p r o c e s s

Life o l d
b i r t h t o
from
age
• Human grow and develop throughout
life.
• Growth: is an increase in body size
or changes in body cell structure,
functions and complexity.
• Development: is an orderly pattern
of changes in structure, thoughts,
feelings, or behaviors resulting from
maturation, experience and learning
Factors influencing growth and
development
• Genetics
• Temperament
• Family
• Nutrition
• Environment
• Health
• Culture
Theories of Growth &
Development
Theory of psychoanalytic
development: Sigmund Freud
• Freud’s theory emphasizes the effect of
instinctual human drives on behavior.
• Freud identified the underlying stimulus
for human behavior is sexuality, which is
called libido
• Libido is defined as general pleasure
seeking instincts rather than purely genital
gratification
Four major components of Freud’s
theory are;
• The unconscious mind: contains memories,
motives, fantasies, and fears that are not easily
recalled but that directly affect the behavior
• The id: is the part of the mind concerned with
self gratification by the easiest and quickest
available means. Defense mechanisms reduce
the stress of unconscious mind but not satisfy
id’s impulses
• The ego: is the conscious part of the mind that
serves as the mediator between the desires of the id
and the constraints of reality, so that one might live
effectively within one’s social, physical and
psychological environment. Ego includes one’s
intelligence, memory, problem solving, separation
of reality from fantasy, and incorporation of
experiences and learning into future behavior
• The superego: is the part of the mind that
represents one’s conscience. It develop from the
ego during the first year of life. The superego
represents the internalization of the rules and values
so that socially acceptable behavior is practiced
Oral stage (0 to 18 months)
• During this stage infant uses his
or her mouth as the major source
of gratification and exploration.
Pleasure is experienced from
eating, biting, chewing and
sucking. Infants primary need is
for security
Anal stage (8 months to 4 years)
• This stage begins with the
development of neuromuscular control
to allow control of the anal sphincter
• Toilet training is a crucial issue,
requiring delayed gratification as the
child compromise between the
enjoyment of bowel function and
limits set by social expectations
Phallic stage (age 3 to 7 years)
• The child has increased interest in gender
differences and his or her own gender
• Oedipus complex in boys and Electra
complex in girls develops based on
feelings of intimate sexual possessiveness
for the opposite sex parent
• Curiosity about the genitals and
masturbation increases during this stage
Latency stage (7 to 12 years)
• Transition to genital stage during
adolescence
• Increasing sex role identification
with the parent of the same sex
prepares the child for adult roles
and relationships
Genital stage (12 to 20 years)
• Sexual interest expressed in
overt sexual relationships.
Sexual pressures and conflicts
usually cause turmoil as the
adolescent makes adjustments
in relationships
Cognitive development theory:
Jean Piaget
• Piaget believed that learning occur as a
result of internal organization of an event,
forming a mental schema, and serving as a
base for further schemata as one grows and
develop.
• Intellectual growth is a continual
restructuring of knowledge to progress to
higher levels of problem solving and
critical thinking
• Restructuring of knowledge through two
processes assimilation and accommodation
• Assimilation : is the process of
integrating new experiences into existing
schemata
• Accommodation : is an alteration of an
existing thought to mange more complex
information.
• Piaget describe 4 stages of cognitive
development as;
Sensory motor stage (0-24month)
• 0 to 1 month: shows basic reflexes eg: sucking
• 1 to 4 month: discovers enjoyment of random
behaviors and repeat them. Eg: thumb sucking,
smiling
• 4 to 8 month: relates own behavior to change in
environment. Eg: shaking rattles to hear sound,
manipulating a spoon to eat
• 8 to 12 month: coordinate more than one thought
pattern at a time to reach a goal eg: repeatedly
throwing object on the floor; only object in sight are
considered permanent.
