of death. A number of other symptoms express the patient’s loss of identity and reactive distress. Proposed criteria and discussion are given in Section III of DSM-5 on page 789. Various cultural syndromes. You’ll find a number of these in an appendix in DSM-5, page 833. F43.9 [309.9] Unspecified Trauma- or Stressor-Related Disorder This diagnosis will serve to categorize those patients for whom there is an evident stressor or trauma, but who don’t fulfill criteria for any of the standard diagnoses already mentioned above, and for whom you do not care to specify the reasons why the criteria are not fulfilled.”

 
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Psychology Chapter 1 Practice Problems homework help

Psychology Chapter 1 Practice Problems homework help

Name:

Chapter 1 Instructions

Practice Problem 12, 15, 19, 20, 21, & 22

Due Week 2 Day 6 (Sunday)

Follow the instructions below to submit your answers for Chapter 1 Practice Problem 12, 15, 19, 20, 21, & 22.

1. Save Chapter 1 Instructions to your computer.

2. Type your answers into the shaded boxes below. The boxes will expand as you type your answers.

3. Resave this form to your computer with your answers filled-in.

4. Attach the saved form to your reply when you turn-in your work in the Assignments section of the Classroom tab. Note: Each question in the assignments section will be listed separately; however, you only need to submit this form one time to turn-in your answers.

Read each question in your text book and then type your answers for Chapter 1 Practice Problem 12, 15, 19, 20, 21, & 22 in the corresponding spaces below.

12a. equal-interval –

12b. rank-order –

12c. nominal –

12d. ratio scale –

12e. continuous –

15. Type your answers to Practice Problem 15a in the shaded boxes below. The “X” represents the speed; “f” represents the frequency; and “%” represents the relative percentage for each score. Round to the nearest whole percentage. For example, if your remainder is .5 or greater, round up (i.e. 2.5 = 3). Note: Fill-in each box. Please do not delete any scores.

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19. Give an example, in words, of something having the distribution shapes listed below.

19a. bimodal –

19b. approximately rectangular –

19c. positively skewed –

20. Describe an example of a misleading graph: Note: Either copy and paste a graph in the first shaded box below, or fully describe the graph if it will not paste. You may also cut and paste a misleading graph onto a Word document and send as an attachment. Please do not include a link to a graph in lieu of pasting a graph onto a Word document. I will not navigate to a link to view your chosen graph.

In the second shaded box, discuss specific characteristics that make the graph misleading.

 

 

21a. Explain the idea of frequency table 1-10 below:

 

21b. Explain the meaning of the pattern of results below:

 

22a. Explain the idea of frequency table 1-11 below:

 

22b. Explain the meaning of the pattern of results below:

 
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Psychology Response homework help

Psychology Response homework help

1. Responded to message below. Should be at least 250 words. Responses should be informative and contribute to advancing knowledge of the topic. Include at least 2 APA-cited references.

Frank, Greitzer & Holimer (2011) makes powerful augments about the difficulties surrounding the trail before the fact. I agree with them. It really is difficult to determine if threats are bogus and if they should be taken seriously. However, once a threat is made it must be taken seriously and that it is highly possible for the individual to carry out their plan. It is also difficult to know the individual’s state of mind or if the individual has psychological issues. Frank, Greitzer & Holimer (2011) states, “there are several factors that should taken into consideration regarding picking up the trail before the fact, (a) the lack of sufficient real-world data that has “ground truth” adequate scientific verification and validate of proposed solutions; (b) the difficulty in distinguishing between malicious insider behavior and what can be described as normal or legitimate behavior (c) the potential quantity of data, and the resultant number of “associations” or relationships that may emerge produce enormous scalability challenges; and (d) despite ample evidence suggesting that in a preponderance of cases, the perpetrator exhibited observable ‘concerning behaviors’. All threats should be taken into account and noted as warning signals and reported to the proper authorities.

Sometimes the most damage is done by individuals who had a personal insight into the company or one who became disgruntled. They know the outs an ins of the organization and how to cause the most damage. I also agree that the methods and skills of the perpetrators have changed in recent years. With all of the new technology, the generations have become wiser and smarter. Therefore, all threats should be observed.

2. Responded to message below. Should be at least 250 words. Responses should be informative and contribute to advancing knowledge of the topic. Include at least 2 APA-cited references.

