Module 2

ASTRA EDUCATION
CURRICULUM
MODULE 2
The Child & Adolescent
Learner and Learning
Principles
Haggai Training and Development Services
PATERNO D. AGUILA
Leonora A. Atanacio
REVISED EDITION
January 2023
Module 2 │The Child and Adolescent Learner & Learning Principles
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THE CHILD AND ADOLESCENT LEARNER AND LEARNING PRINCIPLES
Course Outline
I. Course Description:
This course focuses on child and adolescent development with emphasis on current
research and theories on biological, linguistic, cognitive, social, and emotional dimensions of
development. Further, this includes factors that affect the progress of development of the
learners and appropriate pedagogical principles applicable for each developmental level of the
learners. The course also addresses laws, policies, guidelines, and procedures that provide safe
and secure learning environments, and the use of positive and non-violent discipline in the
management of learner behavior.
II. General Objectives of the Course
This course specifically aims to:
 Theories and etiology of addictions and addictive behaviors

 Biological, neurological, and physiological factors that affect
human development, functioning, and behavior
 Systemic and environmental factors that affect human
development, functioning, and behavior
Ethical and culturally relevant strategies for promoting resilience
and optimum development and wellness across the lifespan
 Characteristics, risk factors, and warning signs of students at risk
for mental health and behavioral disorders
Common medications that affect learning, behavior, and mood in
children and adolescents
Defining Children and Childhood
Introducing Child Development Thinking into Programme Planning
Risk and Resilience in Children and Adolescents
Some Critical Threats to Child Development in Emergency Situations
Promoting Child and Adolescent Development in Programming
Action in “the Best Interests of the Child
Child and Adolescent Participation

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II. Course Outcomes
By the end of the semester, students will be able to articulate their understanding and
application of:
 Developmental theories and their major points, including strengths and weaknesses, of
various theories presented
 Developmental stages and influences
 The relationships between physical, cognitive, and social development from birth through
adolescence.
 Environmental influences that can impact the accomplishment of developmental
tasks.
IV. Course Requirements
Regular attendance
Quizzes
Examinations (Prelim, Midterm and End term)
Active Participation
Individual and Group Activities
Reporting and oral presentation
V. Teaching Approaches/Strategies
Individual Self-Inventory
Reporting
Collaborative and Cooperative Learning
Open discussion/Brainstorming (Dyadic or Group)
Observe different students
Individual activities
VI. Academic Performance Evaluation System
Examination (Prelim, Midterm and End term) ……..................... 30%

Quizzes………………………………………………………………. 30%
Participation……………………………...…………………………. 10%
Attendance……………………………………………….………… 10%
Outputs/Report Presentation…………………………...........…… 20%
Total …………………………………………………...............…. 100%
VII. Academic Infrastructure
Textbooks/References
1. Ahuja A, Baird S, Hicks J Hamory, Kremer M, Miguel E, editors; . 2017. “Economics of

Mass Deworming Programs.” In Disease Control Priorities (third edition): Volume 8,

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Child and Adolescent Health and Development, edited by Bundy D A P, Silva N de,
Horton S, Jamison D T, Patton G C, editors. . Washington, DC: World Bank.
2. Alderman H, Behrman J, Glewwe P, Fernald L, Walker S. 2017. “Evidence of Impact on
Growth and Development of Interventions during Early and Middle Childhood.” In
Disease Control Priorities (third edition): Volume 8, Child and Adolescent Health and
Development, edited by Bundy D A P, Silva N de, Horton S, Jamison D T, Patton G C,
editors. . Washington, DC: World Bank.
3. Alderman H, Bleakley H. 2013. “Child Health and Educational Outcomes.” In Education
Policy in Developing Countries, edited by Glewwe P, editor. 107–36. Chicago, IL:
University of Chicago Press.

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INTRODUCTION TO CHILD DEVELOPMENT AND EDUCATION
This is a book about human development, an interdisciplinary field of study. Human

development involves biological transformation: from a single cell to a fetus to an infant and
then to a toddler. A child matures into an adolescent, who matures into an adult, who ages and
eventually dies. Human development also includes psychological changes—from a newborn
who exhibits more reflexes than intentional behaviors to a child whose thinking is more
concrete than abstract. In turn, the child becomes an adolescent who’s thinking gradually
becomes more abstract and hypothetical. Teenagers soon become adults, whose intellectual
powers increase across the lifespan in some ways and decline in others. Development also
involves social changes— for example, from a newborn experiencing people as sensations to an
infant who is attached to his or her caregivers to a preschooler with an expanding social world.
The world of peers becomes increasingly important as the child grows older and enters
adolescence. Some basic themes have shaped the study of development and over decades have
provided a framework for how to think about developmental theory and research. So, we begin
this book with an overview of some of the concepts and movements that have defined
developmental science and some of the controversies and uncertainties that surround these
ideas.
Children and adolescents are not short adults - they are qualitatively different. They have
physical, psychological and social needs that must be met to enable healthy growth and
development. The extent to which parents, the family, the community and the society are able
to meet these developmental needs (or not) has long-term consequences for the kinds of adults
they will become. Armed conflict, displacement, disruption of normal life, and separation from
family and/or community can have powerful, long-lasting effects that need to be compensated
for in protection and assistance interventions. The fact that almost half of the people of concern
to UNHCR are children and adolescents, gives quantitative significance to these operational
issues. Children and adolescents are not a homogenous group. While they share basic universal
needs, the expression of those needs depends on a wide range of personal, social and cultural
factors. The protection and assistance interventions of UNHCR and its partners are less likely to
achieve their intended impact if a population of concern is treated as an undifferentiated group.
To be effective, an understand is necessary, in a given situation, of what differences among
gender, age, maturity, social class or caste, cultural or religious background have operational
implications. Taking these factors into account is basic to good programming. Children need the
care, protection and guidance which is normally provided by parents or other care-givers,
especially during the early years when they are most dependent. While their emerging abilities
and capacities change the nature of this vulnerability from infancy through adolescence, their
need for attention and guidance at each stage remains. Parents and communities have the
primary responsibility for protecting and caring for their children, and initiating them into
culturally relevant skills, attitudes and ways of thinking. Interventions by outsiders are
significant largely to the extent that they strengthen (or inadvertently undermine) family and
community capacities to provide this care and protection.

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What is Child and Adolescent Development?
“The field of child and adolescent development is different than clinical or psychological
counseling,” says Gilman. “It’s a unique specialization, more focused on research linked to
development, and what’s involved in making ethical decisions and policies that are related to
children and adolescents.”
Development research can influence practitioners who work with children, whether directly
(teacher or counselor), or indirectly (nonprofits or government advocates focused on children’s
issues). It’s an exhaustive field of study. “We study everything from prenatal to puberty to the
completion of adolescence, which we define as around age 25,” said Longo. “We look at every
aspect of a person’s life, at every stage: physical, mental, cognitive, psycho-social. We’re
studying development in the context of society, family, and culture. Everyone has specific
influences bearing on them, and we need to understand the effects of those influences, whether
it’s bullying or access to health care. Every phase has an impact on life—someone’s experience
as an infant can have an effect on them when they’re an adult.”
“We study everything from prenatal to puberty to the completion of adolescence, which we
define as around age 25,” says Longo. “We look at every aspect of a person’s life, at every stage:
physical, mental, cognitive, psycho-social. We’re studying development in the context of society,
family, and culture. Everyone has specific influences bearing on them, and we need to
understand the effects of those influences, whether it’s bullying or access to health care. Every
phase has an impact on life—someone’s experience as an infant can have an effect on them
when they’re an adult.”
Why is this type of research important?
“Anyone working with children and adolescents needs to use best practices. Their work can’t
just be based on experience—they need empirical evidence,” says Longo. “Without research,
That’s why the broad approach, looking at internal and external factors, is so important. “It’s
not just nature and it’s not just nurture,” says Emick. “In order to really understand what’s
happening now, and what’s going to happen in the future, we need understand how to make
outcomes better for children, families, and society. Research is fundamental to that.”
Emick points out that understanding adolescent psychology has led to some important strides,
including the realization that brains aren’t fully formed until about age 25 (it was previously
believed that people were fully mature at age 18). She also points to a recent program that,
using research, realized the best way to reach out to pregnant teenagers to warn them about the
dangers of drinking while pregnant was not to send them a brochure, but a text message.
The field continues to evolve, and that’s likely a constant for the foreseeable future. “For
instance, we’re still learning about resiliency,” Gilman says. “Why are some kids resilient and
some not, even if they’re in the same circumstance? When we can understand through research
what conditions create resiliency, maybe we can help a child develop that attribute.”

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What career opportunities are available with an advanced degree in this field?
There are some obvious career synergies with this type of education. People who work directly
with children and adolescents, like teachers and psychologists, would gain insight and value
from this program.
“But there are so many areas, so many directions someone can go,” says Longo. “From prenatal
counseling to government advocacy work to nonprofits that focus on children and adolescents.
A master’s degree also opens up the possibilities of teaching, whether at the K-12 level or at a
community college.” All three faculty members pointed to advocacy as an area that’s poised for
growth.
That could explain why Capella’s faculty sees such a diverse background in students who enroll
in this program. “I’ve had students who are social workers and want more background on what
they’re doing,” says Emick. “There have been paraprofessionals, like daycare workers and
school aides. There are students who have been volunteering at youth-based nonprofits, or
those who want to work in advocacy or at a government level, or who want to develop
educational materials. We’ve had students who are licensed counselors who want more insight
into developmental issues.”
What all of these students have in common is a passion for children and adolescents and the
desire to work with or on behalf of them. “They need that excitement,” says Emick, “and this
program really gives them a solid foundation from which to explore what’s possible for a career
and the many capacities in which they can help kids.”
On its own, a master’s in child or adolescent development does not qualify someone to become
a licensed counselor. But this specialization can be a stepping stone to a clinical psychology
PsyD or PhD that would open up a career in counseling.
Adolescent Development
• Adolescence is one of the most rapid phases of human development.

• Biological maturity precedes psychosocial maturity. This has implications for policy and
programme responses to the exploration and experimentation that takes place during
adolescence.
• The characteristics of both the individual and the environment influence the changes taking
place during adolescence.
• Younger adolescents may be particularly vulnerable when their capacities are still developing
and they are beginning to move outside the confines of their families.
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• The changes in adolescence have health consequence not only in adolescence but also over the
life-course.
• The unique nature and importance of adolescence mandates explicit and specific attention in
health policy and programmes.
Recognizing Adolescence
Adolescence is a period of life with specific health and developmental needs and rights. It is
also a time to develop knowledge and skills, learn to manage emotions and relationships, and
acquire attributes and abilities that will be important for enjoying the adolescent years and
assuming adult roles.
All societies recognize that there is a difference between being a child and becoming an adult.
How this transition from childhood to adulthood is defined and recognized differs between
cultures and over time. In the past it has often been relatively rapid, and in some societies it still
is. In many countries, however, this is changing.
Age: not the whole story

Age is a convenient way to define adolescence. But it is only one characteristic that delineates
this period of development. Age is often more appropriate for assessing and comparing
biological changes (e.g. puberty), which are fairly universal, than the social transitions, which
vary more with the socio-cultural environment.
Age is a convenient way to define adolescence. But it is only one characteristic that delineates
this period of development. Age is often more appropriate for assessing and comparing
biological changes (e.g. puberty), which are fairly universal, than the social transitions, which
vary more with the socio-cultural environment.
Adolescence: Physical Changes
Adolescence is one of the most rapid phases of human development. Although the order of
many of the changes appears to be universal, their timing and the speed of change vary among
and even within individuals. Both the characteristics of an individual (e.g. sex) and external
factors (e.g. inadequate nutrition, an abusive environment) influence these changes.
Adolescence: Neurodevelopmental Changes
Important neuronal developments are also taking place during the adolescent years. These
developments are linked to hormonal changes but are not always dependent on them.
Developments are taking place in regions of the brain, such as the limbic system, that are
responsible for pleasure seeking and reward processing, emotional responses and sleep
regulation. At the same time, changes are taking place in the pre-frontal cortex, the area
responsible for what are called executive functions: decision-making, organization, impulse
control and planning for the future. The changes in the pre-frontal cortex occur later in
adolescence than the limbic system changes.

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Adolescence: Psychological and Social Changes
Linked to the hormonal and neurodevelopmental changes that are taking place are psychosocial
and emotional changes and increasing cognitive and intellectual capacities. Over the course of
the second decade, adolescents develop stronger reasoning skills, logical and moral thinking,
and become more capable of abstract thinking and making rational judgements.
Changes taking place in the adolescent’s environment both affect and are affected by the
internal changes of adolescence. These external influences, which differ among cultures and
societies, include social values and norms and the changing roles, responsibilities, relationships
and expectations of this period of life.
Implications for Health and Behavior
In many ways adolescent development drives the changes in the disease burden between
childhood to adulthood—for example, the increase with age in sexual and reproductive health
problems, mental illness and injuries.
The appearance of certain health problems in adolescence, including substance use disorders,
mental disorders and injuries, likely reflects both the biological changes of puberty and the
social context in which young people are growing up. Other conditions, such as the increased
incidence of certain infectious diseases, for example, schistosomiasis, may simply result from
the daily activities of adolescents during this period of their lives.
Many of the health-related behaviors that arise during adolescence have implications for both
present and future health and development. For example, alcohol use and obesity in early
adolescence not only compromise adolescent development, but they also predict health-
compromising alcohol use and obesity in later life, with serious implications for public health.
Implications for Policies and Programmes
The changes that take place during adolescence suggest nine observations with implications for
health policies and programmes:
• Adolescents need explicit attention.

• Adolescents are not all the same.
• Some adolescents are particularly vulnerable.
• Adolescent development has implications for adolescent health.
• Adolescent development has health implications throughout life.
• The changes during adolescence affect how adolescents think and act.
• Adolescents need to understand the processes taking place during adolescence.
• To contribute positively, adults need to understand the processes taking place during
adolescence.
• Public health and human rights converge around concepts of adolescent development.

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KEY CONCEPTS
The following are the key concepts, which are addressed in this Resource Pack. These can also
be found in Overhead 1.0.
1. There is no universal definition of children or of childhood. Childhood is a cultural and social

construction, and not simply a universal stage in the human being’s physical and psychological
development.
2. Children and adolescents have needs and capacities that are significantly different from those
of adults.
3. Although certain general features of child development are predictable, there are significant
cultural differences in the ways in which children and adolescents develop, and in the beliefs,
goals and expectations and childrearing practices that shape development.
4. Gender differences are especially significant, as are differences related to social status,
class/caste and specific needs – e.g. related to disability.
5. It is important to integrate both a child rights and a child development perspective into
programme planning.
6. Armed conflict and forced migration are likely to impose various risks which may have a
particularly serious impact on children’s development: these risks can be both multiple and
cumulative.
7. Children and adolescents also have the capacity to be resilient in the face of adversity. The
concept of resilience directs attention to those factors within the individual, the family and the
wider context which help people to cope with adversity.
8. Strengthening supportive networks may be the most effective way of enabling children and
their families to cope with adverse circumstances.
9. Conflict and migration can pose some particularly critical threats to the development and
well-being of children and adolescents: these include experiences of violence and fear;
separation from parents or other caregivers; exploitation and abuse; and involvement in
fighting forces.
10. In situations in which children’s development is under threat because of sudden

displacement, a high priority should be given to restoring a sense normality in their lives and
by protecting them from further threats to their development.
11. The Best Interests of the child is an important principle in both legal and child development
contexts, and can be applied to individual children and more generally in programming. But
implementing it sometimes requires handling complex and contradictory considerations.
12. As well as being an important legal right, child participation can promote child and
adolescent development and can enhance decision-making about young people. Clarity of
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objectives and methods, a careful consideration of issues of culture, gender and age, and the
real commitment by the adults involved will greatly facilitate effective implementation of this
important principle.
Topic 1: Defining Children and Childhood

Key Learning Points
• There is no universal definition of who is a child, adolescent or youth. Chronological age is

not a sufficient criterion for establishing operational definitions.
• Childhood is understood in very different ways in different contexts. Childhood is a social

and cultural construction, not merely a stage in physical and psychological development.
• Children and adolescents can be especially vulnerable because of their immaturity and
dependence, but it is important also to recognize their potential and resilience. A child-centered
situation analysis may be important in identifying and assessing the particular needs of
children in particular situations.
Although it is common to define children by reference to age and the level of children’s
biological and psychological development, definitions of children and of childhood are much
more complex than this.
DEFINING CHILDREN BY AGE
The Convention on the Rights of the Child (Article 1) states that “a child means every
human being below the age of 18 years unless, under the law applicable to the child, majority is
attained earlier” (this appears as Overhead 1.2). While this definition provides a point of
common reference for international organisations, NGOs and governments, operational
definitions in the field may differ. For example, the International Committee of the Red Cross
defines an unaccompanied minor as “below 15 years of age and not being accompanied by an
adult”. In contrast, the UNHCR definition is consistent with the CRC and sets “under 18” as the
age for inclusion in family tracing services. During the return of African National Congress
members to South Africa, the term “youth” was widely applied to single young men, frequently
up to the age of thirty-five. In other countries, the threshold for youth may be at a much
younger chronological age. In many situations of conflict and displacement, the accuracy of
children’s ages may be in question. Lack of official birth records can combine with the fact that,
in many societies, exact dates of birth are of little importance. In others, children are considered
to be aged one at birth. In the context of very high infant mortality, new-born may not be
formally named or even recognized until they have passed a full year, when it becomes more
certain that they will survive. In many cultures there is a distinction between different stages of
childhood especially between stages of the “innocence” or “ignorance” of childhood and a later
stage of “reason” and “responsibility”. Many legal codes define the age at which children are
legally deemed to be responsible for their actions.

