Module 1.

GROWTH AND DEVELOPMENT Growth in height occurs in only one sequence- smaller to
larger.
1. Growth, Maturation, Development
c) Growth and development pass through
Pediatrics - from the Greek word means “child cure”; the
predictable stages at different rates.
study and care of children in sickness and health;
All stages of development have a range of time rather
Pediatrician - a medical practitioner or doctor who
than a certain point at which they are usually
specialized in pediatrics
accomplished.
Growth - increase in physical size or a quantitative
change e.g., child’s height and weight d) Development is cephalocaudal.

➢ weight - measured in pounds or kilograms ➢ Cephalo - Greek word meaning “head”

➢ height - inches, centimeters or meters ➢ caudal - means “tail”

Development - an increase in skill or ability to function or e) Development proceeds from proximal to distal
a qualitative change; an increasing capacity to function at body parts.
more advanced levels Development proceeds from head to tail.
Maturation - process of attaining full development and f) Development proceeds from gross to refined
maturity; synonym for development; the total process skills.
whereby a child grows and develops according to
individual inherited patterns of physical, mental and Once the child is able to control distal body parts such as
emotional potential fingers. He or she is able to perform fine motor skills
The characteristics of maturity are: g) There is an optimum time for initiation of
experiences or learning.
1. confident about what he is/she has learned over
the years A child cannot learn tasks until his/her nervous system is
mature enough to allow that particular learning.
2. awareness of strength and weakness.
h) Neonatal reflexes must be lost before
Eugenics - scientific study and practice of principle that development can proceed.
will improve the hereditary qualities of future generations
An infant cannot grasp with the skill until grasp reflex has
Personality - sum total of inherited and acquired traits of faded nor stand steadily until the walking reflex has faded.
an individual as these interacts with the environment; from Neonatal reflexes are replaced by purposeful
Latin word “personare” which means to sound through; movements.
the total complex of the individual mental attribute and
characteristics
➢ type A - excessive drive, energetic, competitive,
and impatient
➢ type B - relaxed, easy-going and less competitive
Inherited personality traits from parent cells – e.g.,
color of the skin, eyes, hair, body physique
Acquired characteristics - result of exposure to the
individual’s culture and environment; e.g., ability to
communicate and relate.
Behavior - any observable action or response of a
person; a manner in which a person behaves in reacting
to social stimuli; a meaningful response of an individual or
organisms to its environment
2. Principles of Growth and Development i) A great deal of skill and behavior is learned by
practice.
a) Growth and development are continuous
processes from conception until death. Infants practice over and over taking a first step
before they accomplish this securely.
A child growing new cells and learning new skills.
j) All body systems do not develop at the same rate.
b) Growth and development proceed in an orderly
sequence.
 Certain body tissues mature more rapidly than
others.
3. Factors Affecting Growth and Development
a. Genetics. A child can be no more intelligent
than his genetic makeup dictates no matter
how much his /her parent want this or how
much schooling or special training he
receives.
b. Environmental Influences. A child cannot
grow taller than his genetic pattern his
eventual height may be considerably less
than his potential because of his
environment.
c. Gender
On average girls are born lighter by an ounce or two and
shorter by an inch or two than boys.
6 months to 1 year – girls hit their puberty earlier than
boys
14 to 16 years - End of puberty; boys again tend to be
taller and heavier than girls.
d. Health. A child who inherits a genetically
transmitted disease may not grow rapidly or
develop as fully as healthy child depending
on the type of illness and therapy or care
available for the disease.
e. Intelligence. Children with high intelligence
do not generally grow faster physically than
other children, but they do not to advance
faster in skills.
f. Nutrition. A mother who consumes a low
protein during pregnancy may deliver a child
affected in both growth and intelligence.
g. Socioeconomic level. The child born into a
family of low socioeconomic means may not
receive adequate health supervision or good
nutrition.
h. Race and Nationality. Some races or
nationalities tend to be taller or shorter than
others.
i. Parent-child relationship. Children who are
loved thrive better than those who are not.
