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 TENTH EDITION

MARIAN MARION
 PREFACE vii

to a more positive and authoritative style of ca regiving. Not being firmly grounded in a posi-
tive style o f caregiving means that teachers might not understand what child ren, especially
the youngest child ren, need before they can play with other child ren well, express emotions
approp riately, or control their impulses. Adopting a positive autho ritative caregiving style can
be difficult but it is not at all impossible. I was raised in a home provid ing love, but o ften
ove rly strict rules and punishment that seemed unnecessary, and I decided in college while
taking my first preschool education course to try to learn a d ifferent and more positive way
o f wo rking with child ren while explo ring how to set and maintain limits firmly and fairly.
This entire textbook will help you find your ca regiving style and I hope that you decide to
adopt the auth oritative style, because it is exquisi tely effective in helping child ren.
• Alternatives to ti111e-out, as punis hment This edition has emphasized the need LO abandon
o r discard punishment in general and especially the commonly used punishment time-out. I
decided to weave a strong and promine nt th read in the entire book about positive guidance
strategies-alternatives to Li me-out- and decided to note that these strategies are superior
to and more compassionate and effective than any punishment, including time-out. Look for
this thread in several chapters, includ ing Chapters S, 8, 9, 10, 11, and 13.
• School- or home-based examples This text is aimed at futu re teachers. While much of the
research has been de rived from studies of child ren in families, I have focused examples in
this ed ition primarily on school-based examples, but have retained home-based examples
when that was necessary and relevant to a future teacher's understanding of what child ren
expe rience at home.
• Sources o f school-based examples are now weighted in favo r of K and Pre-K, with most
of these at the pre-K level. While the re are examples from Mr. Russo's first grade class, this
tenth edition has a greater numbe r of pre -K examples than from a primary classroom. The
reason: Preschool and child care expulsions are so high, with those in child ca re exceed-
ingly high , that professionals teach ing at those levels need to see appropriate guidance in
action.
• Encouragement vs. Praise This has been a controversial topic for some Li me in ECE. This
edition urges students to adopt encouragement and clarifies the differences between the two.
Chapte r 2 explains how to use encouragement effectively.
• Work wilh ,vhat you have One reviewe r suggested that this text help students understand
that they need at Li mes to work with what they have. So, Chapter 4 presents this concept in
the context of setting up a classroom well even when the furniture and storage items are not
the newest. The idea is to set up a room well using principles of effective room design and
the safe and sturdy materials available.
• Bullying as a form of aggression In Chapter 10, this edition gives greater weight LO caution-
ing teachers of young child ren to tread carefully when using the label "bully." We should not
confuse the normal instrumental aggression of young children with real bullying.
• Role o f inten tionality Chapte r 11, on challenging behavior, has always noted the role of
a teache r's deliberate attention to challenging behavior and tryi ng to figure out the root of
the behavior. Added to this chapter is a highlighting of the role of deliberate and intentional
teacher action in supporting child ren with challenging behavior. This is done through the
addition of a video example with discussion questions.
The tenth ed ition retains features that have helped students construct a developmentally appro-
p riate app roach to guid ing children. It also contains updated research throughout and new
content and features designed to make the teachi ng and learning processes for instructo rs and
students even more effective, efficient, and enj oyable. Following are some examples.
viii PREFACE

•!• FEATURES RETAINED FROM THE PREVIOUS EDITION

My goal has always bee n to write a student-friendly texLbook . With in thaL framework, I want
studenLS to see that a research- and theory-based textbook can challenge them to thi nk critically
abouL guiding children. These effecLive feaLu res from Lhe lasL edition have been retained, but have
been refined to make them eve n more useful:
• Writing Style. Conve rsational and informative.
• Bold Font. Emphasizes definitions and terms seen for the first time.
• Definitions Highlighted and Set Off from Text. Definitions are clearly evident within the
Lext and each defi niLion comes ve ry soon after the word defined is first me ntioned.
• Use of Three Teachers Teaching Children in Different Phases of Early Childhood.
Mr. Martinez (infant- toddler), Mrs. Sandal (preschool), and t-1r. Russo (first grade) appear
Lhroughout the Lext and deal with guidance problems faced every day in real classrooms.
• Chapter-Opening Case Studies. Case studies open every chapLer and focus on children and
teachers in early childhood classrooms (one chapter focuses on parents in the case stud ies
but the chapter information in aimed at Leachers). The last chapter opens with one case SLudy.
In all oLher chapte rs, SLudentS will read case studies from the infant-Loddler, preschool, and
primary (first grade) classrooms. The case SLud ies illustrate major poinLS in each chapte r.
• End of Chapter Features. In add ition LO the in-chapLer learning activities, the end-of-
chapter items give studentS yet another opportunity for learning. These feaLures include the
following.
• Su mmary. A succincLbut complete summary highlights major lessons from the chapter
• Analyze Case Studies. Stude ntS apply newly acquired knowledge from the chapLer to the
chapter-ope ning case SLudy or studies.
• Apply Your Kno,vledge. An end -of-chapter feature focusing on the application level in the
cognitive domain.
• Examples. Gleaned from real classrooms, these illusLrate guidance in early childhood class-
rooms al all levels.
• Appendix. Summarizes major posiLive guidance straLegies and is a good reference.
• Glossary. l isL of Lerms in this text is an effective reference for SLudents.
ContenL new to Lhe ninth ediLion has been retained in this Lenth edition and the research updated
when possible. Some examples follow.
• Information on Challenging Behavior (Chapter 11). This chapLer reLains info rmation on
functional behavioral assessment. The funcLional behavioral assessmenL (FBA) process is
explai ned, Lhen studentS learn how to use the A-B-C method, Lhat is, the anLecedenL, behav-
ior, consequence method to collect the daLa that they need before dealing effectively with
challenging behavior. SLudentS will use these processes to learn how to work with six specific
challengi ng behaviors-inLerrupLions, teasing, biting, whining and pestering, tauling, and
aggressive behaviors (fo r example, hiuing, kicking, damaging and desLroying things, and
temper tantrums). The chapter retains a secLion on supporting infanLS and toddlers wiLh
challengi ng behaviors.
• Content on Bullying (Chapter 10). This edition retains info rmaLion on cyberbullying as
a form of aggression and bullying. SLudents will undersLand the different, currently used
methods Lhat the cybe rbully uses. Students will also read about what they can do LO help
victims of bullying defend themselves. Special emphasis is placed on helping victims deal
with teasing and other forms of face-to-face bullying.
• Content on Social Emotional Leaming (SEL) (ChapLer 8). This chapLer retains a !isling and
discussion of essential topics in SEL. StudentS will learn how to deliberately plan for teachi ng
Lhese topics, such as at large-group Lime and Lhroughout Lhe day. Specific information on
 PREFACE ix

helping child ren handle disappointment and anger as well as on build ing friendship skills
have been retained.
• Focu s on the Role o f Culture in Guiding Children (Chapte rs 1, 2 , 3, 5, 6, 10). Focus on
Culture boxed information has been retained and targets the role that cultural scripts play in
guiding children. Cultural scriptS are acqui red by members of a culture and affect them in
ways that we might not have considered. For example, students will learn about how the
extra talk cultural script a ffectS a teacher's limit setti ng in a classroom.
• Implications of T heories (Chapter 2). Information on the implications of all theo ries pre-
se nted, that is, the practical applications o f each theo ry for an early childhood teacher.
Students will now have access 10 b rief and clearly explai ned implications.
• Coverage of Child Development Information (Chapter 2). This chapter retains the outline
of the maj or facetS of social and emotional growth in children during early childhood. This
info rmation is again presented by age groups.
• Information on Sensory Stimulation in Infancy and Toddlerhood (Chapter 4). Classroom
design is presented chronologically- that is , Sta ns with room design for infants and tod-
dlers first, and is followed by that information for preschool through third grade. The role
of sensory sti mulation in a child's first years is now emphasized. Students will learn about
presenting appropriately ti med sensory stimulation to infants and toddle rs.
• How to Develop Good Relations hips (Chapter 1). This edition retains the expanded cover-
age of the importance of good teache r-child relationships in guiding child ren. Specifically,
students study the practical steps that they can take to develop caring and positive relation-
ships with young ch ild ren.
• Coverage of Schedules (Chapte r 4). Schedules appropriate for an age group are an indirect
form of guid ing children. The section on elements of appropriate Lime schedules has been
retained along with examples of appropriate schedules for different age groups within the
ea rly childhood period. The effect of appropriate schedules on children's development and
learning are explai ned.
• Information on Observation (Chapter 6). This chapter retains the discussion of the role of
assessment in schools of today, achieving objectivity in observing, and using portfolios in
the assessment process.