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AVOIDING ASSUMPTIONS ABOUT VULNERABILITY IN CHILDREN AND
ADOLESCENTS
Children may be especially vulnerable because of their immaturity and reliance on

adults for their care and protection. But it is also important to remember that resilience as well
as vulnerability is a characteristic of the growing human organism. This will be explored in
more detail in Topic 3. Many different factors, relating to the individual child, the family, the
immediate social situation and the wider cultural context may combine to place children in a
position of risk of threats to their well-being, development and rights. The capacity to anticipate,
acknowledge and assess such factors is fundamental to the effective protection of children.
In many refugee contexts, programme responses emphasize children of primary school

age, who are frequently the most visible group of children. However, the relative invisibility of
other groups of children (pre-school children, and adolescents for example) sometimes leads to
their relative neglect in programming. Limited visibility of children with disabilities may mean
that there are relatively few disabled children within the particular population, or alternatively
that they are shut away out of sight and possibly away from human contact and stimulation.
Many of the typically-identified sub-groups of vulnerable children may interact and overlap -
for example, separated children, street children, child soldiers, child headed households and so
on. While it may be vital to identify particular groups of children whose development and well-
being is threatened, the targeting of special assistance to these groups of children may have
negative, unintended consequence if the long-term goals of social and economic integration are
not fully appreciated. A child-centered situation analysis is an important tool for assessing the
particular needs of various categories of children and adolescents who may require special
attention if their assistance and protection needs are to be met adequately. The views of the
children themselves, the opinions of adult community members and the insights of local leaders
are all essential in determining the extent to which particular children may be at risk. Reference
may be made to the ARC Resource Pack on Situation Analysis for further information on this
subject.
Training Materials for Topic 1
Overhead 1.1: Key Learning Points for Topic 1 Summary of the key learning points
Overhead 1.2: CRC Definition of Who is a Child
Provides the text for the CRC, Article 1
Overhead 1.3: Views of Children and Adolescents
Topic 2: Introducing Child Development Thinking into Programme Planning

Key Learning Points
It is important to integrate both a child rights and a child development perspective into
programme planning. • Although certain aspects of child development are predictable and
universal, there are significant cultural differences in the ways in which children and
adolescents develop. • The process of child development can be described as transactional:
children and adolescents are not the passive subjects of socialization, but play a central role in
their own development. • Children and adolescents have needs and capacities which are

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significantly different from those of adults. • Armed conflict and forced migration are likely to
have a particularly serious impact on children’s development which may have long-term
consequences.
CHILD RIGHTS AND CHILD DEVELOPMENT
Although there is a growing recognition of the importance of a child rights perspective

in emergency situations, it is equally important to integrate knowledge of child development
into programming. Child Rights refers to a set of universal rights and principles which have
been given legal status through their expression in the articles of the CRC. The CRC lays down
fundamental principles which are necessary to promote and secure the survival and
development of children. Some articles in the CRC do employ concepts of child development –
e.g. the concepts of immaturity, evolving capacities, “the child’s health, or physical, mental,
spiritual, moral or social development” etc. – see Articles 6, 12, 14, 23, 27, 29 and 32. Children’s
rights issues are explored in more detail in the ARC Resource Pack on International Legal
Standards. Child Development concerns the process of growth and maturation of the human
individual from conception to adulthood. Development is best understood within a lifespan
perspective, with growth and change beginning at conception and throughout the foetal stage,
continuing throughout childhood and adolescence and, in some respects, during adulthood and
old age. During the whole period of his or her development, the individual child will develop a
mature body, brian and nervous system and progressively acquire competence in a wide range
of functions and skills which enable him or her to adapt and survive in many different types of
environment. There are significant cultural differences in children’s developmental pathways,
goals for development and the conditions under which children develop satisfactorily. For
example, while in the West the “ideal norm” is often seen as child rearing within a small, two-
parent family, in other cultural contexts, child rearing tasks are shared among a wider network
of adults and, significantly, among older siblings. Within a particular culture, children of the
same chronological age will nevertheless differ in their level of development because of the
complex interplay of genetic and environmental factors. So, for example, although it can be
safely predicted that children will enter puberty at around the ages of 11 - 15, the onset of
puberty will differ from individual to individual, between the genders (girls typically mature
earlier than boys) and between contexts – for example, the onset of puberty may be delayed in
situations in which there is chronically poor nutrition. Moreover, there will be marked cultural
differences in the way that various changes which characterize the early adolescent period are
understood, and in the expectations for young people’s behavior, especially in relation to their
gender.
Genes also “steer” biological development, the “programme” of emergence of different

functions and levels of competence as the child grows. But within a transactional model of
development, many factors in the environment will interact continuously with the individual
child’s biological potentialities and vice versa to produce developmental effects. For example,
although certain genes determine the basic structure of the brain, it is known that the quality of
adult-child interaction - the way the baby is held, talked to and stimulated - actually influences
the more detailed structure of the brain, the quantity of interconnections between the brain cells
and eventually how the brain functions. Various physical, intellectual and sensory disabilities
can have an obvious and possibly profound impact on the development of the child. Arguably,
however, it is not so much the disability itself, but the way disability is viewed and disabled
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children are treated that has the greatest detrimental effect. Here the transactional nature of
child development is clearly visible: the child who is slow to develop, for example, may be
unrewarding to his or her care-taker and as a consequence may receive less attention and
stimulation. In many cultures, disability confers a sense of shame on the family, while in others
there is to be found a fatalistic attitude which often results in an under-investment in the child.
In some cases, ignorance about the nature of the child’s disability can have very adverse
consequences – for example the mistaken assumption that cerebral palsy inevitably leads to
learning disability. In such situations, children may be deprived of stimulation and attention, of
food and comfort, and of contact with other children – all of which can have a massively
adverse impact on the child’s development. Facilitators are referred to the ARC Resource Pack
on Disability for further information on this subject: in particular, Exercise 7.1 may be used to
illustrate the impact on the child of lack of educational and other opportunities.
SOME GENERAL FACTORS AFFECTING CHILD DEVELOPMENT IN CONFLICT AND

DISPLACEMENT SITUATIONS
All children and adolescents have basic physiological, social and emotional needs which
must be met to ensure healthy development. Some needs are shared in common with adults,
but others are specific to particular ages and stages during childhood. For example, very young
children have a particular need for consistent, secure patterns of care and nurturance, though
these needs can be adequately met through a wide range of family and care systems. If their
needs are not adequately met, young children’s development may be impaired and this may
have long-term impact.
Armed conflict and forced migration impose a potentially wide range of threats to
children’s development. Not infrequently in such situations, children face the potential for an
accumulation of risks: for example, the malnourished child may do less well at school, and poor
school performance may pre-dispose the young person to exploitative work. Separation from
the family may place the child at risk of exploitation while the child who is being abused within
the family may be vulnerable to recruitment into armed forces. It is important to understand
what kind of risks children may be facing and how these may pre-dispose children to other
risks so that appropriate intervention can be planned. Similarly, when any kind of programme
is planned, whether or not children are targeted, it is important that the question is posed
“What effect will it have on children’s rights and child development”? Armed conflict and
displacement occur in many different social, cultural and political contexts, and last for different
lengths of time, but there are a number of factors which pose particular threats to the growing
child which are characteristic of conflict and forced migration situations. It is vital for protection
and assistance agencies to be aware of these in order that they can take steps both to prevent
their worst effects and to deal with them if they do occur. It is also important to understand
how families, children themselves and communities recognize these risks, and how they
respond to lessen them and handle the consequences. Some of the most common impacts on
child development of situations of forced displacement (apart from the four specific areas dealt
with in Topic 4) are listed below.
•Wholesale loss of the child’s home, familiar circumstances, people, possessions etc.

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• Cold and excessive heat can be life-threatening to very young children who do not yet have
fully-developed temperature regulation systems and have little fat under the skin. Even in
relatively hot climates, night temperatures may become very low. Intense heat without fluid
replacement can also be life-threatening.
• Crowded accommodation, lack of health services, lack of clean water and adequate sanitation
can conspire to pose particular threats to the health of the growing child. Inadequate
immunization programmes, lack of capacity to control infectious diseases and poor health
services are likely to have a considerable impact on the healthy development of children and
adolescents.
• Malnutrition is closely linked to disease, especially infectious diseases. Under-nourished

children have less resistance to disease, and once they have a diarrhea or respiratory infection,
eat even less so that a cycle of disadvantage is set up which can quickly lead to death.
Children’s nutritional needs are significantly different from those of adults. Severe clinical
malnutrition which can begin in the foetal state and continue into the first one or two years of
life is associated with long-term effects on the development of the cognitive and behavioral
aspects of development as well as competence in motor functioning. It appears that the risk is
greatest if there is also growth failure. Chronic malnutrition can lead to stunted growth.
• Chronic poor health, often associated with malnutrition, can affect the child’s natural
inclination to explore and learn from the environment and opportunities for taking part in
school and other social activities. Overheads 2.2 and 2.3 illustrate the effects of nutritional
deficiency.
• Physical injuries can also be associated with armed conflict: for example, bomb blasts can
lead not only to shock and anxiety but to hearing loss, which in turn may affect school
performance. Bombs, shells, bullets and land-mines can cause a wide range of physical
disabilities and psychological threats.
• Loss of educational opportunities can have far-reaching effects on children’s development.

Children whose primary education is disrupted often find it difficult to return to schooling later
in their childhood. Girls are particularly likely to be disadvantaged educationally. The absence
of basic education violates the rights of children and often proves to be a life-long handicap.
• Lack of opportunities for play: although children’s play takes different forms for children of
different ages and genders in different cultures, play is an essential and universal feature of
childhood through which children explore, learn, co-operate, cope and adjust. Through play,
children not only develop skills and competencies, but also handle and re-enact difficult life
experiences and express their feelings about them. In conflict and refugee situations, play may
be inhibited by a number of factors, including pressures on the time of parents and other careers;
the possibility of their own anxieties making them emotionally unavailable to the children; lack
of spaces for play; and anxieties about security which may lead parents to restrict their
children’s movements. Topic 4 of this Resource pack examines some of the more specific and
critical threats to child development which are particularly encountered in the context of armed
conflict and forced migration. These consist of; experience of violence and fear; separation;

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exploitation and abuse; and association with armed forces. Firstly, however, Topic 3 of this
Resource Pack will examine the linked concepts of risk and resilience.
Overhead 2.1: Key Learning Points for Topic 2 Summary of key learning points
Overhead 2.2: The Effects of Nutritional Deficiency (1)
How Nutritional Deficiency Can Affect Children’s Development and behavior –
Unborn children, Infants and Toddlers
Overhead 2.3: The Effects of Nutritional Deficiency (2)
Topic 3: Risk and Resilience in Children and Adolescents
Key Learning Points
• In situations of conflict and forced migration, children and adolescents may face an
accumulation of risk factors which may pose a serious threat to their development.
• The concept of resilience directs attention to “protective factors” within the individual, the
family and the wider context which help people to cope with adversity.
• Children’s resilience is intrinsically linked with that of their parents or other careers.
• Strengthening supportive networks may be the most effective way of enabling children and
their families to cope with adverse circumstances.
This Topic overlaps with Topic 3 in the ARC Community Mobilization Resource Pack, which
also includes a number of training materials which are relevant to the issue of resilience.
RISK FACTORS FACING CHILDREN AND ADOLESCENTS IN EMERGENCY

SITUATIONS
In Topic 2, it was suggested that children and adolescents in situations of conflict and
forced migration are likely to face a range of risks and threats to their development.
Displacement is often to be seen as a threat to the social, emotional and intellectual
development of children and adolescents owing to the fact that they have experienced massive
change and that their environment has experienced wholesale disruption. However, in
assessing situations of risk it is important to avoid making assumptions that exposure to a
particular risk or hazard will automatically have a harmful effect on children: the concept of
resilience is a useful framework for examining the way in which different people in similar
circumstances may react quite differently to threats to their development and well-being.

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RISK AND RESILIENCE IN CHILDREN AND FAMILIES
The psycho-social well-being of children in difficult circumstances can be seen as a

product of the balance between, on the one hand the presence of certain risk factors and, on the
other, the existence of certain protective factors. Where the presence of protective factors helps
to counteract the effects of risk factors, the person can be regarded as resilience.
Risk Factors:
Many aspects of the situation of displaced children and adolescents can be seen as risk
factors. Many of them will have had experiences of violence, loss and wholesale disruption to
their lives, and often such stresses are compounded by other factors in the context of
displacement. The many risk factors commonly experienced by displaced children and
adolescents include:
• previous traumatic experiences of violence, separation, fear etc.;
• loss of the family home, familiar surroundings, friends, familiar people etc.;
• loss of self-respect and self-confidence;
• poor diet and nutritional status;
• lack of opportunities for education;
• lack of opportunities for play and recreation;
• excessive burden of paid and/or unpaid domestic work;
• uncertainty about the future.
These points appear as Overhead 3.2.

In addition, children’s well-being is intrinsically linked with that of their parents: this
means that the risks to which parents (or other carers) are exposed will also affect the children.
These risks may include, in addition to the above:
• poor health;
• mental health problems such as depression and anxiety;
• lack of access to health and support services;
• separation from spouse;
• relationship problems and tensions in the marriage;
• excessive demands on their time;
• unemployment and lack of access to economic opportunities;
• lack of material resources;
• worries about other family members and about the future.

For both parents and children, the presence of multiple risk factors, especially if they
stem from both past traumatic experiences and current stresses, can disproportionately increase
the risk. An accumulation of risk factors is likely to adversely affect the child’s development,
and in turn this place him/her at increased susceptibility to other risk factors. Protective Factors
Protective factors serve to shield both parents and children from the worst effects of such risk
factors and thereby contribute to resilience. Some of these protective factors relate to the
characteristics, assets or resources of the individual such as the following:
• cognitive competence - a reasonable level of intelligence, skills in communication,
realistic planning etc.;
• a positive sense of self-esteem, self-confidence and self-control;
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• an active coping style rather than a passive approach - e.g. a tendency to look to the
future rather than to the past;
• a sense of structure and meaning in the individual’s life, often informed by religious or
political beliefs, a sense of coherence etc. In addition, protective factors are also a product of the
child’s immediate social environment such as the following:
• good and consistent support and guidance from parents or other care-givers;
• support from extended family and friendship/community networks, teachers etc., and
the re-establishment of a normal pattern of daily life;
• an educational climate which is emotionally positive, open and supportive;
• appropriate role models which encourage constructive coping.

In situations of conflict and forced migration, many of the child’s personal resources
may have been undermined, and many of his or her social support systems may have been
destroyed or disrupted. For parents or other care-givers, various personal characteristics will
serve to limit, or enhance resilience: within their immediate social environment, protective
factors may include:
• a supportive marital relationship;
• support from the extended family;
• supportive community structures - e.g. informal support from community, neighbors,
women’s associations etc.;
• access to appropriate health and support services;
• opportunities to re-establish an acceptable economic base for the family.

The presence of such protective factors for parents will enhance their capacity for
offering appropriate support to their children, but again many of these will have been adversely
affected by conflict and forced displacement. Exercise 3.1 may be used to illustrate the
interaction between risk and protective factors for children and their parents or other care-
givers, while Exercise 3.2 provides an opportunity for participants to consider risk and
protective factors in a case study.
STRATEGIES TO ENHANCE RESILIENCE
It will be clear from the above that resilience in children is a product of personal
characteristics, the family environment and the availability of other forms of social support
outside of the family, and the interaction between these factors. A focus on the child’s resilience
has the advantage of directing attention to people's strengths rather than their weaknesses; it
underlines the need to identify and strengthen existing support networks within the
community; and it directs attention to those children and families whose assets and resources
may need strengthening, as well as to those who may continue to be especially vulnerable even
when these resources are in place. A resilience approach can be considered in two ways: first, a
risk-focused approach in which intervention is based on the identification of specific actual or
potential risk factors. Examples of such a strategy are: the prevention of child abuse or neglect
through parent and community education; a prevention of separation campaign in mass
movements of people; a reduction in teenage drinking, smoking or drug mis-use through
community-based or youth-to-youth programmes; supplementary feeding programmes where
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children’s nutritional status is unsatisfactory. Topic 4 of this Resource Pack considers some
critical threats to child development in emergency situations, and these are cross-referenced to
other ARC Resource Packs which provide detailed information on the particular critical issue.
A second strategy may be described as a resource-focused approach which will aim to

prevent and reduce risk for the population as a whole by improving the number and quality of
resources available to support children and their families. Sometimes this will consist of
strengthening existing community resources, and possibly reinforcing cultural norms and
practices that seem to facilitate resilience: in other situations, new resources such as clubs for
children or facilities for parents will be required. Topic 5 of this Resource Pack provides a
framework for promoting child and adolescent development through community-based
interventions. Underlying both approaches is the need to view children and adolescents as
active agents in their own development, and not as passive victims of adversity. Assessments of
children need to include their competences, assets, strengths and resources as well as their
problems and areas of vulnerability. The active involvement of young people can be a vital
component in preventing and reducing risk and in enhancing resilience. Issues of Child and
Adolescent Participation are considered in Topic 7, while the community mobilization of young
people is considered in more detail in the ARC Resource Pack on Community Mobilization,
Topic 8. Topic 5 of the ARC Resource Pack on Working with Children provides more practical
ideas on how the concept of resilience can be applied to children whose psycho-social well-
being has been affected by their experiences of violence and displacement.
Topic 4: Some Critical Threats to Child Development in Emergency Situations

INTRODUCTION
This topic is designed to provide a basis of knowledge which links directly with other
ARC Resource Packs - notably Separated Children, Working with Children, Exploitation and
Abuse and Child Soldiers. Facilitators are referred to these for further information on each of
these subjects, and in particular on some of the key issues involved in programmes. Throughout
this Topic, it is important to remember that child-rearing practices vary a great deal between
different cultures. Much of the research on threats to child development - separation and loss
for example - have taken place in western societies and hence cannot simply be transferred to
other cultural settings. Therefore, there is no substitute for examining, within any particular
context, how children have reacted to the situation facing them: this requires a child-centered
situation analysis which directly accesses the views, wishes and feelings of the people involved
- the children, their careers, community leaders, teachers etc. Facilitators are referred to the ARC
Resource Pack on Situation Analysis – especially Topic 3 – for further information and ideas on
this.
4.1 EXPERIENCES OF VIOLENCE AND FEAR

Key Learning Points
• Traumatic events such as violence, sudden flight, loss and intense fear are likely to have
immediate, and maybe long-term, effects on children and adolescents.