j. Ordinal position in the family. The position
of a child in the family will have some bearing
on his growth and development
Only child/oldest child - excels in language development
because his conversations are mainly with adults
k. Neuroendocrine Factors
hypothalamic region - a growth center responsible for
maintaining genetically determined growth patterns
hypothalamus and the endocrine system -influences
growth
peripheral nervous system - may influence growth
3H: growth hormone, thyroid hormone and androgens -
when given to persons deficient in these hormones,
stimulate protein anabolism and thereby produce
retention of elements essential for building protoplasm
and bony tissue.
l. Influence of mass media. Children may
identify closely with people or characters
portrayed in reading materials, movies,
videos and television programs and
commercial.
m. Stress in childhood. Stress is an imbalance
between environmental demands to a
person’s coping resources that disrupts the
equilibrium of the person.
Emotional Bank - can be made to help parents and
caregivers maintain a proper perspective regarding the
effects of stress and coping
4. Directional Trends
a. Cephalocaudal or head-to-tail
direction - development occurs along
the body’s long axis. Control over the
head, the mouth and eye movement
proceeds and control over the upper
body, torso and legs.
b. Proximodistal, or near-to-far – midline
to peripheral; from the center of the body
to the extremities
c. Mass to specific (Differentiation) -
child masters simple operation before
complex one.
d. Sequential Trends - a predictable
sequence of growth and development
stages through which a child normally
proceeds
e. Individual differences - each child
grows in his or her own unique way
f. Sensitive periods. There are limited
times during the process of growth when
the organisms will interact with a
particular environment in a specific
manner.
Critical, Sensitive, Vulnerable, Optimal - times in the
lifetime of an organism when it is more susceptible to
positive or negative influences
first 3 months of prenatal life - sensitive periods for
physical growth of the fetus
first year of child’s life - sensitive, where primary
socialization occurs
 5. Biologic Growth and Physical Development
Temperament - usual reaction pattern of an individual or
an individual’s characteristic manner of thinking, behaving
or reacting to stimuli in the environment; not developed by
stages; inborn characteristic set at birth
Reaction Patterns
9 Separate Characteristics That Define Temperament or
How Children React to Situations- Chess and Thomas
(1995)
1. Activity Level - level of motor development and
energy expenditure e.g., sleeping, eating,
playing, and dressing
2. Rhythmicity - regularity or predictability in the
timing of physiologic function e.g., hunger, sleep,
bowel movement
3. Approach – withdrawal - a child’s response on
initial contact with a new stimulus e.g., people,
situations, places, foods, toys and procedures
Approach responses - positive, displayed by activity or
expression
Withdrawal responses - negative expressions
4. Adaptability - ability to change one’s reaction to
stimuli over time
5. Intensity of reaction - the energy level of
reactions, regardless of whether it is positive or
negative
6. Distractibility - the ease with which external
stimuli can divert attention or behavior
7. Attention span and persistence - A length of
time a child pursues a given activity or the ability
to remain interested in project or activity, and
continues the activity despite of obstacles
(persistence)
8. Threshold of response - intensity level of
stimulation that is necessary to evoke a reaction
9. Mood quality - amount of friendly, happy,
pleasant behavior versus unfriendly, unhappy
behavior in various situations
3 Categories of Temperament
1. The Easy Child - Even-tempered regular, and
predictable; they approach new stimuli positively.
Most children are rated by their parents as being
in this category.
2. The Difficult Child - irregular in habits, have a
negative mood quality, and withdraw rather than
approach new situations; are irritable, highly
active, and intense; react to new stimuli with
negative withdrawal. Only about 10% of children
fall into this category.
3. Slow-to-Warm-Up Child - are overall fairly
inactive; respond only mildly and adapt slowly to
new situations, and have a general negative
mood; moody, inactive and moderately irregular;
react with mild but passive resistance to new
stimuli. About 15% of children display this pattern.
Nursing Implications Regarding Temperament
1. Bringing child’s characteristics to parent’s
attention helps them better understand their child
and lays the foundation for beginning to accept
and respect him or her as an individual.