Pre-operational stage(2 to 7
years)
• Beginning use of symbols, through
increased language skills and pictures to
represent their world
• Egocentrism
• This stage is divided in to two part
• Preconceptual stage (2-4yrs)
• Intuitive stage(4- 7yrs)
• Play activities during this time help the
child to understand life events and
Concrete operational stage (7 to
11years)
• Learn by manipulating concrete or
tangible objects and can classify
objects into two or more
characteristics
• Logical thinking develops-
understanding reversibility, relations
between numbers and loss of
egocentricity
Formal operational stage(11years or
older)
• Abstract thinking and deductive
reasoning
• General concepts are related to
specific situations and alternatives are
considered
• They evaluate the world by testing
belief and attempt to establish values
and meaning in life
Psychosocial development
• Proposed by Erik Erikson
• 4 major concepts
• Stages of development
• Developmental goals or tasks
• Psychosocial crises
• The process of coping
• Each stage is characterized by a
developmental crisis to be mastered, with
possible successful or unsuccessful
resolution of the crisis
Trust v/s Mistrust ( Infancy)
• The infant learns to rely on
caregivers to meet basic needs of
warmth, food and comfort,
forming trust in others.
• Mistrust is the result of
inconsistent, inadequate, or unsafe
care.
Autonomy v/s Shame &Doubt
(Toddler)
• As motor and language skill develop
toddler learns from the environment and
gain independence through encouragement
from care givers to feed, dress and to toilet
self
• If the caregivers are overprotective or
expectations that are too high, shame and
doubt as well as inadequacy might develop
in the child.
 Initiative v/s Guilt (Pre-school)
• Confidence gain as a toddler allows the
preschooler to take initiative in learning, so
that the child seeks out new experience and
explores the how and why of the activities
• If the child experience restrictions or
reprimands for seeking new experience and
learning, guilt result and child hesitates to
attempt more challenging skills in motor or
language development
Industry v/s Inferiority (School
aged)
• Focus on end results of achievement
• They gain pleasure from finishing project
and recognition for accomplishments
• If the child is not accepted by the peers or
cannot meet the parental expectations a
feeling of inferiority and lack of self
worth might be developed
Identity v/s Role confusion
(Adolescence)
• Many physical changes occur as they are in
transition from childhood to adulthood
• Hormonal changes produce secondary sexual
characteristics and mood swings
• Trying on roles even rebellion are considered
as normal behaviors as they acquire sense of
self and deciding what direction will taken in
life
• Role confusion occurs when they are unable to
establish identity and sense of direction
Intimacy v/s Isolation (young
adult)
• They unit self identity with
identities of friends
• Make commitments with others
• Fear of such commitments
results in isolation and
loneliness
Generativity v/s Stagnation (middle
adulthood)
• Marked involvement with family, friends
and community
• They develop concerns for next generation
and desire to make a contribution to the
world
• If this task is not met stagnation results,
person become self absorbed and obsessed
with his/her own needs or regress to an
earlier level of coping
Ego integrity v/s Despair (Later
adulthood)
• As one enters older years
reminiscence about life event
provides a sense of fulfillment and
purpose
• If one believe that their life has been
a series of failures or missed
directions, a sense of despair might
prevail
Theories of moral development
• Lawrence Kohlberg developed a theory of
moral development
• He recognized that a person’s moral
development is influenced by the cultural
effects on one’s perception of justice in IPR
• Moral development of a child begins from the
caregiver and child communications during the
early childhood years, as the young child tries
to please his parents
• The concept of morality emerges as a subset of
person’s belief or values and govern
Pre-Conventional level
• Child learns to conform to rules imposed by
authority figures
• Stage 1: punishment and obedience orientation,
the motivation for choices of action is fear of
physical consequences, a perception of
goodness or badness develops.
• Stage 2: instrumental relativist orientation, the
thought of receiving a reward overcomes fear
of punishment so actions that satisfy this
Conventional level
• Identifying with significant others and
conforming to their expectations
• The person respect the values and ideals of
family and friends regardless of consequences
• Stage 3:”goodboy-good girl” orientation, the
person strives for approval in an attempt to
viewed as “good”
• Stage 4: ”law and order” orientation, behavior
follows social or religious rules
 Post conventional
• It involves moral judgment that is rational
and internalized into one’s standards or
values.
• stage 5:social contact and utilitarian
orientation, correct behavior in terms of
society’s laws.
• Stage 6: universal principle orientation,
represents the person’s concern for
equality for all human beings, guided by
personal values and standards
Theory of Faith
• James Fowlers postulated the theory of the
spiritual identity of humans
• Fowler describe faith as a person’s or
group’s way of moving into the force field
of life.it is our way of finding coherence in
and giving meaning to the multiple forces
and relations that make up our lives.
• Faith, therefore, is not necessarily
religious, but it compromise the reasons
one finds life worth living.