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• The nature of their reactions will depend on many different factors, including age, individual
characteristics and temperament, and the quality of care and support they receive from their
family and other significant people in their social environment.
Children living in areas affected by armed conflict risk experiencing a number of threats
to their development and well-being. These typically involve intense fear, witnessing and
perhaps experiencing brutal violence at close quarters, witnessing the destruction of property
(possibly including their own homes) and the necessity of fleeing in panic. Children living in a
situation of more prolonged conflict may have to face the constant anxiety of fighting or
bombing intruding into their lives, coping with the presence of land-mines or unexploded
ordnance. Many of these experiences can have both immediate and longer-term effects on
children’s development and well-being.
Children living in areas affected by armed conflict risk experiencing a number of threats
to their development and well-being. These typically involve intense fear, witnessing and
perhaps experiencing brutal violence at close quarters, witnessing the destruction of property
(possibly including their own homes) and the necessity of fleeing in panic. Children living in a
situation of more prolonged conflict may have to face the constant anxiety of fighting or
bombing intruding into their lives, coping with the presence of land-mines or unexploded
ordnance. Many of these experiences can have both immediate and longer-term effects on
children’s development and well-being.
The immediate effects of such events on children depend particularly on: • the meaning
of the event for the child (and his/her family) and, most importantly, whether the event caused
the loss of one or both of his/her parents or carers;
• the stage of development of the individual child;
• the personal characteristics of the child;
• the presence or absence of supportive adults, particularly their familiar carers;
• whether the child was personally involved either as a victim or perpetrator. Longer-
term developmental effects may depend on factors such as:
• the extent to which those in the child’s immediate environment react to the changed
behavior, appearance or social status in the child;
• the degree to which highly significant losses can be replaced - such as parents or other
important carers;
• the degree to which further traumatic experiences can be avoided;
• the extent and quality of assistance which the child and family receive;
• the extent to which the events have changed the child’s “life-plan” (i.e. his or her
anticipated life course covering such things as where he or she lives, type of life-style,
expectations for the future - for example, institutionalization following the loss of parents or
carers). Pregnant and lactating mothers may be particularly at risk from violence and the
deprivations of war. Premature delivery, still-births, loss of breast-milk are all possible
consequences. Young children who have had frightening and confusing experiences may
regress - i.e. lose (usually temporarily) developmental gains such as speech or control of
bladder and bowel. Disturbances in sleep and eating habits are also common. These kinds of
reactions may be compounded in situations where the parents or other carers become
depressed or anxious and may have less energy for and interest in the child. Where traumatic
experiences are compounded by the loss of parents or other carers, or separation from them,
reactions and distress may be greatly magnified (see section on Separation below). The apparent
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loss of capacity to play is sometimes observed, or children become preoccupied with themes of
violence, death etc. in their play and drawing. The developmental effects of violence and other
frightening events on older children usually have to do with their capacity to form relationships,
and to learn.
The capacity and will to form relationships can be disturbed by experiences which
destroy trust and which create fear and suspicion in others. This is especially significant where
children lose people close to them, whether through death or separation. Children can become
depressed and hence unable to mobilize interest in learning. Children who become withdrawn
can easily be overlooked in the classroom, especially if there are many children. Others may
retain their will to learn but be troubled by flashbacks - sudden intrusive images of the
traumatic experience which can disturb concentration and motivation. Other symptoms include
an increase in aggression and the various physiological complaints such as headaches, loss of
appetite and energy, mood changes and other signs of anxiety. Older children may also display
a sense of guilt that they have survived when others have not. During the adolescent period,
exposure to violent and frightening experiences can have a particularly pronounced effect.
Their capacity for learning and for forming relationships can be disturbed, and in some cases,
faced perhaps with the loss of educational opportunities and a disturbed developmental life-
course, many adolescents may come to sense a lack of meaning in life and future perspectives.
Young people of this age can experience many of the symptoms which may affect younger
children: extreme fear and anxiety may cause a delay in the onset of puberty. Criminal activity
with peers, drug and substance abuse and other forms of anti-social behavior may represent a
form of meaning as well as an outlet for deep frustration. The vulnerability of adolescents to
voluntary recruitment into armed forces reflects the severe impact of traumatic events at this
crucial stage of development. Facilitators are referred to the ARC Resource Pack Working with
Children for further ideas and training materials on issues related to children who have been
psychologically affected by their experiences.
4.2 SEPARATION FROM PARENTS OR OTHER CARERS

Key Learning Points
• Separation from, or loss of, parents or other familiar carers, may have both short-term and
long-term effects on children of all ages.
• The effects of separation will be different according to the age of the child, his or her level of
intellectual development, maturity, gender and the nature and duration of the separation. •
Some significant cultural differences can be observed.
• A child’s limited sense of time may limit his or her understanding of the likely duration of
the separation.
• Separation is likely to be associated with other threats to child development, including loss of
home and familiar surroundings and the experience of violent or frightening events.
Attachment to care-givers is one of the most fundamental building blocks of child development,
as this bond is critical to the child’s immediate welfare. Most of the research into the effects of
separation have been undertaken in western societies where there has been a strong emphasis
on attachment to a single care-taker, usually the child’s mother. In many other cultures, young
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children have, and are attached to multiple care-takers - mothers, grand-parents, older siblings
etc. Experiences of separation and loss will have differing impact depending on the child’s age,
level of intellectual development, emotional maturity, gender and the nature and duration of
the separation. It will also vary between cultures. In general, however, it seems that infants are
likely to react to separation with evident anxiety.
For infants under the age of about 4 - 6 months, separation is not normally associated
with distress, provided their needs for warmth, food, comfort and stimulation are met. The
reason for this is that up to this age, the infant has not yet learned to recognize the individual
career and that attachment bonds have not yet been formed. Research evidence from the West
suggests that the period from birth to 2 or 3 years is particularly important for the formation of
bonds and the development of attachment behavior. Separation during this period has the
greatest distress reaction, especially between about 6 and eighteen months of age. If separation
is prolonged, it is not unusual for children to regress (i.e. revert to behavior typical of younger
children): for example, the child may become more demanding and want to be fed, or refuse
food altogether, may be more fearful at night, speak less clearly by reverting to “baby talk”,
become more fearful of strangers, and perhaps relinquish the achievement of bladder and
bowel control. The notion of attachment is not limited to the phase of early childhood. School
aged children will also react to loss and separation through other behavior, including denial,
depression, increased aggression, sleep disturbance and physical symptoms such as headache,
stomach-ache and shortness of breath. While adolescents may have learned conventions about
the control of grief, and have acquired cognitive capacities to understand more about what is
happening to them, they continue to benefit from the structure of family life.
The opportunity for adolescents to receive support and guidance from adult mentors
and role models allows for significant developmental gain, as the attitudes, beliefs and values
they adopt during the adolescent period may become lifelong. There is some evidence that
separation during adolescence has a more profound long-term effect than separation
experienced by younger children. One of the reasons for this may be that separation can disrupt
the young person’s sense of self and his/her emerging sense of identity. Research in western
societies has suggested that separations can have long-term effects on children. However, it
seems most likely that the majority of long-term effects are not a product of separation, but of
the lack of adequate substitute care that follows on from separation. It seems clear that
separated children cope best when they are cared for by caring adults (or sometimes older
siblings) who provide an appropriate level of affection, care and stimulation.
Good quality of care is rarely available in an institutional setting. Wherever possible,

children (especially those of pre-school age) should be provided with care within a family
setting. Where children have experienced multiple carers (i.e. where caring tasks are shared, for
example between the child’s mother, older siblings, grandparents etc.), the distress will
probably be minimized if they are able to maintain contact with at least one of their previous
care-takers. For this reason, it is especially important that brothers and sisters should be kept
together whenever possible. In cultures in which siblings have an important role, care within a
supported child-headed family may be preferable to separation from siblings resulting in care
by strangers.

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In the context of separation and the provision of substitute care, another important
feature of child development concerns the child’s sense of time. Young children have yet to
acquire the capacity to appreciate time as measured by the clock or calendar. The baby will not
seek an object that has been taken from sight: it has simply gone! The infant cannot use thinking
to hold on to the image of the departed parent, while children aged around 4 - 6 years of age are
more likely to grasp time as related to events such as “meal-time”, “bed-time” etc. Similarly,
children under the age of around 5 may have difficulty in understanding the concept of death
and may not realize that a deceased parent is not going to return. Reassurances that a separated
child may be able to return to her parents within a few days/weeks/months may have little
meaning and will provide little comfort. When policy-makers and practitioners use terms such
as “interim care” or “short-term placement”, these may have little meaning to children
themselves. Again, however, it should be remembered that there may be significant differences
between cultures.
4.3 EXPLOITATION AND ABUSE

Key Learning Points
• Children and adolescents in situations of conflict and forced migration are at greatly increased
risk of various forms of abuse and exploitation.
• Exploitation and abuse can take many different forms, and any particular instance needs to be
understood within its particular social and cultural context.
• The impact of exploitation or abuse can be profound, and will vary according to the
particular circumstances: it is important to understand both the objective nature of the
experiences and the meaning, and subjective evaluation by the individual child.
• Abuse or exploitation within the family can have particularly profound consequences for the
child’s development. There is now a great deal of evidence that children with a background in
conflict or displacement are at greatly increased risk of various forms of abuse and exploitation.
It is also clear that the presence of one risk factors may make children more vulnerable to other
risks, hence an accumulation of risks can occur: for example, the separated child may be at
enhanced risk of abuse and exploitation, while a child facing abuse within the family may be at
enhanced risk of recruitment into fighting forces. The terms “exploitation” and “abuse” cannot
be used in an absolute or universal sense: rather behavior towards a child which might be
deemed to be abusive or exploitative needs to be seen against cultural norms and standards.
This issue is dealt with in the ARC Resource Pack Abuse and Exploitation,
Topic 1.
In the area of child labour, for example, it is important not to impose a western concept
of childhood (which largely excludes paid work) and not to make the blanket assumption that
all forms of child work are exploitative or damaging to children’s development. On the other
hand, some of the most damaging aspects of work can be psychological in nature and relatively
invisible to the outside observer. Included within the definition of exploitative child labour is
work that interferes with the child's ability to access education whether because of the hours or
any other reason. Children may be more susceptible to some types of work hazards than are
adults because they are in the process of growth and have particular developmental needs:
carrying excessively heavy loads can have a serious and permanent effect on the child’s growth.
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On the other hand, research has demonstrated that working children can have an extraordinary
ability to weigh the complex costs and benefits of work.
In determining whether work is harmful, two sets of criteria may be used. First, the
objective conditions of their work: this may include such criteria as:
• the nature of children’s work activities;
• the nature of the work environment;
• the presence of specific hazards (physical and psychological);
• the nature of the employment relationship. Second, the subjective value given to the
work by the children themselves.
For example, where children perceive that the benefits (e.g. pride in contributing to the
family economy, satisfaction and learning derived from the work) largely outweigh the costs
(e.g. working long hours), it seems that this may partly shield children from the worst effects of
work. Again, it is important to avoid assumptions about the impact of work on children: for
example, it is often assumed that children should not be working because they should be in
school. However, it is clear that many working children can only attend school if they earn
enough to pay their own school fees and expenses. It is important that a thorough situation
analysis is undertaken, which includes a careful attempt to elicit the views of the children
themselves. Gender issues may also be significant: in some cultures, girls tend to carry an
excessive burden of unpaid domestic work, sometimes in addition to paid work outside of the
family. Frequently this is a factor in school enrolment figures which show a bias in favor of boys.
All of these issues are elaborated in the Resource Pack on Abuse and Exploitation.
Topic 3.
The sexual abuse and exploitation of children will frequently have severe and far-
reaching effects, depending on the age, gender and temperament of the child, the nature and
duration of the experience, the identity of the abuser and the quality of support received,
especially from the child’s family. Although the majority of sexually abused and exploited
children will be girls, it is important to remember that boys can also be involved, and that there
may be even greater underreporting of abuse against them than is the case with girls. The
impact of sexual exploitation can be experienced on various levels, including:
• physical consequences - including genital injury, STDs and the contraction of
HIV/AIDS, and unwanted pregnancy;
• emotional consequences can include the trauma of violent exploitation which can have
similar effects to those of other traumatic experiences (see previous discussion);
• in some societies, a sense of shame at having been violated, and especially if
pregnancy results, can have severe consequences for the child;
• social consequences can include ostracism by the family or community especially if the
child is disbelieved or blamed for what has happened. In some cultures, sexual exploitation will
have a negative effect on the child’s chances of marrying;
• secondary trauma can result if the incident is handled insensitively - e.g. aggressive
interviewing of the child, insensitive medical examination etc. All of these can have both
immediate and long-term impacts on children’s development. Abuse within the family
(whether physical, sexual, emotional abuse or neglect) can have particularly serious
consequences for the child’s development. It will be important to consider not just the
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immediate physical and emotional impact of the abuse on the child: abuse within the family
constitutes a gross breach of trust in the adults who are charged with the responsibility for
caring for and protecting the child. Because of the child’s age and developmental stage, he or
she may be powerless to resist or protect him/herself from abusive behaviour.
4.4 CHILDREN’S INVOLVEMENT IN FIGHTING FORCES

Key Learning Points
• Children associated with fighting forces are likely to have lived in a rigid hierarchical
structure and may have acquired a distorted morality based on power, fear and brutality.
• Involvement in violence and brutality and possibly in involuntary and inappropriate sexual
activity may have a severe impact on age appropriate and culturally acceptable behavior.
• Demobilization may raise significant issues in terms of identity and self-esteem and the sense
of purpose in life. • Not all of the child’s experiences with fighting forces will necessarily have
been negative: it is important to acknowledge any positive elements and to consider the child’s
loss of them in any rehabilitative programme. There is a growing awareness not only of the
particular needs of child soldiers, but of those of other children who are involved in fighting
forces - children abducted or otherwise forcibly recruited not just as fighters but for use as
“human shields”, porters and camp assistants, or for sexual purposes. One of the most
challenging effects on children of such experiences is that they have spent a significant part of
their childhood in a strictly hierarchical structure and have experienced a socialization process
which serves the purposes of a military command. Clearly such experiences may make it
difficult for children, upon release, to adjust and to re-learn new codes of behavior and how to
develop relationships not based on power and fear.
Children who have participated in violence and killing have probably been given
messages about what such actions mean from the vantage point of armed forces: again, this
may mean that children have to re-learn moral behavior and acquire the ability to make moral
judgement appropriate to civilian life. Some children do realize the terrible nature of their
previous actions and hence may suffer greatly because of that realization and the guilt and
shame associated with it. Girls who have been on active duty may find particular difficulty in
adjusting to expected ways of how girls should behave in their society, and this may affect
marriage prospects as well as adjustment to the role of wife and mother. Girls are particularly at
risk of rape and prolonged sexual abuse, and this may affect the normal development of age-
appropriate and culturally acceptable behavior: in turn this can pose a challenge for successful
social integration. Some children - especially those who have had positions of responsibility in
the fighting forces - may have particular difficulty in adjusting themselves to civilian life where
their status is no longer recognized.
Even young children may have taken on “adult” roles, responsibilities and authority:
this may make it extremely difficult to return to the expectations associated with childhood - e.g.
conforming to the norms and rules of school, or to the discipline and expectations of the family
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and community. An essential aspect of rehabilitation is finding ways of promoting children’s
self-esteem and a sense of hope and confidence in the future: this may be particularly difficult
for children who have been recruited, partly as a reflection of their own perceptions of the lack
of opportunities available within their own community. Experience suggests that once these
children reintegrate back into more normal life in the community, many struggles with poor
self-esteem and a confused sense of who they are, and need long-term support from their
families and communities. It is not surprising that many remain vulnerable to re-recruitment.
One aspect of life within fighting forces that is not always well recognized is that children may
well have had some positive experiences, intermingled with many negative and brutalizing
ones.
For example, they may have been part of a highly supportive group-living situation,
they may have had a strong sense of purpose, perhaps with in ideology which, though possibly
imposed through an indoctrination process, may have given a sense of meaning to their actions.
They may also have had strong personal relationships with their commanders despite the
potential for an exploitative and brutal aspect of this relationship. These more positive sides of
their experience cannot always be readily replaced, but unless children do have opportunities
for good adult and peer-group relationships, a sense of purpose and self-esteem, they are likely
to experience great difficulties in returning to more normal civilian life in the community. The
implications of these impacts on child development are explored in more detail in the ARC
Resource Pack on Child Soldiers.
Topic 5: Promoting Child and Adolescent Development in Programming

Key Learning Points
• There are many potential threats to the development of all children and adolescents in
situations of armed conflict and displacement.
• Restoring a sense of normality in their lives may be achieved by restoring community

structures, by re-establishing a routine and purpose to daily life, by promoting family life and
parental competence and by building on the strengths and capacities of young people and
advocating for their rights.
• Protecting children and adolescents from further harm may be achieved by avoiding further
separations, inappropriate “trauma” responses, the unnecessary isolation of “vulnerable
groups” and the further victimization of victims.
• The presence of some risk factors may increase the vulnerability of children and adolescents
to other, additional risks.
The previous Topic examined some of the more specific and critical threats to young
people: Topic 5 returns to the theme introduced in Topic 2, that all children and adolescents in
situations of armed conflict and forced migration face threats to their development and well-
being. “Resource-focused” interventions may help to prevent risk, and enhance resilience by
increasing the range of protective factors available to young people who are already at risk. A
wide range of interventions can serve to promote child development by restoring a sense of

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normality in children’s lives and by preventing further harm. This Topic provides an
introduction to some of the most important of these.
RESTORING A SENSE OF NORMALITY IN THE LIVES OF CHILDREN AND

ADOLESCENTS
1. Restoring Community Structures Situations of armed conflict - and especially the

experience of flight and displacement - are enormously disruptive to children’s lives by
creating massive change which frequently involves significant losses, and by seriously
altering the child’s life course and sense of purpose and direction. Displacement
undermines the social networks and institutions (family, school, religious organization,
community etc.) which support normal development, emotional security, relationships
that support children’s learning and their sense of self and identity. Forced migration
tears the fabric of society and thus the developmental consequences on children are best
viewed within their social and cultural context. Interventions which help restore
previous social structures, which facilitate the setting-up of new and adaptive structures
and which strengthen the capacity of existing social networks are most likely to yield
positive impact for children’s development: some of these issues are elaborated in the
ARC Resource Pack on Community Mobilization - see especially Topics 3, 5 and 6.
2. Restoring a Structure, Routine and Purpose to Daily Life For children and adolescents,
establishing predictability is enabled through the trust, purpose and meaning that comes
from sustained contact with the same people, from familiar routines and from continuity
of cultural practices. Daily structured activities - including play and recreation, informal
and formal school and, where appropriate, work is especially important for children of
all ages. Structure in daily life conveys a sense of purpose and dependability that can be
a calming, stabilizing element for the whole community as well as for its children. It also
helps engender feelings of responsibility and respect for other people. Activities should
be responsive to the needs, concerns and resources of the population and might include
some of the following:
• organized play and safe spaces for free play;

• appropriate sports activities for girls and boys;
• traditional music, songs, dance, theatre, story-telling and familiar festivals;
• acquiring traditional knowledge and skills;
• drawing and painting;
• schooling - formal and/or non-formal as appropriate, and vocational training (see
ARC Resource Pack on Education, especially Topics 2 and 4);
• key health, sanitation and nutrition and safety messages, including mines awareness
where appropriate;
• training in conflict resolution skills such as communication, negotiation and decision
making. Gender issues need to be acknowledged: for example, in some situations, it may
be easier for girls to continue to carry out traditionally-prescribed roles than for boys –
especially in situations where it is impossible for boys to carry out tasks in relation to
agriculture and other areas of work. On the other hand, in some contexts, girls are much
less likely to have opportunities to attend school or take part in other social activities.