2. Noticing a child’s temperamental characteristics
when he/she is admitted in the hospital can help
you anticipate a child’s probable reactions to
procedure and pain.
Foundations of Growth and Development
1. Prenatal stage extends from conception to
birth/intrauterine
Germinal - approximately 2 weeks
Embryonic - 2 to 8 weeks
Fetal - 8 to 40 weeks; most crucial periods in the
developmental process
2. Infancy Period: birth to 12 months
Neonatal: birth to 27 or 28 day
Infancy: 1 month to 12 months or 1 year
3. Early Childhood: 1 to 6 years
Toddler - 1 to 3 years
Preschool - 3 to 6 years
Middle Childhood/ school age - 6-12 years
Prepubertal - 10 to 12 years
Later Childhood/ adolescence - 12 to 18 years
Theories of Human Development
Theory - a systematic statement of principles that
provides a framework for explaining some phenomenon.
Developmental Theories - provide road maps for
explaining human development
Developmental task - a skill or growth responsibility
arising at a particular time in an individual’s life, the
achievement of which will provide a foundation for the
accomplishment
Theories Of Growth and Development
Sigmund Freud - an Austrian neurologist and the founder
of psychoanalysis; founder of the psychoanalytic theory
and one of the earliest developmental theorists
revolutionized modern thinking about developmental
processes
Psychoanalysis - a clinical method for treating
psychopathology through dialogue between a patient and
a psychoanalyst
3 Levels of Awareness by Sigmund Freud
 1. Conscious - part of the mind which functions
when the person is awake, causing the individual
to be aware of himself, his thoughts, feelings,
perceptions and what is going on in the
environment (the smallest part)
2. Preconscious or subconscious - the
watchman of the mind; contains some partly
forgotten experiences of living, which can usually
recall spontaneously and voluntarily
3. Unconscious - biggest part of the mind because
it is the warehouse for all painful memories;
contains the memories of one’s past life,
particularly those experiences which have been
unpleasant and emotionally painful stored away
from conscious awareness and difficult to recall
except under certain circumstances.
The following are facts or evidences of unconscious
mind:
1. Slip of the tongue/pen (easiest examples which
are experiences familiar to almost everyone; they
elicited without apparent conscious control)
2. Forgetting well-known names, telephone
numbers
3. Jokes
4. Dreams
5. Behaving in a way which is appropriate and safe
in specific situations and circumstances
6. Dropping thing people who are accident prone or
who habitually drop or break articles are said to
be behaving under the influences of the
unconscious mind.
All behavior has meaning. No behavior occurs by accident
or chance, rather all behavior is an expression of feelings
or needs of which an individual frequently is not aware.
3 Structures/Parts of Personality by Sigmund Freud
1. ID – demons; drives, controls the personal needs,
totally self-centered and unconscious; functions
on pleasure principles and demands stat or
immediate gratification
2. EGO – the conscious self; tests and deals with
reality as one interacts with the environment; acts
as a moderator between ID and SUPEREGO;
controls and guides man’s actions; developing 6-
8 months of life and further develop as person
grow older.
3. SUPEREGO – angel; censor judge which helps
individual to distinguish what is right and what is
wrong; the conscience, which is the source of
feelings of guilt, shame and inhibition; functions
on moral principle; developing in the 2nd year of
life and become fully developed when the child
reaches 7 years old
Libido - a sexual instinct or sexual energy
Fixation - immobilization or the inability of the personality
to proceed to the next stage because of anxiety when
psychosexual development cease to advance
child development - Freud being a series of psychosexual
stages in which a child’s sexual gratification becomes
focused on particular body part
Freud’s Psychosexual Stages of Development
1. Oral Stage – Infant (birth to 12 months or 1 year)
Infant is of complete dependence on the caregiver;
explores the world by using mouth, especially the tongue
because they are interested in oral stimulation or pleasure
this time. Infants suck for enjoyment/pleasure or relief of
tension, as well as for nourishment.