Prestage - undifferentiated faith
• Trust, courage, hope and love
compete with threats of abandonment
and inconsistencies in the infant’s
environment
• The strength of faith in this stage is
based on the infant’s relationship with
primary caregiver.
Stage 1- intuitive projective faith
• This is most typical of the 3-7 year old
child
• Children imitate religious gestures and
behaviors of others (primarily their
parents) without understanding the
meaning
• Imagination in this stage leads to long lived
images and feelings that they may question
and re-integrate in later stages
Stage 2- Mythical – Literal Faith
• It predominate in school-aged child who
is having more social interaction
• Stories represents religious and moral
belief
• Child accept the existence of deity
• Child can appreciate the perspectives of
others
Stage 3- Synthetic- Conventional
Faith
• Characteristic stage of adolescence
• As the person experience increasing
demands from work, school, family, and
peers, the basis for identity become more
complex
• They begin to question life guiding values
or religious practice in an attempt to
stabilize his or her own identity
Stage 4- Individuative- Reflexive
Faith
• Is crucial for older adolescents and
young adult because they become
responsible for their own
commitments, beliefs and attitudes.
• It does not emerge until they are in
their 30s or 40s
Stage 5- conjunctive Faith
• It integrate other viewpoints about faith
into one’s understanding of truth.
• One is able to see the nature of the reality
of one’s own beliefs
• They also observe the divisions of faith
development among people
Stage 6- universalizing Faith
• It involves making tangible the values of
absolute love and justice for humankind
• Total trust in the principle of actively
“being-in-relation” to others in whom we
invest commitment, belief, love, risk and
hope, and in existence of the future,
regardless of what religion image of faith
is involved.
Conception through young adult
Conception & Prenatal
development
• Human G&D begin at the moment the ovum is
fertilized by the sperm and form zygote
• Zygote contains the full complement of genetic
information provided by each parent, that
determine the gender and personality, intellect
and physical and psychological traits
• G & D of the fetus are orderly and continuous
and proceed as follows
 Pre-embryonic stage
• It last for about 3 weeks
• The zygote which implants in the uterine wall, has three
distinct cell layers
• Endoderm (inner layer): become the respiratory system,
the digestive system, the liver and pancreas
• Mesoderm (middle layer): becomes the skeleton,
connective tissue, cartilage, muscles and the circulatory
, lymphoid, reproductive, and urinary systems
• Ectoderm (outer layer):becomes the brain, spinal cord,
nervous system, and outer body parts (skin, hair, and
nails)
Embryonic stage
• It occurs from the 4th through the 8th week
• Rapid growth and differentiation of the cell layers
take place
• By the end of this stage, all basic organs have
been established, the bones have begun to ossify,
and some human features are recognizable
• Fetus is also vulnerable to any factors that might
cause congenital anomalies such as maternal use
of alcohol, nicotine, over the counter medications
drugs
Fetal stage
• It last from 9weeks to birth
• All body organs and system continue to grow and
develop
• 12th week kidney secretion begins, heart beat can be
heard by Doppler, sex of the infant is
distinguishable by outward appearance
• 24th week: fetal heart sound audible by stethoscope,
the liver and pancreas are functioning, hair forms,
sleep wake pattern are established, lung surfactant
is produced, and eyelids open.
• 40th week : testes descended, lung alveoli are
formed, subcutaneous fat is deposited and fetus
actively kicks
• During pregnancy adequate maternal nutrition
is essential for normal growth and development
of the fetus
• Fetus that does not have adequate nutrition
might be SGA (small for gestational age), fail
to have normal brain development, have
learning disabilities as a child and be at
increased risk for chronic illnesses as an adult.
• Vitamin and mineral deficiencies can result
in megaloblastic anemia and neural tube
defect (folic acid deficiency), inadequate
bone calcification (Vit.D & Ca deficiency)
and hypothyroidism (iodine deficiency)
• Premature birth : birth occur before 37
weeks’ gestation)
• LBW (low birth weight) is one of the
leading cause of infant mortality and death
Neonate: birth to 28 days
• At birth neonate must be adapt to extrauterine
life through several physiologic adjustments
• The most important is in the respiratory and
circulatory system as the neonate begins
breathing and becomes independent of the
umbilical cord
• The neonate is assessed immediately after birth
• APGOR rating scale is used to assess neonates
at 1minute and 5 minutes after birth.