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3. Promoting Family Life and Parental Competence One of the most important
contributions that can be made to improve children’s well-being is to help the adults in
the family to re-build a sense of effectiveness as parents.
In a camp context in South East Asia, adolescents who had violated camp regulations
were routinely placed in the camp stockade or jail. They were not separated from adult inmates
and were subjected to both exploitation and abuse. In an extreme case, despite the protests of a
refugee worker, one refugee youth was removed from the camp and placed in the local jail.
Again, he was not segregated from adult inmates and upon his eventual return to the camp,
medical examination revealed that he had been repeatedly sexually abused. This extreme
situation prompted another review of the camp’s detention policy, and ultimately the camp
authorities accepted the responsibility for dealing with disciplinary matters for youth within the
confines of the camp and in consultation with the child-focused agencies who were operating
there.
A group of Sri Lankan children who had lost one or both parents in the civil war were
refused entry to primary school because they had no birth certificate, and insufficient money to
pay the high fee demanded to obtain one. An international NGO working in the country
brought the facts to the notice of the National Child Rights Coalition, which took the matter up
with the education authorities. The children received their birth certificates and were able to
attend school.
A national NGO, in collaboration with an international NGO, persuaded Rwandan

authorities to allow women in prison to place their children with extended family outside of the
prison. The establishment of a policy on regular return visits to their mothers helped maintain
attachment between mother and child during the separation. For the children who remained
with their mothers in prison, a stimulation programme was organized.
PROTECTING CHILDREN AND ADOLESCENTS FROM FURTHER HARM
Unfortunately, it is not uncommon for interventions intended to assist children and

families to actually make matters worse. The following are some examples.
1. Avoiding Further and Unnecessary Separations Unintended separations can easily

result from policies such as opening residential centers, careless documentation
when children or their parents are admitted to hospital or feeding centers, or the
poorly-organized evacuation of children and families from dangerous areas. The
prevention of separation is considered in the ARC Resource Pack on Separated
Children, Topic 2.
2. Inappropriate “Trauma” Programmes can be Deeply Damaging Protecting children

from further harm may require a careful appraisal of the means used to support
them in coping with their experience of violence and displacement. Exploring these
sensitive issues and the meaning they hold for a child can be important to the
process of healing and recovery: but they require expertise in therapies appropriate
to the context, and should take place in a stable, supportive environment with the
participation of care-givers who have a solid and continuing relationship with the
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child. In-depth clinical interviews intended to awake the memories and feelings
associated with the child’s worst moments may be very harmful, especially if
conducted with an unprepared child by a stranger with limited knowledge of the
culture. This kind of interview risks tearing down a vulnerable child’s defenses and
leaving him/her in a worse state of pain and agitation than before. For a child in a
stressful and unsafe situation, it may be a good coping strategy to avoid recalling
traumatic experiences. In any case, talking about intimate feelings and fears with
anyone but one’s closest family is taboo in many cultures. These issues are explored
in more detail in the ARC Resource Pack Working with Children, Topics 3, 4 and 5.
3. Avoiding the Inappropriate Isolation of “Vulnerable Groups” Actions to address the

needs of vulnerable groups of children and adolescents should ensure their long-
term reintegration into their communities, and avoid the short-term assistance that
may increase the probability of their marginalization. Institutionalization, for
example, frequently results in further marginalization and alienation from the wider
society. Targeting separated children, orphans, former child soldiers etc. for special
material assistance may be motivated by the desire to assist vulnerable categories of
young people, but may inadvertently heighten the potential for stigmatization and
conflict, especially in situations where material scarcity is the norm. Similarly,
isolating “psychological trauma” from the other difficult and stressful aspects of the
lives of children and offering a decontextualized form of “treatment” can label
children unhelpfully, isolate them from their peers and ignore current aspects of
children’s lives which are creating difficulties.
4.
Overhead 5.2: Steps to Promoting Child Development in Situations of Conflict and
Forced Migration
Key Points
Exercise Ex5.1: Promoting Child Development in Programming
Case Study Exercise
Exercise Ex5.2: Identifying Opportunities for Promoting Child Development
Discussion Exercise
Topic 6: Action in “The Best Interests of the Child”

Key Learning Points
• Whenever a decision is to be made that will affect an individual child, or a group of children,
their best interests should be a primary consideration: this is a fundamental principle in the
Convention on the Rights of the Child, is an important principle in promoting child
development, and is enshrined in UNHCR’s policy framework.
• “Best Interests” is a clear, simple concept: but implementing it often requires handling
complex and sometimes conflicting considerations in which complete information may not be
available.

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• Decisions in a child’s Best Interests are likely to have to be made by individuals with
appropriate qualifications and expertise, including the ability to engage the child himself or
herself in considering the various options.
• “The Best Interests of the Child” principle is a valuable tool in programming, in monitoring
and for impact assessment. A child-centered situation analysis, in which young people
themselves are involved, may be required in order to assess the likely impact of particular
policy decisions on children.
“THE CHILD’S BEST INTERESTS” IS A FUNDAMENTAL PRINCIPLE IN

DISPLACEMENT SITUATIONS
The Best Interests principle is found widely in national law regarding children, and its
inclusion in Article 3 of the United Nations Convention on the Rights of the Child has given it
global application. But as well as being a central legal principle, the concept of the child’s Best
Interests is vital from a child development perspective in ensuring that the child’s well-being
and future development are central to decision-making. The CRC broadens the scope of the Best
Interests principle to relate it not just to decisions about individual children, but to young
people collectively. Article 3 of the Convention states, "In all actions concerning children,
whether undertaken by public or private social welfare institutions, courts of law,
administrative authorities or legislative bodies, the best interests of the child shall be a primary
consideration". This is presented as Overhead 6.2. Because UNHCR has adopted the CRC as its
normative frame of reference, the rule should be applied to any decision made which affects
children of concern to UNHCR, whether individual children or groups of children. The
UNHCR “Policy on Refugee Children”1 state that, “In all actions taken concerning refugee
children, the human rights of the child, in particular his or her best interests, are to be given
primary consideration”. Like the Convention, this policy applies the principle to children
individually and collectively, but broadens its application to "all actions" and makes Best
Interests the primary consideration for such decisions rather than only a primary consideration.
The Best Interests of the child principle is a valuable tool for impact assessment and monitoring
in programming. Because children are more physically vulnerable than adults, when decisions
are made that affect a population generally, greater weight must be given to assessing the
impact on the youngest members. Because children are still developing, conditions that pose
hardships or discomfort for adults may have serious long-term consequences for children and
adolescents. The concept is simple: when authorities make decisions concerning a child or
children as a group, their Best Interests must be a primary basis for the decision. In practice,
however, a complex set of considerations can arise when applying it in a specific situation. The
best interests’ principle has been criticized because it does not provide detailed guidance on
how to determine what action, in fact, is in the best interests of a child or group of children. At
times parties standing on opposite sides of an issue concerning children will each claim the
child's “best interests” as the basis for their position. The principle recognizes that an individual
child (and more so for a group) has more than one “interest”. When considering an action, the
entire range of a child's needs and rights (physical, psychological, social, cultural, spiritual,
developmental, legal, etc.) must be taken into account - and also their immediate and long-term
implications. The information available is often limited, and the interests that must be
considered can be competing. All this must be taken into account to make a decision that is, on
balance, the best one for the child(ren) concerned. This Topic considers the application of the
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Best Interests principle to individuals and to groups, examines issues of who decides what is in
the best interests of a particular child or group of children, and how decisions should be made.
THE “BEST INTERESTS” PRINCIPLE APPLIED TO INDIVIDUALS AND GROUPS
This important principle should be applied both to decisions relating to individual

children, and to broader policy matters and decisions relating to groups of children. Individual
Best Interests decisions will need to be made in a wide range of different situations, often
raising difficult issues and dilemmas. Such situations may include the following.
• Repatriation situations: as with adults, separated children can have legitimate claims
to refugee status which must be considered before they can be sent back as part of a larger
repatriation movement. Sometimes adolescents may have needs and opinions different from
those of their families, and these need to be taken into account when repatriation decisions are
being made.
• Family reunification situations where a decision needs to be made about the

possibility of a separated child living, for example, with grandparents in the country of origin,
an uncle in a second country of asylum or remaining with an unrelated family in a refugee
situation.
• Situations where abuse or exploitation have been revealed: for example, is it in the best
interests of a teenage girl who has alleged sexually abuse by a step-parent to remain in the
family where the risk of further abuse may exist, or to remove her to another family against her
will? Group situations can also raise questions of the Best Interests of children. In refugee
contexts, the following are some examples of situations which may emerge.
• In some displacement situations basic education has been denied to children because
the availability of schooling was seen to discouraging families from repatriating. Such a policy
may be interpreted as violating the Best Interests principle as well as the specific right of all
children to education specified in the Convention on the Rights of the Child.
• As a displaced population progresses toward self-sufficiency, decisions must be made

about how and when to reduce food rations. The Best Interests principle may be useful in
ensuring that the specific needs of children are continuing to be met.
• In situations where there is ongoing conflict, difficult decisions may have to be made
about whether to assist the population where they are or to arrange to move some or all
members to a safer location. Sometimes other groups organize an evacuation and UNHCR must
decide whether to participate, if only to reduce the likelihood of family separation or other
problems. In all these cases the Best Interests principle must be considered, and a long-term
view taken.
• The large-scale demobilization of former child soldiers may raise questions about
whether they should be allowed to return directly to the families (where this is possible) or
whether they should all first be admitted into some form of residential interim or transit care.

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KEY OBJECTIVES OF “BEST INTERESTS” DECISIONS
The key objectives involved in assessing the best interests of children consist of the following:
1. ensure their protection - both in terms of physical safety and legal rights;
2. ensure that care arrangements provide for both their physical and emotional needs;
3. provide for their ongoing developmental needs - psychological, social, educational and
physical, both for the immediate future and in the long-term;
4. provide for their participation in these decisions, in keeping with their maturity and capacity;
5. put their safety and welfare ahead of all other considerations.
WHO DECIDES WHAT IS IN THE BEST INTERESTS OF CHILDREN?
Where one or both parents are present, national and international law generally
recognize their authority in deciding what is in the best interests of their children. However, the
Best Interests principle is specified as the basis for courts or other authorities to make decisions
concerning the protection and care of children who are without a parent or normal guardian,
whose parents are in a legal disagreement over their care and protection, or where parental
rights have been terminated to protect a child's safety or well-being, as in a case of child abuse.
In many countries, national law provides for a guardian responsible for the protection of a child
not in the care of her or his parents. Often this is a department of child welfare. Court
proceedings may be involved to appoint a specific individual as guardian. The guardian is
charged with responsibility to ensure the protection and care of a child and to make decisions
that are in his or her best interests. Very often, however, particularly in the developing world,
guardianship of separated or orphaned children is determined by customary practice rather
than the specifications of national law. In a situation of displacement, it is important for
government and NGO personnel and UNHCR staff members to know what applicable national
law specifies concerning guardianship of separated children and to have an understanding of
relevant customary practices. It is also true, however, in the context of a failed state or a
complex emergency, that both legal and customary systems of guardianship may have broken
down and procedures must be put in place by those who intervene to make decisions about the
immediate protection and care of separated children. Within the guidance of the Convention on
the Rights of the Child, the Best Interests principle is the basic operational guideline for such
decisions. However, those who intervene to protect children must carefully avoid taking action
in the short run that may not be in their long-term best interests. For example, UNHCR has
included policy guidelines in Refugee Children that prohibit adoptive placements in an
emergency, before family tracing is possible. Particularly in situations where there is no
legitimate state authority responsible for the care and protection of separated children, UNHCR
is obliged as part of its protection mandate to ensure that an appropriate, if interim, system is
put in place to make Best Interests decisions. Likewise, UNHCR has an obligation to ensure that
the Best Interests of children and adolescents are given primary consideration when decisions
are taken that affect them as a group.
UNHCR's Refugee Children: Guidelines on Protection and Care and the Office's "Policy
on Refugee Children" provide guidance on how to do this. Where a procedure must be put in
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place to make Best Interests decisions regarding individual children it is essential that suitably
qualified personnel are involved.
The qualifications needed depend in large part on the nature of the decisions they must
make (e.g., medical intervention, evacuation, type of placement for care, protection from
recruitment). There are, however, certain kinds of knowledge and expertise that are generally
needed among the personnel involved:
• a solid understanding of the practical implications of stages of child and adolescent
development and psycho-social well-being
• an understanding of the issues involved in the decision – physical, psychosocial,
educational etc. • a knowledge of the safety implications and legal context
• an understanding of the cultural and religious context
• a knowledge about the social and economic context
• the ability to engage the child (or children) in discussion about the available options It
is vital that the decision-maker should be able to separate the interests of the child(ren) from
those of all others, including parents, other adults, social groups, institutions and the state, and
subordinate the interests of these other parties in favour of the child’s welfare. The decisions
being taken can have profound longterm implications, and very often the matter of determining
Best Interests is actually a choice among the least damaging of a limited number of alternatives.
The decision-maker must be able to balance the options and make such choices in a way that is
both informed and objective. Those personnel charged with making Best Interests decisions
must carefully consider how children themselves are involved in decision-making: this
important issue is discussed below.
• The notion of participation is important from both a child rights and a child development
perspective.
• Participation can promote child and adolescent development and can enhance decision-
making about young people
• It is important to consider cultural factors and gender issues when planning to develop child
participation in programming
• Child and adolescent participation can be difficult and complex to implement in some
contexts. Clarity of objectives and methods, and careful consideration of areas of difficulty will
greatly facilitate effective implementation.
• It is important to avoid tokenistic participation. Participation requires a real commitment by

the adults who are working with young people to ensure that the principle of participation is
embedded within the programme.
PARTICIPATION AS A CHILD RIGHTS CONCEPT
The notion of participation is firmly embedded in the Convention on the Rights of the
Child. Article 12 states “State Parties shall assure to the child who is capable of forming his or
her own views the right to express those views freely in all matters affecting the child, the view
of the child being given due weight in accordance with the age and maturity of the child”: this
appears as Overhead 7.3. In addition to this important provision, Article 13 refers to the child’s
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right to freedom of expression, Article 14 refers to the child’s right to freedom of association and
of peaceful assembly. Article 17 stresses the importance of children’s access to information.
Roger Hart2 describes participation as “the fundamental right of citizenship” and is of
particular importance in underlining the notion of children as subjects of rights and not merely
as objects of them. But participation does not just happen: it needs adults to provide a
facilitating environment to enable young people to participate in accordance with their
emerging competencies.
PARTICIPATION AND CHILD DEVELOPMENT
Participation is a vital aspect of child development, and can be examined under three
headings:
1. Children are active in their own development. In Topic 2 a “transactional” approach
to child development was suggested, in which children - from a very young age - are responsive
to and participate in shaping their environment. Children are both influenced in their
development by their environment, and in turn they influence it. A healthy, active baby, for
example, will influence parents’ behavior and will cause them to give him/her more positive
attention than would a passive or constantly irritable baby. As children grow up, there is a
recognizable sequence of their evolving capacity to participate, though there will be both
individual and cultural differences about the actual ages at which particular competencies are
developed.
Competencies for participating in social interaction and decision-making will include
the following:
• language ability – the ability to communicate and to use language to collaborate with
others;
• empathy - the ability to understand the feelings and views of others;
• abstract thinking - for example the ability to conceptualize an unseen process
towards a non-concrete goal;
• an understanding of time;
• the capacity for controlling one’s impulses - i.e. the immediate and self-centered
satisfaction of needs and wishes;
• the ability to understand and accept that a participatory exercise may benefit other
people rather than oneself;
• the ability to concentrate, listen, analyze, project one’s point of view etc.;
• the ability to control emotions, especially anger and frustration. In general, children
aged around 5, 6 and 7 are able to participate in and take decisions about activities which are
very concrete and familiar and where the results show themselves immediately. From the age of
around 8 and 9, children’s competence in participation develops rapidly and by the age of 10 -
12, many of the competencies listed above will be acquired at quite a mature level, though care
needs to be taken that the issues involved are understood fully. Experience suggests that, in
general, adolescents are able to be very active participants and can be engaged in programmes
at a deep level. It must be remembered, however, that there will be significant cultural
differences regarding the age at which particular competencies are acquired, as well as
individual differences. There are also significant issues regarding both gender and the cultural
value attached to the participation of children, which will be discussed below.