The chief erotic activities are:
a) Oral passive – sucking and swallowing
b) Oral aggressive – biting
An individual who is fixated at this stage may have
difficulty in trusting others and may demonstrate nail
biting, drug abuse, smoking, overeating, alcoholism,
argumentativeness and overdependence.
Prolonged or over gratification of oral experiences may
lead to:
1. Alcoholism – alcoholics are orally dependent.
They use alcohol as their emotional crutch;
substitute of milk. Bottle of alcohol is a symbolic
of the breast or bottle of milk
2. Obesity/ overeating
3. Over talkativeness
4. Gum chewing/ tobacco chewing
5. Gossipers
Lack of oral experiences or under gratification may lead
to:
1. Maternal deprivation - inability to form trusting
relationship (can be earned through mother and child
relationship in the first year of life)
2. Faulty maternal-child relationship.
Nursing Implications:
1. Provide oral stimulation by giving pacifiers.
2. Do not discourage thumb sucking.
3. Breastfeeding may provide more stimulation than
formula feeding because it requires the infant to
expend more energy.
2. Anal Stage – Toddler (1 to 3 years old)
One way of releasing their tension is through evacuation
of the bowels and the bladder. During this stage, children
learn to control urination and defecation.
The chief erotic areas:
1. Anus
2. Urethra
The chief erotic activities:
1. Defecation - gratification of the anus
2. Micturition or urination - gratification of the urethra
12-18 months - the appropriate time for “toilet training”.
The result of too rigid/strict/perfectionist toilet training:
1. Overly clean
2. Neat
3. Meticulous person
Result of too lax toilet training
1. No self-control
2. Become stubborn
Fixation at this stage can result in obsessive-compulsive
personality traits, such as obstinacy, stinginess, cruelty
and temper tantrums.
Nursing Implications:
1. Help children achieve bowel and bladder control
without undue emphasis on its importance. If at
all possible, continue bowel and bladder training
while child is hospitalized.
2. Toilet training should be pleasurable experience
and appropriate praise can result in a personality
that is creative and productive.
3. Help children achieves bowel and bladder control
without undue emphasis on its importance.
These are the clues to readiness for toilet training:
can already stand alone; can walk readily; can keep
himself dry for intervals of at least 2 hours; can
demonstrate awareness of voiding or defecating; and is
able to use words or gestures regarding toileting needs.
3. Phallic Stage – Preschooler (3 to 6 years old)
Phallic - “phallus” meaning penis
During this stage the child learns sexual identity
through awareness of genital area.
genital area - the pleasure zone
The chief erotic areas:
1. Penis
2. Clitoris
Chief erotic activity
1. infantile masturbation - is a normal
occurrence to accept child’s sexual interest.
This is the stage of child’s start of body and sexual
awareness. Other children may also show exhibitionism
for their hope that this will lead to increased knowledge of
the two sexes. This is also the period of family triangle,
the battle of father, mother and the child.
Voyeurism - a sexual pleasure by looking at their bodies
and sex organ of the opposite sex
3 Analytical Changes Occurring During This Stage of
Sexual Development.
1. Penis envy and castration fear and
Castration complex
Penis envy - child’s desire to have
Castration fear - little boy’s losing his penis or the feeling
that the penis will be cut off.
Nursing Implication:
1. Postpone any surgical operation during
phallic stage because castration fear may
result to castration complex.
Castration complex - unconscious fear of having one's
genitals removed as a punishment for wishing to
have sex with a parent
2. Oedipus complex and Electra complex
Oedipus complex - baby boy loves his mother, hates the
father and eventually gives up the mother and identifies
with the father.
Electra complex - baby girl loves to his father hates her
mother and eventually gives up the father and identifies
with the mother.
Identification - unconscious imitation of one’s
mannerism, behaviors, feelings, either of feminine or
masculine traits.
Fixation at this stage can result in difficulties with sexual
identity and problem with authority.
Nursing Implications:
1. Accepts child’s sexual interest, such as fondling
his/her own genitals as normal area of
exploration. Deviate the child’s attention to
something creative.
2. Do not punish the child just give toys to play as a
substitute.
3. Help parents’ answers child’s questions about
birth or sexual differences.