What Frank, Greitzer & Hohimer (2011) argue about difficulties of picking up the trail before the fact, in order to provide time to intervene and prevent an insider cyber attack?
I agree with Greitzer and Hohimer that insider threat is a serious concern for cyber security that has to be addressed successfully. Unfortunately this is much easier said than done. The nature of insider threat makes it very difficult to detect and as Grietzer and Hohimer (2011) point out, there is a lack of real world data, it is difficult to differentiate between normal and abnormal behavior, there would be scalability challenges in data collected and no one has really decided to tackle this issue with technology yet (p.27). This means that devising a way to identify an insider threat prior to that insider launching an attack is a task that will not be easy to complete. That doesn’t mean that this is not a goal that we should be working towards, quite the opposite actually. This is something that should be given attention and professionals should be working on methods that can help catch insider threats before the damage is done.
Do you agree with them? Why? Why not?
I do agree with Greitzer and Hohimer that insider threat is a big problem. I also agree that there is a lack of data that can be used to help identify patterns and help develop methods and technology that can catch insider threat early. I have to admit that much of what they discussed in the article was a bit over my head. I don’t fully understand how the technology they discussed would work and I also can’t say that I believe that a technological solution would the perfect solution for this issue. Humans can be very unpredictable. This means that any technology developed to be an early identifier of insider threat will not work every time. I do think that more often than not there will be indicators prior to an insider attack occurring but there is always that chance that someone just snaps. With that being said I do think that there should still be research and work done to mitigate the risk of insider attacks.

Quantification: 2 Pages

Assignment: Chapter 2 & Chapter 3

Question1:

(Problem 1): If a program has 471 bytes and will be loaded into page frames of 100 bytes each, and the instruction to be used is at byte 132, answer the following questions:

 

a. How many pages are needed to store the entire job?

b. Compute the page number and the exact displacement for each of the byte addresses where the data is stored. (note: page numbering starts at zero).

 

a) 471/100 + 1=5

b) To store page number: 3 bits

To store offset:7 bits

 

(Problem-2): Given that main memory is composed of only three page frames for public use and that a seven-page program (with Pages a, b, c, d, e, f, g) that requests pages in the following order:

a, c, a, b, a, d, a, c, b, d, e, f

(a). Using the FIFO page removal algorithm, indicate the movement of the pages into and out of the available page frames (called a page trace analysis). Indicate each page fault with an asterisk (*). Then compute the failure and success ratios.

(b). Increase the size of memory so it contains four page frames for public use. Using the same page requests as above and FIFO, do another page trace analysis and compute the failure and success ratios.

Given that main memory is composed of three page frames for public use and that a seven-page program (with pages a, b, c, d, e, f, g) requests pages in the following order: a, b, a, c, d, a, e, f, g, c, b, g

 

a.

page request a b a c d a e f g c b g
                         
page fault *  *    * * * * * * * *  
                         
page 1 a a a a d d d f f f b b
                         
page 2   b b b b a a a g g g g
                         
page 3       c c c e e e c c c
Total faults: 10   Failure: 10/12     83.33e %

Total faultless: 2 Success: 2/12 16.66e%

 

b

page request a b a c d a e f g c b g
                         
page fault *  *    *  *   * * * * *  
                         
page 1 a a a a a a e e e e b b
                         
page 2   b b b b b b f f f f f
                         
page 3       c c c c c g g g g
                         
page 4         d d d d d c c c
Total faults: 9   Failure: 9/12     75 %

Total faultless: 3 Success: 3/12 25%

 

 

 

 

 

 

 

 

Question2:

(Problem 1): Given the following information:

a. Use the best-fit algorithm to indicate which memory blocks are allocated to each of the three arriving jobs.

b. Use the first-fit algorithm to indicate which memory blocks are allocated to each of the three arriving jobs.

 

a) For the best fit algorithm, allocates the smallest free partition which meets the requirement without wasting much memory. So Job A needs 57k so it can fit in any block of the four. but it takes Block 3 so that much memory is not wasted.

Job B needs 920k it cannot fit in both Block 2 and block 1, but it has to use two blocks to fit. Even so much memory is wasted so it fits in Block 2 and takes remaining from other block.

Job C also fits in block 3

Job D can fit in Block 1 and 2 but it fits in block 1 as block 2 is used.

b) For the first fit algorithm, means pick the first block that meets the requirement.

For Job A, it takes first block 1

Job B it takes block 2 but does not fit so it has to wait for Job A

Job C it takes block 3 as per the requirement.

Job D it takes Block 4 but does not fit so it has to wait for other blocks as Job A or Job C to finish which has free space and then fits.

 

 

 

(Problem-2): Next-fit is an allocation algorithm that starts by using the first-fit algorithm but keeps track of the partition that was last allocated. Instead of restarting the search with Block 1, it starts searching from the most recently allocated block when a new job arrives. Using the following information:

 

 

Indicate which memory blocks are allocated to each of the three arriving jobs, and explain in your own words what advantages the next-fit algorithm could offer.

 

 

For Job A it takes for the block 1 and uses it 100k in it and then takes for block 2 for remaining to fit in it. The unused memory in block 2 would be 410k.

For job B it takes for the block 2 and use 50k so remains 360k

For job C it takes block 2 and uses 275k and the remaining memory of the block 2 is 85k

For job D, it takes block 2 which has 85k and uses it and then moves to block 3 uses it and for remaining 95k it moves to block 4 and uses 95k thus leaving 500k remaining unused in block 4.

The advantage of next fit is such that, when a new job is called it searches from the remaining block of memory so that much space is saved rather than wasting some amount of space in each block. Thus speed also is improved in next fit since if memory is released that is earlier in the heap for an application, it will check for that block first and fits there.

 
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