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2. Enabling children to participate can enhance their development. Participation
involves listening to children, in a non-patronizing way, taking their ideas and opinions
seriously, and (where appropriate) allowing them to take responsibility for making decisions.
This can be validating for children and can serve to enhance their self-esteem and confidence, as
well as enabling them to acquire skills such as those outlined above.
PARTICIPATION: CULTURAL AND GENDER ISSUES
The idea of child participation may well challenge what is generally considered
appropriate behavior for children in many societies and child-rearing traditions, and may be
difficult to introduce in contexts in which it is the norm for “children to be seen but not heard”.
This has to be weighed against some of the real advantages which can result from child
participation, while a sensitive approach needs to be taken in order that the key players - staff,
parents, the children themselves etc. - can see the benefits and not perceive participation as a
threat. Participation implies responsibility and it may be helpful to emphasize this fact when
working towards a more participatory way of working. It is worth noting that the African
Charter on the Rights and Welfare of the Child includes a section on the Responsibilities of the
Child (Article 31). It is through the collaborative work with others that children as well as adults
learn to exercise responsibilities. Real participation is unlikely to be achieved unless the staff
involved in a programme are really committed to it. One study has suggested that staff working
within a hierarchical, authoritarian organization that does not encourage staff participation are
likely to find the idea of child participation difficult. Gender issues can be highly significant: in
many contexts, there may be more organized opportunities for boys to participate than girls,
which may reflect both cultural attitudes towards gender, and the fact that girls often have a
greater burden of work placed upon them in the home. It is not uncommon to find programmes
designed mainly around the needs of boys, especially in refugee camps where they may be
more visible - and perhaps perceived as being more potentially troublesome - than girls.
Particular care may need to be taken to ensure that girls become actively engaged, and to ensure
that participation in decision-making is not dominated by boys.
PARTICIPATION - IMPLEMENTATION ISSUES
The principle of child participation is often now promoted by donors and by

international agencies, but in practice fieldworkers frequently find the concept difficult to apply
in a meaningful way, especially in cultures in which the idea is unfamiliar. Roger Hart has
suggested that child participation can be depicted as a ladder, with various steps from activities
which he describes as “non-participation” (manipulation, decoration and tokenism) through to
various more positive degrees of involvement. These ideas are set out in Handout 7.1 and in
Overhead 7.4. One of the limitations of Hart’s model is, firstly, that it is sometimes assumed that
participation on the higher rungs of the ladder is always better than at the lower rungs of
participation. The model should be seen as enabling adults to establish the conditions that
enable children to participate at whatever level is appropriate to the particular circumstances.

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A second limitation is that, in practice, participation cannot always be located along
such a single continuum. Van Beers’ definition (see above) helps to highlight two distinct
aspects of participation: at a basic level, it can involve children in articulating their ideas and
concerns and taking part in something: at a more sophisticated level, it involves empowering
them, enabling them to make decisions, take autonomous action, organize themselves etc.
Programmes may seek to involve young people in the former way but not the latter, or vice
versa. For example, in a non-formal education programme, the approach can be highly
participatory, with children very actively involved in their own learning, but this basic level of
participation could take place within a setting in which the center’s objectives, the curriculum,
teaching methods etc. have been developed by adults without any involvement of the children.
In this sense, children are being actively involved in a participatory way in center activities, but
may not be empowered through involvement in the planning, conduct and evaluation of the
programme.
This may, of course, be entirely appropriate, depending on the circumstances. Hart’s

ladder is very useful in highlighting the danger of tokenism. Effective participation cannot be
something “added on” to a programme, but needs to be embedded in the programme on the
basis of very careful thought and planning. Efforts to help children "express their views"
sometimes become rather prescribed, providing narrow and limited avenues for particular
children or youth to speak to an audience of adults. Indeed, all too often such agendas have not
emerged from children themselves, and it is not always clear that selected views in a formal
context are representative of the broader population of children. A developmental perspective
on participation emphasizes the fact that the nature and format of participation does not fit a
pre-set template or fixed time frame. Rather, genuine participation must evolve according to
basic principles of child development and within the given cultural, socio-economic and
political context. Appropriate and effective child and adolescent participation requires careful
consideration of questions such as the following:
• What are the objectives of involving young people? Are they appropriate to the
children’s emerging competencies and skills?
• In what areas and aspects of the programme are young people being involved? What
are the appropriate limitations of child participation in this context?
• What are the local cultural attitudes towards child participation? How will
participation be explained to the young people, parents, community leaders? What difficulties
can be anticipated and how will they be overcome?
• What methods and techniques will be used to involve young people? • Have gender
issues been thought about and addressed? Will the participation of girls, or of boys, require
particular approaches or techniques?
• Are the staff committed to child participation? Have they experience the benefits of
participation themselves? Do they see it as any kind of threat to their own position, and if so,
how will this be addressed? This list is reproduced as Handout 7.2.

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CHILD AND ADOLESCENT PARTICIPATION AND COMMUNITY MOBILISATION
The mobilization of young people to take collective action within their own communities is an
approach which strongly emphasizes the participation of young people: this is examined in
some detail in the ARC Resource Pack on Community Mobilization, Topic 7
Overhead 7.2: A definition of Child Participation Provides a definition
Overhead 7.3: Child Participation – the CRC Quotes Article 23
Overhead 7.4: The Ladder of Children’s Participation
Illustrates Hart’s “Ladder”
Exercise 7.1: Programme Audit Group exercise
EARLY CHILDHOOD DEVELOPMENT
The curriculum is for young children who have not yet

entered primary school, usually between three to six
years old. It provides an early childhood education
programme that lays the foundation for social and
financial literacy. The programme builds on the evidence
in early childhood education that such early investments
provide children with advantages that are amplified and
reinforced over time.
Early childhood is the most critical time for positive intervention. Children’s development
during this stage is strongly affected by their environment, and that effect continues to exert a
strong influence on the rest of their lives. It is of the utmost importance that educational and life
skills programmes such as Aflatot also begin at this early stage.
Children gather the building blocks of social and financial literacy even before they get to
primary school. Much of what they know about planning, budgeting, saving, spending and
using resources is based on their daily routine. Even before monetary concepts are learned,
simple concepts such as making full use of available resources, i.e. ‘finishing one’s food’ or
‘buying only necessities’, are some of the daily realities that young children are exposed to that
already relate to financial education.
Preschool children are also developing time preferences, when they understand that there are
times when it is better to wait for something rather than to have it now. Children as young as
three years of age are exposed to the social values of giving and sharing, not just with gifts or
tangible materials, but also with interaction with others. Other important life skills that are
embedded in Aflatot include taking turns, making decisions, and setting goals.

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The developmental processes of children and adolescents have intrigued theorists and
researchers for centuries. Prior to the time of John Locke and Jean-Jacques Rousseau, during the
late 17th and early 18th centuries, most people viewed children as miniature adults. During the
Middle Ages children as young as six years of age were often sent off to work as apprentices in
professions such as farming, blacksmithing, and carpentry. However, toward the end of the
Middle Ages, the economic situation dramatically shifted; many occupations switched from
requiring manual labor to necessitating academic skills. Thus, the treatment of children became
refocused, away from integration with adults and toward educational instruction. This article is
designed to introduce readers to topics (i.e., physical, cognitive, language, personality and
social, and morality development) that have helped us to better understand how children and
adolescents are not miniature adults but unique, intriguing beings.
RESEARCH AND THEORY
Physical Development
Much of the physical growth and development that occurs in childhood is a

continuation of earlier growth patterns seen in infancy. As was the case in infancy, development
continues on the cephalocaudal (i.e., a pattern of physical and motor growth from head to tail)
and proximodistal (i.e., a pattern of physical and motor growth from the center of the body
outward) track. In other words, physical and motor development begins with the head, chest,
and trunk and then follows with the arms and legs, ending with the feet and hands. When
children enter the adolescent period this growth pattern reverses, with hand and foot growth
followed by that of the trunk or upper body. Examples of associated milestones of motor
development in childhood include walking up and down stairs using alternating feet between
the ages of 3 to 5 years; developing abilities to jump, hop, and skip; and increasing upper-body
motion when throwing and catching a ball. Between the ages of 7 and 12 years, there are
increases in speed when running, increases in vertical-jump height, increased accuracy in
throwing and kicking, and overall fluidity in physical body movement. However, it is
important to note that because the extremities (hands and feet) grow before the upper body
during the adolescent spurt of physical growth, teens may experience a brief period of
awkward stature and movement.
Much of the physical growth that occurs in childhood and adolescence is coordinated by
endocrine glands through the release of hormones. Human growth hormones are released
primarily by the pituitary gland. The pituitary gland is regulated by and located near the
hypothalamus, toward the base of the brain. One pituitary hormone that is secreted throughout
the life span is growth hormone (GH), which influences the growth of bones. Another
important hormone that influences growth and development is thyroxine, a hormone released
by the thyroid gland that influences body and brain maturation. Thyroxine is necessary for GH
to have its fullest impact on a body’s development. During adolescence, the pituitary gland
releases sex hormones (estrogens and androgens). Both of these hormones are found in males
and females, but at differing levels, dependent upon the sex of the individual. It is during
prepubescence (the period leading up to completion of development or puberty) that the release
of hormones spurs the continued development of the brain and growth of primary and
secondary sex characteristics. Primary sex characteristics include the development of the sex
organs (i.e., in females, the ovaries, uterus, and vagina; in males, the penis, scrotum, and testes),
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whereas secondary sex characteristics consist of outward signs of pubertal growth (e.g., growth
of underarm and pubic hair, facial hair for boys, breast development for girls, and skin changes
for both sexes). The signal of puberty completion for girls is the occurrence of menarche (the
first menstrual cycle and period). Puberty ends for boys with the completed development of
their testes, seminal vesicles, and prostate gland. The sperm Arche, or ability to ejaculate semen,
is indicative of the end of puberty for boys. The process of adolescent physical growth begins
and ends earlier for girls than for boys.
Cognitive Development
Our understanding of cognitive development comes, in large part, from the research and
theory of Jean Piaget. Piaget developed his theory of cognitive development based upon
observations of his own and other children. Before outlining his theory, it is important to
understand the underlying assumptions. First, although Piaget recognized the probability of
individual differences in development, he believed in an invariant sequence of developmental
stages that were qualitatively different. Second, Piaget’s theory is constructivist; children are not
simply waiting for development to occur or maturation to take place, they actively construct the
experiences they have and make sense of the environment. Third, under normal circumstances
there should be no stage regression. That is, the knowledge and skills gained in each stage build
upon one another and, barring unforeseen circumstances, individuals should not regress in
their cognitive abilities.
Piaget’s observational research allowed for an understanding of how children gain and
refine their knowledge (thought patterns or schema) of the world. Children are born into this
world with very little knowledge and only a set core of reflexes, but as they mature and interact
more with their environment, they begin to integrate and change their existing knowledge.
There are two processes by which children deal with new information. One such way is called
assimilation—an attempt to integrate new information into what they already know. For
example, as children are learning the different sounds animals make, they may have a clear
understanding of the sound a cow makes, “moo.” When confronted with new information, they
will likely rely on their old knowledge to make sense of the world. So, when the child sees a
horse for the first time, and you ask what sound a horse makes, he or she may respond “moo!”
Clearly, at some point children learn that horses do not “moo.” Piaget explained this shift in
understanding as accommodation—altering existing knowledge to incorporate new information.
So, a child’s learning that a horse “neighs” is an example of accommodation of knowledge and
new schemes developing. Piaget described our cognitive process as being in a state of balance
or equilibrium. However, when we are confronted with information that does not fit, we are
thrown into a state of disequilibrium and must reorganize our thinking to fit new information
and achieve equilibration. Piaget is most well-known for his four stages of cognitive
development: sensorimotor, preoperational, concrete operational, and formal operational.
Sensorimotor period (birth to roughly 2 years of age)
Piaget believed that generally children gain knowledge through their senses and motor
behavior. Piaget outlined six substages to this first stage of development.

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1. Reflexes (0 to 1 months). Infants are born with a set of reflexes that are uncoordinated at
first, but quickly become synchronized and serve as the foundation for later cognitive
development.
2. Primary circular reaction (1 to 4 months). During this substage there is a crude
beginning of intent in behavior. Specifically, as infants accidentally produce a desirable
occurrence using their body, they will attempt to recreate that event. For example, an
infant may unintentionally brush her lips with her hand and induce the sucking reflex.
In an attempt to recreate that pleasurable experience of sucking, the infant may more
purposefully put her thumb or finger in her mouth. This recreation of an experience is
an example of how, at a very early age, children are constructing their experiences
within the environment.
3. Secondary circular reactions (4 to 8 months). Whereas the focus of recreating
occurrences during the primary circular reactions stage is on the infant’s body, the focus
for secondary circular reactions is outside the self. For example, if a baby were to
accidentally shake a toy that had a rattle inside it and create a pleasurable noise, the
baby would attempt to recreate the noise by shaking the toy again. Piaget described this
recreation of events in the environment as demonstrating the infant’s interest in the
world.
4. Coordination of secondary circular reactions (aka means end behavior; 8 to 12 months).
This stage offers a clear indication of intentional behavior. For example, if an object is in
front of a toy the child desires, the child will intentionally move the object to grasp the
toy. An important cognitive milestone of this stage is object permanence—
understanding that objects exist even though we cannot perceive them. Once a child has
the understanding of object permanence, he understands how to find a missing toy by
removing the blanket that covers it. Object permanence is another indication of the
child’s further development of schemes.
5. Tertiary circular reaction (12 to 18 months). At this stage Piaget described children as
little scientists because they are experimenting within their environments. There is clear
and combinational intent in children’s behavior at this stage, building on the intent
found in stage four. It is at this point that babies will repeat actions using different
objects only to see what the end result will be. For example, a child may drop different
objects over the side of her high chair, only to see what sounds each object will make.
6. Mental representation (18 months to 2 years). At this stage, children continue to develop
and refine their schemes and are able to solve simple problems in their heads. It is at this
point that children begin to play make-believe and also demonstrate differed imitation.
For example, because a child now understands what it looks like to sleep, she may
pretend play that she is sleeping to “fool” her parents.
Preoperational period (2 to 7 years)
The preoperational period is an expanded time frame that consists of rapid cognitive
development. Children at this stage are able to represent schemes mentally and can think about
objects and events that are not physically present. The biggest limitation at this stage of
cognitive development is children’s egocentrism—the inability to take the perspective of
another. Piaget described children’s egocentrism as perceptual, affective, and cognitive.
Perceptual egocentrism is illustrated by children’s believing that others can see (or hear, or

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some other sensory experience) what they see. Although egocentrism is defined as a child’s lack
of ability to understand the emotions of another, cognitive egocentrism is best described by the
term conservation. Piaget discovered that children during this stage lack the understanding that
changing the size, shape, or location of an object does not change the amount of that object (i.e.,
conservation).
Concrete operational period (7 to 11 years)
During the concrete operational period, children become more logical in their thinking
and now have the ability to conserve objects and take the perspective of others. Children’s
thought processes at this stage are more flexible and organized compared to during previous
stages; however, at this stage, children’s thoughts tend to be focused on the here and now. That
is, during this time period, children have a difficult time thinking abstractly or in a hypothetical
form.
Formal operational period (11 years and beyond)
During Piaget’s last stage of cognitive development, adolescents are now able to think
logically and flexibly, and they have the newfound ability to think about abstract concepts and
hypothetical situations. Adolescents are able to use hypothetic-deductive reasoning, whereby
they begin with a general theory of possible factors influencing a situation and then deduce
specific hypotheses to test in an orderly fashion. Piaget described a new type of egocentrism as
a limitation to adolescent thinking, however. Although adolescents have the ability to
understand other people’s perspectives, they tend to focus on themselves. Three examples of
this adolescent egocentrism include the personal fable, the imaginary audience, and the
invincibility fable. The personal fable is adolescents’ belief that their experiences are special or
unique. Because of this belief, adolescents often think that no one could possibly understand
their thoughts, feelings, and experiences. The imaginary audience consists of adolescents’
beliefs that everyone else is as interested in their appearance and behavior as they are. Because
of this egocentrism, adolescents will often feel extremely self-conscious and engage in behaviors
to “fit in” with age-mates. Finally, the invincibility fable consists of adolescents’ belief that they
will never fall victim to risky or dangerous behavior. Because of this belief, adolescents often
will engage in unprotected sex (thinking they will not get pregnant or get an STD),
drinking/using drugs and driving, and driving in extreme fashions (e.g., at high speeds).
Piaget is very well known and respected for his research and theory. Still, to understand
cognitive development, it is important to consider at least one other influential theorist. Lev
Vygotsky is known for his sociocultural theory of cognitive development. Whereas Piaget’s
theory focuses on the child interacting with the environment in somewhat of a self-guided
process, Vygotsky’s focus for cognitive development is on the benefit of social interaction that
children have with adults and others. Vygotsky believed that through social interaction,
children are able to master tasks and skills that they would not be able to accomplish if left to
their own devices. He called this the Zone of Proximal Development, the differential range of
working by oneself versus working with the assistance of a skilled peer or adult.