4. Encourage identity.
4. Latency Stage - School age 6-12 years old
Latent - means quiet or dormant
➢ The child’s personality development appears to
be non-active or dormant.
➢ This is the time in which children’s libido appears
to be diverted into concrete thinking and sexual
impulses tend to be repressed.
school activities - child’s focus
Period of: ➢ While Freud looked at ways mental illness
develops, Erikson looked at actions that lead to
1. gang formation mental health
2. hero worship
3. normal homosexuality ➢ Erikson describe 8 developmental stages
covering the entire life span. At each stage there
Unresolved conflicts at this stage can result in is a conflict between two opposing forces. The
obsessiveness and lack of self-motivation. resolution of each conflict, or accomplishment of
Nursing Implications: developmental task of that stage, allows the
individual to go on to the next phase of
1. Help a child to have a positive experience so developmental stage.
his/her self-esteem continues to grow and the
child prepares for the conflicts of ➢ These development tasks can be viewed as a
adolescence. series of crises and successful resolution the
2. Encourage child with physical and intellectual crises are supportive to the person’s ego.
pursuits. ➢ Failure to resolve the crises is damaging to the

5. Genital Stage: Adolescence (12 and older)

Adolescence - develops sexual maturity and learn to
establish satisfactory relationships with the opposite sex;
the establishment of new sexual aims and the finding of
new love objects.
Energy is directed toward:
1. Attaining a mature heterosexual
development
2. Reactivation of the pregenital impulses
The genital conflicts can result in sexual problems
1. Rigidity
2. Impotence
3. Inability to have a satisfactory sexual
relationship.
Nursing Implications:
1. Provide appropriate opportunities for the
child to relate with opposite sex.
2. Allow child to verbalize feelings about new
relationship.
3. Encourage separation from parents,
achievement of independence and decision
making.
Erikson’s Theory of Psychosocial Development
Erik Homburger Erikson – German - American
developmental psychologist and psychoanalyst known for
his theory on psychological development of human
beings; trained in psychoanalytic theory but later
developed his own theory of psychosocial development
psychosocial development - a theory that stresses the
importance of culture and society in the development of
the personality
➢ One of the main tenets of his theory, that a ego. After attaining one stage the person may
person’s social view of himself/herself is more fall back and need to approach it again.
important than instinctual drives in determining
behavior, allows for a more optimistic view of the
possibilities for human growth.
Jean Piaget – Cognitive Development Theory
Cognitive development - manner in which people learn
to think, reason, and use language; involves a person’s
intelligence, perceptual ability, and ability to process
information.
Three Primary Abilities:
1. Assimilation - process through which humans
encounter and react new situations by using the
mechanisms they already possess.
2. Accommodation - process of change whereby
cognitive processes nature sufficiently to allow
the person to solve the problems that were
unsolvable before.
3. Adaption, or coping behavior, - ability to handle
the demands made by the environment.
According to Piaget (1966), cognitive development is an
orderly, sequential process in which a variety of new
experiences (stimuli) must exist before intellectual
abilities can develop.
5 Major Phases of Piaget’s Developmental Process
1. Sensorimotor Phase (Birth to 2-y.o.)
2. Preconceptual Phase (2-7 y.o.)
3. Intuitive Thought Phase
4. Concrete Operations Phase (7-11 y.o.)
5. Formal Operations Phase (adolescent – adult)
INFANCY
I - SENSORY MOTOR (birth to 2 years old)
a) Neonatal Reflex (1 month)
Motor stage - words and symbol for thinking and problem
solving are not yet available to the children at this stage.
At the beginning of infancy, babies relate to the world
through the senses, using reflex behavior.
b) Primary circular reaction (1–4 months)
During this time, the child studies objects grasped by her
hands and mouth in an attempt to discover which one is
permanent.
➢ Primary – refer to activities related to the child’s
own body.