Physiologic development
• Reflexes: moro reflex, stepping reflex, grasp
reflex, hand-to-mouth activity, sucking,
swallowing, blinking, sneezing, and yawning
• Body temperature responds quickly to
environmental temperature
• Senses are used to respond to the environment,
see color and form, hear and turn toward sound,
smell and taste, and feel touch and pain
• Stool and urine are eliminated
• Exhibit both active crying and quiet alert
state
• Neonate inherits transient immunity from
infections as a result of immunoglobulin
that cross the placenta
• The high lactose content in the breast milk
combined with the little protein, promotes
an acid environment that is unsuitable for
bacterial growth.
Health of the newborn
• Respiratory difficulty: occur if drugs given to
the mother during labor and delivery have
sedated the neonate
• Premature neonates are vulnerable to
respiratory distress syndrome because of their
relatively immature lung function
• Neonates delivered by LSCS are at risk for
respiratory difficulties because of excess mucus
in the lungs and might require frequent
suctioning
• Incompatibility between neonate’s and
mothers blood groups requires prompt
care at birth.
• Congenital malformations like; cleft lip
and palate, neural tube defect,
hydrocephalus etc. cause long term
problem
• Reassurance of parents especially during
birth trauma that will not reappear eg:
caput succedaneum( localized edema of
the scalp), subconjuctival hemorrhage.
• The non- threatening nature of physiologic
jaundice, which commonly occurs in the
neonate’s first days, should also be explained to
the parents
• Smoking causes LBW, maternal drinking result
in fetus alcohol syndrome and leading cause of
birth defect, including growth retardation,
developmental delay and impaired intellectual
ability
• Maternal drug abuse result in congenital
anomalies, prematurity, low birth weight and
drug withdrawal symptoms
Infant: 1 month to 1 year
• Physiologic development
• Brain grows in about half the adult size
• Body temperature stablizes
• Motor abilities develop, use building blocks,
attempting to feed self, crawling, walking
• Eyes begin to focus and fixate. Heart doubles in
weight, heart rate slows, and blood pressure
rises
• Deciduous teeth begin to erupt at 4 to 6 month
• Birth weight usually triples by 1 year, length
increase by 50%
Cognitive development
• They are in the sensorimotor stage
• Language : prelinguistic phase
• Babies begin to coo and make sound
soon after birth
• By 12 month convey wishes through
a few key words
 Psychosocial Development
• Oral stage
• Trust develops
• Attachment, bonding, play and temperament.
• Attachment: active, affectionate, reciprocal
relationship between 2 people
• Bonding: emotional linkage of two people
• Play : infants and children discover their
environment and learn to control it through play.
• Temperament: it is primarily inborn also
influenced by the environment
• Baby – easy, slow to warm or difficult
• Easy infant sleep, eat ,eliminate easily;
smiles spontaneously and cries in response
to significant needs
• Slow to warm infant is more passive and
distant
• Difficult infant has volatile, and labile
responses, often is a restless sleeper, is
highly sensitive to noise and eats poorly
 Language development
Age Receptive language Expressive language
1month • Responds to human voice • Open and closes mouth as the adult
speaks
• Utter sounds of comfort while
feeding
• Crying pattern developing
• Begins to coo.

2month Alert expressions when • Cry pattern develop (hunger,

listening sleepiness, or pain)
• Respond vocally (ah, eh,uh etc.)
• Coos

3month Looks in direction of speakers • Cries less shows pleasure in making

sounds
• Coo and chuckles may laugh aloud
• Babbles from 3rd to 8th month
 Age Receptive language Expressive language
4month Respond differently to • Laugh loud.
normal and angry voice, • Vocalize socially, coos and
dose not cry when gargles
scolded • Can vocalize consonants
5month Responds when own • Squeals when happy or excited
name is spoken • Displeasure when a desirable
object is taken away
• Sounds like vowels appears
6month Recognize familiar words • Actively vocalizes pleasure
with cooing or crowing, cries
easily, lallation or imperfect
imitations begins (6-9 months)
7month Responds to own name, • Vocalizes eagerness(m,m..)
and gestures to word such • Vocalizes with adult like
as “come” inflection when other is
speaking.
