Developmental Issues Impacting Mental Health Infancy to Adolescence

So I'd like to welcome you to human growth and addressing and preventing stuck points. And today is part one of two. We're going to be looking at infancy through adolescence today, and then on Monday we're going to pick up with early adulthood, late adolescence through old age. And one of the things I really want you to think about during this is, you know, the clients we're working with. A lot of us work with adults, and not so much with children, but things that happen in childhood, things that fail to occur in childhood, developmental things that may not have happened, don't have to continue to negatively influence people in their adulthood. We can help them kind of reparent themselves, if you will. So we're going to talk about ways that we can help parents prevent these problems, but also help parents or help adults who are experiencing issues sort of address those issues to mitigate problems. Because we can't change the past. We can't give them the warden. JUNE Cleaver Childhood and so what can we do to help them improve the next moment and live a rich and meaningful life? We're going to identify the major psychosocial milestones for each age group, and we're going to talk a lot more about the psychosocial stuff than the biological, but we're going to hit on the biological just a smidge. So you kind of can put everything into perspective and think of your children, your grandchildren, the kid down the street, or maybe your clients in terms of what they're going through. Learn about things that may thwart development, identify protective factors for healthy development, and conceptualize behaviors as goal driven in order to better understand their purpose and provide appropriate redirection. So when we're looking at youth who are engaging in maybe early sexual behaviors, you know, let's look at that as goal driven. What is the function of that? And it may be to get acceptance and to compensate for, if you will, low self esteem. It may be for a variety of other reasons. But we want to look at that instead of saying this is a bad behavior, we want to say this is a functional behavior. How is it functioning and what, what went wrong? What do we need to help this person do to live a life that's going to be less fraught with problematic behaviors? So infancy milestones, you think, well, you know, stuff that happens in infancy, does it really impact the child? And the answer is a big, gigantic yes, it does. Between 0 and 1, children master the use of their hands, start crawling, respond to familiar words, discover voices. They rely on parents for comfort, to meet their basic Needs. Now this is a really important point, children. Babies have five different cries and each one means something a little bit different. I'm hungry, I'm cold, my diaper's wet. And you begin to learn that with your own child, what that sounds like. And if you're around other children, you begin to differentiate between their cries. And you can tell a sleepy cry from an angry cry or a scared cry. And this is the way the child starts learning to communicate and trust his or own needs. They get this feeling. They don't know what hunger is, but they get this feeling. And when they make that cry, they get fed and they're like, oh, made the problem go away. Score. The problem comes in when the parent is unable or unwilling. Generally it's unable to differentiate the child's needs and stuff. So responds to everything with a pacifier or a bottle or just puts them in their bed and you cry it out. Then the child's like, this isn't helping me meet my needs. I can't trust myself to be able to communicate to you. And I can't trust you to meet my needs and make the pain or discomfort go away. So infancy is a real big issue. And Erickson referred to it as the period of trust versus mistrust. The child starts developing a secure attachment to the caregiver. And this is the period when where those initial relationships off of which all future relationships are likely going to be based. This is when they start to be developed. This is the first secure attachment. So in order for an attachment to be secure, there has to be compassionate, consistent meeting of the child's needs. This is also when a child learns to trust in his or herself to properly interpret signals and get their needs met. And a little bit of self efficacy here. You know, obviously they're infants, they're not really thinking whether I can or I can't. But a child who regular, an infant who regularly fails to get their needs met will start feeling hopeless and helpless. And from a piagetan perspective, object permanence develops. And this is another big one. Now think about kids whose parents are psychologically unavailable, but they just, they withdraw into their room. You know, they're not even physically present. For a child of this age, when somebody disappears, you can't see them anymore. They're gone forever. You know, that concept of you can put a toy under the blanket and the child won't realize the toy is still there until they're a little bit older. Same thing applies for humans. So when we put kids down for their, for their nap and we walk out the door. In the child's mind, we've gone to Never Neverland, we've gone away. So when children cry or call out or whatever and we consistently respond and come back through that door, they may not realize that we haven't gone away and come back, but they start developing a confidence that we're going to be able to be there to meet their needs. Towards the end of this period, object permanence develops. They realize that hey, mom doesn't actually go away, she's going to come back. They may not, you know, again, still really conceptualize where you go, but they're confident that you're going to come back. They're able to figure out that things that go below a blanket come back. So they're also more able to accept, you know, when grandma and grandpa come for a visit and then they go away, that, you know, they may come back. It doesn't mean when something disappears, it's gone forever. Attachment is the quality of a relationship with the caregiver characterized by trust, safety and security. The quality of the infant parent attachment is a powerful predictor of child's later social and emotional outcome. So this infancy period is so crucial. And unfortunately this is also when we've got postpartum depression. This is also when we've got a lot of other things that may distract. We've got parents who just don't understand because kids don't come with instruction manuals. They