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For the interaction between child and another to be successful, or for a child to be
successfully pushed to the higher end of his or her Zone of Proximal Development, two
important factors must be involved. First, there must be intersubjectivity—the child and others
begin a task with different understandings or knowledge of the situation, but by the completion
of the task, they have come to a shared agreement. During the process of intersubjectivity, the
adult must work to share his or her knowledge in a manner that is understandable to the
specific child.
The second important factor for successful interaction is the process of scaffolding—
adults (or skilled peers) change the quality of social interaction by adjusting the amount of
assistance they provide to the child. Early in a child’s learning a task, the adult may engage in
more direct instruction and heavily guide the child’s actions; however, as the child gains greater
insight into the problem or task, the adult begins to withdraw the extra assistance to the point at
which the child is able to do the task alone. For example, when a child is first learning how to
make her bed, her parent may offer several direct commands and physically show the child
how to do the task. However, as the child becomes more knowledgeable, the parent offers less
direction but more “helpful hints” and has the child doing the task alone.
Vygotsky also described how children guide their own behavior using private speech—
self-directed speech that children engage in as a means to guide their own thoughts and
behavior. When children are small, it is not uncommon to hear them talking themselves
through a task (e.g., washing their hands, tying a shoe, buttoning a button, etc.). Research has
suggested that children will engage in more frequent private speech when the task is difficult, if
they have made an error, or if they are uncertain or confused about how to proceed with a
problem. However, as we age, this self-direction becomes internalized and private speech
becomes more of a thought process than outward expression. Vygotsky was a firm believer in
the connection between language development and thought processes. He suggested that as we
develop language, there is a profound shift in our thinking processes.
Language Development
Language development can be understood by highlighting the sequential process of its

development and then explaining that process using recognized theories. When examining the
process or stages of human language development, we find a path that is fairly universal in
nature. All infants begin the communication process with reflexive crying that, although
unintentional, clearly sends messages about hunger, pain, or discomfort. The hunger cry is
lower in pitch and intensity, whereas the pain cry is high in pitch and intensity. Infants do not
have to think about what type of cry they’d like to express; it occurs naturally. Also, although
there is some debate as to whether adults can recognize the different types of cries infants
express, one can argue that, given enough time with an infant, the adult will quickly pick up on
the messages being sent.
Even though there can be great variation and individual differences in the rate of
language development, most researchers recognize that the foundation for language begins
around the age of two months with vowel-like noises called cooing. Common cooing consists of
“oo” sounds. Cooing is an oral expression of sounds that the infant can make. At approximately

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four months of age, as infants develop greater muscle control over their tongue and mouth, they
will begin to add consonant-vowel combinations, typically heard in strings. These combinations
are called babbling. An example of babbling from the English language consists of phrases like
“bababababa” and “nananana.” It is during this stage of language development, at around
seven months of age, that infants begin specialization within their own language. Interestingly,
individual maturation and exposure to language within the environment influence the age at
which infants truly begin to babble. For babies who are hearing impaired, vocal babbling will
most often be delayed, and for deaf babies, completely absent. However, researchers Petitto and
Marentette (1991) have found that when infants who are deaf are exposed to sign language
within their environment, they will babble similarly with their hands as hearing babies do with
their voice.
The third stage of language development is known as one-word utterances. At about

one year, infants are expressing their first words. Common first words in the English language
include phrases like “mama” and “dada,” but it is important to recognize the influence of the
infant’s language environment on his or her first word. The first 50 words a child learns tend to
happen rather slowly, but after those first 50 a language explosion occurs. This rapid connection
between words and objects or events, called fast mapping, occurs so rapidly that children
cannot reasonably understand all possible meanings of the words.
The next stage of language development is called two-word utterances. At about two
and one-half years, children begin stringing words together. In their early sentences, children’s
language is described as telegraphic speech because, as is the case with telegrams, children use
only the important or necessary words to communicate meaning. Unimportant words (e.g., “a,”
“and,” “the”) are often left out. So, a child might say or sing, for example, “itsy bitsy spider, up
water spout” instead of “the itsy-bitsy spider went up the water spout.”
At about three to five years, children enter the last stage of language development and
start using what is called basic adult sentence structure. By this age, they have a basic
understanding of the way that words are ordered (syntax) and have become quite sophisticated
communicators. Sometimes children of this age will misapply grammatical rules to words that
are exceptions to those rules. This error is called overregularization and is exemplified by
adding an inappropriate –s to make a word plural. For example, a child may say “mouses”
instead of “mice.” Another error is inappropriately adding –ed to make the past tense of an
irregular verb: “I goed to the store today.”
How can we explain children’s phenomenal ability to acquire language? As is the case
with most aspects of development, one theory argues nature’s role in language development,
and another suggests the predominant importance of nurture. Beginning with the nurture side,
most recognized is an application of B. F. Skinner’s operant Conditioning. Theorists who argue
operant conditioning as the explanation of language development would look at how parents
reinforce an infant or child through smiles and verbal praise for making different sounds.
Another learning approach, Bandura’s social learning theory, explains language development
by examining how children imitate what they hear in their environment. Learning theories give
some insight into how language develops, and one would be remiss to ignore the impact of the
environment on language development, but taking a nurture stance alone is not enough to

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explain how and why children develop language. For example, why would a child say “goed”?
It is highly unlikely that she or he hears parents saying “goed,” and chances are, parents are not
reinforcing that utterance. It is through examining the nature side of this debate that we have
additional understanding and insight into language development.
Linguist Noam Chomsky is best known for arguing that language is the result of innate
processes. Chomsky explains that parents and teachers cannot directly teach language
organization and grammatical/syntactical rules. Yet, we see children understanding basic
syntax and attempting to apply grammatical rules. Thus, he reasoned, language development
must be guided by an internal process. Specifically, he suggested that humans are born with a
language acquisition device (LAD). The LAD is innate and allows the child to arrange language
in a grammatically logical fashion. Chomsky argued that within the LAD exists what he called
universal grammar, a store of grammatical rules that apply to language. Another well-known
linguist, Steven Pinker, suggests that it is not that anyone language is within our genes; rather,
the ability to arrange and produce language is innate. Nativists like Chomsky and Pinker do
acknowledge that children must have at least a limited amount of exposure to language within
their environment to prompt the innate process; however, they do not agree with learning
theorists that parents or adults must deliberately work with or teach children language. Most
theorists and developmental psychologists recognize the importance of both nature (e.g., LAD)
and nurture (conditioning of language) in an attempt to understand how language develops.
Personality and Social Development
Although many theorists have attempted to explain personality differences and

development, because of the limited nature of this article, we will discuss only two widely
recognized and influential theories: Freud’s psychodynamic theory of personality development
and Erik Erikson’s psychosocial theory. Two important correlates of personality development
(i.e., temperament and attachment) will also be highlighted.
Sigmund Freud was one of the earliest theorists to attempt to explain the root causes for
personality development and differences. He viewed personality development as involving five
stages that consist of internal biological needs that are the focus of interactions between child
and parent. According to Freud, at each stage there is an erogenous zone, or area of the body
that is the focus for libidinal energy and gratification. He also believed that if our gratification
needs were not met appropriately (i.e., over- or under met) during the early stages, fixation
could occur. Fixation is a process whereby the child would show characteristics of that stage in
behavior and personality later in life. Freud also believed there were three separates, but
interacting, elements of the mind that guide thoughts and behavior: the id (pleasure seeking),
superego (an internal sense of right and wrong or conscience), and ego (the part of the mind
grounded in reality that must appease the id and superego). There are many more elements to
Freud’s theory, but these are the most important to help in understanding his personality stages:
 Oral (birth to approximately 18 months)
At this stage, the erogenous zone is the mouth. Infants gain pleasure through
sucking and biting. If the child’s needs are not met (e.g., not being fed when hungry), the

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child will become fixated at this stage and seek oral gratification later in life. Examples
of oral-fixation behavior would be biting one’s nails, chewing on pens or pencils, over-
or undereating, and being verbally aggressive. Personality characteristics of individuals
who are fixated include being dependent, gullible, and overly optimistic, according to
Freud.
 Anal (18 months to 3 years)
During this stage, an important milestone is potty training. Hence, Freud

believed pleasure is gained through the retention and expulsion of feces. Depending
upon how parents manage the potty-training process, children can develop a fixation at
this stage as well. If parents are rigid and harsh in the process, children may exhibit
signs of anal retention later in life, whereby they are rigid and compulsive in their
behavior. Individuals who are considered anal retentive, in Freudian terms, tend to be
compulsive, organized, and attentive to details. However, if parents are very lax in the
potty-training process, their children may fixate and become anal expulsive. Individuals
who are anal expulsive tend to be very disorganized, messy, and inattentive to details.
 Phallic (4 to 5 years)
This is considered to be Freud’s most controversial stage. The erogenous zone for
the phallic stage is the genitals; it is not uncommon for children of this age to discover
their genitals and begin to understand that stimulation of the genitals can bring pleasure.
However, Freud believed it is at this time that boys go through the Oedipal complex and
girls experience the Electra complex. The theme for each of these complexes is similar—
they both involve a sexual attraction to the opposite-sex parent. However, for boys,
during the process of sexual attraction toward their mother, they develop a fear of their
father’s reprisal that might result in injury to their genitals. This developing fear is called
castration anxiety. To compensate for this fear, boys must repress their sexual attraction
toward their mother and identify with their father. According to Freud, during the
process of this identification, the super ego develops. Freud argued that during this
stage girls develop penis envy—the result of anger toward their mother and sexual
attraction toward their father (which would result in seducing the father to obtain a
penis vicariously). To resolve this complex, girls must repress their anger toward their
mother and their sexual attraction toward their father, and ultimately identify with their
mother. Freud also believed that girls develop a super ego at this point, but because the
Electra complex is not as traumatic as the Oedipal complex for boys, the resulting super
ego is not as strong, ultimately meaning that boys/men are more moral than
girls/women.
 Latency (6 to puberty)
Because the previous stage was very traumatic, a period of rest is needed. During
the latency stage all sexual interest and desire is suppressed, and the focus of this stage
is developing same-sex friendships.

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 Genital (puberty and beyond)
Around the time of puberty, our sexual desires and interests are reawakened
and result in the desire to find mature, healthy (heterosexual, according to Freud) adult
relationships.
Erik Erikson, like Freud, believed that personality develops in stages and that our
environment and early relationships can influence who we ultimately become, but Erickson’s
theory integrated fewer biological needs and expanded the notion that society may put certain
pressures or demands on us that can cause psychosocial conflict or crises. Each of his stages,
thus, is described in terms of conflicts that are of focus during specific age ranges. Erikson also
described ego strengths, which result from the successful resolution of each of these crises.
Although his theory consists of eight stages across the complete life span, because this article is
focused on childhood and adolescence, only those age-relevant stages will be highlighted.
 Basic Trust versus Mistrust (birth to 1 year of age). Society at this stage is represented
by the immediate family. The focus of this stage is infants’ learning of whether they can
trust their parents to be responsive to their needs. If their needs are consistently met,
infants will develop a sense of trust; however, if infants’ needs are not met consistently
and regularly, then a sense of mistrust will follow. Resulting Ego Strength: Hope.
 Autonomy versus Shame and Doubt (1 to 3 years). During this period children develop
a new sense of independence and make every attempt to exercise this newfound ability.
Through events such as walking, potty training, and refining motor skills, infants learn
that they can be autonomous apart from their parents. If parents are very supportive
and allow the opportunity for freedom of choice, then children will develop a clear sense
of autonomy; however, if children are restricted in their behaviors, they will likely
develop a sense of shame and doubt. Resulting ego strength: will.
 Initiative versus Guilt (3 to 6 years). Children continue to develop skills and abilities in
this stage and begin to imagine who they may become in the future. It is also at this
stage that Erikson’s concept of society begins to expand beyond family to include the
school setting. In this new setting children are expected to set and follow through with
tasks and goals. If a child is in a supportive environment that helps set realistic goals
that the child can meet or exceed, then the end result will be initiative; however, if
parents and teachers are too demanding and not supportive, the child may develop a
sense of guilt. Resulting ego strength: purpose.
 Industry versus Inferiority (6 to 11 years). At this stage, there is increasing societal
pressure for children to cooperate and contribute to society. If a child can work or
cooperate with others, then she will feel a sense of industry; if the child feels as though
she cannot get along well with others, she will develop a sense of inferiority. Resulting
ego strength: competence.
 Identity versus Identity Confusion (Adolescence). During the adolescent time period,
Erikson believed that we seek to find a definition of self (i.e., identity). Through this
process we may question our goals, attitudes, beliefs, and place in society. If adolescents
can resolve this questioning with a sense of defining themselves, they will develop an
identity; however, if there is not a successful resolution, Erikson argued they will feel a
sense of identity confusion, which ultimately can affect the later search for intimacy.

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James Marcia built upon Erikson’s adolescent stage of development, recognizing that there
can be different identity statuses that result during this questioning or search for identity. Some
adolescents do not actively engage in the questioning process, and also have not committed to
any personal set of beliefs and values. Marcia describes these individuals as identity diffused. If
adolescents do not question who they are and what they believe, but readily accept what others
define for them, Marcia suggests they are identity foreclosed. Adolescents who are active in the
questioning process but have not yet committed to any set of beliefs or values are labeled as
experiencing an identity moratorium. Finally, Marcia notes that the ideal situation is one in
which an individual has actively questioned beliefs and values and ultimately commits to a core
identity. These individuals are described as identity achieved.
It is clear from Freud’s and Erikson’s theories that the relationships that children have with
their parents influence subsequent personality development. From other research and theories,
we also know that personal characteristics of children (i.e., temperament) can influence the
relationships they have with parents and others.
Through research examining behavioral patterns and responsivity, physicians Alexander

Thomas and Stella Chess have helped us better understand individual differences in
temperament that children exhibit. Because these behavioral response patterns are seen very
early in life, researchers suggest that temperament is biologically based and perhaps consists of
inherited traits. Based on their observations, Thomas and Chess note that children fall roughly
into three categories of temperament:
 Easy Children (approximately 40 percent of American children fall into this category).
These children are very easygoing, are adaptable to change, have a positive demeanor,
and are not fearful in approaching new situations.
 Slow-to-Warm-Up Children (approximately 15 percent of American children fall into
this category). These children are less adaptable to change and can have intense or
negative reactions to new situations. They are slow to warm up to new situations and
changes in routine, but they can ultimately (with repeated exposure) adapt to change.
 Difficult Children (approximately 10 percent of American children fall into this
category). Difficult children are prone to persistent negative mood patterns, do not
adapt to change well, and behave in inconsistent patterns.
Attachment is an intense emotional bond, often referred to in the context of parent-child

relationships. Much of what we know about human attachment comes from the research of
John Bowlby and Mary Ainsworth. Bowlby was primarily interested in the attachment
disturbances experienced by children who were raised in institutionalized settings. The lack of
exposure to close intimate relationships left many of these children with emotional problems
and the inability to form subsequent connections with others. Based on his research and
observation, Bowlby offered a description of what could be considered normal phases of
attachment. His theory is based not only on his observation, but also on his ethological and
instinctual beliefs about attachment.

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 Phase 1: Preattachment (birth to 6 weeks). During the first phase of attachment, babies
show similar responses to all people.
 Phase 2: Attachment in the Making (6 weeks to 6 to 8 months). During this phase,
infants become more intentional and less reflexive in behavior. In response to this shift,
babies become more restrictive in their smiles, babbling, and even crying behavior.
Infants begin showing a preference for two to three people.
 Phase 3: Clear-Cut Attachment (6 to 8 months to 18 months to 2 years). During this
phase infants show a clear preference for one person. An indication of this preference is
seen via separation anxiety. That is, when infants are separated from their preferred care
provider, they will signal distress, and when they are reunited with the care provider,
infants will show a sense of relief. Children also show stranger anxiety, or a fear of
adults with whom they are not familiar, at this time.
 Phase 4: Reciprocal Relationships (18 months to 2 years and beyond). The relationship
between care provider and child becomes much more of a give-and-take process,
whereby the child not only receives care and attention but also is attentive to the
caregiver’s emotional displays.
Based on his research with institutionalized children and children who were separated for
periods of time from their parents, Bowlby offers a description of the effects of separation. At
first, children will protest the separation with cries and refusal of care from other adults. In the
next phase, they experience a period of despair in which they become introverted, withdrawn,
and inactive. Bowlby describes this phase as a period of mourning the loss of the attachment.
After this period of quiet, children enter the final stage of detachment, during which they may
become more active and accepting of substitute care.
Mary Ainsworth entered the attachment arena when conducting naturalistic observations of
attachment between children and their mothers in Uganda. When she returned to the United
States, she began formal research with babies and their mothers in Baltimore, Maryland, and
developed and refined a widely accepted measure of attachment behavior known as the strange
situation. The strange situation consists of separations and reunions between mother and child
in an unfamiliar setting. There also is an introduction of a stranger during the process to see
how the baby or child responds to a stranger in comparison to the mother. Based upon her
initial research, Ainsworth identified three patterns of attachment:
 Securely attached infants. Infants who are securely attached are upset when mothers
leave the room, but are easily comforted upon reunion. When in the room with the
mother, these children use their mother as a secure base, or a source of reassurance to go
and explore the environment. There is a clear preference for the mother over a stranger.
 Insecure/avoidant infants. These children are not upset when their mother leaves the
room. In fact, they have very little interaction with the mother at all. Avoidant children
show no preference for their mother over a stranger.
 Insecure/ambivalent infants. These children are very preoccupied with their mother’s
location during the strange situation process. When the mother leaves the room, these
children become very upset and inconsolable. Upon her return, these children are often
resistant to comfort from their mother as well.

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Subsequent research led Ainsworth and colleagues to relabel the insecure/ambivalent
category “resistant” and add another category, “disorganized/disoriented.”
Disorganized/disoriented children are very inconsistent in their behavior during the strange
situation and appear to be very confused by the relationship and process of assessment.
Although there is some debate as to whether early attachments are predictive of later
attachments, most researchers and theorists agree that early relationships have an impact on
how children develop and, on the connections, they will have with others. More recent research
has focused on factors that affect the quality of attachment, examining variables such as
sensitivity in caregiving, infants’ characteristics, parents’ experiences with attachment, the
influence of daycare, and cultural differences. One area that has been under investigated
historically, but has been more researched recently, is the role of child-father attachment.
(Mothers have been the primary focus for attachment research because of social roles [i.e.,
mothers are seen as the primary caregiver], and because of their availability and willingness to
participate in such research.) Findings to this point suggest that infants can securely attach to
their fathers just as easily as they do to their mothers. Important factors in promoting
attachment with fathers are similar to attachment with mothers (e.g., sensitivity, parental
investment, expression of care, and nurturance).
Moral Development
Moral development is an area that is influenced greatly by many of the previously

discussed topics. Obviously, we must have physical maturation and cognitive development to
achieve moral reasoning. We also use our language to express and explain our moral reasoning.
Without question, our personality and social surroundings influence our reasoning and
justification for our moral decisions.
Preconventional level: Moral reasoning at this level generally is guided by external forces.
 Stage 1: Obedience Orientation. Children look to authority figures for determining

right from wrong and use punishment as a determinant for moral reasoning. If someone
is punished for an act, the act must be wrong. For example, children are told by
authorities (e.g., parents, teachers) that stealing is wrong, and thus believe that a person
who steals is committing a wrongful act. Also, people who are caught stealing are
punished, so stealing must be wrong.
 Stage 2: Instrumental Orientation. Individuals are concerned about their own personal
well-being, gain, and needs. Right and wrong are often determined by some exchange of
favors that directly benefit the self. For example, a child may reason that it is not wrong
to report a friend for stealing candy because the friend shared the candy.
Conventional level: Moral reasoning is guided by society’s norms.
 Stage 3: Interpersonal Norms. This stage is also known as the “good boy/good girl
stage.” Individuals are concerned with the perceptions of others, and use that concern to
determine right from wrong. For example, people who steal are often seen as “bad”
people by others, thus stealing must be wrong. However, if, for example, parents steal