 Age Receptive language Expressive language
8month • Stop activity when own • Shout for attention
name is spoken • Imitate sound sequences
• Beginning to understand • Continue syllables like mama
the meaning of ‘no’ dada
9month • Stop activity in • Cries when scolded
response to “no” • Echolalia
• Beginning to respond • Association of words with
simple commands persons or object
given verbally
• Responds to adults
anger
10month Understand simple • Speak one word beside mamma,
commands; give a toy on dada eg; no,hi
request that is • Understand the meaning of bye-
accompanied by gestures bye and waves
• Imitate adults inflection, pitch
variation, and sound of animal
 Age Receptive language Expressive language
11month Responds to simple • Imitate specific speech, sound of
questions eg: where is others, jargon well established
your doll by pointing
and looking towards
the object
12month Respond with gestures • May speak 2 or more besides
or actions to more mama, dada
complex verbal • Understand meaning of many more
response eg: please give words that can be spoken
it to me • Knows name of increasing number
of objects
• Imitate sound of animals
• Indicate no by shaking head
• Intonations becoming more like
adult speech
• Jargon continues
Toddlers
15 months
Gross motor
• Assume standing position without help, walk
with out support
• Wide based gait
• Loses balance when stops suddenly
• Kneels without support
• Creep up chair
• Repeated throw of object and pick them
Fine motor Self care
• Build tower of 2- • Feeding skill
3cubes • Enjoy finger
• Open boxes feeding
• Pokes finger in hole
• Removes socks
• Makes line with
crayon
• Indicates when
• Pats picture in book diaper is wet
and begins to turn
pages
• Psychosocial :autonomy v/s shame and
doubt
• Psychosexual: anal stage
• Spiritual: intuitive projective
• Moral: preconventional
Language
• Receptive: comprehend more than
communicate
• Recognize name of various part of the body
• Responds to familiar simple command
Expressive
• Continues use of expressive jargons
• Say 2-6 words
• Shake head to communicate ‘no’
• Communicates no even when following request
Play
• Stuffed animals
• Dolls
• Musical toys
• Picture books
18 month –motor development
Gross motor
• Walk with wide stance, walk side
ways and back ward
• Walk upstairs with one hand held
• Run stiffly, often falls
• Climb on furniture
Fine motor
• Build tower of 3-4 cubes
• Scribbles vigorously
• Imitate vertical stroke with crayon
• Put blocks into hole
• Transfer object from one hand to hand
at will
• Receptive language
• Identify pictures of familiar objects when
named
• Identify one or more parts of the body when
named
• Expressive
• Vocabulary increases speaks 10 real words
• Names pictures
• Use words more than gestures to express
desires
• Play
•Pull toys
•Running & chasing games
•Low wheeled toys to ride
 24 months: Motor development
• Gross motor
• More grown up, steady gait
• Runs more quickly in more controlled way.
Have fewer falls
• Walks up and down stairs both feet on one
step at a time, holding railing or the walls
• Jump crudely with both feet on ground
• Kick large ball without falling
• Pick up objects from floor without loosing
balance
Fine motor
• Build tower of 6-7 cubes
• Make cubes in to train one behind the other
• Scribbled in more controlled way
• Imitate circular stroke
• Turn pages of the book one at a time
• Open doors by turning door knob
• Unscrew lid of the jar
• Feels proud of accomplishment of motor
skill
 Self care
• Feeding skill
• Drink well from glass held in one hand
• Put spoon in mouth
• Plays with food
• Can use straw
• Imitate eating habit of others
• May request certain foods
• Dressing skill
• Pulls on one single garment
• Remove most of own cloths
• Toileting and grooming
•Verbalizes toilet needs
•Usually bowel trained with
occasional accidents
•Usually urinate when taken into
toilet
•May brush teeth with help
•Attempt to wash self during shower
Sensory
• Visual acuity 20/40
• Accommodation well developed
• Insert square objects into its
appropriate place or hole
• May develop esotropia (strabismus)
• Psychosocial:
• sense of autonomy
• Separation anxiety
• Shows early sign of independence from
care giver
• Upset by changes in routine
• Would like to make friend but cannot
know how
• Negativism and dawdling continues
• Decrease violent temper tantrum
• Psychosexual : anal stage
• Spiritual: intuitive projective
• Intellectual : preoperational
and preconception stage
• Moral :preconventional morality
• Language and speech
•Receptive language
• Understand more complex
sentences
• Obey one directional prepositions &
2 commands
• Enjoy stories with picture