don't understand how to meet kids needs. When I worked in community mental health, one of the units that I ran was a mother baby unit. And I remember when I first took over the unit, one of my first changes from the way it had been run was to insist, insist that the parents, the mothers, not put their child in the swing in front of the TV eight hours a day. Yes, they were in therapy, they were doing group and stuff. But we needed to allow the children to be on the floor, to explore, to play, to use their muscles. And I didn't want them with an electronic babysitter. I wanted them interacting with their parents and teaching the parents how to be consistently responsive to that child's needs. Because a lot of these women never experienced that themselves. So they didn't even have that to go with, to know how to interact with the child in a way that was going to produce a secure relationship. So there was a lot of frustration and angst when they learned that they weren't going to be able to use the swings as much. Secure attachment or attachment in general, attachment style is Determined by the caregiver's response to the infant. When the infant's attachment system, their threat response system basically is activated when they're hungry, when they're scared, when they're sleepy, when something is needed because they can't propel themselves, they can't put themselves to bed, they can't get food, they can't change their diapers. So when they have a need and they send out one of those five cries, does the caregiver respond appropriately and compassionately? Beginning at about 6 months old, infants come to anticipate caregivers responses to their distress and shape their behaviors accordingly. So if a caregiver has not been responsive, the child is less likely to be consolable or to even cry out. They may just be like, you know, whatever. This caregiver is not going to respond. So, you know, it doesn't matter what I do. So the children start developing strategies for dealing with distress in the presence of that caregiver. So even at six months old, children are starting to learn how to shape their behavior in response to the people and the environment. A sensitive, responsive, loving caregiver is going to produce a secure attachment. One who is insensitive, which, you know, doesn't necessarily mean, you know, mean, it can mean insensitive, meaning they can't differentiate, they're not sensitive to the different types of needs. So an insensitive, rejecting, you know, a caregiver who's just like, you know what? I can't deal with? You go in your cage, or go, not your cage, I'm sorry, your crib, or go in the swing. Or an inconsistent caregiver who sometimes is there when they're emotionally available or when they're sober and sometimes just kind of sits on the couch and looks at the kid like, I can't do it. And that can produce an insecure attachment. That can produce a child who doesn't know how to trust another person for safety and security and doesn't know how to trust themselves or their own instincts. Attachment continues through childhood, but formative attachment relationships are those developed in infancy. So why are we so concerned? Secure attachment helps children learn basic trust, which serves as the basis for all future emotional relationships. This helps them develop fulfilling, intimate relationships later on in life and maintain emotional balance. When they feel like they're scared and they know that if they cry out because they're scared, they're going to have someone come and comfort them, it's a lot easier to deal with the stress than if they get scared and they're like, I Know nobody's there to help me and I'm just flopping out here in the wind. It helps them feel confident and good about themselves. Like I said, even early on, when children voice their needs, even if it's in the form of one of those five cries and they get their needs met, it gives them a sense of self efficacy. They enjoy being with others. They can rebound from disappointment and loss because again, remember secure attachments. When the child, when something happens, the child gets upset. You know, maybe they're trying to learn how to pull themselves up, you know, on the sofa or whatever. They progressed a little past crawling and they fall on their bum and they start to cry. Well, that's a disappointment for them. They're probably not really hurt. But if a parent goes over and comforts them and encourages them to try again, it helps them start learning how to rebound from disappointment and loss. And they learn how to share their feelings and seek support. At one, at six months, they're not coming up to you going, I am feeling really upset today. They're cranky, they are irritable, they are sad, they are sullen, they are withdrawn, whatever the. However the child is acting, if the parent is sensitive to it and is able to try to meet that child's needs and figure out what's going on, which can be a guessing game sometimes, but it still helps the child know that if they share their feelings, know that there's somebody there that will give them support. So we really want to look at, in adult relationships or in adults who didn't have secure attachment growing up, how do we help them? We want to help them become mindful of what are your needs when you were an infant, maybe those needs weren't met. Maybe you were told that your needs didn't matter even as an older child. So now let's start being mindful. Let's start paying attention to what your needs are and let's look at why those needs are important. Why is it important to take care of yourself when you're exhausted? Why is it important to take care of yourself when you need comfort and support? You know, is that weakness or is that being strong, knowing that it's okay to ask for comfort, comforting and support from others. So we want to help people really start looking at what they were supposed to develop in this initial secure relationship and develop that secure relationship with their own internal parent, their own internal self that says it's okay to be sad right now. So yes, they've got to sometimes do some reparenting and play split roles but ideally, once they start learning how to re parent themselves and do all this stuff that ideally a parent would have done, they can start communicating that to others. When they need a hug, they can say they need a hug. When they're exhausted, they can identify, you know what? I'm really tired today. I just can't do that. They can start setting boundaries and getting their needs met in healthy, appropriate ways. More effects