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food because they have no money to buy it for their children, perhaps the parents would
be seen as “good,” and stealing may be justified in this case.
 Stage 4: Social Systems Morality. Stage 4 is also known as the “Law and Order” stage
because individuals who reason at this stage firmly believe that there are laws in society
to maintain order and promote good within society, and breaking those laws would
likely lead to chaos or anarchy.
Postconventional level: Generally, at this level, moral reasoning stems from a personal moral
code.
 Stage 5: Social Contract. Individuals who reason using Stage 5 principles believe that
laws are based on an agreed-upon contract that is meant to benefit the members within
society. However, if those laws are unjust to the society’s members, there may be cause
for breaking them.
 Stage 6: Universal Ethical Principles. Individuals rely upon abstract principles such as
justice and equality to guide their moral reasoning. They also recognize that their
personal moral beliefs may, at times, conflict with societal expectations, but they take
ownership and responsibility for their reasoning and beliefs.
Kohlberg’s theory, although supported by his and others’ research and widely accepted,
falls short, according to researchers, such as Carol Gilligan, who point to the limitation of
Kohlberg’s sample (i.e., only including boys/ men as participants). Gilligan also argued that
Kohlberg’s theory bases moral decisions on the notion of justice, and whereas justice may be the
guiding focus for boys and men’s moral reasoning, she suggests that women reason using the
notion of care.
In response to Kohlberg’s theory, Gilligan devised a three-level theory. At the

preconventional level, Gilligan notes that there is an emphasis on caring for the self. Thus, self-
preservation influences decisions about right and wrong. At the conventional level, women
shift their focus of care and concern from themselves to others. Finally, at the postconventional
level, the focal point for moral reasoning is care for self and others in an interdependent manner.
Although there has been research support to suggest that girls and women use a “care”
model in determining right from wrong, there has also been research to suggest that some men
also use a similar model of “care,” and some women use a model of “justice,” as proposed by
Kohlberg. Hence, sex may not be the sole explanation for these different approaches to moral
reasoning; other factors such as family upbringing may contribute to how we determine right
from wrong.
It seems that society and the common legal definition have got it about right: it takes
some 21 years for a human being to reach adulthood. The evidence shows a particular need to
invest in the crucial development period from conception to age two (the first 1,000 days) and
also during critical phases over the next 7,000 days. Just as babies are not merely small people—
they need special and different types of care from the rest of us—so growing children and
adolescents are not merely short adults; they, too, have critical phases of development that need
specific interventions. Ensuring that life’s journey begins right is essential, but it is now clear

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that we also need support to guide our development up to our 21st birthday if everyone is to
have the opportunity to realize their potential. Our thesis is that research and action on child
health and development should evolve from a narrow emphasis on the first 1,000 days to
holistic concern over the first 8,000 days; from an age-siloed approach to an approach that
embraces the needs across the life cycle.
To begin researching and encouraging action, this volume, Child and Adolescent Health
and Development, explores the health and development needs of the 5 to 21 year age group and
presents evidence for a package of investments to address priority health needs, expanding on
other recent work in this area, such as the Lancet Commission on Adolescent Health and
Wellbeing (Patton, Sawyer, and others 2016). Given new evidence on the strong connection
between a child’s education and health, we argue that modest investments in the health of this
age group are essential to attain the maximum benefit from investments in schooling for this
age group, such as those proposed by the recent International Commission on Financing Global
Education Opportunity (2016). This volume shares contributors to both commissions and
complements an earlier volume, Reproductive, Maternal, Newborn, and Child Health, which focuses
on health in the group of children under age 5 years.
There is a surprising lack of consistency in the language used to describe the phases of
childhood, perhaps reflecting the historically narrow focus on the early years. The neglect of
children ages 5 to 9 years in particular is reflected in the absence of a commonly reflected name
for this age group. Figure 1.1 illustrates the nomenclature used in this volume, which we have
sought to align with the definitions and use outlined in the 2016 Lancet Commission on
Adolescent Health and Wellbeing. The editors of this volume built upon the commission’s
definitions to include additional terms that are relevant to the broader age range considered
here, including middle childhood to reflect the age range between 5 and 9 years. The editors also
refer to children and adolescents between ages 5 and 14 years as “school-age,” since in low- and
lower-middle-income countries these are the majority of children in primary school, owing to
high levels of grade repetition, late entry to school, and drop outs. As income levels rise and
secondary schooling enrollment increases, children attending school will be older than age 14
years. Figure 1.1 also demonstrates the overlap between many of these terms. For example, the
Convention on the Rights of the Child defines child as every human being younger than age 18
years, whereas this volume defines adolescence as beginning at age 10 years and continuing
through age 19 years (United Nations General Assembly 1989). Figure 1.1 also shows the
alignment between age groups and four key phases critical to development. These key phases
are used as an organizing principle for intervention throughout this volume. Where possible,
the editors have extended the analyses to include children through age 21 years; but standard
reporting of age data is in quintiles, so for convenience the editors have accepted the upper age
range as 15-19 years.
Some issues of potential importance to child development are examined in other

volumes of DCP3. For example, environmental issues are examined in some depth in volume 7
(Mock and others 2017), which examines the impact of pollution on health and human
development—especially the exceptional prevalence of lead poisoning, which affects the
intellectual development of children.

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A premise of this volume is that human development occurs intensively throughout the
first two decades of life (figure 1.1), and that for a person to achieve his or her full potential,
age- and condition-specific interventions are needed throughout this 8,000 days (box 1.3). We
use four key tools—cost-effectiveness, extended cost-effectiveness, benefit-cost, and returns on
investment—to identify and prioritize investments at different ages and to propose delivery
platforms and essential packages that are costed, scalable, and relevant to low-resource settings.
These analyses suggest that public investment in health and development after age 5 years has
been insufficient. Investment lags far behind the potential for return and is far below
investments in health in the first five years and in primary education after age 5 years. Table
1.1 compares our recommendations for additional spending with current spending on
education and with spending on health for children under age 5 years.
Early Childhood Development
Table 1.1
Estimates of Public Sector Investment in Human Development in Low- and Lower-Middle-
Income Countries. US$, billions per year
This bias in investment is paralleled by a similar bias in research. Approximately 99

percent of publications in Google Scholar and 95 percent in PubMed on the first 20 years of life
focus on children under age 5 (annex 1A shows the number of publications since 2004 that our
search found that include the terms health, mortality, or cause of death). The availability of age-
specific publications reflects a lack of research funding for and attention to middle childhood
and adolescence, resulting in a lack of data. The analysis for the Global Burden of Disease 2013
came to a similar conclusion, pointing out that most of the unique data sources for risk factors
for adolescents ages 15–19 years were from school-based surveys, that children younger than
age 5 had the most data available of any age group, and that adolescents ages 10–14 years had
the fewest data sources (Mokdad and others 2016). The World Development Report 2007:
Development and the Next Generation similarly found severe data shortcomings for these older
age groups (World Bank 2006), whereas Hill and others found no empirical studies of mortality
rates for the age group 5–14 years in countries without vital statistics, which include the
majority of low- and middle-income countries (LIMCs) (Hill, Zimmerman, and Jamison 2017).

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Essential Packages of Interventions for School-Age Children and Adolescents
Appropriate health interventions for the first 1,000 days are addressed in detail in
volume 2, which describes two essential packages of interventions targeted at young children:
one on maternal and newborn health and the other on child health. In volume 8, we
complement these packages with an analysis of early childhood development (Alderman and
others 2017; Black, Gove, and Merseth 2017; Horton and Black 2017; Horton and others
2017, chapters 7, 19, 24, and 26, respectively, in this volume). Our analysis suggests that there is
significant value in adding “responsive stimulation” to these health packages (box 1.3). More
detailed analysis of the cost and relative effectiveness of the early child development package is
presented in chapter 2 of volume 9 (Watkins, Nugent, and others 2018).
This volume focuses on the three phases of development for those older than age five
years: middle childhood growth and consolidation, the adolescent growth spurt, and adolescent
growth and consolidation (figure 1.1). We argue that intervention during each of these stages is
essential to enhanced survival and to effective development; in addition, each stage provides an
opportunity to remedy earlier failures in development, at least to some extent.
First we discuss a package of interventions aimed at school-age children (see table 1.2);
this package addresses both middle childhood growth and consolidation (ages 5–9 years) and
the adolescent growth spurt (ages 10–14 years). We then discuss a package aimed at later
adolescence, which addresses adolescent growth and consolidation (ages 15–19 years) (table 1.3).
In practice, there is considerable overlap between the age groups able to benefit from these two
packages, and both packages are required to cover the needs of adolescents from ages 10 to 19
years.
Table 1.2
Essential Package of Interventions for School-Age Children (Ages 5–14 Years)

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Table 1.3 Essential Package of Investments for Adolescents (Ages 10–19 Years, Approximately)
Essential Package of Interventions for School-Age Children
Health and nutrition programs targeted through schools are among the most ubiquitous
for school-age children in LMICs. Since the inclusion of school health programs in the launch of
Education for All in 2000, it is difficult to find a country that is not attempting to provide school
health services at some level, although the coverage is often limited (Sarr and others 2017). The
World Food Programme estimates that more than 360 million schoolchildren receive school
meals every day (Drake and others 2017, chapter 12 in this volume), many of whom live in
LMICs, and the World Health Organization (WHO) estimates that more than 450 million
schoolchildren—more than half of the target population—are dewormed annually (Bundy,
Appleby, and others 2017, chapter 13 in this volume) in nearly all LMICs. These largely public
efforts are variable in quality and coverage, but the large scale of existing programs indicates a
willingness by governments to invest in health as well as education for this age group.
The school system represents an exceptionally cost-effective platform through which to

deliver an essential package of health and nutrition services to this age group, as has been well
documented in high-income countries (HICs) (Shackleton and others 2016). It is also
increasingly equitable, especially because increases in primary enrollment and attendance rates,
and narrowing of gender gaps, are among the greatest achievements of the Millennium
Development Goals (Bundy, Schultz, and others 2017, chapter 20 in this volume). In LMICs with
weak health systems, the education system is particularly well-situated to promote health
among school-going children and adolescents who may not be reached by health services. There
are typically more schools than health facilities in all income settings, and rural and poor areas
are significantly more likely to have schools than health centers.
In this section, we examine the investment case for providing an integrated package of
essential health services for children attending school in low- and lower-middle-income
countries (see table 1.2). “School-age” includes both middle childhood and younger adolescence.
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Middle Childhood Growth and Consolidation Phase
An important economic rationale for targeting the health and development of school-age
children is to promote learning at an age when they have what may be their only opportunity to
attend school. Ill health can be a catalyst for extended absence from or dropping out of school;
for example, malaria and worm infections can reduce enrollment, and anemia resulting from
malaria or worm infections can affect cognition, attention span, and learning (Benzian and
others 2017; Brooker and others 2017; Bundy, Appleby, and others 2017; Drake and others
2017; LaMontagne and others 2017; Lassi, Moin, and Bhutta 2017 [chapters 11–16 in this
volume]). Estimates suggest that in areas where malaria and worm infections are prevalent,
poor students could gain the equivalent of 0.5 to 2.5 extra years of schooling if given
appropriate health interventions, while sustaining benefits across multiple years of schooling
could improve cognitive abilities by 0.25 standard deviation, on average. Extrapolating the
benefits of improved accumulation of human capital could translate to roughly a 5 percent
increase in earning capacity over the life course (Ahuja and others 2017, chapter 29 in this
volume).
Chapter 8 in this volume (Watkins, Bundy, and others 2017) shows that some of these
interventions also have important roles to play in maintaining and sustaining the gains of
earlier investments, and children who slip through the early safety net can still achieve some
catch-up growth with interventions in middle childhood. Furthermore, the new mortality
analyses presented in chapter 2 (Hill, Zimmerman, and Jamison 2017) show that, for those ages
five to nine years, survival continues to be a significant challenge, largely because of the
persistently high prevalence of infectious diseases, including pneumonia, diarrhea, and malaria.
The control of infectious diseases therefore remains a critical element of intervention in this age
group.
In many malaria-endemic areas, successful control programs have reduced the level of
transmission substantially (Noor and others 2014; O’Meara and others 2008; WHO 2015).
However, since the age pattern of clinical malaria is determined by the level of transmission and
the consequent level of acquired immunity (Carnerio and others 2010; Snow and others 1997),
clinical attacks of malaria are becoming more common in older children. In The Gambia, the
peak age of hospital admission for severe malaria increased from 3.9 years in 1999–2003 to 5.6
years in 2005–2007 (Ceesay and others 2008); similar changes have been seen in Kenya (O’Meara
and others 2008). This has created a new challenge for intervention, because none of the
population-based presumptive treatment approaches are recommended for the school-age
group and the current policy of testing and treating with Artemisinin-based combination
therapy does not appear cost-effective in this age-group (Brooker and others 2017, chapter 14 in
this volume; see also Babigumira, Gelband, and Garrison 2017, chapter 15 in volume 6).
Analyses in this volum (Bundy, Appleby, and others 2017, chapter 13) and in volume 6
(Fitzpatrick and others 2017, chapter 16) also show that intestinal worm burdens are often
greatest in school-age children, and whereas there is broad consensus on the benefits of treating
infected children, there is controversy regarding the most cost-effective approach to school-
based delivery. In practice, most countries use school-based mass treatment—that is, treatment
of all children at risk, without prior screening. In 2015, more than 450 million children were
treated, and India alone claims to have treated 340 million children in 2016.
Adolescent Growth Spurt Phase

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The pubertal growth spurt is a watershed feature in the transition from childhood to
adolescence, a process that occurs earlier for girls and that can be modified by external factors,
including diet. The phase may provide the best opportunity for catch-up growth, with growth
velocities reaching equivalence to those of children at age two years.
The growth spurt is a time of rapidly increasing muscle, bone, and organ mass, and of
high dietary demand. One way of responding to this—providing meals in schools—is arguably
the most prevalent publicly funded resource transfer program worldwide, with some 360
million children being fed every school day. A narrow focus on health outcomes underestimates
the benefits of multiple cross-sectoral outcomes, including promoting school participation,
especially for girls; providing a productive social safety net in hard-to-reach communities; and
stimulating rural economies through the procurement of local produce (Drake and others
2017, chapter 12 in this volume). School feeding should be viewed as an option among other
transfer programs with multiple outcomes. From a social perspective—often taken in economic
evaluation—the net cost of a transfer is often close to zero, or the 10 percent to 15 percent of the
total cost that is required for delivery (see discussion of the costs of cash and other transfer
programs from multiple perspectives in chapter 23 in this volume, de Walque and others 2017).
School feeding can thus be viewed as conditional (because school attendance triggers the
transfer) non-cash transfer programs, and evaluations suggest that offering school meals
typically increases attendance rates by 8 percent (Drake and others 2017). From this effect alone,
benefit-cost ratios of 2 or more can be inferred.
School-based delivery of vaccination is particularly effective at this age, especially for

girls. Tetanus toxoid vaccination lowers the risk of contracting tetanus both for recipients and
for the children of adolescent girls, thus providing an intergenerational benefit. In addition, 70
percent coverage of human papillomavirus vaccine that is effective over a lifetime could avert
more than 670,000 cases of cervical cancer in Sub-Saharan Africa over consecutive birth cohorts
of girls vaccinated as young adolescents (LaMontagne and others 2017, chapter 15 in this
volume). There is evidence that school-based vaccination programs can achieve effective
coverage.
Early adolescence is the age when the most common vision problems—refractive
errors—first emerge, and school-based screening of children in select grades is a cost-effective
way to detect and correct refractive errors of vision that could otherwise increase the probability
of dropping out of school, perhaps leading to lifelong visual impairment (Graham and others
2017, chapter 17 in this volume). Early adolescence is also a key phase for promoting lifelong
healthy behaviors (World Bank 2006), including oral hygiene and good dietary practices. This
phase may be particularly sensitive to diet, as it is associated with the emergence of
micronutrient deficiency diseases, such as anemia and iodine deficiency.
Essential Package of Interventions for Later Adolescence
A phase of adolescent growth and consolidation begins around 15 years of age,