• Identify 4 body parts when named
•Expressive language
• Vocabulary
• Not use jargoned
• Knows 300 words
• Use pronouns “I, me and mine”
• Tell about immediate experience
• Identify familiar objects
• Play
• Parallel play: Little social interaction with
other children even though their activity is the
same
• Motor play: pull wagon, place beads in a box
• Creative play: manipulate clay, sing song,
brush paints
• Quiet play: enjoy hearing stories illustrated
with picture
• Dramatic play: enjoy playing with dolls,
mimic domestic activities of parents
30 month
• Physical development
• Weight gain about5 Kg between 1-
3year
• Weight quadrupled by 2 ½ years
• Height grows about 6-8 cm during 3rd
year
• Full set of 20 temporary teeth formed
• Day time bowel and bladder control
possibly established
Motor development
• Gross motor
• Stands on one foot alone momentarily
• Walk on tip toe for few steps,
alternating feet
• Jump well in place with both feet off
floor
• Jump from step or low chair
• Ride a walker or a pedal car
Fine motor
• Build tower of 8 cubes
• Adds chimney to train of cubes
• Make vertical and horizontal strokes
• Hold crayon with fingers instead of
entire hand
• Good hand finger coordination
 Sensory
• Visual acuity 20/30
• Feeding skill
•Self feeding with occasional spilling
•Gets drink without assistance
•Distinguish between finger and spoon
food
•Chew with mouth closed
• Dressing skill
•Put arms through large arm hole
•Button one large front button
• Toileting & grooming
•Mastered day time bladder control
•May go to toilet by self
• Psychosocial :
• Autonomy v/s shame and doubt
• Psycho sexual
• Anal stage
• Spiritual
• Intuitive projective
• Intellectual and moral stage
• Preoperational and pre conventional
Language & speech
Receptive language
• Identifies five body parts when named
Expressive language
• Vocabulary
• Gives full name when asked
• Use plurals and past tense of verbs
• Talks constantly
• Ask “why”
• Use 4-5 sentences
Play – parallel play
Motor play
• Pushes and steers toys well
• Blocks train that are interlock
• Carries breakable objects
Creative play
• Clay
• Finger paints
• Cut paper with blunt scissor
• Large wooden puzzles
 3 years – motor development
Gross motor
• Walks straight line
• Walks backward
• Walks on tip toes
• Runs without looking at feet
• Catch balls with extended arms
• Kicks a ball
• Jump from height
• Ride tricycles
Fine motor
• Build a tower of 9-10 blocks
• Copies a circle
• Use blunt scissors with one hand to cut
• Shows preference for handedness
• Put beads on a string
• Can help with simple household
activities
Self care
• Dressing skills
• Can put over coat without help and
can undress self
• Can pull pant up & down
• Brush teeth with help
• Can go to toilet alone
• Sensory: visual acuity :20/20
• Psychosocial
• Beginning of self initiative, negative part
guilt
• Alternate between reality and imagination
• Able to share but express idea of ‘mine’
• Tolerate short separation from parents
• Fears the dark
• Knows own sex
• May have dream and nightmare
• Psychosexual : phallic stage
• Spiritual : intuitive- projective faith
• Intellectual : preoperational
characterized by language
acquisition, able to follow
directional commands
• Moral: preconventional morality
stage
Language development
• Receptive : to obey two prepositional
command (on, under)
• Expressive : use 4 words in sentence,
give sexes and full name, name
figures in picture, has vocabulary of
800-1000 words
Play
• Like things that move, talk and make
noise
• Use crayons, paint
• Transportation toys : tricycle, wagons,
dump trucks, doll carriage
• Play telephone, music record players
• Single puzzles toy dishes and soap
bubbles
Preschooler (3-5 years)
4years
Gross motor
• Run on tiptoes
• Balance on one foot for 3-5seconds
• Hops , climb ladder, trees. Use alternate feet on
descending
Fine motor
• Copies square, draw simple face, cuts around
picture with scissors
Feeding skill
• Manage spoon with little spilling
• Eat with forks
Dressing
• Button side button and small buttons
• Can put on socks with help
• Put on shoes without help
• Knows back and front of cloths
• Psychosocial: initiative v/s guilt
• Psychosexual: phallic stage
• Spiritual: intuitive projective faith
• Intellectual: preoperational thought
• Moral: preconventional morality
• Language
• receptive: understand directives
• Expressive: name one or more colors correctly,
use “I”, counts to five. Use 3-7 words
sentence, has vocabulary of 1500 words
Play
• Plays cooperative with others
• Interested in world
• Interested in
• Puppets
• Doll house
• Costume box
• Doctor kit
• Black board
• Papers
• Scissors
• Clay etc…..