of secure attachment. People who are securely attached explore the environment with feelings of safety and security, which leads to healthy intellectual and social development. So people who don't have this may be really timid. They may not go for promotions, they may not interview for jobs that may be a little bit outside their scope. They may be afraid to reach out and try to make friends with people because they're afraid of rejection. So if they're not secure, children who have a secure relationship have a base to go back to. You know, if they go out there and they have a failure, it is not pleasant, but they know they can go back to home base where there's comfort and security and kind of regroup and figure out what to do next. If they didn't have that, then they're out there, they have a failure or an unpleasant event and they're just kind of like flopping in the wind. So we want to encourage people as adults again to encourage themselves to explore the environment, to be willing to be open to relationships and encourage them to look at the successes they've had and learn how to to accept failure and nurture themselves. Secure attachment helps people develop the ability to control their behavior, resulting in effective management of impulses and emotions. If you're getting your needs met as they come up, instead of stuffing them all down until you're just like one big pit of neediness, then you're going to have more energy to deal with life on life's terms. So if you're getting enough sleep, if you're eating well, if you're taking care of yourself, if you've got positive relationships, if you are, when you have something go wrong and you need help, you ask for assistance instead of, you know, carrying the weight of the world on your shoulders. It's going to be easier to manage impulses and emotions when something bad happens because you've got that energy freed up, you're not still trying to juggle 16 things from last week that you haven't dealt with yet. So living mindfully, living true to oneself is really important to encourage in clients. Secure attachments create a foundation for the development of identity, which Includes a sense of capability, self worth, and a balance between dependence and independence. Now, each one of those characteristics can be an entire session or group in and of itself. But that self efficacy is really important. The ability to control one's own body and get one's needs met. Those are the basic developmental tasks of infancy and early childhood. Self worth is being loved and being able to be loved for what you need. If you've got a rejecting parent or caregiver, then the child may start to feel that they are not worthy of love. If the caregiver is always ignoring the child or telling the child to be quiet, go do something, putting them in their crib, whatever, the child may start to experience a lowering of self worth because the parent doesn't even want to be around them and develop that balance between dependence and independence. Dependence relies on you being able to trust somebody else, being dependent on their help and those sorts of things. Interdependence is what we talk about in our groups. Dependence, independence and interdependence is kind of the middle of the continuum. So we talk about what independence means and how to be independent, you know, make decisions, etc. But how we also need other people to be supportive, to be our cheerleaders, because we were kind of created to be affiliative, if that's a word. We weren't created to live in isolation. So. And culturally it's going to vary. You know, some cultures are very interdependent and some cultures focus more on. On independence. But to the best of my knowledge, there's no culture that is completely independent where people are just supposed to grow up, move out and live by themselves forever. Secure attachments establish a moral framework that leads to empathy, compassion and conscience. So we can start helping people develop empathy for others at this point, generate a core set of beliefs and provide a defense against stress and trauma. Stuck points. If the child doesn't have basic food, shelter, safety, love needs met, they may never be able to trust others. Well, I won't say never because they can address that in their own therapy and personal development as they go. But lack of getting those needs met will cause an inability to trust self or others. Reliance on others will be required to tell them what they need. Because if they can't trust themselves, then they're just like they're looking for others for validation, for direction. There's a lot of dependence that's created. They may lack a sense of worthiness for basics and not feel like they're worth asking for help, not feel like they're Worth, you know, taking care of themselves. They may have discomfort with and or a craving for attention. So they may be uncomfortable getting a lot of attention, but at the same time, there's a part of them that really wants to be loved and they can express irritability and anxiety. So what do we need to do? We want to encourage them. And as clinicians, whatever role you want to put yourself in here, we want to model consistency. We want to encourage them to be consistent with themselves. We want to model care and understanding and ensuring basic needs are met. So we want to go over with the clients and ensure that they are paying attention to their needs. Compassion, being calm and accepting of the child's emotions and needs. Well, okay, that's what a parent can do. As clinicians, we can be calm and accepting of the adult emotions and needs and we can teach them to be calm and accepting of their own emotions and needs. Instead of saying, I shouldn't feel this way or I shouldn't need this, say it is what it is, what's the next step? And providing compassionate redirection. Add, don't just subtract. Especially with infants, if we're talking about prevention, when you tell an infant no, when you take something away from them, when you won't let them do something, okay, but what do they do? Because they don't have this big repertoire of behaviors. So we don't always want to just take away something. So if you're not going to do this, what else can you do? If you're not supposed to be climbing on the TV and taking down mommy's knickknacks, what can you do? So you take the infant over and you place them a blanket or in a playpen with their toys so they have something to play with and they can explore. But it's something safe. When we're talking about adults, when they start doing something that is harmful to