•!• THIS TEXTBOOK HAS EVOLVED FROM A SET OF BELIEFS

The tenth edition continues 10 renect my co re beliefs about children and ch ild guidance; it is
these beliefs that I want 10 pass on 10 studentS.
• I believe that protecting children is our most important role. StudentS read ing this text
should understand that we teach and protect children most effectively by making active,
conscious decisions about positive strategies. We protect children when we refuse to use strategies
that are degrading or hurtful or have the potential to harm or humiliate children . Some strategies
denigrate and d ishonor ch ildren and should never be used, such as biting, shaking, hitting,
and othe r forms of physically hurtful interaction; hostile humor; embarrassment; ridicule;
sarcasm;judging; manipulating; playing mind games; exe rting hurtful punishment; ignoring;
terrorizing; isolating; and violating boundaries. These are personality-numbing horrors. They
are abusive and have no place in ou r lives with children.
The National Association for the Education of Young Children (NAEYC), in iLS Code of Ethics,
notes that the most important pan of the code is that early ch ildhood professionals neve r engage
in any practice that hurts o r degrades a child. The refo re , this textbook takes this approach: first,
do no harm. Students who use this textbook will learn only positive strategies and a respectful
approach to guiding children.
X PREFACE

• I believe that we have a choice about how ,ve think about and behave with children.
John Steinbeck , in East of Eden, described the beauty inherent in the ability to make choices.
Students need to know that what they choose to think about child ren, how they act with
them, and the d iscipline strategies they use do matter. Using a positive, constructivist, and
optimistic approach daily has a long-term impact on children-helping them become self-
responsible, competent, independent, and coope rative people who like themselves and who
have a strong core of values.
• I believe that an adult's "style" of guiding children does affect children. It affectS several
pa rtS of their pe rsonality and thei r app roach to life- for example, their moral compass,
emotional intelligence, level of self-esteem, how they manage anger and aggression, how
they handle stress, thei r willingness to cooperate with others, whether they can take another
person's perspective, and their social skills.
The refore, the organizing force for this text is the concept of styles of caregiving- a concept
presented right away in Chapte r 1. Students should come away from that chapter with a clear
idea of the authoritarian, authoritative, and permissive styles. They will learn about adult beliefs
and behavior in each style and about the likely effect of that style on children. They will then
encounte r the concept of caregiving style woven into al most every chapte r.
• I believe that constructivist, positive, and effective child gu idance is based on solid
knowledge of child development. \Vithout this knowledge, adultS might well have unreal-
istic expectations of children. Having this knowledge gives professionals a firm foundation
on which to build child guidance skills .
• I believe that there is no one right way to deal with any issue but that there are many
good ways. I do not give students a set of tricks LO use with child ren. However, studentS will
find numerous exercises and questions designed to help them construct basic concepts of
child guidance. They might enjoy thinking critically about typical guidance issues and even
more challenging behaviors.
• I believe that we shou ld each develop a personal approach to guiding children, one
built on theoretical eclecticism. In this text, students will study and use the decision-
making model of child guidance, a model that evolves from understanding various theoretical
approaches to guiding children. StudentS will apply the major theories forming our beliefs and
perspectives on guiding children.

•!• ANCILLARIES FOR THIS EDITION

All online ancillaries can be downloaded from the Instructor Resource Center at Pearson's Higher
Education website by adopting professors and instructors.
• Online Test Bank with Ans,vers, separate from the Instructor's Manual. The test bank
is easy LO use and provides di fferent types of questions.
• Online Instructor's Manual. This manual has been updated. I have retained the teachi ng
objectives and suggestions for teaching each section. Handouts are included that support
teaching and learning.
• Online PowerPoint® Presentations. There is one PowerPoint® presentation for each chap-
ter. These are intended to decrease the Li me that you spend preparing materials for the class.
• TestGen. TestGen is a powerful assessment generation program available exclusively from
Pearson that helps instructors easily create and quizzes and exams. You install TestGen on
your personal compute r (Windows or Mac) and create your own exams for print or online
use. It contains a set of test items o rganized by chapter, based on this textbook's contents.
The items are the same as those in the Online Test Bank. The testS can be downloaded in a
variety o f learning management system formatS.
 PREFACE xi

•!• ACKNOWLEDGMENTS
The professionals at Pearson support authors as they write. I thank my editor, Julie Pete rs; the
development editor, Krista Slavicek ; the managing content produce r fo r Teache r Ed ucation at
Pearson, Megan t-1offo ; as weJJ as the p roduction team, Maria Pi per, Sasibalan Chidambaram,
Thomas Dunn , and the photography researche rs for your professionalism and expertise.
Reviewers have been gene rous in offering ideas for enriching the content and structure of
Guidance of Young Children, JO'h Edition. Several colleagues from around the country reviewed the
mate rial for the tenth ed ition: Lois MicheJJe Edwards, Owensboro Community and Technical
CoJJege; J ill Harrison, Deha College; Je nni fer Henk, University of Arkansas; Lo ri Ki Hough, lord
Fai rfax Community CoJJege; and Carla \Veigel , Hennepin Technical CoJJege.
Reviewe rs provided hel pful and constructively given comments, and I assume their students
receive the same type of supportive feedback with suggestions for change. The reviewe rs made
several specific recommendations that I have noted and heeded. For example, 1 have retained
info rmation on Functional Behavior Assessment (FBA) and the A-B-C method of data coJJec-
tion in the chapte r on challe ngi ng behavior and information on cyberbullying in the chapter on
aggression and bu Hyi ng, and practical info rmation on helping children deal with disappoi ntment
and anger as well as on how LO develop friendsh ip skills. I restructu red one chapter's end of chap-
ter "Apply Your Knowledge" items based on one of the reviewe r's comments. I also reo rganized
the chapter on stress and resilience LO make it more streamli ned. Reviewe r feedback has reshaped
the structu re of pan s of this textbook.
Once again , please feel free to email me with questions, comments, or suggestions about
Guidance of Young Children, Tenth Ed ition.
Marian Marion
Email: mariancmarion94@yahoo.com
 PART I GUIDING YOUNG CHILDREN:
THREE ESSENTIAL ELEMENTS 1
Chapter 1 A Teacher's Role in Guiding Children 3
Chapter 2 Theoretical Foundations of Child Gu idance 26
Chapter 3 Understand Child Development: A Key to Guiding
Children Effectively 56

PART II "DIRECT" AND "INDIRECT"

CHILD GUIDANCE 77
Chapter 4 Supportive Physical Environments: Indirect Guidance 79
Chapter 5 Positive Guidance and Discipline Strategies: Direct
Guidance 110
Chapter 6 Using Observation in Gu id ing Children 142

PART Ill SPECIAL TOPICS IN CHILD

GUIDANCE 165
Chapter 7 Self-Esteem and the Moral Self 167
Chapter 8 Feelings and Friends: Emotional and
Social Competence 190
Chapter 9 Resilience and Stress in Childhood 221
Chapter 10 Aggression and Bullying in Young Children 248
Chapter 11 Minimizing Challenging Behavior 272

xii
 BRIEF CONTENTS xiii

PART IV APPLY YOUR KNOWLEDGE

OF CHILD GUIDANCE 297
Chapter 12 Apply Your Knowledge: Gu id ing Children
du ring Routines and Transitions 298
Chapter 13 Apply Your Knowledge: Use the Decision-Making
Model of Child Guidance 319
Appendix Review: Major Positive Discipline St rat egies 338
PART I GUIDING YOUNG Feedback 21
Physical Environment 22
CHILDREN: THREE ESSENTIAL
Expect.aLions 22
ELEMENTS 1
Change 22

Analyze Case Study 24

Chapter 1 A Teacher's Role
Summary 25
in Guiding Children 3
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • App ly You r Knowledge 25
Learning Outcomes 4 Websites 25
Intro duction 5
Develo p ing Good Relati onships with Ch ild ren 6 Chapter 2 Theoret ical Foundations
Major Dimensio ns of Caregiving Styles 7 of Child Guidance 26
•• ••••••• • • • ••••• ••••••• •• • •• •• ••••••• •
Responsiveness 7
De mandingness 11 Learni ng Outcomes 27
Introduction 28
Styles of Caregiving 12
Theo ries Focusi ng o n th e Setti ngs or Systems
The AuLhorit.ative Style 13 in w hich Child ren Develop 28
High Demandingness, High Responsiveness 13
U rie Bronfenbrenne r 28
Positive and Powerful Effect on Young Children's
Development 14 Family Systems Theory 30

The Authoritarian SLyle 15 Implications of Theories Focusing on Systems

for Guiding Child ren 32
High Demandingness, Low Responsiveness 15
Negative EffecLon Young Ch ild ren's Development 16 Theo ries Focusi ng o n How Children Construct
Knowledge 32
The Permissive SLyle 18
Low De mandingness 18 John Dewey 32

Indulgent: Low Demandingness Plus High Jean PiageL 33

Responsiveness 18 Stages of CogniLive Development 35
Uninvolved: Low Demandingness Plus Low Lev Vygotsky 40
Responsiveness 19 Implications of Theories Focusing on How Ch ild ren
How Pe rmissiveness AffectS Young Ch ild ren 19 ConstrucLKnowledge fo r Guiding Child ren 42

Basic Processes Ad ults Use to Influence Theo ries Focusi ng o n Psychological, Emotio na l,
Chi ldre n 20 an d Social Learn ing Needs 43
Modeling 20 Erik Erikson 43
Instruction and Practice 20 Abraham Maslow 45

xiv
 CONTENTS XV

Alfred Adler 46 PART II "Direct" and "Indirect"