➢ Circular reaction – to demonstrate the repetition
of behaviors occurs.
c) Secondary circular reaction (4–8 months
Secondary - used to denote activities separate from the
child’s body. Infant learns to initiate, recognize, and
repeat pleasurable experiences from environment,
This is the transitional phase to the pre-operational
thought period. The child uses memory and imitation to
act, can solve basic problems, and foresee maneuvers
that will succeed or fail. Examples: if a box is given,
children will investigate how the top of the box can be
removed, if given a second, even one that varies in shape,
- transitional phase to the pre-operational thought period;
example: when a baby hit a mobile and notice that his
hand make it move so hits it again.
New processes of human behavior occurred and
these are:
a) Imitations requires the differentiation of selected
acts from several events
b) Play become evident as children take pleasure in
performing an act after they have mastered it.
c) Affect is the outward manifestation of emotion &
feeling. Seen in infant begin to develop a sense
of permanency.
4. Coordination of secondary schema (8-12 months)
➢ Infant can plan activities to attain specific goals
e.g., can search for and retrieve toy that
disappears from view, and recognizes shapes
and sizes of familiar objects.
➢ Good toy: nesting toys (i.e., colored boxes)
Crucial events take place during this phase:
1. Separation – infants learn to separate
themselves from other objects in the environment
2. Object Permanence – realization that objects
that leave the visual field still exist. This skill
develops at 9-10 months of age. Example: they
look for hidden object under pillow.
3. Ability to use symbols or mental
representation – this allows the infant to think of
an object or situation without actually
experiencing it
TODDLERS
➢ completed the 5th and 6th stages of sensorimotor
phase & starts the preoperational thought at 2
yrs. of age.
❖ Tertiary circular schema – 12-18 months
Toddlers solve problems by trial and error to discover
new characteristics objects and events.
The child achieves the following tasks
1. experiment to discover new properties of objects
and events
2. capable of space perception and time perception
as well as permanence
3. objects outside self are understood as causes of
actions
➢ Good game for this period is throws and
retrieve.
❖ Invention of new means - 18-24 months
child uses memory and imitation to act, can solve basic
problems, and foresee maneuvers that will succeed or fail
➢ Good toys: blocks, colored plastic rings.
PRESCHOOLER
II – PREOPERATIONAL THOUGHT (2-7 yrs.)
➢ During this period preoperational thinking is
concrete and tangible.
egocentric - unable to see the viewpoint of another
static thinking - inability to remember what he/she
started to talk about so that at the end of a sentence the
child is talking about another topic
➢ No awareness of reversibility (for every action
there is an opposite action) is present. Unable to
state cause-effect relationships, categories, or
abstractions.
Intuitive - receiving input and ideas without knowing
exactly how and where it got (e.g., the stars have to go to
bed just as they do.)
transductive - the child fails to understand the true
relationships between cause and effect.
Good toys: modeling clay
III – CONCRETE OPERATIONAL THOUGHT (7-12
years)
➢ thought becomes increasingly logical and
coherent
➢ Children are able to classify, sort, order and
organize facts about the world to use in problem
solving
➢ Reasoning and self-regulation begin to develop
➢ Children realize that physical factors such as
volume, weight, and number remain the same
even though outward appearances are changed
They do not have the capacity to deal in abstraction; they
solved problems in a concrete, systematic fashion based
on what they can perceive. Reasoning is inductive (from
specific to general), less centered and they can consider
points of view other than their own.
Good activity: collecting and classifying natural
objects such as native plant, sea shell, etc.
ADOLESCENT
IV – FORMAL OPERATIONAL THOUGHT (12 years)
➢ cognition achieves its final form
➢ characterized by adaptability and flexibility
➢ can solve hypothetical problems with scientific
reasoning; understands causality and can deal
with the past, present and future
Good activity: “talk time” to sort through attitudes and
opinions.
Kohlberg’s Theory of Moral Development
Lawrence Kohlberg
➢ American psychologist best known for his theory of stages of moral development
➢ studied the reasoning ability of boys and based on Piaget’s developmental stages, and developed a theory on the
way children gain knowledge of right and wrong or moral reasoning.
moral maturity - According to Kholberg, ability to independently decide for oneself what is “right”

Age (Year) Stage Description Nursing Implications

Preconventional Level 1 Child does right because a Child needs help to
Punishment/obedience orientation parent tells him/her to and to determine what right actions
(heteronomous morality). 1 avoid punishment. are.