themselves, whether it's drinking or binge eating or whatever it is they're doing, encouraging them to look at that, and if they decide that that's not a helpful behavior, okay, what are you going to do instead? What need is that behavior meeting, you know, it's goal driven. Is it helping you address stress, loneliness, low self esteem? What need is it meeting? And how can you do it in a way that's more helpful and meaningful to you? Toddlers work on autonomy versus shame and doubt. This is our potty training period. They develop personal control over physical skills and their body. This is when, I mean, think back to toddlers. They want to start Dressing themselves, they want to start. Well, sometimes they want to start potty training and they learn that word no. And they like that word no, especially when they're saying it. Not so much when it's being said to them. Through age 7, they think symbolically about things. So when they play they can use little dolls and now they can see this little doll as mom instead of just little dolly. And they can pretend play so they can think more symbolically and begin to understand the concept of past and future. You know, think about when grandma came the last time. Now she's going to come like that again next week. So they can start conceptualizing on a timeline. And they continue to develop secure attachments during this period. Overly permissive or overly strict parents can kind of thwart development if the child doesn't learn how to toilet train as effect as quickly as parents want to. Children can develop shame if they make a mistake and they have an accident in their pants. They can feel too much pressure. I mean, think back to Freud and anal retentiveness and all that other stuff. So we know that there's something that goes on here. I like to look at the more, more along the Ericksonian level where they're establishing competence over their, over their own body. This is also the age when they start becoming pickier eaters and what they don't want to eat. And as parents, you know, we can't necessarily tell them, well, you don't have to eat any of that. You can have Cheerios for every meal. Well, that doesn't work. That's not a healthy diet. So it's important, even with a 2 and 3 year old, that we set some limits to make sure they stay healthy and keep doing positive health behaviors, but also to allow them a little bit of wiggle room. And this is where we can, we can start negotiating with them a little bit. They have to eat a certain amount of vegetables to get their, to get their dessert or whatever it is. And we want to encourage children by providing praise for exploration and experimentation. If they try a bite of something that they've never tried before, provide copious praise even if it's something that they should like anyway, you know, it's still something new. So we want to make sure that they get that. If they try doing something new physically, maybe throwing a ball or whatever they're doing, providing praise even if they don't do it, great. If they try, if they're exploring, that's what we want to encourage at this point because they've got to start trying things before they can figure out what they like and what they're good at. If they don't experience this and overly permissive parents, the children may kind of run rampant and become, like I said, they may eat Cheerios every day and might not engage in healthful behavior so they don't learn what they need to in order to be healthy. Overly strict parents, they can start feeling ashamed if they don't do things perfectly. But they also may not learn to think for themselves. They may continue to rely on parents to tell them what to do, when to do it and how to do it. So what happens if they don't have a perfect toddlerhood? They can won't always develop low self esteem and a need for external validation. A lack of motivation. If parents are overly permissive and don't provide a lot of reward and encouragement, or if they are overly strict and very stifling, both of these can have an effect on motivation. So what do we want to do? We want to encourage the child to explore and experiment. We want to encourage the adult to explore and experiment. Figure out who you are, what you like, you know, go out there, try new things and guess what, you're going to fail at some of them and that's okay. And this is where children really start learning that failure is a learning opportunity. Failure is maybe a learning opportunity. It's not the way to do it or not something you ever want to do again, but it's a learning opportunity and it doesn't mean anything negative about them. We want to praise the child for working with children, for trying even if they fail. And if it's an adult, encourage them to give themselves kudos for giving it the old school try even if they fail. You know, I'm almost 50 and I still don't know how to ride a two wheel bike. But I've gotten on and I've tried before and it's been pretty disastrous, but at least I tried. And now I've just decided that it's not that important to my future goals to learn how to ride a two wheeler. But it's important to be able to look at things like that. And I mean, a lot of people are like, you don't know how to ride a bike? I'm like, nope, never had one. So we all have different things that we've explored, experimented, tried, had access to. And it's important that people know that they're not going to be perfect and that they're loved for who they are, not for what they can or can't do. So our unconditional positive regard really starts coming in infancy, toddlerhood and early childhood. Really Rogerian in terms of parenting, we want to provide that support, encouragement and positive redirect. Unconditional positive regard for the person. And if they didn't get that, then we need to teach them how to do that. Now. Preschool is the initiative versus guilt stage, according to Erickson, where they start asserting control and power over the environment. Too much disapproval can result in guilt. So this is when they're going to school, they're trying to make friends, they're trying to do new things, and they're testing limits. Four to six year olds test limits and we have to set limits. But there's also a place for approval. We want to make sure that we're providing approval for things they do well and ideally not resorting to just the no, because I said so. When we provide disapproval, explaining to them why that's not okay, you know, it's not okay because it's not safe. It's not just not okay. So they can understand that you're not disapproving of