Carl Rogers 46
Child Guidance 77
Social learning Theo ry 50
Use Encouragement: A Form of
Acknowledgment 52 Chapter 4 Su pportive Physical
Pitfalls to Avoid : Ineffective Encouragement 53 Environ ments: Indi rect Guidance 79
••••••••• ••••••• •••••••• ••••••• ••••••• •
Implications of Theo ries Focusing on Psychological,
Emotional, and Social Needs for Guidi ng Learning Outcomes 80
Ch ild ren 54
Introduction 82
Analyze a Case Study 54
Theo retical Fou ndations for Early Child hood
Summary 55 Class room Design 83
Apply Your Knowledge 55 Theories Focusing on the Systems in Which Ch ildren
Websites 55 Develop 83
Theories Focusing on How Child ren Construct
Knowledge 83
Chapter 3 Underst and Child Theories Focusing on Psychological and Emotional
Developme nt: A Key t o Guiding Needs 83
Children Effectively 56 Physical Environ ments and Sensory Stim ulatio n
•• •• • •••• ••• • •••• •• • •• ••• •• • ••• • •• • ••• • fo r Infant s a nd Toddlers 85
Learning Outcomes 57 Child Development Theory Supports Effective
Introduction 58 Teaching and Room Design 85

Social Emotional Development: Sensory Sti mulation: A Powerful Avenue for

W hat to Ex pect 59 Infant- Toddle r Development 85

Perception a nd Memory 60 Developmentally App ropriate Physical

Environment s for 3- t o 8-Year-Olds: Ind irect
Perception: \.Vhat to Expect 60 Gu idance 86
Memory: What to Expect 62
Room Design Based on Theory 88
Social Cognitio n: How Children Think about Bene fits of Well-Designed Spaces fo r Children 89
Others 64
Gu ideli nes: Developmentally Appro priate Room
Preoperational Th inkers: Ages 2 to 6 Years Old 64 Design for 3- to 8-Year-Old Child ren 90
Concrete Operational Thinkers: Ages 6 to 11
Organize the Classroom into Activity Areas 90
o r 12 Years Old 65
Develop Enough Activity Areas 96
Self-Control a nd Prosocial Behavior 65
Arrange Activity Areas l ogically 97
Self-Control: What to Expect 65 Create Attractive, Sensory-Rich Activity Areas 100
Prosocial Behavior: What to Expect 69
Ti me Sched ule, Curriculum, Activities, and
Ana lyze Case Study 75 Materials: Sources of Ind irect Guida nce for
3- to 8 -Year-Olds 102
Summary 75
Schedule 102
Apply Your Knowledge 76
Curriculum 104
We bsites 76
xvi CONTENTS

Activities and the Project Approach 105 Red irect Child ren's Behavio r- Dive rt and Distract
Criteria for Developmentally Appropriate the Youngest Children 131
Activities 107 Red irect Child ren's Behavio r- Make Substitutions
Materials: Choosing and Managing 107 with Older Child ren 132
Listen Actively 133
Analyze a Case Study 108
Deliver !-Messages 133
Summary 108
Teach Conflict Resolution (Problem Solving) 135
Apply Your Knowledge 1 09 Preve nt Overstimulation and Teach Calming
Websites 109 Techniques 136
Help Children Save Face and Preserve Their Dignity 137

Chapter 5 Positive Guidance Beliefs about Discipline Influence Choices

about Guidance Strategies 138
and Discipline Strategies: Direct
Guidance 1 10 Beliefs and Practices 138
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • An Opportunity to Examine Your Beliefs about
Learni ng Outcomes 111 Discipline 138

Introduction 1 12 Analyze a Case Study 139

The Concept of Guidance and Discipline 11 2 Summary 139

Culture and Socialization 112 Apply You r Knowledge 140

Discipline, Guidance, Punishment 113 Websites 141

Guidi ng Infants and Toddlers 11 4

Chapter 6 Using Observation
Guidance for lnfantS 115
in Guiding Children 142
Guidance for Toddle rs 116 •• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Guidi ng 3-Through 8-Year-Olds 117 Learning Outcomes 143

Guidance for 3- Th rough 8-Year-Olds 117 Introduction 144
Guidance and Disci pline Encounters: Assessment in Early Child hood Education 144
3- Through 8 -Year-Olds 117
Purposes of Assessment in ECE 144
Guidance Strategies 118
Diffe rent Forms of Assessment 145
Positive Guidance Strategies: Descriptio n Benefits of Authentic Assessment 146
and Explanation 119
Reasons fo r Observing Children's Behavior 146
Use LimiLS Effectively 119
Teach Helpful or Approp riate Behavior 126 Child ren Communicate with Behavior 146

Set Up Practice Sessions and Give "On-the-Spot" Discove r and Build on Ch ild ren's Strengths 148
Guidance 126 Obse rve Individual Needs for Possible Further
Give Signals or Cues for Appropriate Behavior 12 7 Sc reening 148

Encourage Children's Effo rts to Acce pt LimitS 128 Ac hieve Objectivity a nd Avoid Subjectivity
Change Something about a Context or Setting 128 in Observing 149
Ignore Behavior (Only When It ls Appropriate Teachers Are Responsible for Record ing Observations
to Do So) 130 Objectively 149
 CONTENTS xvii

Practical Suggestions for Achieving Objectivity Control 175

in Observing 149 \Vorth 176
Practical a nd Effective Methods for Observing Self-Esteem Develops in a Social Context 176
Child re n' s Developme nt a nd Behavio r 150
AdultS Influence a Child's Self-Esteem: Ga rbage In,
Anecdotal Reco rds 15 1 Garbage O ut (GIGO) 177
Running Record 152 Bullyi ng and Self-Esteem 178
ChecklistS 154
THE MORAL SELF 1 79
Rating Scales 156
Event Sampling 157 \Vhat Is t-1oral Ide ntity? 179

Time Sampli ng 159 \Vhen and How Does Moral Identity Develop) 179
Theoretical Perspectives on Moral Identity 181
Portfolios in Observing and Guiding
Child re n 160 Practices t hat Help Children Develop Authent ic
Self-Esteem 181
\Vhat Is a Portfolio? 160
Benefits of Portfolios for Ch ild ren, Teachers, Believe in and Adopt an Authoritative Caregivi ng
and Families 160 Style 182

Efficient Use of Portfolios 161 Plan Appropriate Activities Deserving of Child ren's
Time 182
Analyze a Case Stu dy 162 Express Genui ne Interest in Child ren and Their
Sum mary 162 Activities 182

Apply Your Knowledge 163 Give Meaningful Feedback LO Child ren 182
Use Encouragement and Appreciation and Avoid
Websites 163
Empty Praise 183
Acknowledge Both Pleasant and Unpleasant
Feelings 184
PART Ill Special Topics in Child
Demonstrate Respect for All Family Groups
Guidance 165 and Cultures; Avoid Sexism and Judging Physical
Attributes 185
Teach Specific Social Skills 186
Chapter 7 Self-Esteem and the
Moral Self 167 Analyze a Case Study 188
•• ••• •••• ••••••• •••• •••• ••• •••• •••• ••• •
Summary 188
Learni ng Outcomes 168
Apply Your Knowledge 189
Introd uction 169 Websites 189
Parts of the Self 169
Self-Awareness 169
Self-Concept 171
Chapter 8 Feelings and Friends:
Emotional and Social
Self-Control 171
Compet ence 190
Self-Esteem 172 •• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Buildi ng Blocks of Self-Esteem 172 Learning Outcomes 191
Competence 174 Introduction 192
xviii CONTENTS

Emotional Compet ence 193 Chapter 9 Resilience and Stress

Perceiving Emolions 194 in Childhood 221
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Exp ressing Emotions 195
Regulating Emotions 198
Learni ng Outcomes 222
Child ren's DevelopmenLAffects How They UndersLand Introduction 223
Feelings 200 Res ilie nce in Young Ch ild ren 223
Social Competence 203 Resilience Grows in Families, Schools,
and Communities 223
Soc ially CompetenLChild ren Tune in to Their
Surroundings 203 ProLective FacLors That Foste r Resilience 224
Soc ially CompetenLChild ren Relate \Veil to 0Lher Stress During Childhood: Types, Sources,
Child ren 203 an d How Stress Affects Child ren 227
Soc ially CompetenLChild ren Have Good Social
Skills 204 Types o f Stressors 227
Sou rces o f Stress 229
Social Emotional Learning: Setti ng
t he Stage 205 How SLress Affects Child ren 230

Suppo rtive Interpersonal Envi ronmentS 205 Stages in Respo nd ing to Stress an d Cop ing
w ith Stress 232
Suppo rtive Physical Envi ronments 206
Stages in Responding to Stress 232
Essential To pics in Social Emotional
Learning 207 Coping with Stress 234

Emotions as Normal and Having a Purpose 207 He lp ing Chi ldre n Cope with Stress 238
Limits on Expressing Emotions 208 General Guideli nes: Helping Ch ild ren Cope wiLh
Stress 238
Alte rnative Responses to Emolions 209
Teachers Can Help Children Facing Lhe Specific Stress
Strong Emotions Vocabulary 211
of Moving 243
Emotions Vocabulary of Younger vs Older Child ren 212
How to Talk abouLEmotions: How LO Use You r
Analyze Case St ud ies 246
\Vords 214 Summary 247
Friendship Skills 215 App ly You r Knowledge 247
Social Emotional Learning O pportunities: We bsites 247
Duri ng Large Group and Focused on Th roughout
t he Day 215
Chapter 10 Aggression and Bullying
Helping Children Handle Disappointment 216 in Young Children 24 8
Helping Children Deal with Ange r 217 •• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Helping Children Learn Friendshi p Skills 218 Learni ng Outcomes 24 9
Analyze a Case Study 219 Introduction 250
Summary 219 Aggress io n 250
App ly Your Knowledge 219 Fo rms of Aggression 250
Websites 220 Gender Differences in Aggression 251
 CONTENTS xix