Give clear instructions to
avoid confusions.
2-3 2 Carries out actions to satisfy Child is unable to recognize
Individualism own needs rather than that like situations require
Instrumental purpose and societies. like actions.
exchange/ Instrumental relativist Will do something for another Unable to take responsibility
orientation if that person does something for self-care because
for the child. meeting own needs
interferes with this
Interpersonal concordance 3 Orientation to interpersonal Child enjoys helping others
7-10 relations of mutuality. because this is “nice”
Child follows rules because of behavior.
a need to be a “good” person Allow child to help with bed
in own eyes and eyes of making and other like
others. Approval of others is activities.
sought through one’s actions. Praise for desired behavior
Authority is respected. such as sharing

Law and order orientation 4 Maintenance of social order,
10-12 fixed rules and authority
Child finds following rules
satisfying.
Follows rules of authority
figures as well as parents in
an effort to keep the “system”
working.
Post Level III) Social contract, utilitarian law-
Conventional/ making perspectives.
autonomous / principled 5 Follows standards of society
Social contract orientation for the good of all people.
Older than 12 It is “wrong” to violate others
right
Universal ethical principle 6 Follows internalized standards
orientation. of conduct. The persons
understand the principles of
human rights & personal
conscience. He believes that
trust is basis for relationship.
May have difficulty modifying
a procedure because one
method may not be “right”.
Follows self-care measures
only if someone is there to
enforce them.
An adolescent can be
responsible for self-care
because he/she views this as
a standard of adult behavior.
Many adults do not reach
this level of moral
development.
Fowler’s Spiritual Development
James W. Fowler
➢ American theologian who was Professor of
Theology and Human Development at Emory
University.
➢ He stated that faith and religion are not
synonymous and should not be considered as
such.
Faith – According to Fowler, it is “a generic feature of
the human struggle to find and maintain meaning”
- “a human universal”
the “ultimate environment” - the versions of the world
that individuals create in their minds that shape the ways
in which they understand and live in the real world
Faith - results from interactions and experiences that
individuals have in the various components that make up
their lives and unites these components so that they can
feel their lives are “whole”
Faith or spiritual dimension - a force that gives meaning
to a person’s life
James Fowler’s Spiritual Development
Stage 0: Undifferentiated (0-3 yrs.)
➢ children have no concept of right or wrong, no
beliefs, and no convictions to guide their
behaviors
➢ unable to formulate concepts about self or the
environment.
The “first pre-images of God have their origins” in this
stage as individuals begin to develop a sense of trust in
others.
Stage 1: Intuitive-projective (4-6 years)
➢ A combination of images & beliefs given by
trusted others, mixed own experience &
imagination
Toddlerhood - time of imitating the behavior of others.
intuitive-projective faith - spans the ages of two through
six or seven
- individuals have developed language and are
capable of drawing on stories that have been told
to them as well as images they have seen to form
conceptions of God
Stage 2: Mythical-literal (7-12 years)
➢ spiritual development parallels cognitive
development and is closely related to
children’s experiences and social interaction
7-10 y.o. - capable of narrating stories that they
understand in literal terms
Stage 3: Synthetic-convention (adolescent)
➢ influenced by puberty and adolescents’
development of self-images that are formed
based on how they think others see them
➢ During this stage, “a person has an ‘ideology,’ a
more or less consistent clustering of values and
beliefs, but he or she has not objectified it for
examination and in a sense is unaware of having
it”.
➢ Developed conceptions of faith from various
influences; yet do not engage in active personal
reflection
➢ Recognize that prayers are not always answered
and may begin to abandon or modify some
religious practices
Stage 4: Individuating-reflexive.
➢ People can adopt new value systems as a result
of exposure to different ways of life
➢ Result of questioning the faith conceptions that
had previously been circumscribed to them
➢ Adolescents become more skeptical and begin to
compare the religious standards of their parents
with those of others. It is the time for searching
rather than reaching. The individual assumes
responsibility for own attitudes and beliefs.