continues into the 20s, and requires a package of age-specific interventions (table 1.3). This
period has traditionally been viewed as socially important but has lacked concerted attention as
a critical period for health and development. This is an age when self-agency becomes
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increasingly important, and although the concept of adolescent-friendly health services has
been widely adopted, in reality the quality and coverage rarely respond to the need, in
particular, ensuring that adolescents are able to make their own decisions about their health.
School-based interventions that go beyond the teaching of health education in classrooms and
encompass changes to the curriculum and the wider social environment, as well as engagement
with families and the community, are more likely to improve sexual health, reduce violence,
and decrease substance abuse (Reavley and others 2017, chapter 18 in this volume; Shackelton
and others 2016). In the broader population, intersectoral action has been central to public
health gains in many countries, including transport sector actions to reduce road traffic injuries
and taxes to achieve tobacco control (Elvik and others 2009; Farrelly and others 2013).
With the exception of sexual and reproductive health, available evidence on preventive
interventions derives largely from high-income countries and the United States in particular.
The social and environmental determinants of adolescent health and well-being act at different
levels and across different sectors. The most effective responses are likely to operate at multiple
levels of particular settings (Viner and others 2012). The lives of young people are affected by
community behavior and norms as well as by the values of adults and other adolescents.
Community interventions have commonly involved local government, families, youth-focused
and religious organizations, and schools.
Universal health coverage for adolescents requires training health care providers not
only to respond to specific health problems beyond a focus on sexual and reproductive health
but also to adopt nonjudgmental attitudes, to maintain confidentiality, and to engage with
adolescents—while maintaining lines of communication with families. There needs to be a focus
on addressing the financial barriers that are especially important for adolescents to overcome,
such as making out-of-pocket payments and finding accessible platforms for health delivery
that work for this age group. There is growing recognition of the importance of agency for this
age group and of the importance of identifying approaches to health that enhance decision
making and engagement of adolescents around their health and health care. Lack of adolescent
agency is particularly common in LMICs.
Particularly for girls, the expansion of secondary education, which is one of the
Sustainable Development Goals (SDGs) targeted for 2030, offers remarkable opportunities to
improve health and well-being. Secondary education is effective in increasing the age at
marriage and first pregnancy (Verguet and others 2017, chapter 28 in this volume). Participation
in quality secondary education enhances cognitive abilities; improves mental, sexual, and
reproductive health; lowers risks for later-life noncommunicable diseases; and offers significant
intergenerational benefits (Blank and others 2010). Secondary schools also provide a platform
for health promotion that can strengthen self-agency around health; provide essential health
knowledge, including comprehensive sexuality education; and help to maintain lifestyles that
minimize health risks. Equally, achieving the educational and economic benefits that secondary
schools offer requires the avoidance of early pregnancy, infectious diseases, mental disorders,
injury-related disabilities, and undernutrition.
Media messages have particular salience during the adolescent years and provide an
essential platform for health action and have proven effective in HICs. Adolescents are
biologically, emotionally, and developmentally primed for engagement beyond their families,
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and the media, particularly social media, offer that opportunity. Social media may also bring
hazards, among the most conspicuous being online grooming, cyberbullying, and a growing
preoccupation with body image, and so any intervention has to take these negatives into
account (Durlak, Weissberg, and Dymnicki 2011; Farahmand and others 2011; Murray and
others 2007).
Economic Analysis of the Essential Packages
Table 1.1 summarizes current levels of public investment in three important areas for
child and adolescent health and development in LMICs: basic education (pre-primary, primary,
and secondary), health in the first 1,000 days, and the two intervention packages for ages 5–19
years in low- and lower-middle-income countries. Table 1.4 summarizes the costs of the
essential packages to promote health of school-age children and adolescents.
Table 1.4
Cost of Components of Essential Packages to Promote Health of School-Age Children and
Adolescents in Low- and Lower-Middle-Income Countries.
Of the three areas, education attracts the largest investment at US$206 billion per year in
2015, much of which is from the public sector and is intended to provide pre-primary, primary,
and secondary education free at the point of delivery. The International Commission on
Financing Global Education Opportunity (2016) calls for governments to increase domestic
public expenditures to support universal provision of primary education in low- and lower-
middle-income countries by 2030, requiring an increase from 4.0 to 5.8 percent of gross
domestic product (GDP), which is equivalent to an annual rate of growth in public education
spending of 7 percent over a 15-year period. In addition to education interventions, the
commission identifies 13 nonteaching interventions as “highly effective practices to increase
access and learning outcomes,” including three health interventions: school feeding, malaria
prevention, and micronutrient intervention. The achievement of universal secondary education
by 2030 is a specific Sustainable Development Goal and is also cited in the report of
the Lancet Commission on Adolescent Health and Wellbeing as key to adolescent growth and
development.
In contrast to these very large public expenditures for education, the current annual investment
for children younger than age five years is an estimated US$28.6 billion, which includes
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investments in maternal and newborn health, as well as child health for children under age five
years. It is estimated, based on current prices, that the cost of increasing coverage to 80 percent
would be an additional US$27.3 billion annually (table 1.1). This is based on estimates in
volume 2 (Black, Walker, and others 2015) of the cost of the two packages: maternal and
newborn health, and health of children under five.
In contrast to these very large public expenditures for education, the current annual
investment for children younger than age five years is an estimated US$28.6 billion, which
includes investments in maternal and newborn health, as well as child health for children under
age five years. It is estimated, based on current prices, that the cost of increasing coverage to 80
percent would be an additional US$27.3 billion annually (table 1.1). This is based on estimates
in volume 2 (Black, Walker, and others 2015) of the cost of the two packages: maternal and
newborn health, and health of children under five.
For interventions in the health and development of children in the age range of 5–19
years in low- and lower-middle-income countries, we have no direct estimate of current
expenditure. We present here the estimated total and incremental costs of providing a school-
age package and an adolescent package to this age group (table 1.1). We estimate the total cost
as US$6.9 billion, comprising US$1.4 billion and US$5.5 billion in low- and lower-middle-
income countries, respectively (not including HPV vaccination). Assuming that current
provision is on the order of 20 percent to 50 percent of need, this implies an incremental need of
between US$3.4 billion and US$5.4 billion annually, representing between 0.03 percent and 0.07
percent of GDP, dramatically less than the increments sought for education or for the health
programs for children under five years of age.
The single most costly component is school meals, which account for almost half of the
additional investment required. We have argued earlier that this is a special case and is neither
paid for by the Ministry of Health nor primarily aimed at improving health. It is standard
in DCP3 to distinguish between interventions within the health sector and those delivered and
financed outside the health sector. School meals, although part of the health package, are
intersectoral in origin. For this reason, table 1.1 shows the costs with and without school meals.
See also volume 9 for further discussion of this issue (chapter 2 [Watkins, Nugent, and others
2018]).
Taken together, these analyses suggest two important conclusions for investing in health
in the 5 to 19 age group. It is apparent that education investments dominate all other public
investments in human development during the first two decades of life. Using our estimates of
current expenditure, the current costs of providing access in low- and lower-middle-income
countries to basic education and a health care services package for under-fives (including
maternal and newborn health) are US$206 billion and US$28.6 billion, respectively. The cost of
the additional essential health and development packages for those ages 5–19 years are between
US$1.4 billion and US$3.4 billion, respectively. Given that the latter two health and
development investments underpin those in education, it seems difficult to justify investing in
education without making the complementary investments in health and human development
for this age group, especially given the comparatively low cost of the health and development
packages. The modest cost of the two packages suggests that scaling up the health packages for
those ages 5–19 is therefore a high return and low-cost investment that addresses the most
pressing development needs throughout the first two decades of life.
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Health and Education: Two Sides of the Same Coin
Parents gasp and clap in excitement as they witness their toddlers' first steps, or
hear them babble their first words. Children's first day of school, their first piano recital,
and their first soccer game, can cause parents to beam with pride. However, similar
developmental milestones during their children's transition into adulthood are much
less welcome. This transitional period, from childhood to adulthood, is called
Adolescence and spans the ages of 12-24 years old. During adolescence the desire for
independence and autonomy increase, and parents usually find themselves much less
thrilled with the developmental indicators of this increasing maturity. Instead of
beaming with pride when their teens question the rules or challenge authority, parents
often find themselves wanting to scream in frustration, "Why are they doing that!?"
While this developmental period certainly presents parents with many

challenges, it also includes many bittersweet moments that mark their child's increasing
maturity. Some of these developmental milestones may include graduation from high
school or trade school, a teen's first romantic relationship, a first job, or the first home-
away-from-home. But along the way, a teen's normal developmental process can
certainly confound and frustrate even the most patient and understanding parents.
It may be surprising to learn that the concept of adolescence as a separate and

distinct period of development is a relatively recent phenomenon. Prior to the mid-
twentieth century, children became adults by transitioning directly from school into the
workforce, often beginning their own families at the same time. However, as the
industrial revolution's new wave of digital, electronic, information technology surged,
the transition from child-to-adult became lengthier and more complex. In today's
technological world, it simply takes longer for youth to become adequately trained,
employed, and financially independent.
Similarly, the post-World War II era marked the beginnings of radical social changes in
American culture. The advent of the counter-culture movement during the 60's, the
development of reliable birth-control, and the mass entry of women into the workforce, all
exerted a powerful influence on the fundamental structure of the American family. These forces
changed the traditional American values about marriage and family, and altered the way in
which children transitioned into adulthood. When youth get married today, they are generally
older than previous generations and usually wait longer to before having children of their own.
As a result of these changes to the American economy and American culture, the
duration of adolescent development extends beyond "teenage" years to include development
from ages 12 to 24. Because the adolescent developmental period is so lengthy (10-12 years), it is
usually broken down and discussed in terms of early, middle, and late adolescence. In fact,
some developmental theorists even refer to yet another, separate developmental period
between childhood and early teens calling these youth, "tweens" or "tweeners" (be-tween
childhood and adolescence).

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Subsequently, today's youth face many challenges that are quite different from their
parents' own teenage years; challenges that their parents simply did not encounter. Therefore,
the parents of today's youth cannot readily draw upon their own teenage experiences to
understand some of the difficulties facing youth in contemporary society.
In addition to these simple observations of a changing culture and economy, the validity
of a separate and distinct period of adolescent development has been supported by scientific
research. This research provides additional evidence that adolescents are uniquely different
from children and adults in a number of significant ways. This article will explore these
differences, and will discuss the many facets of adolescent development. We will specifically
discuss six dimensions of development: 1) physical, 2) cognitive, 3) emotional, 4) social, 5) moral,
and 6) sexual development. Our goal is to describe the normal, average, development of
adolescents so that parents and other caregivers can recognize, understand, and appreciate the
important developmental milestones of this transitional period. With this increased knowledge
and understanding, parents are in a better position to support and guide their teens throughout
these amazing, but often difficult years. While this article is primarily descriptive in nature,
our Adolescent Parenting article provides parents with concrete advice and practical solutions
for common problems that often occur during this developmental period.
QUIZ
1. Examples of choices that can have long-term consequences:
o A. Sex
o B. Body piercings
o C. Drugs and alcohol
o D. Trouble with the law
o E. A, C and D
2. Define Identity:
o A. When you look at someone else
o B. A sense of oneself as a unique person
o C. A sense of someone else
o D. Your buddy
3. Define Adolescence:
o A. Process or state of growing to maturity
o B. Process of growing from adulthood to old age
o C. When you get old
o D. When you are a child
4. What is the range of adolescence?

o A. 31-39
o B. 51-59
o C. 11-19
o D. 21-29
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5. Who matures faster?
o A. Boys
o B. Girls
6. Peer pressure is
o A. Always negative
o B. Means conforming to your friends
o C. Increases throughout adolescence
o D. Has not affect on adults
7. What circumstances kept young people from going to work early in life and helped
contribute to the extension of adolescence?
o A. Moving off of farms
o B. Child labor laws
o C. Compulsory education laws
o D. All of the above
8. Which of the tasks that teens are dealing with?

o A. Overcoming insecurities with the changing body
o B. Adjusting to new intellectual abilities
o C. Achieving new and more mature relations with age-mates of both sexes
9. Which of the following is a common thinking of adolescents?

o A. It won't happen to me (invincibility)
o B. Imaginary audience (everyone is looking at me)
o C. Personal fable (no one else can possibly understand)
o D. Egocentric thought (thoughts focus on self)
o E. All of the above
10. New cognitive (mental) abilities lead teens to:

o A. Argue so they try out their new thinking abilities
o B. Give up completely on schoolwork
o C. Have difficulty in reversing a situation
o D. Believing everything they see
11. The percent of teens that rebel in a serious way is:

Discuss
o A. 10
o B. 50
o C. 80
o D. 20
12. An example of a serious rebellion is:

o A. Tattoo
o B. Trouble with law
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o C. Purple hair color
o D. Gothic dress
13. Some teenagers rebel because of internal family problems that are caused by conflict,
permissive parenting and addictions.
o A. True
o B. False
14. Teens need independence from their parents, but the majority of teens still want their
parents involved in their lives.
o A. False
o B. True
15. When choosing friends, which of the following are good guidelines?
o A. Popularity
o B. Similar values and goals
o C. Ones who inspire you to be a better person
o D. Both B and C
16. As the adolescence moves towards independence, the wise parents:

Discuss
o A. Read the teen's email
o B. Keep firm control for the teen's well being
o C. Give the teen the opportunity to make more choices and decisions and acts as
a resource
o D. Restrict the teen clothing styles and dress
17. A ceremony that marks the transition from adolescence to adulthood is called:
o A. Rite of passage
o B. Transition
o C. Crisis
o D. Discretion
18.Emotional fluctuations in adolescence are caused by:

o A. Hormonal changes and brain in development
o B. Hormonal imbalances
o C. Lead to a need for professional counseling
o D. Environmental factors
19. Based on research, which group would be mostly likely to have low self-esteem?
o A. Maury, a 19 year old male
o B. Martin, a 13- year old male
o C. Marua, a 19 year old female
o D. Maria, a 13 year old female

63 | P a g e
20. Friendships during the teen years:
o A. Are not to be encouraged
o B. Often become as or more important than being with family
o C. Are nice, but not necessary for teens social development
o D. Should be chosen by the teen's parents
21. Competent development during adolescence are promoted by all of the following
except:
Discuss
o A. Respect of the teens by parents
o B. Taking responsibility for one's actions
o C. Parents showing an interest in the teen
o D. Perfect behavior expected by parents
22. It is illegal to carry graffiti equipment even if you have not used it.
o A. True
o B. False
23. If you have your parent's permission, you may marry at this age:
o A. 16
o B. 14
o C. 15
o D. 17
24. Curfew for students in high school on weekend nights is:

o A. Midnight
o B. 10:45
o C. 11:00
o D. 10:30
25. Having sex with a minor is called:

o A. Sodomy
o B. Statuary rape
o C. Public Indecency
o D. Legal
26. It is illegal for teens to carry a pocket knife of 3 " if you are not at school.
o A. False
o B. True
27. Brass knuckles are illegal to purchase if you are a teen, but not an adult.
o A. False
o B. True

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28. Establishing emotional independence from your parents means all of the following
EXCEPT:
o A. Talking to a teacher or friend at times about issues
o B. Having your parents make all decisions for you
o C. Reading self-help articles "on-line" about your problem
o D. Sharing your inner feelings with a boyfriend or girlfriend
29. The section of the brain that helps you make good decisions is called:
o A. Frontal Cortex
o B. Cerebellum
o C. Nucleus Accumbens
o D. Amygdala
30. Hollywood stereotypes of groups in high school include the following:

o A. Stoners
o B. Preps
o C. Jocks
o D. Nerds
o E. All of the above
31. All of the following have contributed to a prolonged adolescence; meaning young
people are staying home longer.
o A. A later age of marriage
o B. Graduate school attendance leading to high college loans
o C. Stiffer competition for jobs
32. Rushing to grow up can result in negative consequences if:

o A. You take on adult roles before you have the skills to handle them
o B. Will help you in reaching independence quickly
33. Which of the following are true about romantic relationships?

o A. You must both be at the same level in the relationship so that there is no
pressure from one individual
o B. Relationships cannot be serious in high school
o C. Relationships require skills so that one person is not taken advantage of
o D. Both A and C
34. Relationships have different levels and what is appropriate at one level, is often not
appropriate at another level.
o A. False
o B. True
35. When stopped by a police officer as a teenager for a DUI, the legal limit for alcohol is:
o A. .08
o B. .06
o C. 0
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36. The age of onset of puberty varies.

o A. True
o B. False
37. Adolescence who have siblings and parents who engage in delinquent behavior are
also more likely to do so.
o A. True
o B. False
38. The early use of drugs and alcohol makes addiction more likely and slows the
development of the brain.
o A. False
o B. True
39. According to the video on brain development of teens, teenagers have high
motivation.
o A. True
o B. False
40. Arrests are more likely to occur during young adulthood than any other time in life.
o A. True
o B. False
41. The bottom section of the brain is called the cerebellum. It develops first and it...
o A. Controls motor function, physical activity
o B. Controls judgement
o C. Controls emotions
42. The brain does not fully develop until around this age.
o A. 6
o B. 13
o C. 18
o D. 24
43.Gay and lesbian teens who "come out" often face special problems due to rejection by
family and friends.
o A. True
o B. False
44. Conflicts with parents usually decline in later adolescence.

o A. True
o B. False
45. Adolescents are usually in a constant state of rebellion with their parents.
o A. True
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o B. False
46. Texting nude photos of yourself, if you are a minor, is considered child pornography.
o A. True
o B. False
47. A misdemeanor is a more serious crime than a felony.

o A. True
o B. False
48. It is legal to carry pepper spray to defend yourself.

o A. True
o B. False
49.Parents can legally have their children smoke marijuana, but only if it is in their own
home.
o A. True
o B. False
50. Boys are especially to risky behavior during adolescence. The peer pressure to prove
"manhood" is often done in the following ways
o A. Street Racing
o B. Multiple Sex "Scores"
o C. Joining gangs, Fighting
o D. Binge Drinking
o E. All of the Above

67 | P a g e

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ASTRA EDUCATION

Haggai Training and Development Services

II. General Objectives of the Course

This course specifically aims to:

 Theories and etiology of addictions and addictive behaviors

Module 2 │The Child and Adolescent Learner & Learning Principles

IV. Course Requirements

VI. Academic Performance Evaluation System

Examination (Prelim, Midterm and End term) ……..................... 30%

VII. Academic Infrastructure

1. Ahuja A, Baird S, Hicks J Hamory, Kremer M, Miguel E, editors; . 2017. “Economics of

Module 2 │The Child and Adolescent Learner & Learning Principles

Module 2 │The Child and Adolescent Learner & Learning Principles

This is a book about human development, an interdisciplinary field of study. Human

Module 2 │The Child and Adolescent Learner & Learning Principles

Why is this type of research important?

Module 2 │The Child and Adolescent Learner & Learning Principles

• Adolescence is one of the most rapid phases of human development.

Age: not the whole story

Adolescence: Physical Changes

Adolescence: Neurodevelopmental Changes

Module 2 │The Child and Adolescent Learner & Learning Principles

Implications for Health and Behavior

Implications for Policies and Programmes

• Adolescents need explicit attention.

Module 2 │The Child and Adolescent Learner & Learning Principles

1. There is no universal definition of children or of childhood. Childhood is a cultural and social

10. In situations in which children’s development is under threat because of sudden

Topic 1: Defining Children and Childhood

• There is no universal definition of who is a child, adolescent or youth. Chronological age is

• Childhood is understood in very different ways in different contexts. Childhood is a social

DEFINING CHILDREN BY AGE

Module 2 │The Child and Adolescent Learner & Learning Principles

Children may be especially vulnerable because of their immaturity and reliance on

In many refugee contexts, programme responses emphasize children of primary school

Training Materials for Topic 1

Topic 2: Introducing Child Development Thinking into Programme Planning

Module 2 │The Child and Adolescent Learner & Learning Principles

CHILD RIGHTS AND CHILD DEVELOPMENT

Although there is a growing recognition of the importance of a child rights perspective

Genes also “steer” biological development, the “programme” of emergence of different

SOME GENERAL FACTORS AFFECTING CHILD DEVELOPMENT IN CONFLICT AND

Module 2 │The Child and Adolescent Learner & Learning Principles

• Malnutrition is closely linked to disease, especially infectious diseases. Under-nourished

• Loss of educational opportunities can have far-reaching effects on children’s development.

Module 2 │The Child and Adolescent Learner & Learning Principles

Topic 3: Risk and Resilience in Children and Adolescents

Key Learning Points

RISK FACTORS FACING CHILDREN AND ADOLESCENTS IN EMERGENCY

Module 2 │The Child and Adolescent Learner & Learning Principles

The psycho-social well-being of children in difficult circumstances can be seen as a

These points appear as Overhead 3.2.

These points appear as Overhead 3.3.

These points appear as Overhead 3.4.

These points appear as Overhead 3.5.

STRATEGIES TO ENHANCE RESILIENCE

A second strategy may be described as a resource-focused approach which will aim to

Topic 4: Some Critical Threats to Child Development in Emergency Situations

4.1 EXPERIENCES OF VIOLENCE AND FEAR

Module 2 │The Child and Adolescent Learner & Learning Principles

4.2 SEPARATION FROM PARENTS OR OTHER CARERS

Good quality of care is rarely available in an institutional setting. Wherever possible,

Module 2 │The Child and Adolescent Learner & Learning Principles