Purposes of Aggressio n 251 Roots of Challenging Behavior 277

Instrumental Aggression 251 Developmental Characteristics 278
Hostile Aggression 253 Unmet Needs 279
\Vhat about Unintentional Injury or Damage to Lack of Skills 281
Propeny, "Accidental Aggression?" 254 Factors in the Classroom (Contextual Issues) 282
Bullyi ng Is a Form of Aggression 255 Functional Behavioral Assessment and Supporting
Forms of Bullying 256 Positive Behavior 283
ParticipantS in Bullyi ng 258 Functional Behavioral Assessme nt 283
Intervening in and Preventi ng Bullying 259 Suppo rting Positive Behavior 285

How Children Learn to Be Aggressive 260 ReOect 286

ScriptS for Aggression 261 Specifi c Challenging Behaviors: Apply

Your Knowledge of Functio na l Behavior
ScriptS from Aggression-Teaching Families: Writing, Assessment 286
Rehearsing with, and Activating the Scripts 262
Un responsive Parenting Fosters Aggression 264 Biting 287

Peers: Children Get Scripts from Other Teasing 288

Children 265 Aggressive Behavior (Hitting, Damaging o r Destroying
Med ia: Children Get Scripts from \Vatching Things, Tempe r Tantrums) 291
Violence 266 \.Vhining and Peste ring 291
Neutralize Media's Aggressive Message: Tattling 292
Help Child ren Take Charge of What They Watch in
the Media 267 Supporting Infant s and Toddlers w ith Challengi ng
Behavior 293
Neutralize Med ia's Aggressive Message: Watch
Television with Children and Comment on Summary 294
Aggressive Content 267 Apply Your Knowledge 294
Analyze Case Study 270 Websites 295
Summary 270
Apply Your Knowledge 270
PART IV Apply Your Knowledge
Websites 271
of Child Guidance 297
Chapter 11 Minim izing Challenging
Behavior 272 Chapter 12 Apply Your Knowledge:
•• ••••••• •••••••• •••••••• •••••• ••••••• • Guiding Children during Rout ines and
Learning Outcomes 273 Transitions 298
•• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Introduction 274
Learning Out comes 299
The Natu re of Challenging Behavior 274
Introduction 300
Challenging Behavior ls "In the Eye of the
Beholder" 274 Arrival a nd De parture 300
Challenging Behaviors Are the Hot Spots in a \Vhat Child ren Need during Arrival
Classroom 275 and Depanure 301
XX CONTENTS

Indi rect Guidance 302 Steps in the Decision-t-1aking Model 326

Direct Guidance 302 Develop Guidance plans by using the Decision-t-1aking
Model 32 7
Large Group 303
\Vhen to Refer a Family to OutSide Help 327
\Vhat Child ren Need during Large Group 304
Usi ng the Decision-Making Model in Everyday
Indirect Guidance 304 Discipline Encounters and w ith Challenging
Direct Guidance 306 Behaviors 329
Small Group 308 Outdoor Cleanup Time 330

\.Vhat Child ren Need during Small Group 308 Smashing Pumpkins in a Primary
Classroom 331
Indi rect Guidance 308
Direct Guidance 309 Usi ng the Decision-Making Model to
Make Contextual Changes (Changes to
Transit ions 310 t he Setting) and to Change a n Adu lt's
Practices 332
\Vhat Child ren Need during Transitions 312
Examples of Transitions 312 A Preschool Classroom: Keep the Sand in the Pan,
Please 332
Indi rect Guidance 313
Liam and the Math \Vorkbook 333
Di rect Guidance 3 14
Usi ng the Decision-Making Model to Change
Visual Su pports 31 S t he Context and Change the Teacher's Own
Analyze a Case Study 317 Practices 334
Summary 317 A Thi rd-Grade Classroom Joseph and Chloe
\Viii Not "Sit Still" During the Last Large-Group
Apply Your Knowledge 31 7
Lesson 334
Websites 318
Concluding Statement about Guidi ng Young
Children 335
Chapter 13 Apply Your Knowledge: Analyze a Case Study 336
Use t he Decision-Making Model of Summary 337
Ch ild Guidance 319 Apply You r Knowledge 337
•• ••••••• •••••••• ••••••• ••• ••••• •••••• •
Websites 337
Learning Outcomes 320
Introduction 321
Append ix: Review: Majo r Positive Discipli ne
Decision-Making Model of Child Strategies 338
Guidance 322
Glossary 346
Knowledge, Skills, and Respect: The Basis of the
Decision-Making t-1ode1 322 References 351
Eclectic- One Strategy Does Not Fit All 323
Name Index 365
Di fferent Children, Different Families Call for an
Eclectic Approach 324 Subject Index 369
 PA RT

Guiding Young Children

Three Essential Elements

Chapter 1 A Teacher's Role in Guiding Children

This chapter emphasizes the importance of building a caring relationship with chil-
dren. IL then describes three adult caregiving styles- authoritarian, autho ritative, and
permissive-explaining the concept of developmentally appropriate practice as part
of the authoritative style. IL focuses on the processes 1ha1 adults (both parents and
teachers) use Lo influence children. The feature on cultu re in this chapte r focuses on
the effect of a person's cultural scripts on how they guide children.

Chapter 2 Theoretical Foundations of Child Guidance

Chapter 2 desc ribes theory as a firm foundation on which LO base decisions about
guid ing young children. The goal is not 10 memorize information about different theo-
ries but LO understand that, without theory, we would not have a foundation for our
profession. The chapter explains three categories of theories: theo ries explaining how
child ren's behavior develops in different systems; theories focusing on how children
construct ideas; and theories examining child ren's psychological, emotional, and
soc ial learning needs. Direct and practical implications of each theory are described.
The feature on culture for this chapter focuses on understanding the effect that pov-
erty has on a child's life.
2 PART I •> GUIDING YOUNG CHILDREN

Chapter 3 Understand Child Development: A Key to Guiding Children

Effectively
This chapter opens by describing what to expect in general about the social and emotional devel-
opment of child ren in the different phases of early childhood. Then, we shift to perception and
memory, two parLS of a child's cognitive development that are imporLant in how child ren take
in, organize, and remember what they see and hear during interactions. Then, we will examine
how children understand the behavior of others, how they view friendship, and how they under-
stand accidental versus intentional behavior. Finally, we will look at how children build on
perception, memory, and social cognition to develop self-control and to become compassionate
and caring individuals. The feature on culture for this chapter focuses on the impact of ind ividu-
alistic and interdependent cultures on your guidance of children from such cultures.
 • • •
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•• ••
• •• ••
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4 PART I •> GUIDING YOUNG CHILDREN

Learning Outcomes
II-
• Defe nd the idea that teache rs must develop good relatio nsh ips with children to guide
them effectively.
• Expla in the two majo r di1nensions of a teacher's style of caregiving.
• Desc ribe major ca regiving styles in te rms o f an adult's level of demandingness and
respons iveness.
• Explain the bas ic processes through which teache rs influence ch ildren.

NAEYC Standards and Key Elements

• The following NAEYC Standa rds and Key Elements a re addressed in th is chapte r:
STANDARD 1. PROMOTING CHILD DEVELOPMENT AND LEARNING
l a: Knowing and understanding young children's characteristics and needs, from birth
through age 8.
lb: Knowing and understanding the multiple influences on early development and learning.
le: Using developmental knowledge to create healthy, respectfu l, supportive, and challenging learn-
ing environments for young children.
STANDARD 4 . USING DEVELOPMENTALLY EFFECTIVE APPROACHES
4a: Understanding positive relationships and supportive interactions as the foundation of their work
with young children.
4b: Knowing and understanding effective strategies and tools for early education, includi ng appro-
priate uses of technology.
4c: Using a broad repertoire of developmentally appropriate teaching/learning approaches.
4d: Reflecting on own practice to promote positive outcomes for each child,

---CASE STUDIES ----------------------

BLAKE IGNORES HIS MOTHER'S REQUEST

Blake left his scooter in the middle of the living room. His mother called out to him, "Put the
scooter outside. Blake." Blake heard but ignored her as he walked away. "Blake, did you hear
me? Put that scooter outside this instant I mean it. No water park for you this afternoon ifyou
don't put that scooter outside!" Blake shuffied down the hall to his room, and Mom continued
in an exasperated tone, "Blake, get back here. I want that scooter put away."
Finally, l\llom just tun1ed back to the kitchen. "That boy never listens to me."
Blake pays little attention to hiS mother's limits. He also knows that she hardly ever follows
up on her threats. That aften1oon, for example, Mom took Blake to the water park, after saying,
"Next lime, Blake, you'd better listen to me when I tell you to do something." Blake tun1ed his
head away Jrom l\llom and rolled his eyes.