5years
Gross motor
• Skips alternate feet
• Jump rope over objects
• Walks a balance
• Imitate dance steps
• Roller skates
Fine motor
• Copies triangle
• Crosses vertical line
• Copies letters
• Draw 3 part man
• Feeding: select fork over spoon when appropriate
• Dressing : able to lace shoes, manage zippers in
back
• Toileting: bathes self, flush toilet after use
• Language
• Receptive : carries out instructions with 3
suggested tasks eg:wash, dry and sit down
• Expressive: name primary color, ask meaning of
words, counts to 10
• Play: plays competitive exercise
• Loves to transport thing trucks, cars and wagon
School –age child (6-12years)
6-8 years
• Gross motor
• Rides bicycle
• Constantly in motion, runs, jumps,hops,climbs
• Clumsy and awkward
• Coordination improving
• Fine motor
• Knows right from left hand
• Draw a person with 12-16 parts
• Print words, learns cursive writing, improved hand
eye coordination
• Psychosocial: industry v/s inferiority
• Psychosexual: latency stage
• Spiritual: mythical- literate faith
• Intellectual: preoperational thought
• moral : preconventional morality
Language
• Receptive: follow series of 3
commands, responds depend on mood,
respond to praise and recognition
Expressive:
• can repeat 10-12 sentences
• vocabulary 2500 words
• develop sense of humor
• enjoy telling jokes
Play
• Likes rough and tumble play, loves active play
• Prefer group play
8-10 years
Gross motor
• Perform tricks on bicycle: races
• Begins to participate in organized sports like
base ball, soccer
• Throw a ball skill fully
Fine motor
• Use both hand independently
• Draws a person with 18-20 parts
• Cursive writing improved
• Psychosocial: industry v/s
inferiority
• Psychosexual: latency stage
• Spiritual: mythical- literate faith
• Intellectual: concrete operational
thought
• Moral: conventional morality
• Language : follows suggestions better
than commands
• Use shorter and more compact
sentences
• Play: prefer companionship in play,
require supervision, fight may occur,
continue collections, enjoy making
things and dramatic play
10-12 years
• Gross motor: Enjoy all physical activity
• Fine motor: coordination continue to improve
• Psychosocial: industry v/s inferiority
• Psychosexual: latency stage
• Spiritual: mythical- literate faith
• Intellectual: concrete operational thought
• Moral: conventional morality
• Language
• Receptive: follow suggestion better than
request; is obedient
• Expressive: vocabulary oral 7200; reading
50000 words, able to give precise, use
number more than 100 with meaning
• Play: large muscle & out door activity,
reading, collection, construction activities ,
athletic sports
12-13 years
• Motor development
• Clumsiness occur due to rapid physical
growth, eye hand coordination at adult
level, possess manual dexterity
• Psychosocial: identity v/s role confusion
• Psychosexual : genital state, masturbation
occur
• Spiritual: synthetic conventional faith
• Intellectual : formal operational thought
• Moral : preconventional stage
Play :
• Parties
• Conversation
• Helping others
• Interest in world affairs
• Expressive arts
• Hobbies
• Craft
• Social drinking
• Drugs
14-16 Years

Physical changes
• Rapid
• Sexual maturation
• Development of primary and
secondary sexual characteristics
• Four main changes
1. Increase growth rate of skeleton,
muscle and viscera
2. Sex specific changes, such as
changes in shoulder and hip width
3. Alteration in distribution of muscle
and fat
4. Development of reproductive system
and secondary sexual characteristic
• Girls tend to begin their physical
changes earlier than boys
• Growth spurts for girls begins
between 8 and 14 years
• Their weight and height increases
rapidly .