Stage 5: Paradoxical consolidative.
Conjunctive faith - individuals are capable of exploring
other religions and belief systems in such a way that their
own views can be either reinforced or amended.
➢ They are able to merge conceptions that
previously seemed to be in opposition to one
another without feeling that their own belief
systems are being jeopardized, with this stage
usually occurring during middle-age.
➢ Integrates other perspectives about faith into own
definition of truth. Awareness of truth from a
variety of viewpoints.
Stage 6: Universalizing faith:
➢ Individuals are willing to “sacrifice the self and to
risk the partial justice of the present order for the
sake of a more inclusive justice and the
realization of love”
Martin Luther King Jr. and Gandhi - examples of
individuals who reached the sixth stage of faith
development
Sullivan’ s Theory of Interpersonal Development
Herbert “Harry” Stack Sullivan (1892– 1949)
➢ American Neo-Freudian psychiatrist and psychoanalyst who held that the personality lives in a complex of
interpersonal relations.
➢ Focused on interpersonal relations as important behavioral motivators and the source of psychological health
➢ He acknowledges the importance of environment (especially the home), and also emphasized the role of social
approval and disapproval in forming a child’s self-concept.
➢ Believed that personality development was largely the result of childhood experiences, interpersonal encounters,
and the mother-child relationship
➢ According to him, poor environmental interactions caused anxiety and tension; a positive social relationship resulted
in security, a major life goal.
self-concept - key to personality development

Stage Age Characteristics

Infant Birth to 18 months Developmental task oral gratification; -anxiety first occurs
Learns to rely on others, especially mothers, “good me/bad me”
emerges.
“Good me” feelings occur when acceptance is sensed.
“Bad me” feelings occur when the infant experiences anxiety while
interacting with caregivers.
“Good me/Bad me” fuse around 18 months of age, but the dominant
“me” can change with situational or maturational crises.
Early Childhood 18 months to 6 years Developmental task delayed gratification
Learns to clarify communication; recognizes approval or disapproval;
delays gratification.
Able to communicate with others thereby facilitating interpersonal
relationships.
Late childhood 6 to 9 years Developmental task: Forming peer-relationships
Increasing intellectual abilities, learns to control behavior and own
place in the world
-Learn to pay attention to other’s wishes, forms satisfying relations with
peers of both genders, and sometimes oppose rules.
 -Learn to accept subordination from authority figures (parents,
teachers, other adults) and develop a sense of their own status and
role in society.

Preadolescence 9 to 12 years Developmental task: Same-sex relationships

- Vulnerable to teasing; “chum” important – become interested in
relating closely to a peer of the same gender. “Chums” may share
secrets, fantasies, dreams and realities of life, and often collaborate,
experiment, explore, and manipulate people, and the environment.
- Those who do not have a chum may experience difficulty with
relationships later.
Early 12 to 15 years Developmental task delayed gratification
Adolescence Developmental task: Opposite-sex relationships
Learns to clarify communication; recognizes approval or disapproval;
delays gratification.
-Able to communicate with others thereby facilitating interpersonal
relationships.
Late childhood 6 to 9 years Developmental task: Forming peer-relationships
Increasing intellectual abilities, learns to control behavior and own
place in the world
Learn to pay attention to other’s wishes, forms satisfying relations with
peers of both genders, and sometimes oppose rules.
Learn to accept subordination from authority figures (parents, teachers,
other adults) and develop a sense of their own status and role in
society.
Preadolescence 9 to 12 years Vulnerable to teasing; “chum” important – become interested in relating
closely to a peer of the same gender. “Chums” may share secrets,
fantasies, dreams and realities of life, and often collaborate,
experiment, explore, and manipulate people, and the environment.
Those who do not have a chum may experience difficulty with
relationships later.
Early 15 to 19 years Masters expression of sexual impulses, forms responsible and
Adolescence satisfying relationships with others – believes initial feelings of love for
the opposite gender emerge here.