DAVID DOES WHATEVER HE WANTS TO Do

Al 18 months, David, when visiting a friend with his mother, banged on the friend's television
screen and pushed at the door screen. His mom said nothing until the friend expressed concern
for her property. Then she said, "David, do you think you should be doing that?" To the friend
she said, "You know, I don't think I should order him around." When he was 4 years old, David
stayed up until 11:30 when company was over. To the friend who inquired about his bedtime,
Mom replied, "Oh, I let David make decisions 011 his own." David Jell asleep in the book comer
al his preschool the next day. At 6 years of age, David pushed ahead of others at a zoo
Another random document with
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partial unconsciousness, or even by more marked congestive
symptoms. The pain may seem to fill the whole cranium, may be
located in a cerebral region, or fixed in a very limited spot. Heubner
asserts that when this headache can be localized it is generally
made distinctly worse by pressure at certain points, but my own
experience is hardly in accord with this. Any such soreness plainly
cannot directly depend upon the cerebral lesion, but must be a reflex
phenomenon or due to a neuritis. According to my own experience,
localized soreness indicates an affection of the bone or of its
periosteum. In many cases, especially when the headache is
persistent, there are distinct nocturnal exacerbations.
39 Book Y., p. 88, 1879.

It will be seen that there is nothing absolutely characteristic in the

headache of cerebral syphilis; but excessive persistency, apparent
causelessness, and a tendency to nocturnal exacerbation should in
any cephalalgia excite suspicion of a specific origin—a suspicion
which is always to be increased by the occurrence of slight spells of
giddiness or by delirious mental wandering accompanying the
paroxysms of pain. When an acute inflammatory attack supervenes
upon a specific meningeal disease it is usually ushered in by a
headache of intolerable severity.

When the headache in any case is habitually very constant and

severe, the disease is probably in the dura mater or periosteum; and
this probability is much increased if the pain be local and augmented
by firm, hard pressure upon the skull over the seat of the pain.

Disorders of Sleep.—There are two antagonistic disorders of sleep,

either of which may occur in cerebral syphilis, but which have only
been present in a small proportion of the cases that I have seen.
Insomnia is more apt to be troublesome in the prodromic than in the
later stages, and is only of significance when combined with other
more characteristic symptoms. A peculiar somnolence is of much
more determinate import. It is not pathognomonic of cerebral
syphilis, yet of all the single phenomena of this disease it is the most
characteristic. Its absence is of no import in the theory of an
individual case.

As I have seen it, it occurs in two forms: In the one variety the patient
sits all day long or lies in bed in a state of semi-stupor, indifferent to
everything, but capable of being aroused, answering questions
slowly, imperfectly, and without complaint, but in an instant dropping
off again into his quietude. In the other variety the sufferer may still
be able to work, but often falls asleep while at his tasks, and
especially toward evening has an irresistible desire to slumber, which
leads him to pass, it may be, half of his time in sleep. This state of
partial sleep may precede that of the more continuous stupor, or may
pass off when an attack of hemiplegia seems to divert the
symptoms. The mental phenomena in the more severe cases of
somnolency are peculiar. The patient can be aroused—indeed in
many instances he exists in a state of torpor rather than of sleep;
when stirred up he thinks with extreme slowness, and may appear to
have a form of aphasia; yet at intervals he may be endowed with a
peculiar automatic activity, especially at night. Getting out of bed;
wandering aimlessly and seemingly without knowledge of where he
is, and unable to find his own bed; passing his excretions in a corner
of the room or in other similar place, not because he is unable to
control his bladder and bowels, but because he believes that he is in
a proper place for such act,—he seems a restless nocturnal
automaton rather than a man. In some cases the somnolent patient
lies in a perpetual stupor.

An important fact in connection with the somnolence is that it may

develop suddenly without marked premonition. Thus in a case
reported by J. A. Ormerod40 a man who had been in good health,
save only for headache, awoke one morning in a semi-delirious
condition, and for three days slept steadily, only arousing for meals;
after this there was impairment of memory and mental faculties, but
no more marked symptoms.
40 Brain, vol. v. 260.
Apathy and indifference are the characteristics of the somnolent
state, yet the patient will sometimes show excessive irritability when
aroused, and will at other periods complain bitterly of pain in his
head, or will groan as though suffering severely in the midst of his
stupor—at a time, too, when he is not able to recognize the seat of
the pain. I have seen a man with a vacant, apathetic face, almost
complete aphasia, persistent heaviness and stupor, arouse himself
when the stir in the ward told him that the attending physician was
present, and come forward in a dazed, highly pathetic manner, by
signs and broken utterances begging for something to relieve his
head. Heubner speaks of cases in which the irritability was such that
the patient fought vigorously when aroused; this I have not seen.

This somnolent condition may last many weeks. T. Buzzard41 details

the case of a man who after a specific hemiplegia lay silent and
somnolent for a month, and yet finally recovered so completely as to
win a rowing-match on the Thames. I have seen a fair degree of
recovery after a somnolence of four months' duration.
41 Clinical Lectures on Dis. Nerv. Syst., London, 1882.

In its excessive development syphilitic stupor puts on the symptoms

of advanced brain-softening, to which it is indeed often due. Of the
two cases with fatal result of which I have notes, one at the autopsy
was found to have symmetrical purulent breaking down of the
anterior cerebral lobes; the other, softening of the right frontal and
temporal lobes, due to the pressure of a gummatous tumor, and
ending in a fatal apoplexy.

This close connection with cerebral softening explains the clinical

fact that apoplectic hemorrhage is very apt to end the life in these
cases of somnolent syphilis. But a prolonged deep stupor in persons
suffering from cerebral syphilis does not prove the existence of
extensive brain-softening, and is not incompatible with subsequent
complete recovery. As an element of prognosis it is of serious but not
of fatal import.
Paralysis.—When it is remembered that a syphilitic exudation may
appear at almost any position in the brain, that spots of encephalic
softening are a not rare result of the infection, that syphilitic disease
is a common cause of cerebral hemorrhage, it is plain that a specific
palsy may be of any conceivable variety, and affect either the
sensory, motor, or intellectual sphere. The mode of onset is as
various as the character of the palsy. The attack may be
instantaneous, sudden, or gradual. The gradual development of the
syphilitic gumma would lead us, a priori, to expect an equally gradual
development of the palsy; but experience shows that in a large
proportion of the cases the paralysis appears suddenly, with or
without the occurrence of an apoplectic or epileptic fit. Under these
circumstances it will be usually noted that the resulting palsy is
incomplete; in rare instances it may be at its worst when the patient
awakes from the apoplectic seizure, but usually it progressively
increases for a few hours, and then becomes stationary. These
sudden partial palsies probably result from an intense congestion
around the seat of disease or from stoppage of the circulation in the
same locality; whatever their mechanism may be, it is important to
distinguish them from palsies which are due to hemorrhage. I believe
this can usually be done by noting the degree of paralysis.

A suddenly-developed, complete hemiplegia or other paralysis may

be considered as in all probability either hemorrhagic or produced by
a thrombus so large that the results will be disorganization of the
brain-substance, and a future no more hopeful than that of a clot. On
the other hand, an incomplete palsy may be rationally believed to be
due to pressure or other removable cause; and this belief is much
strengthened by a gradual development. The bearing of these facts
upon prognosis it is scarcely necessary to point out.

Although the gummata may develop at almost any point, they

especially affect the base of the brain, and are prone to involve the
nerves which issue from it. Morbid exudations, not tubercular or
syphilitic, are rare in this region. Hence a rapidly but not abruptly
appearing strabismus, ptosis, dilated pupil, or any paralytic eye
symptom in the adult is usually of syphilitic nature. Syphilitic facial
palsy is not so frequent, whilst paralysis of the nerve from rheumatic
and other inflammation within its bony canal is very common.
Paralysis of the facial nerve may therefore be specific, but existing
alone is of no diagnostic value. Since syphilitic palsies about the
head are in most instances due to pressure upon the nerve-trunks,
the electrical reactions of degeneration are present in the affected
muscles.

There is one peculiarity about specific palsies which has already

been alluded to as frequently present—namely, a temporary,
transient, fugitive, varying character and seat. Thus an arm may be
weak to-day, strong to-morrow, and the next day feeble again, or the
recovered arm may retain its power and a leg fail in its stead. These
transient palsies are much more apt to involve large than small brain
territories. The explanation of their largeness, fugitiveness, and
incompleteness is that they are not directly due to clots or other
structural changes, but to congestions of the brain-tissues in the
neighborhood of gummatous exudations. Squint due to direct
pressure on a nerve will remain when the accompanying monoplegia
due to congestion disappears.

Motor palsies are more frequent than sensory affections in syphilis,

but hemianæsthesia, localized anæsthetic tracts, indeed any form of
sensory paralysis, may occur. Numbness, formications, all varieties
of paræsthesia, are frequently felt in the face, body, or extremities.
Violent peripheral neuralgic pains are rare, and generally when
present denote neuritis. Huguenin, however, reports42 a severe
trigeminal anæsthesia dolorosa, which was found, after death from
intercurrent disease, to have depended upon a small gumma
pressing upon the Gasserian ganglion. A somewhat similar case has
also been reported by Allen McLane Hamilton.43
42 Schwiez. Corr. Blät., 1875.