• They reaches the maximum height
16-17 and continue to taller until 18-
20 years
Cognitive change
• Changes within the mind and widening of
social environment result in the highest
level of intellectual development
• Can determine the possibilities and solve
problems
• Think abstractly and deal effectively with
hypothetical problems
Psychosocial changes
• Sexual identity: enhanced by the
physical changes of puberty
• Becomes interested in heterosexual
relationships
• Development of masculine and
feminine behaviors
Group identity
• They seek group identity because they
need esteem and acceptance
• Popularity with opposite sex and same
sex peer is the major concern for teens
Family identity
They move towards peer and move
away from parents
Moral identity
• Moral judgment depend heavily on
cognitive and communication skills
and peer interactions
• Learns to understand the rules are
cooperative agreements that can be
modified to fit the situation rather than
absolutes
• They use their own judgment rather
than use the rules to avoid punishment
Health identity
• Healthy adolescents evaluate
their own health according to
the feeling of well-being, ability
to function normally and
absence of symptoms
Motor development
• Motor functions comparable to
that of adult
• Eye-hand coordination at adult
level
• Posses manual dexterity
• Psychosocial :identity v/s role confusion
• Psychosexual: genital stage
• Spiritual: synthetic conventional faith
• Intellectual: formal operational thought
• Moral : post conventional
• Language: fully developed
• Play : organized sports
Health problems
• Injuries
• Substance abuse
• Suicide
• Pregnancy
• Nutritional problems like anorexia,
bulimia, obesity etc.
• Sexually transmitted infections
• Developmental and situational stressors
YOUNG ADULT
• Period between late teens and mid to
late 30’s
• Physical changes
– Completed physical growth by 20 years
– Quite active, less commonly experience
severe illness
– Tends to ignore physical symptoms and
often postpone seeking health care
• Cognitive changes
– Increase critical thinking
– Formal and informal educational
experience
– General life experience & occupational
opportunities are increased
– Improve conceptual, problem solving
and motor skills
– Because of their continuous adjustment ,
their decision making are flexible
• Psychosocial changes
• Improved emotional health, emotional
maturity
• Alterations are made in personal, professional
and social life
• They starts to prepare for marriage and to have
their own family
• They attempt to improve their socioeconomic
status
• Develop mature sexual relationships
 Developmental task
• Selecting a mate
• Learning to live with a marriage partner
• Starting a family
• Rearing children
• Managing a home
• Getting start in an occupation
• Taking on civic responsibility
• Finding a congenial social group
MIDDLE ADULT
 Physical changes
• Mid 30s -60
• Makes lasting contribution through involvement
with others
• Graying of hair
• Wrinkling of skin
• Thickening of waist
• Decrease in hearing and vision
• Menopause
• Climcteric
• Cognitive changes: are less except in
diseases
• Psychosocial changes:
– Children moving away from home
– Marital separation
– Spouse demise
– “Sandwich generation” rearing children
and caring old parents
 Developmental task
• Peak of their influence upon society and at the
same time it demands more responsibilities
from them
• Achieving adult civic and social responsibility
• Establishing and maintaining an economic
standard of living
• Assisting teenage children to become
responsible and happy adults
• Developing adult leisure –time
activities
• Relating oneself to one’s spouse as
a person
• Accepting and adjusting to the
physiological changes of middle
ages
• Adjusting to ageing parents
OLDER ADULTS
• Age 65 years is the start of older
adulthood
• Physical changes
• Older adults concepts of health generally
depend on personal perceptions of
functional ability
• They engage in ADL
• Consider themselves as healthy
• Physical, emotional or social impairments
are perceive as illness
 Cognitive changes
• Structural and physiological Brain changes
– Reduction in the number of cells , deposition of
lipofuscin amyloid in the cells, changes in
neurotransmitter level
– Cognitive impairment : disorientation, loss of
language skill, loss of ability to calculate or poor
judgmental skill
– Delirium, dementia, depression , cerebral anoxia,
hypoxia , medication, drug effect, trauma,
• Deterioration in ADL activities
• Common dementia is Alzheimer’s disease
• Impairment of social and occupational
functioning
• Depression reduces happiness and well being
contributing to physical and social limitations
 Psychological changes
• Changes in role and relationship

• Retirement
• Stopps attending social activites
 Developmental task
• Adjusting to retirement and reduced income
• Adjusting to death of spouse
• Establishing an explicit affiliation with one’s
age group
• Meeting social and civic obligations
• Establishing satisfactory physical living
arrangement
• The principal values needed by older adult
• Quiet
• Privacy
• Independence of action
• Nearness to relative and friends
• Residence among own cultural group
• Clossness to transportation lines , communal
institutions