them, you're trying to protect them in some way. Preschoolers live in a magical world where inanimate objects are alive and dreams are real. So it can be a challenge to differentiate in this group, truth versus fiction. When you start asking them, you know, who broke the lamp or tell me about what happened at school today. You can get some children who are very fantasy oriented so needing to bring it back down. I remember at this age my son had, he thought he had. Well, he, he wished he had poof up powers. And he would tell me that if he had poof up powers, he would poof up. And he was really into Star wars at this point and Millennium Falcon, and he would poof up this and poof up that. And this was, you know, his creativity. And I would regularly remind him that poof up powers weren't real. Just for my own sanity. But, you know, I think most children are pretty clear. But there's, you know, we want to check in with them periodically to make sure that they remember, you know, not everything you see on TV is actually safe to do. They have trouble distinguishing between appearances and reality. So the parenting challenge at this point is helping them realize that even things that look safe may be very dangerous. So helping them learn safe versus danger. And again, truth versus fiction. Take them to a magic show and they see a woman just disappear into thin air. Is that truth or is that fiction? And helping them differentiate what's actually happening. They can focus on one aspect of a situation but struggle to see other vantage points. So what they see, their way is the only way. And I think we can all think back to times when we've kind of felt that way and we've worked with clients whose main form of thinking was this way. It's my way or the highway. I'm right about everything and I can't see anybody else's perspective. So the parenting challenge here is to encourage children to find their voice, to be able to articulate and state what their perspective is, but not be a bully and be able to hear other people's perspectives and learn. Learn or take in from them and maybe say, oh yeah, I see what you're talking about. And this will help them make better choices in terms of interpersonal skills. Children at this age typically love to play make believe. So with the parents, sometimes it's a challenge to find our make believe. I had a really hard time finding my make believe when I was, you know, had young children at home because that's just not what we do on a day to day basis. So having the tea parties and playing the fairy princess and those things just. And children pick up on that if you're not engaged in it. So try to find your make believe. But if you can't, then redirect, you know, what else can we do that the child likes? And try to understand what children are communicating through their play. And a lot of times it is exactly what the manifest content appears to be. There's no underlying, you know, latent stuff going on. But sometimes, you know, if a child is displaying aggressive tendencies in their, in their play, we may want to investigate what that means. Preschoolers love to ask questions to both learn facts as well as to interact with others. So some of the parenting challenges at this age are to not get impatient with the Mommy, why is the sky blue? Why is the dog black? Why do six different colored kittens come from one mama cat? I don't. Genetics, pundit squares. But not getting impatient with their curiosity. The nice thing is now that we've got Google and Alexa, we can look it up. Whereas back in the olden days we just had to say, I don't know, next time we go to the library we can check that out. Help children learn how to answer their own questions. Help them learn how to look it up in a book or figure out where the answer is. And learn to self regulate in mutual conversations so they don't dominate a conversation or likewise so they're not just sitting there going huh, uh huh. And not carrying on their own end. So these are things preschool children learn. If preschool children were withdrawn for some reason or overly aggressive and kind of bullyish, they may not have learned effective interpersonal skills. So we can help adults start to learn those. Preschoolers use everyday objects in conventional and unconventional purposes. So we want to honor their creativity in the right time, in the right place. You know, you may find that they're using your best pasta pot as a hat as they're walking down, having a parade. But we also want to get outside the box and encourage them if they want to have a fort, but it's 12 degrees outside. How can you build a fort in the house? Let's get it outside the box. Is it couch cushions? Do we have an old box somewhere? What can you do? There are also little scientists trying to see what will happen, such as, wow, what will happen if I drop my ball of play doh. Into the aquarium? Let's check it out. And they don't have a stop between, I wonder if I should do this. It's just like, oh, I'd be curious to find out. So they may test rules and boundaries. So parenting challenges here can include cleaning the aquarium, being consistent when children try things, developing rules. You know, before you try something, why don't you ask for mommy's help or call me, because I'd love to see what would happen that way. We can always intervene if we need to to help children stay safe, but we also still want to encourage that exploration. Children at this stage crave structure. So if they don't have structure, they may act out in order to get boundaries and limits placed upon them. They may act out for other reasons. So again, we want to ask in this situation with this child, what does this behavior mean? But we need as parents to provide structure and consistency and steadfastness with adults. They'll, you know, as adults, they're running their own lives. They are going to set the amount of structure that's comfortable for them. But you want to encourage them to be true to themselves in how much structure they need. Some people don't need much, but some people start to get really stressed if they don't have a lot of structure. So encouraging them to figure out what do they need in order to have the highest quality of life. Piaget uses the term pre operational to describe the reasoning patterns typical of children in this age group. There is easily fooled by appearances. So it's up to us as parents to remind them that appearances can be deceiving and not everything Happens the way you expect, as if you're working with an adult. This is where you start introducing dialectical