43 Alienist and Neurologist, iv. 58.

The special senses are liable to suffer from the invasion of their
territories by cerebral syphilis, and the resulting palsies follow
courses and have clinical histories parallel to those of the motor
sphere. The onset may be sudden or gradual, the result temporary
or permanent. Charles Mauriac44 reports a case in which the patient
was frequently seized with sudden attacks of severe frontal pain and
complete blindness lasting from a quarter to half an hour; at other
times the same patient had spells of aphasia lasting only for one or
two minutes. I have seen two cases of nearly complete deafness
developing in a few hours in cerebral syphilis, and disappearing
abruptly after some days. Like other syphilitic palsies, therefore,
paralyses of special senses may come on suddenly or gradually, and
may occur paroxysmally.
44 Loc. cit., p. 31.

Among the palsies of cerebral syphilis must be ranked aphasia. An

examination of recorded cases shows that syphilitic aphasia is
subject to vagaries and laws similar to those connected with other
specific cerebral palsies. It is usually a symptom of advanced
disease, but may certainly develop as one of the first evidences of
cerebral syphilis. Coming on after an apoplectic or epileptic fit, it may
be complete or incomplete: owing to the smallness of the centre
involved and the ease with which its function is held in abeyance, a
total loss of word-thought is not so decisive as to the existence of
cerebral hemorrhage as is a total motor palsy. Like hemiplegia or
monoplegia, specific aphasia is sometimes transitory and
paroxysmal. Buzzard45 records several such cases. Mauriac46 details
a very curious case in which a patient, after long suffering from
headache, was seized by sudden loss of power in the right hand and
fingers, lasting about ten minutes only, but recurring many times a
day. After this had continued some time the paroxysms became
more completely paralytic, and were accompanyed by loss of the
power of finding words, the height of the crises in the palsy and
aphasia being simultaneously reached. For a whole month these
attacks occurred five or six times a day, without other symptoms
except headache, and then the patient became persistently paralytic
and aphasic, but finally recovered. To describe the different forms of
specific aphasia and their mechanism of production would be to
enter upon a discussion of aphasia itself—a discussion out of place
here. Suffice it to say that every conceivable form of the disorder
may be induced by syphilis.
45 Loc. cit., p. 81.

46 Aphasie et Hemiplégia droite Syphilit., Paris, 1877.

Owing to the centres of speech being situated in the cortical portion

of the brain, aphasia in cerebral syphilis is very frequently associated
with epilepsy. Of course right-sided palsy and aphasia are united in
syphilitic as in other disorders. If, however, the statistics given by
Tanowsky47 be reliable, syphilitic aphasia is associated with left-
sided hemiplegia in a most extraordinarily large proportion. Thus in
53 cases collected by Tanowsky, 18 times was there right-sided
hemiplegia, and 14 times left-sided hemiplegia, the other cases
being not at all hemiplegic. Judging from the autopsy on a case
reported in Mauriac's brochure, this concurrence of left-sided
paralysis and aphasia depends partly upon the great frequency of
multiple brain lesions in syphilis, and partly upon the habitual
involvement of large territories of the gray matter secondarily to
diseased membrane. An important practical deduction is that the
conjoint existence of left hemiplegia and aphasia is almost diagnostic
of cerebral syphilis.
47 L'Aphasie syphilitique.

Probably amongst the palsies may be considered the disturbances

of the renal functions, which are only rarely met with in cerebral
syphilis, and which are probably usually dependent upon the specific
exudation pressing upon the vaso-motor centres in the medulla.
Fournier speaks of having notes of six cases in which polyuria with
its accompaniment, polydipsia, was present, and details a case in
which the specific growth was found in the floor of the fourth
ventricle. Cases have been reported of true saccharine diabetes due
to cerebral syphilis,48 and I can add to these an observation of my
own. The symptoms, which occurred in a man of middle age, with a
distinct specific history, were headache, nearly complete hemiplegia,
and mental failure, associated with the passage of comparatively
small quantities of a urine so highly saccharine as to be really a
syrup. Under the influence of the iodide of potassium the sugar in a
few weeks disappeared from the urine.
48 Consult Servantié, Des Rapports du Diabète et de la Syphilis, Paris, Thèse, 1876;
also, case reported by L. Putzel, New York Med. Record, xxv. 450.

Epilepsy.—Epileptic attacks are a very common symptom of

meningeal syphilis, and are of great diagnostic value. The
occurrence in an adult of an epileptic attack or of an apoplectic fit, or
of a hemiplegia after a history of intense and protracted headache,
should always excite grave suspicion.

Before I had read Fournier's work on Nervous Syphilis I taught that

an epilepsy appearing after thirty years of age was very rarely, if
ever, essential epilepsy, and unless alcoholism, uræmic poison, or
other adequate cause could be found was in nine cases out of ten
specific; and I therefore quote with satisfaction Fournier's words:
“L'épilepsie vraie, ne fait jamais son premier dêbut à l'âge adulte, à
l'âge mûr. Si un homme adulte, au dessus de 30, 35, à 40 ans, vient,
à être pris pour la première fois d'une crise épileptique, et cela dans
la cours d'une bonne santé apparente, il y a, je vous le répète, hui
ou neuf chances sur dix pour que cette épilepsie soit d'origine
syphilitique.”

Syphilitic epilepsy may occur either in the form of petit mal or of haut
mal, and in either case may take on the exact characters and
sequence of phenomena which belong to the so-called idiopathic or
essential epilepsy. The momentary loss of consciousness of petit
mal will usually, however, be found to be associated with attacks in
which, although voluntary power is suspended, memory recalls what
has happened during the paroxysm—attacks, therefore, which
simulate those of hysteria, and which may lead to an error of
diagnosis.

Even in the fully-developed type of the convulsions the aura is only

rarely present. Its absence is not, however, of diagnostic value,
because it is frequently not present in essential epilepsy, and it may
be pronounced in the specific disease. It is said that when in an
individual case the aura has once appeared the same type or form of
approach of the convulsion is thereafter rigidly adhered to. The aura
is sometimes bizarre: a severe pain in the foot, a localized cramp, a
peculiar sensation, indescribable and unreal in its feeling, may be
the first warning of the attack. An aura may affect a special sense.
Thus, I have at present a patient whose attacks begin with blindness.

In many, perhaps most, cases of specific convulsions, instead of a

paroxysm of essential epilepsy being closely simulated, the
movements are in the onset, or more rarely throughout the
paroxysm, unilateral; indeed, they may be confined to one extremity.
This restriction of movement has been held to be almost
characteristic of syphilitic epilepsy, but it is not so. Whatever
diagnostic significance such restriction of the convulsion has is
simply to indicate that the fit is due to a cortical organic lesion of
some kind. Tumors, scleroses, and other organic lesions of the
brain-cortex are as prone to cause unilateral or monoplegic epilepsy
when they are not specific as when they are due to syphilis.

Sometimes an epilepsy dependent upon a specific lesion implicating

the brain-cortex may be replaced by a spasm which is more or less
local and is not attended with any loss of consciousness. Thus, in a
case now convalescent in the University Hospital, a man aged about
thirty-five offered a history of repeated epileptic convulsions, but at
the time of his entrance into the hospital, instead of epileptic attacks,
there was a painless tic. The spasms, which were clonic and
occurred very many times a day, sometimes every five minutes,
were very violent, and mostly confined to the left facial nerve
distribution. The trigeminus was never affected, but in the severer
paroxysms the left hypoglossal and spinal accessory nerves were
profoundly implicated in all of their branches. Once, fatal asphyxia
from recurrent laryngeal spasm of the glottis was apparently averted
only by the free inhalation of the nitrite of amyl. The sole other
symptom was headache, but the specific history was clear and the
effect of antisyphilitic remedies rapid and pronounced.
It is very plain that such attacks as those just detailed are closely
allied to epilepsy; indeed, there are cases of cerebral syphilis in
which widespread general spasms occur similar to those of a
Jacksonian epilepsy, except that consciousness is not lost, because
the nervous discharge does not overwhelm the centres which are
connected with consciousness.49 On the other hand, these epileptoid
spasmodic cases link themselves to those in which the local brain
affection manifests itself in contractions or persistent irregular clonic
spasms. Contractures may exist and may simulate those of
descending degeneration,50 but in my own experience are very
rare.51
49 Case, Canada Med. and Surg. Journ., xi. 487.

50 Case, Centralbl. Nerv. Heilk., 1883, p. 1.

51 A case of syphilitic athetosis may be found in Lancet, 1883, ii. 989.

The clonic spasms of cerebral syphilis may assume a distinctly

choreic type, or may in their severity simulate those of hysteria,
throwing the body about violently.52 It is, to my mind, misleading, and
therefore improper, to call such cases syphilitic chorea, as there is
no reason for believing that they have a direct relation with ordinary
chorea. They are the expression of an organic irritation of the brain-
cortex, and are sometimes followed by paralysis of the affected
member; in other words, the disease, progressing inward from the
brain-membrane, first irritates, and then so invades a cortical centre
as to destroy its functional power.53
52 See Allison, Amer. Med. Journ., 1877, 74.