thinking. The both and can it appear to be a wonderful thing and be not a good choice for you? Yes, it can. So encouraging people to think dialectically. Preschool children often have difficulty putting into words how they feel or what's going on inside. So parents need to pay attention to nonverbal and verbal cues and help children label their feelings if they're angry or if you think they're angry, seems like you're really angry right now. And teach children to check in with themselves periodically. How are they doing? How are they feeling? Are they sleepy? Are they overwhelmed? Are they overstimulated, as my son used to say? And what do they need to do about it? And you know, a lot of times when my son was this age, I would ask him, what do you need to do about it? And if he didn't know, then I could provide information or suggestions, but I wanted him to start thinking about, okay, when I feel this way, what do I need to do? Children begin using strategies for remembering, but they often use inappropriate and ineffective strategies. So as parents, it's important for us to continue to differentiate truth from fiction and identify intentional lying from ineffective recall. Now, they probably remember if they broke the lamp, but they may not remember if they brushed their teeth. Interferences, overly strict enmeshed parents and enmeshed parents parents and lack of encouragement to take risks. So the manifestations are a low self esteem, need for external validation, difficulty making or maintaining friends, and unclear, being unclear about what they like, want and feel because they've never had that really encouraged, they've never been encouraged to explore that. So we want to encourage the child or the adult who re parenting, encourage them to explore and experiment and figure out what interests them. Encourage them to praise themselves or praise the child for trying even if they fail. Reassure the person that they're loved for who they are, that unconditional positive regard and encourage children to develop friendships with a variety of people. So thinking about what we've talked about so far, what other things can we do to help people become mindful, live authentically and improve their self esteem? That's really what early childhood is about. And I mean there's also development of coping skills. Okay, so moving on to middle childhood. Well, early childhood, 7 to 12 years, industry versus inferiority. And Erikson's stages, the way he labeled them didn't necessarily always make sense to me, but this is when the child is coping with new academic and social demand. And is developing a sense of confidence and efficacy. Is he industrious? Is he able to do what he sets his mind to? Is he able to make a change, make a difference in his or her little aspect of the world? Cognitively thinking becomes less egocentric. They start becoming more able to take other people's perspectives and begin to realize that their thoughts and feelings are unique. So let's ask what other people think, and it's the beginning of logical thought. A plus B equals C, and they're starting to see consequences. If I do this, then this is going to happen. Age 8 is a milestone across cultures, and children are perceived by adults as having attained a new level of competence at this age and are often permitted to be on their own more often. So the parenting challenge here is creating a safe, stable environment for youth to fledge. Now, these dimensions were created many, many, many, many years ago. So these ages slide up and down a little bit depending on the state of the world and things. But age 8 is typically a milestone where kids are allowed to spend more time on their own without parental, like, direct oversight. I'm not saying leaving them home alone, just spending time independently, they acquire the logical reasoning associated with concrete operations. Unfortunately, in life, not all things are logical. So sometimes we have to work with children to help them think dialectically and accept the fact that this is illogical but is still true. Children begin to use advanced strategies when they learn new material. They gain much from teachers who help them cultivate useful strategies for learning. So identify your child's temperament. If you're an adult, identify your own temperament and learn how you most effectively learn through hearing, through seeing, through doing, and try to arrange your environment that way so you have you're meeting your needs in the most effective way. So I've mentioned it before. Effective teaching Effective Learning by Alice Fairhurst is a great tool to use to help learn how to educate, interact with people of different temperaments, especially if you're a supervisor or a teacher or even a counselor. They're able to be fairly logical and organized when working on problems with concrete objects. But that abstract stuff, not so well. So this is where manipulatives are usually really helpful. They have difficulty dealing with abstractions, hypothetical situations, and multiple variables. So it's helpful for parents to work with children on conceptualizing hypotheticals. The what if all right, you're going over to Sam's this weekend to go swim in the pool, and so what do you need to bring with you? Your swimsuit, Sunscreen. But what if it starts to rain? Hypothetically you get over there and it starts to rain or the pool's broken, what are you going to do? And do you need to bring something else with you? And teaching children how to organize and solve problems, multivariable problems. And so you're going to your grandparents house and this is generally where we start with multi variable problems. You're going to your grandparents house for the week and you're going to be going to the zoo, you're going to be going to the museum and you're going to be going to church. So what different types of clothes do you need to bring with you? Helping them kind of conceptualize and organize. Perspective taking skills increase. And as parents we can help children continue to take another's perspective and ask them, you know, how do you think Johnny felt when you took his chair from him? Or how do you think you would feel if Johnny took your chair from you? Sometimes you got to turn it back around to help them really grasp that empathy concept. But empathy is coming out. School age children acquire a relatively stable and comprehensive understanding of self so we can help them appreciate their physical characteristics. Some are going to be taller, some are going to be shorter, you know, appreciate who they are and you