53 Case, Chicago Med. Journ. and Exam., xlvi. 21.

Psychical Symptoms.—As already stated, apathy, somnolence, loss

of memory, and general mental failure are the most frequent and
characteristic mental symptoms of meningeal syphilis; but, as will be
shown in the next chapter, syphilis is able to produce almost any
form of insanity, and therefore mania, melancholia, erotic mania,
delirium of grandeur, etc. etc. may develop along with the ordinary
manifestation of cerebral syphilis, or may come on during an attack
which has hitherto produced only the usual symptoms. Without
attempting any exhaustive citation of cases, the following may be
alluded to.

A. Erlenmeyer reports54 a case in which an attack of violent

headache and vomiting was followed by paralysis of the right arm
and paresis of the left leg, with some mental depression; a little later
the patient suddenly became very cheerful, and shortly afterward
manifested very distinctly delirium of grandeur with failure of
memory. Batty Tuke reports55 a case in which, with aphasia,
muscular wasting, strabismus, and various palsies, there were
delusions and hallucinations. In the same journal56 S. D. Williams
reports a case in which there were paroxysmal violent attacks of
frontal headache. The woman was very dirty in her habits, only ate
when fed, and existed in a state of hypochondriacal melancholy.
Leiderdorf details a case with headache, partial hemiplegia, great
psychical disturbance, irritability, change of character, marked
delirium of grandeur, epileptic attacks, and finally dementia,
eventually cured by iodide of potassium.57 Several cases illustrating
different forms of insanity are reported by N. Manssurow.58
54 Die luëtischen Psychosen.

55 Journ. Ment. Sci., Jan., 1874, p. 560.

56 April, 1869.

57 Medicin Jahrbucher, xx. 1864, p. 114.

58 Die Tertiäre Syphilis, Wien, 1877.

That the attacks of syphilitic insanity, like the palsies of syphilis, may
at times be temporary and fugitive, is shown by a curious case
reported by H. Hayes Newington,59 in which, along with headache,
failure of memory, and ptosis in a syphilitic person, there was a brief
paroxysm of noisy insanity.
 59 Journ. Ment. Sci., London, xix. 555.

DIAGNOSIS.—In a diagnosis of cerebral syphilis a correct history of the

antecedents of the patients is of vital importance. Since very few of
the first manifestations of the disorder are absolutely characteristic,
whilst almost any conceivable cerebral symptoms may arise from
syphilitic disease, treatment should be at once instituted on the
appearance of any disturbance of the cerebral functions in an
infected person.

Very frequently the history of the case is defective, and not rarely
actually misleading. Patients often appear to have no suspicion of
the nature of their complaint, and will deny the possibility of syphilis,
although they confess to habitual unchastity. My own inquiries have
been so often misleading in their results that I attach but little weight
to the statements of the patient, and in private practice avoid asking
questions which might recall unpleasant memories, depending upon
the symptoms themselves for the diagnosis.

The general grounds of diagnosis have been sufficiently mapped out

in the last section, but some reiteration may be allowable. After the
exclusion of other non-specific disease, headache occurring with any
form of ocular palsy or with a history of attack of partial monoplegia
or hemiplegia, vertigo, petit mal, epileptoid convulsions, or
disturbances of consciousness, or attacks of unilateral or localized
spasms, should lead to the practical therapeutic test. Ocular palsies,
epileptic forms of attacks occurring after thirty years of age, morbid
somnolence, even when existing alone, are sufficient to put the
practitioner upon his guard. It is sometimes of vital importance that
the nature of the cephalalgia shall be recognized before the coming
on of more serious symptoms; any apparent causelessness,
severity, and persistency should arouse suspicion, to be much
increased by a tendency to nocturnal exacerbations or by the
occurrence of mental disturbance or of giddiness at the crises of the
paroxysms. Not rarely there are very early in these cases curious,
almost indefinable, disturbances of cerebral functions, which may be
easily overlooked, such as temporary and partial failures of memory,
word-stumbling, fleeting feelings of numbness or weakness,
alterations of disposition. In the absence of hysteria an indefinite and
apparently disconnected series of nerve accidents is of very urgent
import. To use the words of Hughlings-Jackson, “A random
association or a random succession of nervous symptoms is very
strong warrant for a diagnosis of a syphilitic disease of the nervous
system.” Cerebral syphilis occurring in an hysterical subject may be
readily overlooked until fatal mischief is done. When any paralysis
occurs a study of the reflexes may sometimes lead to a correct
diagnosis. Thus in a hemiplegia the reflex on the affected side in
cerebral syphilis is very frequently exaggerated, whilst in hysteria the
reflexes are usually alike on both sides. When both motion and
sensation are disturbed in an organic hemiplegia, the anæsthesia
and motor paralysis occur on the same side of the body, whilst in
hysteria they are usually on opposite sides.

In all cases of doubtful diagnosis the so-called therapeutic test

should be employed, and if sixty grains of iodide of potassium per
day fail to produce iodism, for all practical purposes the person may
be considered to be a syphilitic. No less an authority than Seguin
has denied the validity of this, but I believe, myself, that some of his
reported cases were suffering from unsuspected syphilis. I do not
deny that there are rare individuals who, although untainted, can
resist the action of iodide, but in ten years' practice in large hospitals,
embracing probably some thousands of cases, I have not met with
more than one or two instances which I believed to be of such
character. Of course in making these statements I leave out of sight
persons who have by long custom become accustomed to the use of
the iodide, for although in most cases such use begets increase of
susceptibility, the contrary sometimes occurs. Of course the
physician who should publicly assert that a patient who did not
respond to the iodide had syphilis would be a great fool, but in my
opinion the physician who did not act upon such a basis would be
even more culpable.

PROGNOSIS.—Cerebral meningeal syphilis varies so greatly and so

unexpectedly in its course that it is very difficult to establish rules for
predicting the future in any given case. The general laws of
prognosis in brain disease hold to some extent, but may always be
favorably modified, and patients apparently at the point of death will
frequently recover under treatment. The prognosis is not, however,
as absolutely favorable as is sometimes believed, and especially
should patients be warned of the probable recurrence of the affection
even when the symptoms have entirely disappeared. The only safety
after the restoration of health consists in an immediate re-treatment
upon the recurrence of the slightest symptom. The occurrence of a
complete, sudden hemiplegia or monoplegia is sufficient to render
probable the existence of a clot, which must be subject to the same
laws as though not secondary to a specific lesion. If a rapid decided
rise of temperature occur in an apoplectic or epileptic attack, the
prognosis becomes very grave. An epileptic paroxysm very rarely
ends fatally, although it has done so in two of my cases.

The prognosis in gummatous cerebral syphilis should always be

guardedly favorable. In the great majority of cases a more or less
incomplete recovery occurs under appropriate treatment, and I have
seen repeatedly patients who were unconscious, with urinary and
fecal incontinence, and apparently dying, recover. Nevertheless, so
long as there is any particle of gummatous inflammation in the
membrane the patient is liable to sudden congestions of the brain,
which may prove rapidly fatal, or he may die in a brief epileptic fit. On
the one hand there is an element of uncertainty in the most favorable
case, and on the other so long as there is life a positively hopeless
prognosis is not justifiable.

PATHOLOGY.—Gummatous inflammation of the brain probably always

has its starting-point in the brain-membranes, although it may be
situated within the brain: thus, I have seen the gummatous tumors
spring from the velum interpositum in the lateral ventricle. The
disease most usually attacks the base of the brain, and is especially
found in the neighborhood of the pons Varolii and the optic tract. It
may, however, locate itself upon the vault of the cranium, and in my
experience has seemed to prefer the anterior or motor regions. The
mass may be well defined and roundish, but more usually it is
spread out, irregular in shape, and more or less confluent with the
substance of the brain beneath it. It varies in size from a line to
several inches in length, and when small is prone to be multiple. The
only lesion which it resembles in gross appearance is tubercle, from
which it sometimes cannot be certainly distinguished without
microscopic examination.

The large gummata have not rarely two distinct zones, the inner one
of which is drier, somewhat yellowish in color, opaque, and
resembles the region of caseous degeneration in the tubercle. The
outer zone is more pinkish and more vascular, and is semi-
translucent.