know, kind of fight. The mass media support children in exploring their values and reactions to things. Sometimes their reactions will be right on par with yours, sometimes they will be different. So encouraging them to share with you their values and reactions and, and how they arrived at those so you can discuss them openly and encourage them to make educated decisions. And you know, sometimes they have a very, you know, spot on informed point of view and it's like okay, cool and you can agree to disagree or you may change your point of view. Children acquire a set of standards and expectations with respect to dealing with others. The formation of friendships and close affiliations with peers is a hallmark of this period. So this is middle school time we're talking about. As parents we can help children define a realistic and healthy set of standards and expectations to live by and to deal with others by. People aren't going to be perfect. Nobody is going to keep every promise that they make, most likely. So encouraging them to look at that and also encouraging them, encouraging them to take other perspectives. You know, if their best friend was supposed to come over this weekend and cancel at the last minute, does it mean that their best friend isn't their best friend anymore? Or does it mean that their best friend had something else going on they had to go do so? Encouraging them, you know, like I've always, like I've said many times before. Give me three other explanations for why this might have happened besides it being about you. And identify in yourself what standards and expectations you model for your child. So if you want children to grow up to be responsible, dependable people, then we need to model that ourselves. There's a new appreciation of authority and interest in understanding and abiding by the rules. So our challenge is to have an explanation for every rule and not fall back on the because I said so and pick your battles. And I'm learning this over and over and over again and even into teenage years. Pick your battles because there are going to be plenty to come. Which ones are necessary in order to help the child continue to develop. There's a reciprocal relationship between cognitive development and social interaction and interpersonal effectiveness. So if you have a child that's lagging in one of these areas, if they're cognitively lagging for some reason, intellectually at school, struggling, or socially interpersonally, if they are lagging in their ability to communicate feelings or develop relationships, we need to address because they found that there's a reciprocal interaction in these areas. Interferences, lack of consistent support and encouragement even with failure. Lack of successes. I mean, we can give support and encouragement, but we also need to make sure that we help set children up for successes where they can look back and go, I did that. Not just go out, skin a knee, come back, try again. If they don't have these successes and they don't have consistent support, they may have low self esteem and lack motivation. So we want to encourage the child to develop skills in areas in which he can excel. You know, not just those areas, but when they try something and they seem to be good at it, encourage them to explore that. So they start knowing that they're good at some things and there are going to be other things that come up, like algebra or calculus that they may not be good at. But then they can look and say, well, I'm not good at this, but I am good at these things. Praise children for trying even if and when they fail, reassured that children are loved for who they are Again, want to do this with adults too, in adolescence. We're really developing identity at this point, and it's confusing and it is chaotic. Successes lead to the development of a self, of a sense of self and personal identity. So what they're successful at, they're going, okay, I can do that. So I'm a good cook. I am a, you know, I can do this, I can do that. So these are starting to be the Roles that I can take on failures provide an opportunity for learning coping skills and compassion. So not only how to deal with failure, but how to be compassionate with themselves and not tell themselves that they're a stupid idiot but say, you know what, that may not be for you. So developing self compassion when they experience failure. During this time, youth are developing the ability to think about abstract concepts and logically test hypotheses. Sometimes it's if I sneak out my bedroom window, are my parents going to catch me? And that's, you know, it's adolescent thinking 101. But they're going to test limits and they're going to test hypotheses. Can I pass this test if I don't study for it? I'm sure most adolescents try that one. Interferences in the development of identity and a strong self esteem. Lack of support for individual wants, needs and goals. Youth during this period will go through phases. Most youth go through phases where their parents are just kind of cringing going oh my gosh, I know both of my children went through phases like that where I was kind of gritting my teeth because it was their independent showing wasn't what I would have chose but you know, wanted them to work through it and decide whether that was something they were going to embrace or move on because it wasn't harmful to them. So I needed to support them for being an individual. Lack of stable, consistent, positive relationship. So it's important during this period not only with the parents, but that they also have friendships that are stable, consistent and positive. And it doesn't have to be 17 friendships, it can be 12 and those one or two are going to have hiccups. So stable is kind of relative, you know, but somebody that they can consider a confidant. We want to make sure that they have successes in things that they do and they get educations about and opportunities to develop coping, life and interpersonal effectiveness skills. Most of you know that I homeschool both of my children, but just because they're homeschooled doesn't mean that they don't get out and socialize. And as K12 and online schooling becomes much more prominent, it's going to become more important to remind parents that children need to get out and experience have the ability to experience other teens and other youth and develop their interpersonal effectiveness skills. As mobile devices and texting have taken over, people have lost a lot of interpersonal skills. They don't know how to look at one another eye to eye and have a conversation as much anymore. They become Very anxious. Social anxiety is going way up right now. So it's important, you know, culturally right now. What I'm saying is it's important to make sure that you have face to face opportunities for interaction and are able to, even if it's on social media, they have opportunities to develop coping and life skills to deal with stuff they see that they don't like. Stuff that's triggering. Okay, it's triggering. How do you deal with it? Manifestations still low self esteem and lack of motivation. So what do we do? Encourage the person to develop skills and areas in which you can excel. Provide support when the child's world seems chaotic. Now, if you're working with an adult who didn't develop a secure identity in early adolescence or in adolescence, we want to encourage them to figure out where can you get support? Where can you fall back to? Where is your safe home base when life seems a little bit chaotic, who can you rely on? And as clinicians, we may be part of that support network initially, but we want to encourage them to reach out to other people and develop a support net. And I encourage people to have three or four people in their life that they can rely on. And sometimes they can't rely on them for the same things, but they need to have support. Identify and help. Help people learn how to identify and set smart goals. Specific, measurable, achievable, realistic and time limited smart goals will set them up for success, which will set them up for increased self esteem and self efficacy. But a lot of people really stink at goal setting. Have them start out telling you how to do something they know how to do, like bake a cake or rebuild an engine or change the oil in your car. That's a goal. And then have them tell you step by step how to get there. And then say, okay, now let's do that with something else that you want to do, like get your degree. What's the first thing you need to do and help them see that it's not as complicated as they may be. Making it remind them that they are loved for who they are, not for what they do. For being good, honest, helpful people. You know, those values that they find so important, that's who they are. It doesn't have anything to do with what they can do, whether they can bake, whether they can drive, whether they can, you know, sing the national anthem. Model and reinforce positive coping skills. Whether you're a parent or a clinician. We want to be able to model this and reinforce it when clients use them and encourage opportunities for the development of interpersonal skills. Whether it's, you know, if you're working with a client, encouraging them to go out on social outings, having support groups, or various different types of, you know, peer led support groups may be hosted at your facility in order to encourage people to develop relationships and interact and develop those interpersonal skills. So preventative protective factors include parental involvement. So if the parent wasn't involved and you've got an adult who you know is struggling because they didn't accomplish some of these tasks, how can they do that? Well, they need to tap into their inner parent. And you know, a lot of people back in the 70s and stuff talked about the inner child. Well, you've got an inner parent too. Think about it, you know, remember Bugs Bunnies, angel and Devil on the shoulder. Encourage the person to tap into their inner parent and tell themselves what they wish they would have had a parent telling them when they were growing up. You know, what do you wish a parent would have done for you when this happened? You know, what do you wish if you had a parent here right now, what do you wish they would do for you? Parental consistency again, if we're working with parents, encouraging them to take the time, if they're going to set a rule, they need to enforce it consistently, otherwise the child will learn ways to manipulate it. So being consistent also tells the child that, you know, you're worth the attention and the effort. For the adult, encouraging them to be consistent with themselves and they're going to make mistakes sometimes and they're going to fall back into self defeating patterns but be consistent in their compassion for themselves, picking themself back up and going, okay, let's learn from this and move on. Connection to positive adults and peers. So it's important, you know, regardless of the age, to have positive relationships and ideally get involved in community organizations. It can be volunteering, it can be church, it can be whatever, but so there's a connection to the community. It can be helping out at work if you really enjoy your job and you want to be there on your time off so you have a sense of connection and meaning in some of the things that you do. Develop a positive view of self and future. So looking at identifying those things that are important in your life and those people that are important in your life and where do you see yourself a year, five years from now? What does it look like? How do you see yourself as a happy person five years from now? And people need exposure to and development of coping skills. You know, to this day when I'm working on different presentations, I occasionally come across a new approach that I'd never heard of before and I'm like, oh, well, that sounds cool. I mean, mindfulness has been around for a long time, but has really only come to the mainstream over the past 10 years or so, I think. And this is something that is so helpful with a lot of our clients. So encouraging adults to even go and explore what are some new ways that might be out there that can help me deal with anxiety, depression, social anxiety, etc. Develop interpersonal effectiveness Skills Most of us have some very few of us have perfect interpersonal effectiveness skills. There's always ways we can learn to interact and interface with other people so we can develop more empathy and be more understanding and open. And life skills, including goal setting and time management. These are things that unfortunately aren't taught in a lot of schools and a lot of people just don't know how to do them. So these will help reduce stress and anxiety in a lot of our clients. Behaviors represent the person's best attempt to meet a need, such as love to prevent rejection and isolation or security or control of self, the environment or the situation in order to prevent rejection, failure, and loss of control. Identifying the need and alternatives to meet that same need often helps people eliminate inappropriate or harmful behaviors.