On microscopic examination the most characteristic structures are

small cells, such as are found in gummatous tumors in other portions
of the body. These cells are most abundant in the inner zone, which,
indeed, may be entirely composed of them. In the centre of the
tumor they are more or less granular and atrophied; in some cases
the caseous degeneration has progressed so far that the centre of
the gumma consists of minute acicular crystals of fat. In the external
or peripheral zone of the tumor the mass may pass imperceptibly
into the normal nerve tissue, and under these circumstances it is that
it contains the spider-shaped cells or stellate bodies described by
Jastrowitch, and especially commented upon by Charcot and
Gombault and by Coyne. These are large cells containing an
exaggerated nucleus and a granular protoplasm, which continues
into multiple, branching, rigid, refracting prolongations, which
prolongations are scarcely stained by carmine. Alongside of these
cells other largish cells are often found without prolongations, but
furnished with oval nuclei and granular protoplasm. Amongst these
cells will be seen the true gummatous cells, as well as the more or
less altered neuroglia and nerve-elements. In the perivascular
lymphatic sheaths in the outer part of the gumma is usually a great
abundance of small cells. The spider-shaped cells are probably
hypertrophied normal cells of the neuroglia, and have been
considered by Charcot and Gombault as characteristic of syphilitic
gummata of the brain. In a solitary gumma, however, of considerable
size from the neighborhood of the cerebellum, studied by Coyne and
Peltier, there were no stellated cells. Coyne considers that their
presence is due to their previous existence in the normal state of the
regions affected by the gumma. Exactly what becomes of syphilitic
gumma of the brain in cases of recovery it is difficult to determine. It
is certain that they become softened and disappear more or less
completely, and it is probable that the cicatrices or the small
peripheral cysts which are not rarely found in the surfaces of the
brain are sometimes remnants of gummatous tumors. In a number of
cases collected by Gros and Lancereaux there were small areas of
softened tissue or small calcareous and caseous masses or cerebral
lacunæ corresponding to the cicatrices of softening or imperfect
cysts, coincident with evidences of syphilis elsewhere. V. Cornil also
states that he has found small areas of softening with well-
established syphilitic lesions of the dura mater and cranium, but
believes that the lacunæ or cysts depend rather upon chronic
syphilitic lesions of cerebral arteries than upon gummatous
inflammation.

When a gummatous tumor comes in contact with an artery, the latter

is usually compressed and its walls undergo degeneration. The
specific arteritis may pass beyond the limit of the syphilome and
extend along the arterial wall. Not rarely there is under these
circumstances a thrombus, and if the artery be a large one
secondary softening of its distributive brain-area occurs.

TREATMENT.—The treatment of cerebral syphilis is best studied under

two heads: First, the treatment of the accidents which occur in the
course of the disease; second, the general treatment of the disease
itself.

It must be remembered that in the great majority of cases in which

death occurs in properly-treated cerebral syphilis the fatal result is
produced by an exacerbation—or, as I have termed it, an accident—
of the disease. Under these circumstances the treatment should be
that which is adapted to the relief of the same acute affection when
dependent upon other than specific cause. In a large proportion of
cases the acute outbreak takes the form either of a meningitis or
else of a brain congestion. In either instance when the symptoms are
severe free bleeding should be at once resorted to. The amount of
blood taken is of course to be proportionate to the severity of the
symptoms and the strength of the patient. I have seen life saved by
the abstraction of about a quart of blood, whilst in other cases a few
ounces suffice. Care must be, of course, taken not to mistake a
simple epileptic fit for a severe cerebral attack; but when this fit has
been preceded by severe headache and is accompanied by stupor,
with marked disturbance of the respiration, measures for immediate
relief are usually required; and if the convulsions be perpetually
repeated or if there be violent delirious excitement, the symptoms
may be considered as very urgent. In taking blood the orifice should
be large, so as to favor a rapid flow, and the bleeding be continued
until a distinct impression is made upon the pulse. In some cases
which I have seen in which the action of the heart continued to be
violent after as much blood as was deemed prudent had been taken,
good results were obtained by the hypodermic injection of three
drops of the tincture of aconite-root every half hour until the
reduction of the pulse and the free sweating indicated that the
system was coming under the influence of the cardiac sedative.

Of course, I do not mean to encourage the improper or too free use

of the lancet in these cases, but in the few fatal cases which I have
seen I have almost invariably regretted that blood had not been
taken at once very freely at the beginning of the acute attack. In
most of these cases the symptoms had progressed too far for good
to be achieved before I reached the patient. After venesection, or in
feeble cases as a substitute for it, the usual measures of relief in
cerebral congestion should be instituted. I shall not occupy space
with a discussion of these measures, as they are in no way different
from those to be employed in cases not syphilitic.

The most important part of the treatment of cerebral syphilis itself is

antisyphilitic, and the practitioner is at once forced to select between
the iodide of potassium and the mercurial preparations. In such
choice it must be remembered that even a very small amount of
syphilitic deposit in the brain may at any time cause a sudden
congestion or other acute attack, and is therefore a very dangerous
lesion. I have seen a cerebral syphilis which was manifested only by
an epileptic attack occurring once in many months, and in which
after death the affected membrane was found to be not larger than a
quarter of a dollar, and the deposit not more than an eighth of an
inch in thickness, suddenly produce a rapidly fatal congestion; and I
have known a case fast progressing toward recovery suddenly
ended by the too long continuance of the arrest of respiration during
an epileptic fit. I have, myself, no doubt of the superiority of the
mercurials over the iodide of potassium as a means of producing
absorption of gummatous exudates; and as these exudates in the
brain are so very dangerous, a mercurial course should in the
majority of cases of cerebral syphilis be instituted so soon as the
patient comes under the practitioner's care. When, however, there is
a history of a recent prolonged free use of the mercurial, or when
there is marked specific cachexia, the iodide should be chosen.
Cachexia is, however, a distinctly rare condition in cerebral syphilis,
the disease usually developing in those who have long had apparent
immunity from the constitutional disorder. In my opinion the best
preparation of the mercurial for internal use is calomel. It should be
given in small doses, one-quarter of one grain every two hours,
guarded with opium and astringents, so as to prevent as far as
possible disturbance of the bowels, and should be continued until
soreness of the teeth, sponginess of the gums, or other evidences of
commencing ptyalism are induced. After this the dose of the
mercurial should be so reduced as simply to maintain the slight
impression which has been created, and the patient should be kept
under the mercurial influence for some weeks.

A very effective method of using the mercury is by inunction, and

where the surroundings of the patient are suitable the mercurial
ointment may be substituted for the calomel. It should be applied
regularly, according to the method laid down in my treatise on
therapeutics. I have sometimes gained advantage by practising the
mercurial unction and at the same time giving large doses of iodide
of potassium internally.
After a mercurial course the iodide of potassium should always be
exhibited freely, the object being not only to overcome the natural
disease, but also to bring about the complete elimination of the
mercury from the system. There is no use in giving the iodide in
small doses; at least a drachm and a half should be administered in
the twenty-four hours, and my own custom has been to increase this
to three drachms unless evidences of iodism are produced. The
compound syrup of sarsaparilla covers the disagreeable taste of the
iodide of potassium better than any other substance of which I have
knowledge. Moreover, I am well convinced that there is some truth in
the old belief that the so-called “Woods” are of value in the treatment
of chronic syphilis. I have seen cases in which both the iodide of
potassium and the mercurials had failed to bring about the desired
relief, but in which the same alteratives, when given along with the
“Woods,” rapidly produced favorable results. The old-fashioned
Zittmann's decoction, made according to the formula of the United
States Dispensatory, may be occasionally used with very excellent
effect. But I have gradually come into the habit of substituting a
mixture of the compound fluid extract and the compound syrup of
sarsaparilla in equal proportions. The syrup itself is too feeble to
have any influence upon the system, but is here employed on
account of its flavor. A favorite method of administration is to furnish
the patient with two bottles—one containing a watery solution of the
iodide of potassium of such strength that two drops represent one
grain of the drug, and the other the sarsaparilla mixture above
mentioned. From one to two drachms of the solution of the iodide
may be administered in a tablespoonful of the sarsaparilla well
diluted after meals. When the patient has been previously
mercurialized, or there is any doubt as to the propriety of using
mercurials, corrosive sublimate in small doses may be added to the
solution of the iodide, so that one-tenth to one-fifteenth of a grain
shall be given in each dose. I have never seen especial advantage
obtained by the use of the iodides of mercury. They are no doubt
effective, but are not superior to the simpler forms of the drug.
 Syphilitic Disease of the Brain-Cortex.

The psychical symptoms which are produced by syphilis are often

very pronounced in cases in which the paralysis, headache,
epilepsy, and other palpable manifestations show the presence of
gross brain lesions. In the study of syphilitic disease of the brain-
membranes sufficient has been said in regard to these psychical
disturbances, but the problem which now offers itself for solution is
as to the existence or non-existence of syphilitic insanity—i.e. of an
insanity produced by specific contagion without the obvious
presence of gummatous disease of the brain-membranes. Very few
alienists recognize the existence of a distinct affection entitled to be
called syphilitic insanity, and there are some who deny that insanity
is ever directly caused by syphilis. It is certain that insanity often
occurs in the syphilitic, but syphilis is abundantly joined with
alcoholism, poverty, mental distress, physical ruin, and various
depressing emotions and conditions which are well known to be
active exciting causes of mental disorder. It may well be that syphilis
is in such way an indirect cause of an insanity which under the
circumstances could not be properly styled syphilitic.

If there be disease of the brain-cortex produced directly by syphilis,

of course such disease must give rise to mental disorders; and if the
lesion be so situated as to affect the psychic and avoid the motor
regions of the brain, it will produce mental disorder without paralysis
—i.e. an insanity; again, if such brain disease be widespread,
involving the whole cortex, it will cause a progressive mental
disorder, accompanied by gradual loss of power in all parts of the
body, and ending in dementia with general paralysis; or, in other
words, it will produce an affection more or less closely resembling
the so-called general paralysis of the insane, or dementia paralytica.

As a man having syphilis may have a disease which is not directly

due to the syphilis, when a syphilitic person has any disorder there is
only one positive way of determining during life how far said disorder
is specific—namely, by studying its amenability to antisyphilitic
treatment. In approaching the question whether a lesion found after